Do the cognitive and neural mechanisms underlying inattention differ between very preterm and term-born children?

Background: Compared with their term-born peers, school aged children born very preterm (≤32 weeks gestation) are at increased risk of inattention. It remains unclear whether the cognitive and neural mechanisms underlying inattention are the same in both very preterm and term-born children. Aims: The aim of this study was to determine whether the cognitive and neural mechanisms underlying inattention differ between term-born and very preterm children. Chapter 3 explored cognition, while Chapters 4 & 5 explored neural processing in terms of event-related potentials (ERPs) and frequency analysis of functional connectivity respectively, to identify mechanisms underlying inattention. Method: A sample of 65 children born very preterm (≤32 weeks gestation) aged 8-11 years was recruited. A comparison group of 48 term-born peers (≥37 weeks gestation) matched for inattention symptoms using the parent-rated Strengths and Weaknesses of ADHD and Normal behaviour (SWAN) questionnaire was selected for comparison. All children were asked to complete neurocognitive tests to assess basic cognitive processes, executive function and sustained attention. Electroencephalography (EEG) was recorded from a sub-sample of children (very preterm n=43; term-born n=40) while they completed a sustained attention task. The contingent negative variation ERP component and theta and alpha frequency changes following the cue stimulus were derived from the EEG as neural indices of response preparation. Similarly, following the presentation of cued and uncued target stimuli, the P1, P2, and P3 ERP components were derived from the EEG as neural indices of stimulus detection, stimulus categorisation, and evaluation of task-relevance respectively. Results: In both groups, more severe parent-rated inattention on the SWAN was predicted by poorer verbal and visuo-spatial short term memory, visuo-spatial working memory, and greater response time variability, and by smaller amplitude of the P2 ERP to uncued targets at the neural level. In children born very preterm only, slower motor processing speed, and smaller theta increases at the neural level, predicted more severe parent-rated inattention. Similarly, in term-born children only, shorter P2 ERP latencies to all targets predicted more severe parent-rated inattention. Conclusions: In sum, the cognitive and neural mechanisms underlying inattention in term-born and very preterm children were partially overlapping, but some mechanisms were unique to only one group. These results present candidate mechanisms that may be useful for the identification of children at risk for inattention, and as potential targets for intervention

Do the cognitive and neural mechanisms underlying inattention differ between very preterm and term-born children?

Background: Compared with their term-born peers, school aged children born very preterm (≤32 weeks gestation) are at increased risk of inattention. It remains unclear whether the cognitive and neural mechanisms underlying inattention are the same in both very preterm and term-born children. Aims: The aim of this study was to determine whether the cognitive and neural mechanisms underlying inattention differ between term-born and very preterm children. Chapter 3 explored cognition, while Chapters 4 & 5 explored neural processing in terms of event-related potentials (ERPs) and frequency analysis of functional connectivity respectively, to identify mechanisms underlying inattention. Method: A sample of 65 children born very preterm (≤32 weeks gestation) aged 8-11 years was recruited. A comparison group of 48 term-born peers (≥37 weeks gestation) matched for inattention symptoms using the parent-rated Strengths and Weaknesses of ADHD and Normal behaviour (SWAN) questionnaire was selected for comparison. All children were asked to complete neurocognitive tests to assess basic cognitive processes, executive function and sustained attention. Electroencephalography (EEG) was recorded from a sub-sample of children (very preterm n=43; term-born n=40) while they completed a sustained attention task. The contingent negative variation ERP component and theta and alpha frequency changes following the cue stimulus were derived from the EEG as neural indices of response preparation. Similarly, following the presentation of cued and uncued target stimuli, the P1, P2, and P3 ERP components were derived from the EEG as neural indices of stimulus detection, stimulus categorisation, and evaluation of task-relevance respectively. Results: In both groups, more severe parent-rated inattention on the SWAN was predicted by poorer verbal and visuo-spatial short term memory, visuo-spatial working memory, and greater response time variability, and by smaller amplitude of the P2 ERP to uncued targets at the neural level. In children born very preterm only, slower motor processing speed, and smaller theta increases at the neural level, predicted more severe parent-rated inattention. Similarly, in term-born children only, shorter P2 ERP latencies to all targets predicted more severe parent-rated inattention. Conclusions: In sum, the cognitive and neural mechanisms underlying inattention in term-born and very preterm children were partially overlapping, but some mechanisms were unique to only one group. These results present candidate mechanisms that may be useful for the identification of children at risk for inattention, and as potential targets for intervention

