Acquiring a new understanding of illness and agency: a narrative study of recovering from chronic fatigue syndrome

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.Background: The condition known as chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is poorly understood. Simplified medical models tend to neglect the complexity of illness, contributing to a terrain of uncertainty, dilemmas and predicaments. However, despite pessimistic pictures of no cure and poor prognosis, some patients recover. Purpose: This study’s purpose is to provide insight into people’s experiences of suffering and recovery from very severe CFS/ME and illuminate understanding of how and why changes became possible. Methods: Fourteen former patients were interviewed about their experiences of returning to health. A narrative analysis was undertaken to explore participants’ experiences and understandings. We present the result through one participant’s story. Results: The analysis yielded a common plotline with a distinct turning point. Participants went through a profound narrative shift, change in mindset and subsequent long-time work to actively pursue their own healing. Their narrative understandings of being helpless victims of disease were replaced by a more complex view of causality and illness and a new sense of self-agency developed. Discussion: We discuss the illness narratives in relation to the disease model and its shortcomings, the different voices dominating the stories at different times in a clinically, conceptually, and emotionally challenging area.publishedVersio

Smooth values of polynomials

Given $f\in \mathbb{Z}[t]$ of positive degree, we investigate the existence of auxiliary polynomials $g\in \mathbb{Z}[t]$ for which $f(g(t))$ factors as a product of polynomials of small relative degree. One consequence of this work shows that for any quadratic polynomial $f\in\mathbb{Z}[t]$ and any $\epsilon > 0$, there are infinitely many $n\in\mathbb{N}$ for which the largest prime factor of $f(n)$ is no larger than $n^{\epsilon}$

Controlling dietary cation-anion differences in forages by chloride fertilisation

Rations with low to negative dietary cation-anion difference (DCAD) given to dairy cows before calving reduce the risk of hypocalcaemia (milk fever). Different strategies for increasing forage DCAD were investigated in field trials in Central and Western Norway. Fertilisation with 70, 140 or 210 kg Cl per hectare as calcium chloride and low supply rates of K reduced DCAD in forage harvested at late developmental stages in spring growth of timothy and meadow fescue. The ideal negative DCAD was only attained on soils very low in plant available K. Timing (spring versus late spring) and source of Cl (CaCl2 versus MgCl2) were of no importance for the result. When pure stands of seven grasses were fertilised in spring either without chloride or with 140 kg chloride per hectare, the lowest values of DCAD after chloride fertilisation were found in perennial ryegrass and reed canary grass. By comparison, cocksfoot had equally high or higher Cl concentrations in its tissues, but accumulated more K, and seemed to be poorly suited for low DCAD forage production. It was concluded that Cl fertilisation is a more efficient means of controlling DCAD than sward species composition

‘Existential’ in Scandinavian healthcare journals: An analysis of the concept and implications for future research

The concept of ‘existential’, used frequently in Scandinavian healthcare journals, is associated with various, often unclear, meanings, highlighting the need for a more accurate understanding of the concept. In this integrative review we analyse how the concept has been used in Scandinavian healthcare journals from 1984 to 2020, exploring the trajectory of the concept, its definitions and its applications. A secondary aim is to offer some clarity regarding how the concept may be used in future healthcare research and provide a definition of ‘existential’ based on our findings. Our findings show that while the concept is increasingly used, it is rarely defined, and there appears to be no consensus on the concept’s meaning. We categorise applications of the concept into five overarching themes: (1) Suffering and re-orientation, (2) Meaning and meaninglessness, (3) Existential philosophy in relation to health (4) Existential questions as approaches to care and (5) Usage and demarcation of existential, spiritual and religious concepts. Based on the findings, we propose a definition of the concept of ‘existential’ in the healthcare context. The study contributes to, and underscores advantages and limitations of, the use of the concept in healthcare research.publishedVersio

Ullpellets som gjødsel

Det er estimert at i overkant av 400 tonn ull ikke leveres inn til norske ullsentraler. I en nasjonal spørreundersøkelse ble sauebønder blant annet spurt om hvordan de håndterer og bruker ullen. Av de som svarte at de ikke leverer til mottak, var det 46 % som svarte at ullen enten brennes eller graves ned. Det betyr at store mengder ull kunnet vært nyttet på en mer bærekraftig måte. Ull er et næringsrikt materiale og derfor en god kilde til gjødsel, spesielt for næringsstoffene nitrogen og til dels kalium og svovel. Som en strategi for bedre sirkulærøkonomi er det gode grunner for å tilbakeføre ull til landbruksjord. Ull kan i prinsippet brukes ubehandlet som et jordforbedringsmiddel eller gjødselkilde da ull brytes forholdsvis raskt ned i kontakt med jord. Økende etterspørsel etter gjødselprodukter som er lette å håndtere og produkter som kan brukes i økologisk produksjon, gjorde det aktuelt å prøve ut ullpellets som gjødsel. I prosjektet ble ullpellets testet til veksthusplanter (hagepelargonium og busktomat) og som gjødsel til eng. I tillegg ble det gjennomført et inkubasjonsforsøk for å undersøke nedbrytningshastigheten til ull og samtidig registre hvor raskt næringsstoffer (i hovedsak nitrogen) blir tilgjengelig. En hovedkonklusjon for alle testene var at ullpellets ikke frigjør næring raskt nok til kortvarige kulturer, men at ullpellets kan ha verdi som en langsomtvirkende gjødseltype. En annen utfordring med ull er at næringssammensetningen er ubalansert for mange vekster pga. lavt fosforinnhold. Forslag til videre utviklingsarbeid med ull som gjødsel, er å undersøke muligheter for å lage pellets av blandinger av ulike materialer, f.eks. makroalger som kan tilføre kalium, og fiskebein som kan tilføre fosfor. Ulike blandinger med ull kan da tilpasses ulike veksters behov. Det kan også være aktuelt å utføre risikoanalyser ved bruk av ull til matproduksjon ettersom det finnes begrensete kunnskaper om de hygieniske, helse- og miljømessige sidene ved bruk av ull og ullprodukter i jord- og hagebruk

Risk factors for re-hospitalization following neonatal discharge of extremely preterm infants in Canada

Objective: Survivors of extremely preterm birth are at risk of re-hospitalization but risk factors in the Canadian population are unknown. Our objective is to identify neonatal, sociodemographic, and geographic characteristics that predict re-hospitalization in Canadian extremely preterm neonates. Methods: This is a retrospective analysis of a prospective observational cohort study that included preterm infants born 22 to 28 weeks’ gestational age from April 1, 2009 to September 30, 2011 and seen at 18 to 24 months corrected gestational age in a Canadian Neonatal Follow-Up Network clinic. Characteristics of infants re-hospitalized versus not re-hospitalized are compared. The potential neonatal, sociodemographic, and geographic factors with significant association in the univariate analysis are included in a multivariate model. Results: From a total of 2,275 preterm infants born at 22 to 28 weeks gestation included, 838 (36.8%) were re-hospitalized at least once. There were significant disparities between Canadian provincial regions, ranging from 25.9% to 49.4%. In the multivariate logistic regression analysis, factors associated with an increased risk for re-hospitalization were region of residence, male sex, bronchopulmonary dysplasia, necrotizing enterocolitis, prolonged neonatal intensive care unit (NICU) stay, ethnicity, Indigenous ethnicity, and sibling(s) in the home. Conclusion: Various neonatal, sociodemographic, and geographic factors predict re-hospitalization of extremely preterm infants born in Canada. The risk factors of re-hospitalization provide insights to help health care leaders explore potential preventative approaches to improve child health and reduce health care system cost

Quantitative assessment of white matter injury in preterm neonates: Association with outcomes.

OBJECTIVE: To quantitatively assess white matter injury (WMI) volume and location in very preterm neonates, and to examine the association of lesion volume and location with 18-month neurodevelopmental outcomes. METHODS: Volume and location of WMI was quantified on MRI in 216 neonates (median gestational age 27.9 weeks) who had motor, cognitive, and language assessments at 18 months corrected age (CA). Neonates were scanned at 32.1 postmenstrual weeks (median) and 68 (31.5%) had WMI; of 66 survivors, 58 (87.9%) had MRI and 18-month outcomes. WMI was manually segmented and transformed into a common image space, accounting for intersubject anatomical variability. Probability maps describing the likelihood of a lesion predicting adverse 18-month outcomes were developed. RESULTS: WMI occurs in a characteristic topology, with most lesions occurring in the periventricular central region, followed by posterior and frontal regions. Irrespective of lesion location, greater WMI volumes predicted poor motor outcomes ( CONCLUSIONS: The predictive value of frontal lobe WMI volume highlights the importance of lesion location when considering the neurodevelopmental significance of WMI. Frontal lobe lesions are of particular concern

Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada

Administration of magnesium sulphate (MgSO4) to women with imminent preterm birth a

Neonatal Pain-Related Stress Predicts Cortical Thickness at Age 7 Years in Children Born Very Preterm

Background Altered brain development is evident in children born very preterm (24–32 weeks gestational age), including reduction in gray and white matter volumes, and thinner cortex, from infancy to adolescence compared to term-born peers. However, many questions remain regarding the etiology. Infants born very preterm are exposed to repeated procedural pain-related stress during a period of very rapid brain development. In this vulnerable population, we have previously found that neonatal pain-related stress is associated with atypical brain development from birth to term-equivalent age. Our present aim was to evaluate whether neonatal pain-related stress (adjusted for clinical confounders of prematurity) is associated with altered cortical thickness in very preterm children at school age. Methods 42 right-handed children born very preterm (24–32 weeks gestational age) followed longitudinally from birth underwent 3-D T1 MRI neuroimaging at mean age 7.9 yrs. Children with severe brain injury and major motor/sensory/cognitive impairment were excluded. Regional cortical thickness was calculated using custom developed software utilizing FreeSurfer segmentation data. The association between neonatal pain-related stress (defined as the number of skin-breaking procedures) accounting for clinical confounders (gestational age, illness severity, infection, mechanical ventilation, surgeries, and morphine exposure), was examined in relation to cortical thickness using constrained principal component analysis followed by generalized linear modeling. Results After correcting for multiple comparisons and adjusting for neonatal clinical factors, greater neonatal pain-related stress was associated with significantly thinner cortex in 21/66 cerebral regions (p-values ranged from 0.00001 to 0.014), predominately in the frontal and parietal lobes. Conclusions In very preterm children without major sensory, motor or cognitive impairments, neonatal pain-related stress appears to be associated with thinner cortex in multiple regions at school age, independent of other neonatal risk factors