The role of companions in outpatient seizure clinic interactions: A pilot study

Purpose: This study explored contributions that patients' companions (seizure witnesses) make to interactions in the seizure clinic and whether the nature of the companions' interactional contributions can help with the differentiation of epilepsy and psychogenic nonepileptic seizures (PNES). Methods: Conversation analysis methods were used to examine video recordings and transcripts of neurologists' interactions with patients referred to a specialist seizure clinic and their companions. Results: The companions' behavior correlated with interactional features previously observed to distinguish patients with epilepsy from patients with PNES. Patients with PNES, but not those with epilepsy, tended to exhibit interactional resistance to the doctor's efforts to find out more about their seizure experiences and, thereby, encouraged greater interactional contribution from companions. Conclusion: The contributions that companions make (in part, prompted by patient's interactional behavior) may provide additional diagnostic pointers in this clinical setting, and a number of candidate features that may help clinicians distinguish between epilepsy and PNES when the patient is accompanied by a seizure witness are described. However, companion contributions may limit the doctor's ability to identify linguistic and interactional features with previously demonstrated diagnostic potential in the conversational contributions made by patients themselves. To help offset potential diagnostic losses, doctors may need to explicitly discuss the role of the companion in the consultation when a seizure witness (or another companion) accompanies the patient

Health related quality of life of people with non-epileptic seizures: The role of socio-demographic characteristics and stigma

Purpose People with non-epileptic seizures (NES) consistently report poorer Health-Related Quality of Life (HRQoL) than people with epilepsy. Yet, unlike in epilepsy, knowledge of how social factors influence the HRQoL of adults with NES is limited. To add to the evidence base, this study explores the relationship between HRQoL and perceived stigma among adults with NES, and the role of socio-demographic characteristics. Methods Data was gathered from a survey of 115 people living with the condition, recruited from online support groups. Participants provided socio-demographic and health-related data and completed a series of questions investigating their HRQoL (QOLIE-31) and stigma perceptions (10-item Epilepsy Stigma Scale). Results Participants were found to experience high levels of perceived stigma (median 5.2, mean 4.9). A significant and moderate inverse correlation was observed between HRQoL and stigma (rs − 0.474, p = < 0.001); suggesting higher perceptions of stigma contribute to poorer HRQoL among adults with NES. Stigma perceptions were found to be most strongly associated with the seizure worry (rs = − 0.479), emotional wellbeing (rs = − 0.421), and social functioning (rs = 0.407) HRQoL domains. Participants who reported being in employment or education were found to have significantly better HRQoL than those who were not (p = < 0.001). Conclusion More (qualitative and quantitative) research is justified to understand how – and why – those with the condition experience stigmatisation, and the factors that impede and help facilitate the participation of people with NES in education and employment

Double Λ\Lambda and the Λ−Λ\Lambda-\Lambda Interaction

The $\Lambda$-$\Lambda$ effective interaction, in the channel $L=S=0$, in the nuclear medium is fitted to the available binding energies, $B_{\Lambda\Lambda}$, of double $\Lambda$ hypernuclei: $^{6}_{\Lambda\Lambda}$He, $^{10}_{\Lambda\Lambda}$Be and $^{13}_{\Lambda\Lambda}$B. The mesonic decay of these hypernuclei is also investigated. Finally, this effective interaction is used to predict the binding energies and mesonic decays widths of heavier double $\Lambda$ hypernuclei.Comment: 4 pages, (latex file, postscript-file and 3 Postscript-figures included

Correlated ππ\pi\pi and KKˉK\bar K exchange in the baryon-baryon interaction

A dynamical model for correlated two-pion and two-kaon exchange in the baryon- baryon interaction is presented, both in the scalar-isoscalar ($\sigma$) and the vector-isovector ($\rho$) channel. The correlations between the two pseudoscalar mesons are taken into account by means of $\pi\pi - K\bar K$ amplitudes derived from a meson-exchange model, which is in line with the empirical $\pi\pi$ data. It is found that correlated $K\bar K$ exchange plays an important role in the $\sigma$-channel for baryon-baryon states with non- vanishing strangeness. The strength of correlated $\pi\pi$ plus $K\bar K$ exchange in the $\sigma$-channel decreases with the strangeness of the baryon- baryon system becoming more negative. The results for correlated $\pi\pi$- exchange in the vector-isovector channel deviate from what is expected in the naive SU(3) picture for genuine $\rho$-exchange. Shortcomings of a simplified description in terms of sharp mass $\sigma$- and $\rho$-exchange are pointed out.Comment: 51 pages, Latex file, figures available from [email protected]

Lost that lovin' feeling: The erosion of trust between small, high-distance partners

