‘Unfettered expression of thought’? Experiences of anonymous online role play

Advocates suggest that anonymity allows all learners to have an equal voice in a learning environment, and that it encourages participation. This paper explores tutors’ and learners’ experiences of an anonymous, synchronous role play activity conducted using online discussion forums. A qualitative study was undertaken to investigate the experiences of five groups of learners and four tutors. Data were obtained from an online questionnaire and interviews with students and tutors. The findings reveal a huge diversity in responses to the activity. Learners’ emotions before the activity ranged from ‘confident’ to ‘panic’. Afterwards many stated that ‘anonymity’ was the best thing about the activity, suggesting that it ‘loosened inhibitions’ and allowed ‘unfettered expression of thought’. At the same time, some respondents admitted trying to guess the identity of participants, and played their roles with varying degrees of conviction and engagement. Some participants may even have refrained from playing any part in the activity, hiding behind their anonymity. For tutors issues of control were significant and issues of facilitation were raised, although inappropriate behaviour was rare. This study has revealed the diversity of learners’ responses to online role play, and the generally positive attitude towards anonymity. It also highlights the potential for anonymity to contribute to inequality in participation and raises the question of whether genuine anonymity can be useful or achievable. Key findings with significance for future implementation of similar role play activities are presented here

MRI and Neuropsychological Correlates of Carbon Monoxide Exposure: A Case Report

A 45-year-old woman experienced long-term, chronic exposure to carbon monoxide in the restaurant kitchen where she was employed as a cook. After returning to the restaurant after 5 days off work, she noticed that her symptoms returned immediately; she then aired out the room and called the gas company. Approximately 6 hr after a leak was detected, the patient went to the hospital, where her carboxyhemoglobin was found to be within normal limits and results of a neurologic examination were described as normal. Based on her symptoms, the patient believed she had been exposed to CO for at least 1 year before the leak was discovered. Initially, she experienced flu-like symptoms, which eventually resolved. At the time of her first neuropsychological evaluation (17 months after the exposure was identified), her persisting complaints included difficulties in reading, writing, speaking and word retrieval. The test results were consistent with secondary frontal lobe dysfunction associated with subcortical disorders such as those seen after CO exposure. Results of a subsequent neuropsychological examination (29 months postexposure) showed slight improvement in performance, but her performance was still consistent with mild frontal/subcortical dysfunction. Although the initial screening of a brain magnetic resonance image (MRI) performed 15 months after the exposure was interpreted as being within normal limits, two subsequent blind reviews of the same scans identified multiple bilateral lesions in the basal ganglia, which were consistent with chronic CO exposure. We present this case as an example of the utility of MRI and neuropsychological examinations in detecting central nervous system dysfunction secondary to CO exposure

Council tax valuation band predicts breast feeding and socio-economic status in the ALSPAC study population

BACKGROUND: Breast-feeding rates in the UK are known to vary by maternal socio-economic status but the latter function is imperfectly defined. We test if CTVB (Council Tax Valuation Band – a categorical assessment of UK property values and amenities governing local tax levies) of maternal address predicts, in a large UK regional sample of births, (a) breast-feeding (b) personal and socio-economic attributes of the mothers. METHODS: Retrospective study of a subset (n.1390 selected at random) of the ALSPAC sample (Avon Longitudinal Study of Parents and Children), a large, geographically defined cohort of mothers followed from early pregnancy to 8 weeks post-delivery. Outcome measures are attitudes to breast-feeding prior to delivery, breast-feeding intention and uptake, demographic and socio-economic attributes of the mothers, CTVB of maternal home address at the time of each birth. Logistic regression analysis, categorical tests. RESULTS: Study sample: 1360 women divided across the CTVBs – at least 155 in any band or band aggregation. CTVB predicted only one belief or attitude – that bottle-feeding was more convenient for the mother. However only 31% of 'CTVB A infants' are fully breast fed at 4 weeks of life whereas for 'CTVB E+ infants' the rate is 57%. CTVB is also strongly associated with maternal social class, home conditions, parental educational attainment, family income and smoking habit. CONCLUSION: CTVB predicts breast-feeding rates and links them with social circumstances. CTVB could be used as the basis for accurate resource allocation for community paediatric services: UK breast-feeding rates are low and merit targeted promotion

Pneumococcal Colonisation Rates in Patients Admitted to a UK Hospital with Lower Respiratory Tract Infection - a prospective case-control study

BACKGROUND Current diagnostic tests are ineffective at identifying the aetiological pathogen in hospitalised adults with lower respiratory tract infection (LRTI). The association of pneumococcal colonisation with disease has been suggested as a means to increase diagnostic precision. We compared pneumococcal colonisation rate and density of nasal pneumococcal colonisation by a) classical culture and b) quantitative real time lytA Polymerase Chain Reaction (qPCR) in patients admitted to hospital in the UK with LRTI compared to control patients. METHODS 826 patients were screened for inclusion in this prospective case-control study. 38 patients were recruited, 19 with confirmed LRTI and 19 controls with another diagnosis. Nasal wash (NW) was collected at the time of recruitment. RESULTS Pneumococcal colonisation was detected in 1 LRTI patient and 3 controls (p=0.6) by classical culture. Using qPCR pneumococcal colonisation was detected in 10 LRTI patients and 8 controls (p=0.5). Antibiotic usage prior to sampling was significantly higher in the LRTI than control group 19 v. 3 (p8000 copies/ml on qPCR pneumococcal colonisation was found in 3 LRTI patients and 4 controls (p > 0.05). CONCLUSIONS We conclude that neither prevalence nor density of nasal pneumococcal colonisation (by culture and qPCR) can be used as a method of microbiological diagnosis in hospitalised adults with LRTI in the UK. A community based study recruiting patients prior to antibiotic therapy may be a useful future step

Pneumococcal colonisation is an asymptomatic event in healthy adults using an experimental human colonisation model

Introduction Pneumococcal colonisation is regarded as a pre-requisite for developing pneumococcal disease. In children previous studies have reported pneumococcal colonisation to be a symptomatic event and described a relationship between symptom severity/frequency and colonisation density. The evidence for this in adults is lacking in the literature. This study uses the experimental human pneumococcal challenge (EHPC) model to explore whether pneumococcal colonisation is a symptomatic event in healthy adults. Methods Healthy participants aged 18–50 were recruited and inoculated intra-nasally with either Streptococcus pneumoniae (serotypes 6B, 23F) or saline as a control. Respiratory viral swabs were obtained prior to inoculation. Nasal and non-nasal symptoms were then assessed using a modified Likert score between 1 (no symptoms) to 7 (cannot function). The rate of symptoms reported between the two groups was compared and a correlation analysis performed. Results Data from 54 participants were analysed. 46 were inoculated with S. pneumoniae (29 with serotype 6B, 17 with serotype 23F) and 8 received saline (control). In total, 14 became experimentally colonised (30.4%), all of which were inoculated with serotype 6B. There was no statistically significant difference in nasal (p = 0.45) or non-nasal symptoms (p = 0.28) between the inoculation group and the control group. In those who were colonised there was no direct correlation between colonisation density and symptom severity. In the 22% (12/52) who were co-colonised, with pneumococcus and respiratory viruses, there was no statistical difference in either nasal or non-nasal symptoms (virus positive p = 0.74 and virus negative p = 1.0). Conclusion Pneumococcal colonisation using the EHPC model is asymptomatic in healthy adults, regardless of pneumococcal density or viral co-colonisation

Functional Status After Operation for Ebstein Anomaly The Mayo Clinic Experience

ObjectivesThe objective of this study was to review the long-term functional outcome of patients with Ebstein anomaly who had cardiac operation at our institution.BackgroundEbstein anomaly is a spectrum of tricuspid valvular and right ventricular dysplasia. Many patients will require operation in an attempt to improve quality of life.MethodsFrom April 1, 1972, to January 1, 2006, 539 patients with Ebstein anomaly underwent 604 cardiac operations at the Mayo Clinic in Rochester, Minnesota. Patient records were reviewed, and all patients known to still be alive were mailed a medical questionnaire or contacted by telephone.ResultsAt the initial operation at our institution, the mean age of the patients was 24 years (range 8 days to 79 years) and 53% were female patients. Survival at 5, 10, 15, and 20 years was 94%, 90%, 86%, and 76%, respectively. Survival free of late reoperation was 86%, 74%, 62%, and 46% at 5, 10, 15, and 20 years, respectively. Surveys were returned by 285 of 448 (64%) patients known to be alive at the time of this study. Two hundred thirty-seven (83%) patients were in New York Heart Association functional class I or II, and 34% were taking no cardiac medication. One hundred three patients (36%) reported an incident of atrial fibrillation or flutter, 5 patients (2%) reported having had endocarditis, and 1 patient (<1%) reported having a stroke. There were 275 pregnancies among 82 women. The recurrence of congenital heart disease was reported in 9 of 232 (3.9%) liveborn children.ConclusionsPatients have good long-term survival and functional outcomes after undergoing surgery for Ebstein anomaly. Atrial arrhythmias are common both before and after surgery. Many patients have had one or more successful pregnancies with a low-recurrence risk of congenital heart disease