Pocket-type reinforced brickwork retaining walls

From the literature survey it is clear that reinforced brickwork pocket type retaining walls are a well established form of construction in the USA, however, only a small number have been built in the UK. This is surprising since coat studies have consistently indicated that pocket type construction la more economical than fair-faced concrete walls. The available and forthcoming design guidance on reinforced brickwork is reviewed. The main aim of this research was to Investigate the structural performance of pocket type walls in relation to the requirement of the Draft Code for Reinforced Masonry. Reported within are the method and results of an experimental research programme. In all six walls and fifteen beams were tested. The parameters examined were brick type, percentage of reinforcement, slenderness and shear span ratio. Flexural failure occurred in all the walls and in the medlum-1ightly reinforced beams whilst only the heavily reinforced beams failed in shear. The experimental results were predicted accurately when analysed using the flexural design equations in the Draft Code. However the Code requirements for shear appear to be unduly conservative. Concurrent with the experimental work a finite element program was developed to analyse pocket type walls. In spite of the many assumptions made in the modelling of material properties there was good agreement between analytical and experimental results. Subsequently a parametric survey was undertaken. The variables selected for examination were slenderness, pocket spacing, panel thickness percentage of reinforcement and arching action in the panels. Both rectangular and flanged sections were investigated. The results indicated that the Draft Code gave good predictions when flexural failure of the stem occurred. But when panel failure developed neither yield line analysis nor arching theory was able to predict collapse. Guidance is given on the sizing of panels. It is concluded that pocket type walls, when designed to the requirements of the Draft Code, perform adequately at serviceability and ultimate design loads for pocket spacings up to 1.0m. Further experimental work is necessary to establish whether the guidance given in the Code is applicable to walls with pocket spacings greater than 1.0m

Doctors' and nurses' views and experience of transferring patients from critical care home to die: a qualitative exploratory study.

BACKGROUND: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. AIM: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. DESIGN: Exploratory two-stage qualitative study SETTING/PARTICIPANTS: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. FINDINGS: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. CONCLUSION: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting

Transferring critically ill patients home to die: developing a clinical guidance document.

BACKGROUND: With preferred place of care at the time of death a key consideration in end of life care, it is important that transfer home be considered for critically ill patients who want this as part of their end of life care. However, there is limited guidance available to inform the transfer of critically ill patients home to die. AIMS AND OBJECTIVES: To develop clinical guidance on the practice of transferring patients home to die for doctors and nurses in critical care. DESIGN: Consensus methodology. METHODS: At a one-day national event, stakeholders from cross-community and hospital settings engaged in group work wherein 'virtual clinical teams' mapped out, and agreed on, the processes involved in transferring critically ill patients home to die. Using two clinical cases and nominal group technique, factors were identified that promoted and inhibited transfer home and areas in need of development. Findings from the day informed development of a clinical guidance document. RESULTS: Eighty-five stakeholders attended the event from across England. The majority of stakeholders strongly agreed that transfer of critically ill patients home to die was a good idea in principle. Stakeholders identified 'access to care in the community' (n = 22, 31.4%) and 'unclear responsibility for care of patient' (n = 17, 24.3%) as the most important barriers. Consensus was reached on the processes and decision-making required for transfer home and was used to inform content of a clinical practice guidance document. This underwent further refinement following review by 14 clinicians. A final document in the form of a flow chart was developed. CONCLUSIONS: Transferring critically ill patients home to die is a complex, multifactorial process involving health care agencies across the primary and secondary care interface. The guidance developed from this consensus event will enable staff to actively consider the practice of transferring home to die in appropriate patients

Transferring patients home to die : what is the potential population in UK critical care units?

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/OBJECTIVES: Most people when asked, express a preference to die at home, but little is known about whether this is an option for critically ill patients. A retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish. METHODS: Medical notes of all patients who died in, or within 5 days of discharge from seven critical care units across two hospital sites over a 12-month period were reviewed. Inclusion/exclusion criteria were developed and applied to identify the number of patients who had potential to be transferred home to die and demographic and clinical data (eg, conscious state, respiratory and cardiac support therapies) collected. RESULTS: 7844 patients were admitted over a 12-month period. 422 (5.4%) patients died. Using the criteria developed 100 (23.7%) patients could have potentially been transferred home to die. Of these 41 (41%) patients were diagnosed with respiratory disease. 53 (53%) patients were conscious, 47 (47%) patients were self-ventilating breathing room air/oxygen via a mask. 20 (20%) patients were ventilated via an endotracheal tube. 76 (76%) patients were not requiring inotropes/vasopressors. Mean time between discussion about treatment withdrawal and time of death was 36.4 h (SD=46.48). No patients in this cohort were transferred home. CONCLUSIONS: A little over 20% of patients dying in critical care demonstrate potential to be transferred home to die. Staff should actively consider the practice of transferring home as an option for care at end of life for these patients.Final Published versio

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

Characterization, conservation and loss of dignity at the end-of- life in the emergency department. A qualitative protocol

Aims: to explore and understand the experiences of terminally-ill patients and their relatives regarding dignity during end-of-life care in the emergency department. Background: the respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end-of-life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in-hospital emergency departments, where there is a lack of research which takes the experiences of end-of-life patients and their relatives into account. Design: a phenomenological qualitative study. Methods: the protocol was approved in December 2016 and will be carried out from December 2016 to December 2020. The Gadamer's philosophical underpinnings will be used in the design and development of the study. The data collection will include participant observation techniques in the Emergency Department, in-depth interviews with terminally-ill patients and focus groups with their relatives. For the data analysis, the field notes and verbatim transcriptions will be read and codified using ATLAS.ti software to search for emerging themes. Discussion: emerging themes that contribute to comprehending the phenomenon of dignity in end-of-life care in the Emergency Department are expected to be found. This study's results could have important implications in the implementation of new interventions in Emergency Departments. These interventions would be focused on improving: the social acceptance of death, environmental conditions, promotion of autonomy and accompaniment, and assumption (takeover) of dignified actions and attitudes (respect for human rights)

The structural performance of brickwork arches Part 1

5.00Available from British Library Lending Division - LD:8673.73(BCRA-TN--352) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo