Patients' learning in cyberspace: a thematic analysis of patient-patient discussions in a chronic illness Facebook page.

Online support groups play an increasingly important role in patients' lived experience of chronic illness. The objective of this study was to explore how learning takes place from patients' interactions in an online chronic illness support group. Qualitative data consisted of 1,478 messages posted to a publicly accessible non-illness specific Facebook support page. Data was analysed using inductive thematic analysis. Four themes were identified from the analysis. This paper presents two themes, information sharing and dis(trust). Employing Wenger's communities of practice theoretical framework (Wenger, 1998), themes are discussed in terms of learning, participation in practices and identity. Online support groups can be pivotal to learning in illness. Patients' online information sharing provides them with opportunities for informal learning about their condition to take place. These online interactions lead to patients developing trust for one another and distrust for the medical care system

Public domain or private data? Developing an ethical approach to social media research in an inter-disciplinary project.

This paper discusses the ethical issues faced in undertaking research about the role of learning in the subjective experience of chronic illness, where data were taken from social media. Drawing on psychology and education, this paper discusses the ways in which authors from these disciplines are laying the groundwork for legitimate online research by actively debating the public versus private nature of online spaces. The paper explains how this debate informed the development of an ethical approach to research. Relevant ethical guidelines and previous research are used to support the argument that individuals' informed consent is not necessary in online contexts where data exist within the public domain, and where risk of harm to users is low. This paper provides an insight into one educational researcher's journey through the process of doing ethical social media research, and suggests ways forward for others embarking upon that same journey

Peripartum Cardiomyopathy

AUDIENCE: This simulation is appropriate for emergency medicine (EM) residents of all levels. INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare, idiopathic condition that occurs in the mother around the time of childbirth. Heart failure with reduced ejection fraction and/or reduced systolic function diagnosed in patients during the last month of pregnancy or up to five months following delivery defines PCCM.1 Another broader definition from the European Society of Cardiology defines PPCM as heart failure that occurs towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found. 2 Though PPCM occurs worldwide, most data is extracted from the United States (incidence 1:900 to 1:4000 live births), Nigeria, Haiti, and South Africa.3,4Risk factors for PPCM include pre-eclampsia, multiparity, and advanced maternal age. Unfortunately, the complete pathophysiology of PPCM remains unclear. However, it is important for emergency physicians to be aware of this rare diagnosis because though 50-80% of women with PPCM may eventually recover normal left ventricle systolic function,5 positive outcomes depend on timely recognition of PPCM as a disease and the appropriate management of heart failure. Symptomatic PPCM is an emergent condition that requires an attentive and knowledgeable emergency medicine physician for rapid recognition and treatment. A simulation of this rare condition can give residents the experience of identifying and managing this disease that they might not otherwise see personally during their training. EDUCATIONAL OBJECTIVES: By the end of this simulation session, learners will be able to: 1) initiate a workup of a pregnant patient who presents with syncope, 2) accurately diagnose peripartum cardiomyopathy, 3) demonstrate care of a gravid patient in respiratory distress due to peripartum cardiomyopathy, 4) appropriately manage cardiogenic shock due to peripartum cardiomyopathy. EDUCATIONAL METHODS: This simulation was conducted as a high-fidelity medical simulation case followed by a debriefing. It could potentially be adapted for use as a low-fidelity case or an oral boards exam case. RESEARCH METHODS: The educational content and clinical applicability of this simulation was evaluated by oral and written feedback from participant groups at a large three-year emergency medicine residency training program. Each participant completed the case and the facilitated debriefing afterwards. Case facilitators also provided their personal observations on the implementation of the simulation. RESULTS: The participants gave the simulation positive feedback (n=18). Seventeen EM residents and one pediatric emergency medicine (PEM) fellow participated in the feedback survey. Learners overall agreed (18.75%) or strongly agreed (81.25%) that participating in this simulation would improve their performance in a live clinical setting. DISCUSSION: Peripartum cardiomyopathy is a low frequency, high acuity illness that requires a synthesis of the learner\u27s knowledge of complex physiology, navigation of logistical and systems-based challenges, and advanced communication and leadership skills to ensure the best possible patient outcome. All EM physicians will be expected to expertly manage this illness after completion of an EM training program, yet not every EM resident will encounter this type of patient during training. Supplementing the EM resident\u27s standard training with this simulation experience provides a psychologically and educationally safe space to learn and possibly make mistakes without causing patient harm. Practically all residents were able to correctly diagnose the patient with a cardiomyopathy even if they were not familiar with the diagnosis of peripartum cardiomyopathy. The residents particularly enjoyed the case to explore concepts of benefits and risks of medical therapeutics (ie, positive pressure ventilation, vasopressors/inotropes) and safe practice for the gravid patient. This case and the associated high yield debriefing session were effective teaching tools for emergency medicine residents about PPCM. TOPICS: Medical simulation, peripartum cardiomyopathy, pregnancy, respiratory failure, cardiogenic shock, emergent cesarian section

Within- and between-host dynamics of producer and non-producer pathogens

For infections to be maintained in a population, pathogens must compete to colonise hosts and transmit between them. Within the host, much research has been conducted into pathogeni interactions, yet less is known about whether within-host interactions can affect between-host transmission. In this study, we use an experimental approach to investigate within-and-between host dynamics using the pathogen Pseudomonas aeruginosa and the host Caenorhabditis elegans. Within-host interactions often involve the production of goods, that are beneficial to all the pathogens in the local environment but susceptible to exploitation by non-producers. We exposed the nematode host to ‘producer’ and two ‘non-producer’ bacterial strains (specifically for siderophore production and quorum sensing), in single infections and coinfections, to investigate within-host colonisation. Subsequently, we introduced infected nematodes to pathogen-naive populations, to allow natural pathogen transmission between hosts. We find that producer pathogens are consistently better at colonising hosts and transmitting between them than non-producers during coinfection and single infection. Non-producers were poor at colonising hosts and between-host transmission, even when coinfecting with producers. Understanding pathogen dynamics across these multiple levels will ultimately help us to predict and control the spread of infections and contribute to explanations for the persistence of cooperative genotypes in natural populations

Analysis of the role of 13 major fimbrial subunits in colonisation of the chicken intestines by Salmonella enterica serovar Enteritidis reveals a role for a novel locus

<p>Abstract</p> <p>Background</p> <p><it>Salmonella enterica </it>is a facultative intracellular pathogen of worldwide importance. Over 2,500 serovars exist and infections in humans and animals may produce a spectrum of symptoms from enteritis to typhoid depending on serovar- and host-specific factors. <it>S</it>. Enteritidis is the most prevalent non-typhoidal serovar isolated from humans with acute diarrhoeal illness in many countries. Human infections are frequently associated with direct or indirect contact with contaminated poultry meat or eggs owing to the ability of the organism to persist in the avian intestinal and reproductive tract. The molecular mechanisms underlying colonisation of poultry by <it>S</it>. Enteritidis are ill-defined. Targeted and genome-wide mutagenesis of <it>S</it>. Typhimurium has revealed conserved and host-specific roles for selected fimbriae in intestinal colonisation of different hosts. Here we report the first systematic analysis of each chromosomally-encoded major fimbrial subunit of <it>S</it>. Enteritidis in intestinal colonisation of chickens.</p> <p>Results</p> <p>The repertoire, organisation and sequence of the fimbrial operons within members of <it>S. enterica </it>were compared. No single fimbrial locus could be correlated with the differential virulence and host range of serovars by comparison of available genome sequences. Fimbrial operons were highly conserved among serovars in respect of gene number, order and sequence, with the exception of <it>safA</it>. Thirteen predicted major fimbrial subunit genes were separately inactivated by lambda Red recombinase-mediated linear recombination followed by P22/int transduction. The magnitude and duration of intestinal colonisation by mutant and parent strains was measured after oral inoculation of out-bred chickens. Whilst the majority of <it>S</it>. Enteritidis major fimbrial subunit genes played no significant role in colonisation of the avian intestines, mutations affecting <it>pegA </it>in two different <it>S</it>. Enteritidis strains produced statistically significant attenuation. Plasmid-mediated <it>trans</it>-complementation partially restored the colonisation phenotype.</p> <p>Conclusion</p> <p>We describe the fimbrial gene repertoire of the predominant non-typhoidal <it>S. enterica </it>serovar affecting humans and the role played by each predicted major fimbrial subunit in intestinal colonisation of the primary reservoir. Our data support a role for PegA in the colonisation of poultry by <it>S</it>. Enteritidis and aid the design of improved vaccines.</p

An Electroactive Oligo-EDOT Platform for Neural Tissue Engineering

The unique electrochemical properties of the conductive polymer poly(3,4-ethylenedioxythiophene):polystyrene sulfonate (PEDOT:PSS) make it an attractive material for use in neural tissue engineering applications. However, inadequate mechanical properties, and difficulties in processing and lack of biodegradability have hindered progress in this field. Here, the functionality of PEDOT:PSS for neural tissue engineering is improved by incorporating 3,4-ethylenedioxythiophene (EDOT) oligomers, synthesized using a novel end-capping strategy, into block co-polymers. By exploiting end-functionalized oligoEDOT constructs as macroinitiators for the polymerization of poly(caprolactone), a block co-polymer is produced that is electroactive, processable, and bio-compatible. By combining these properties, electroactive fibrous mats are produced for neuronal culture via solution electrospinning and melt electrospinning writing. Importantly, it is also shown that neurite length and branching of neural stem cells can be enhanced on the materials under electrical stimulation, demonstrating the promise of these scaffolds for neural tissue engineering

Leveraging population admixture to characterize the heritability of complex traits.

Despite recent progress on estimating the heritability explained by genotyped SNPs (h(2)g), a large gap between h(2)g and estimates of total narrow-sense heritability (h(2)) remains. Explanations for this gap include rare variants or upward bias in family-based estimates of h(2) due to shared environment or epistasis. We estimate h(2) from unrelated individuals in admixed populations by first estimating the heritability explained by local ancestry (h(2)γ). We show that h(2)γ = 2FSTCθ(1 - θ)h(2), where FSTC measures frequency differences between populations at causal loci and θ is the genome-wide ancestry proportion. Our approach is not susceptible to biases caused by epistasis or shared environment. We applied this approach to the analysis of 13 phenotypes in 21,497 African-American individuals from 3 cohorts. For height and body mass index (BMI), we obtained h(2) estimates of 0.55 ± 0.09 and 0.23 ± 0.06, respectively, which are larger than estimates of h(2)g in these and other data but smaller than family-based estimates of h(2)