Shared Consciousness: A Social History of Tourette Syndrome and its Treatments

This study tracks how treatments and personal management strategies for the medical condition Tourette syndrome have changed over time. Additionally, the purpose of this research is to discover the shared experiences that influence the treatment choices of American adults with the condition. Clinical theories about the causes of Tourette syndrome have directed the treatment of the disorder and its symptoms for many years. Recent patient discontents with side effects from medications have led many people with the disorder to practice complementary and alternative therapies. While some of these alternative interventions continue to rely on the guidance of a standard health care professional, several individuals with Tourette syndrome, often referred to as Touretters, have formulated treatments of their own. Many therapies that Touretters practice today are often based on certain idiosyncrasies of an individual’s condition. As a result, a variety of different treatment methods have been used by Touretters in recent years

Towards the identification of the threshold concepts in parkour – A case study

peer reviewedBased on the interview of an expert of Parkour, that chapter identifies the elements that would contribute to motivate the practice in that activity and the development of the motor competences needed to enjot the practice. Several aspects were proposed: (1) Agreement to try a movement and perceive it as a possible challenge; (2) Learning to control his/her movement to guarantee his/her safety; (3) Demonstration of supportive behaviours to his/her classmates; (4) Showing persistence; (5) Developping autonomy and creativity to find ways to overcome barriers; (6) Listening to his/her body, and; (7) Developping a goal orientation for task mastery

A randomised controlled trial of early insulin therapy in very low birth weight infants, "NIRTURE" (neonatal insulin replacement therapy in Europe).

BACKGROUND: Studies in adult intensive care have highlighted the importance of insulin and improved glucose control on survival, with 32% reduction in mortality, 22% reduction in intensive care stay and halving of the incidence of bacteraemia. Very low birth weight infants requiring intensive care also have relative insulin deficiency often leading to hyperglycaemia during the first week of life. The physiological influences on insulin secretion and sensitivity, and the potential importance of glucose control at this time are not well established. However there is increasing evidence that the early postnatal period is critical for pancreatic development. At this time a complex set of signals appears to influence pancreatic development and beta cell survival. This has implications both in terms of acute glucose control but also relative insulin deficiency is likely to play a role in poor postnatal growth, which has been associated with later motor and cognitive impairment, and fewer beta cells are linked to risk of type 2 diabetes later in life. METHODS: A multi-centre, randomised controlled trial of early insulin replacement in very low birth weight babies (VLBW, birth weight < 1500 g). 500 infants will be recruited from 10 centres in the UK and Europe. Babies will be randomised to receive a continuous insulin infusion (0.05 units/kg/h) or to receive standard neonatal care from the first day of life and for the next 7 days. If blood glucose (BG) levels fall infants will receive 20% dextrose titrated to maintain normoglycaemia (4-8 mmol/l). If BG is consistently above 10 mmol/l babies will receive standard treatment with additional insulin infusion. The primary end point will be mortality on or before expected date of delivery, secondary end points will be markers of morbidity and include episodes of sepsis, severity of retinopathy, chronic lung disease and growth

TIPIT: A randomised controlled trial of thyroxine in preterm infants under 28 weeks' gestation

<p>Abstract</p> <p>Background</p> <p>Infants born at extreme prematurity (below 28 weeks' gestation) are at high risk of developmental disability. A major risk factor for disability is having a low level of thyroid hormone which is recognised to be a frequent phenomenon in these infants. At present it is unclear whether low levels of thyroid hormone are a cause of disability, or a consequence of concurrent adversity.</p> <p>Methods</p> <p>We propose an explanatory multi-centre double blind randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks' corrected gestational age. The primary outcome will be brain growth. This will be assessed by the width of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks' corrected gestational. The secondary outcomes will be (a) thyroid hormone concentrations measured at increasing postnatal age, (b) status of the hypothalamic pituitary axis, (c) auxological data between birth and 36 weeks' corrected gestational age, (d) thyroid gland volume, (e) volumes of brain structures (measured by magnetic resonance imaging), (f) determination of the extent of myelination and white matter integrity (measured by diffusion weighted MRI) and brain vessel morphology (measured by magnetic resonance angiography) at expected date of delivery and (g) markers of morbidity including duration of mechanical ventilation and chronic lung disease.</p> <p>We will also examine how activity of the hypothalamic-pituitary-adrenal axis modulates the effects of thyroid supplementation. This will contribute to decisions about which confounding variables to assess in large-scale studies.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN89493983</p

Learning from Parkour: A Belgian Case Study

Parkour is the focus of this paper, because of its characteristics and the growing interest in the “fun culture” (Loret, 1995). Traditionally, parkour is not something that young people practise. When they do try, they discover opportunities to explore the environment and the limits of their body in a natural and positive way. This paper shows how parkour underlines fundamental factors that contribute to the development of a positive attitude towards movement in children, adolescents, and young adults. Such factors include: personal challenges, positive atmosphere, and social support. These enhance a positive perception of competence, leading to intrinsic motivation and voluntary participation. The DT methodology used is underpinned by the socio-ecological approach. It centred on understanding the teacher’s views on being ‘in the zone’ or ‘flow’ and, building on this, the parkour practitioner’s understanding of this experience. Thematic analysis was applied to the interview data. There were seven key threshold concepts for parkour: Agree to try a movement and perceive it as a possible challenge; Learn to control his/her movement to guarantee is/her safety (maintaining a low level of excitement, imagining the movement to be realized, identifying the possible risks); Demonstrate supportive behaviours to his/her classmates; Be able to show persistence; Show autonomy and creativity to find way to overcome barriers; Listen his/her body; and, Develop a goal orientation for task mastery. Success in parkour can be explained by characteristics specific to the fun culture, environmental influences but also by a series of task-oriented pedagogical principles. A possible next step is to find ways in which these threshold concepts could now be nurtured within Physical Education more broadly

From Birth to Death? A Personalist Approach to End-of-Life Care of Severely Ill Newborns

In this paper, a personalist ethical perspective on end-of-life care of severely ill newborns is presented by posing two questions. (1) Is it ethically justified to decide not to start or to withdraw life-sustaining treatment in severely ill newborns? (2) Is it ethically justified, in exceptional cases, to actively terminate the life of severely ill newborns? Based on five values-respect for life and for the dignity of the human person, quality of life, respect for the process of dying, relational autonomy, and justice-an ethical assessment is conducted that brings us answers to the two ethical questions. (1) Noninitiation or withdrawal of life-sustaining medical treatment in severely ill newborns is ethically acceptable, and might even be a moral duty, when initiation or continuation of medical treatment can be considered futile or even harmful. (2) However, according to the personalist approach, it is not ethically acceptable to actively terminate the life of a severely ill newborn. © The Author 2013. Published by Oxford University Press, on behalf of The Journal of Christian Bioethics, Inc. All rights reserved.status: publishe

Intestinal Colonization Patterns of Staphylococci in Preterm Infants in Relation to Type of Enteral Feeding and Bacteremia

Abstract Objective: This study investigated the intestinal colonization with staphylococci in very low birth weight infants in relation to the type of enteral feeding and evaluated the intestine as potential source for staphylococcal bacteremia. Patients and Methods: Infants born in the Level III neonatal intensive care unit of a university hospital with a gestational age below 32 weeks and/or birth weight below 1,500 g were included in a prospective, observational study. The infants received either preterm formula or mother's own milk, with random allocation to raw or pasteurized milk. Precise viable staphylococcal counts of serial fecal specimens were examined in the first 8 weeks of life. In the case of bloodstream infection, fecal and blood isolates of staphylococci were compared by antibiotypes or pulsed-field gel electrophoresis. Results: One hundred fifty neonates, with a mean of 29 weeks of gestation and 1,260 g at birth, had 1,045 fecal samples analyzed and were found to be heavy carriers of staphylococci in the intestine with 10(6)-10(7) colony-forming units/g of feces from the first week of life. Colonization rate and patterns were not different in relation to the type of enteral feeding. In nearly 80% of 42 patients exhibiting a staphylococcal bloodstream infection, intestinal colonization retrieved a predominant strain that was different from the one recovered from the blood. Conclusions: In very low birth weight infants, predominance of staphylococci in the gut is not related to the type of enteral feeding. An endogenous origin of staphylococcal bloodstream infection seems to play a minor role.status: publishe

The use of human milk in the neonatal intensive care unit: practices in Belgium and Luxembourg

Human milk remains the preferred feeding for all infants, including premature and sick newborns. However, mother's milk is not sterile, and expressed milk can be a source of commensal and pathogenic microorganisms. Microbiological quality standards for the use of expressed human milk in hospitals are not available, unlike for donor or formula milk.status: publishe