Mandatory role of proteinase-activated receptor 1 in experimental bladder inflammation

BACKGROUND: In general, inflammation plays a role in most bladder pathologies and represents a defense reaction to injury that often times is two edged. In particular, bladder neurogenic inflammation involves the participation of mast cells and sensory nerves. Increased mast cell numbers and tryptase release represent one of the prevalent etiologic theories for interstitial cystitis and other urinary bladder inflammatory conditions. The activity of mast cell-derived tryptase as well as thrombin is significantly increased during inflammation. Those enzymes activate specific G-protein coupled proteinase-activated receptors (PAR)s. Four PARs have been cloned so far, and not only are all four receptors highly expressed in different cell types of the mouse urinary bladder, but their expression is altered during experimental bladder inflammation. We hypothesize that PARs may link mast cell-derived proteases to bladder inflammation and, therefore, play a fundamental role in the pathogenesis of cystitis. RESULTS: Here, we demonstrate that in addition to the mouse urinary bladder, all four PA receptors are also expressed in the J82 human urothelial cell line. Intravesical administration of PAR-activating peptides in mice leads to an inflammatory reaction characterized by edema and granulocyte infiltration. Moreover, the inflammatory response to intravesical instillation of known pro-inflammatory stimuli such as E. coli lipopolysaccharide (LPS), substance P, and antigen was strongly attenuated by PAR1-, and to a lesser extent, by PAR2-deficiency. CONCLUSION: Our results reveal an overriding participation of PAR1 in bladder inflammation, provide a working model for the involvement of downstream signaling, and evoke testable hypotheses regarding the role of PARs in bladder inflammation. It remains to be determined whether or not mechanisms targeting PAR1 gene silencing or PAR1 blockade will ameliorate the clinical manifestations of cystitis

Functional Status After Operation for Ebstein Anomaly The Mayo Clinic Experience

ObjectivesThe objective of this study was to review the long-term functional outcome of patients with Ebstein anomaly who had cardiac operation at our institution.BackgroundEbstein anomaly is a spectrum of tricuspid valvular and right ventricular dysplasia. Many patients will require operation in an attempt to improve quality of life.MethodsFrom April 1, 1972, to January 1, 2006, 539 patients with Ebstein anomaly underwent 604 cardiac operations at the Mayo Clinic in Rochester, Minnesota. Patient records were reviewed, and all patients known to still be alive were mailed a medical questionnaire or contacted by telephone.ResultsAt the initial operation at our institution, the mean age of the patients was 24 years (range 8 days to 79 years) and 53% were female patients. Survival at 5, 10, 15, and 20 years was 94%, 90%, 86%, and 76%, respectively. Survival free of late reoperation was 86%, 74%, 62%, and 46% at 5, 10, 15, and 20 years, respectively. Surveys were returned by 285 of 448 (64%) patients known to be alive at the time of this study. Two hundred thirty-seven (83%) patients were in New York Heart Association functional class I or II, and 34% were taking no cardiac medication. One hundred three patients (36%) reported an incident of atrial fibrillation or flutter, 5 patients (2%) reported having had endocarditis, and 1 patient (<1%) reported having a stroke. There were 275 pregnancies among 82 women. The recurrence of congenital heart disease was reported in 9 of 232 (3.9%) liveborn children.ConclusionsPatients have good long-term survival and functional outcomes after undergoing surgery for Ebstein anomaly. Atrial arrhythmias are common both before and after surgery. Many patients have had one or more successful pregnancies with a low-recurrence risk of congenital heart disease