We investigate the role of high distance in trust erosion between small partners. High distance is known to hinder the formation of trust between potential partners, but its role in trust erosion in established partnerships is less understood by international business scholars. Through a qualitative longitudinal study, we extend current theory of how high distance effects the trust dynamics between cross-border partners. Specifically, we unearth three inter-related mechanisms that together explain how and why trust can erode due to high distance. We show that before a partnership is formed, high distance can lead partners to erroneously attribute cues to a potential partner’s high quality, leading to over-expectations of partner performance. Once the partnership is operational, high distance hinders actors’ ability to understand situational factors associated with disappointing outcomes, and so they are attributed to failings of the partner. At the same time, distance-related challenges of bounded reliability render partners reluctant to discuss partnership outcomes. This can result in a vicious cycle of inertia as partners strive to protect goodwill while abandoning efforts to produce partnership outcome because of doubts of the other’s quality. Thus, our theoretical model illustrates the limitations of trust and explains how, paradoxically, high distance can facilitate both trust formation and trust erosion

Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics

Objective: This study explores whether the profile of patients' interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases. Methods: Conversation Analysis of video recordings of neurologists' interactions with patients attending a specialist memory clinic. "Gold standard" diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging. Results: Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients' responses to neurologists' questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent "I don't know" responses. Conclusion: Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD. Practical implications: Our findings demonstrate that conversational profiles based on patients' contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care

Strange Particles in Dense Matter and Kaon Condensates

We discuss the role of strangeness in dense matter and especially in neutron stars. The early (in density) introduction of hyperons found in many calculations is probably delayed by the decrease in vector mean field acting on the neutron. The decrease results from both conventional many-body rescattering effects and from the movement towards asymptotic freedom at high densities. Subthreshold $K^-$-meson production by the KaoS collaboration at GSI shows that the $K^-$-mass must be substantially lowered, by $\gtrsim$ 200 MeV at $\rho\sim 2\rho_0$. It is shown that explicit chiral symmetry breaking through the kaon mass may be responsible for $\Sigma^-$-nucleon and $\Xi^-$-nucleon scalar attraction being weaker than obtained by simple quark scaling. The normal mode of the strangeness minus, charge $e^-$, excitation is constructed as a linear combination of $K^-$-meson and $\Sigma^-$, neutron-hole state. Except for zero momentum, where the terms are unmixed the "kaesobar" is a linear combination of these two components.Comment: 10 pages, 8 postscript figures, Talk given at the International Conference on Hypernuclear and Strange Particle Physics (HYP97), Brookhaven Nat'l Lab., USA, October 13-18, 1997, to be published in Nucl. Phys.

Single-Particle Spin-Orbit Strengths of the Nucleon and Hyperons by SU6 Quark-Model

The quark-model hyperon-nucleon interaction suggests an important antisymmetric spin-orbit component. It is generated from a color analogue of the Fermi-Breit interaction dominating in the one-gluon exchange process between quarks. We discuss the strength S_B of the single-particle spin-orbit potential, following the Scheerbaum's prescription. Using the SU6 quark-model baryon-baryon interaction which was recently developed by the Kyoto-Niigata group, we calculate NN, Lambda N and Sigma N G-matrices in symmetric nuclear matter and apply them to estimate the strength S_B. The ratio of S_B to the nucleon strength S_N =~ -40 MeV*fm^5 is (S_Lambda)/(S_N) =~ 1/5 and (S_Sigma)/(S_N) =~ 1/2 in the Born approximation. The G-matrix calculation of the model FSS modifies S_Lambda to (S_Lambda)/(S_N) =~ 1/12. For S_N and S_Sigma, the effect of the short-range correlation is comparatively weak against meson-exchange potentials with a short-range repulsive core. The significant reduction of the Lambda single-particle potential arises from the combined effect of the antisymmetric LS force, the flavor-symmetry breaking originating from the strange to up-down quark-mass difference, as well as the effect of the short-range correlation. The density dependence of S_B is also examined.Comment: 26 page

Subjective versus objective measures of distress, arousal and symptom burden in patients with functional seizures and other functional neurological symptom disorder presentations : a systematic review

Symptoms and functioning can be measured subjectively using self-report measures or objectively, based on physiological changes. This raises the question whether subjective and objective measures are closely correlated and – if not – whether one is more accurate or meaningful than the other, especially in patients with Functional Seizures (FS) or other Functional Neurological Symptom Disorders (FND), where subjective and objective observations may be thought particularly likely to deviate. This systematic review explores these questions focussing on measures of distress, arousal and symptom burden. Eighteen studies (12 FS, 6 other FND) capturing 396 FND patients were included. Eleven reported no correlation between subjective and objective measures. Only four studies reported significant correlations (r’s = −0.74–0.59, p’s < 0.05). The small number of studies and diverse methodologies do not provide conclusive answers to the questions posed. Given that subjective and objective measures capture different aspects of current state or function, a combination of measurement approaches is likely to provide optimal information about patients’ health state. In view of the attentional and perceptual alterations implicated in FND, the difference between objective and subjective measures may represent an interesting observation in its own right