When experiences of presence go awry: A survey on psychotherapy practice with the ambivalent‐to‐distressing ‘hallucination’ of the deceased

Objectives: Experiences of presence, involving the sensory perception or felt presence of the deceased, are common amongst the bereaved (30–60%). Despite them being predominantly comforting and reassuring, a minority (approximately 25%) report ambivalent or distressing experiences. The study’s aim was to explore how psychotherapy is practised with this subset. Method: A mixed‐method approach, involving both quantitative analysis and thematic analysis, was used to analyse data from an online survey, conducted in English and Spanish, amongst mental health therapists (i.e., psychologists, psychotherapists, and counsellors). Seventy responded to the survey and four of them were further interviewed. Results: The participants primarily framed interventions for ambivalent‐to‐distressing experiences of presence as grief therapy, with the severity of the presentation as the main factor influencing their clinical decision‐making, but several perspectives co‐existed regarding how to intervene. These discourses were categorized into two themes: ‘A normalising and exploratory psychotherapy’ and ‘A grief stages psychotherapy’. The main sources of patient’s distress, as understood by the sample, were located in the bereaved–departed relationship, in pre‐existing mental health issues, and in a societal taboo or stigma. Conclusion: After comparing and contrasting the participants’ working hypotheses with existing knowledge on experiences of presence, and contemporary theories in the research area, guidelines are presented on how to intervene with people disturbed by their experiences of presence. Practitioner points: Perceiving the deceased person, or feeling their presence, is common and normal amongst bereaved people. When these experiences are distressing or ambivalent, therapists’ share that psychological suffering may originate from the departed–bereaved relationship, pre‐existing mental health issues, or the effect of societal taboo or stigma. Psychotherapy is frequently aimed at normalizing, accepting, supporting, and exploring patient’s experienc

When learning becomes a fetish: the pledge, turn and prestige of magic tricks

It is our contention that the process of higher education could be read as a commodity and in both Marxian and Freudian assumptions, a fetish. Instrumental in this discussion are; Marx’s theorising of the commodity fetish (1867) that deceives by conflating the distinction between use and exchange value, and Freud’s (1927) re-visiting of his theory of fetishism, where he considers the fetish in the context of dealing with separation and loss in everyday life. This paper highlights how the consequence of fetishised behaviour has led to violent outcomes, such as the policy decision to introduce a ‘Teaching Excellence Framework’ (TEF). We argue that the TEF may bring about the death of learning in HE and diminish the role of academic staff. Nevertheless, influenced by Winnicott, Cixous and Biesta, we offer a more hopeful ‘Teaching that is Good Enough Framework’

Education then and now: making the case for ecol-agogy

The processes, settings and outcomes of human education have distinctive impact on the human and non-human world: this paper sets out to discuss what may have motivated the initiation of human education, how it has been maintained why the outcome has wide-ranging, and often negative, planetary impact. The analysis offers a multi-disciplinary account of education, from pre-history to the present, noting that humans, past and present are born into an ‘open world’ that requires world building or, niche construction. As a result, cultural and genetic evolution are out of synchronisation instigating an existential threat and the anxious experience of ‘adaptive-lag’ leading to the motive for continued niche construction. Education is presented as a particular type of niche construction requiring teachers and the use of symbolic verbal language to help learners move from simplistic ‘split’ thinking to the more mature position where the needs of self and others can be met

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Longitudinal assessment of health-span and pre-death morbidity in wild type Drosophila

The increase in human life expectancy is accompanied by age-related cognitive and motor disability, thus raising the demand for strategies toward healthy aging. This requires understanding the biology of normal aging and late-life functional phenotypes. Genetic model organisms, such as Drosophila melanogaster, can help identifying evolutionary conserved mechanisms underlying aging. Longitudinal assessment of motor performance of more than 1000 individual flies revealed age-related motor performance decline and specific late-life motor disabilities. This allows defining heath- and ill-span and scoring late-life quality of individual flies. As in mammals, including humans, onset, duration, severity, and progression dynamics of decline are heterogenic and characterized by both, progressive worsening and sudden late-life events. Flies either become increasingly incapacitated by accumulating disability over multiple days prior to death, or they escape disability until few hours prior to death. Both late-life trajectories converge into a terminal stage characterized by stereotypical signs of functional collapse and death within 3 hours. Drosophila can now be used to evaluate life prolonging manipulations in the context of late-life quality. High sugar diet increases lifespan and late-life quality, whereas lifespan prolonging antioxidant supplementation has either no, or negative effects on late-life quality, depending on base diet and gender. © Gaitanidis et al

Differential electrophysiological responses to odorant isotopologues in Drosophilid antennae

Olfaction presents the ultimate challenge to molecular recognition as thousands of molecules have to be recognized by far fewer olfactory receptors. We have presented evidence that Drosophila readily distinguish odorants based on their molecular vibrations using a battery of behavioral assays suggesting engagement of a molecular vibration-sensing component. Here we interrogate electrophysiologically the antennae of four Drosophilids and demonstrate conserved differential response amplitudes to aldehydes, alcohols, ketones, nitriles, and their deuterated isotopologues. Certain deuterated odorants evoked larger electroantennogram (EAG) amplitudes, while the response to the normal odorant was elevated in others. Significantly, benzonitrile isotopologues were not distinguishable as predicted. This suggests that isotopologue-specific EAG amplitudes result from differential activation of specific olfactory receptors. In support of this, odorants with as few as two deuteria evoke distinct EAG amplitudes from their normal isotopologues, and this is independent of the size of the deuterated molecule. Importantly, we find no evidence that these isotopologue-specific amplitudes depend on perireceptor mechanisms or other pertinent physical property of the deuterated odorants. Rather, our results strongly suggest that Drosophilid olfactory receptors are activated by molecular vibrations differentiating similarly sized and shaped odorants in vivo, yielding sufficient differential information to drive behavioral choices. © 2016 Drimyli et al

Predictive Nomograms for Synchronous Liver and Lung Metastasis in Colon Cancer

Background: The risk of distant metastasis may be estimated using predictive nomograms. The purpose of this study is to develop nomograms that may assess the risk of synchronous metastasis in patients with colon cancer. Methods: A retrospective analysis of the Surveillance Epidemiology and End Results database between 2010 and 2014. Logistic regression was performed to identify factors associated with synchronous liver and lung metastasis. Results: Overall, 117,934 patients with colon cancer (59,076 [50.1%] males, mean age 68.3 ± 13.7 years) were included, of which 16,135 (13.7%) had liver metastasis and 4601 (3.9%) had lung metastasis at diagnosis. Age, sex, race, tumor location, tumor grade, CEA levels, perineural invasion, and T and N stage were associated with the presence of liver metastasis. Age, sex, race, tumor location, tumor grade, CEA levels, perineural invasion, T stage, N stage, and presence of liver metastasis were associated with the presence of lung metastasis. These variables were used to construct predictive nomograms. The c-indexes for both predictive models were 0.97. Conclusions: In this study, we constructed predictive nomograms for the presence of synchronous liver and lung metastasis in patients with colon cancer that may be used to quantitatively assess the risk of synchronous metastatic disease. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

The positive effect of eugenol on acute pancreatic tissue injury: A rat experimental model

Introduction: we present a rat experimental model used to evaluate the possible reduction in the extent of pancreatic tissue injury in acute pancreatitis cases, after administration of eugenol. Methods: one hundred and twenty Wistar rats were used, which were randomly assigned in 3 groups: sham (n=20), control (n=50) and eugenol (n=50). Acute pancreatitis was induced by biliopancreatic ligation in the control and eugenol groups, but not in the Sham group. In the eugenol group, eugenol was administered per-os. Five histopathological parameters, such as edema, inflammatory infiltration, duct dilatation, hemorrhage and acinar necrosis were evaluated. Results: at 72 h from acute pancreatitis induction, the total histological score was diminished in the eugenol group (p<0.0005) and duct dilatation and inflammatory infiltration were reduced compared to the control group (p<0.05). In addition, at 72 h, eugenol reduced pancreatic myeloperoxidase activity (p<0.0005). Conclusion: eugenol, a highly free radical scavenger agent, may have a preventive role in acute pancreatic injury, as it was evident in our rat experimental model. © Alexandra Tsaroucha et al

Low-molecular-weight heparin versus unfractionated heparin in pediatric traumatic brain injury

OBJECTIVE The incidence of venous thromboembolism (VTE) in patients with traumatic brain injury (TBI) has in-creased significantly. The Eastern Association for the Surgery of Trauma recommends using low-molecular-weight hepa- rin (LMWH) over unfractionated heparin (UH) in pediatric patients requiring VTE prophylaxis, although this strategy is unsupported by the literature. In this study, the authors compare the outcomes of pediatric TBI patients receiving LMWH versus UH.METHODS The authors performed a 4-year (2014 & ndash;2017) analysis of the pediatric American College of Surgeons Trau-ma Quality Improvement Program. All trauma patients (age <= 18 years) with TBI requiring thromboprophylaxis with UH or LMWH were potentially eligible for inclusion. Patients who had been transferred, had died in the emergency department, or had penetrating trauma were excluded. Patients were stratified into either the LMWH or the UH group on the basis of the prophylaxis they had received. Patients were matched on the basis of demographics, injury characteristics, vital signs, and transfusion requirements using propensity score matching (PSM). The study endpoints were VTE, death, and craniotomy after initiation of prophylaxis. Univariate analysis was performed after PSM to compare outcomes.RESULTS A total of 2479 patients met the inclusion criteria (mean age 15.5 +/- 3.7 years and 32.0% female), of which 1570 (63.3%) had received LMWH and 909 (36.7%) had received UH. Before PSM, patients receiving UH were younger, had a lower Glasgow Coma Scale score, and had a higher Injury Severity Score. Patients treated in pediatric hospitals were more likely to receive UH (12.9% vs 9.0%, p < 0.001) than patients treated in adult hospitals. Matched patients re-ceiving UH had a higher incidence of VTE (5.1% vs 2.9%, p = 0.03).CONCLUSIONS LMWH prophylaxis in pediatric TBI appears to be more effective than UH in preventing VTE. Large, multicenter prospective studies are warranted to confirm the superiority of LMWH over UH in pediatric patients with TBI. Moreover, outcomes of VTE prophylaxis in the very young remain understudied; therefore, dedicated studies to evaluate this are needed.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie