Acute stress symptoms 1-2 weeks after stroke predict the subsequent development of post-traumatic stress symptoms: A prospective cohort study.

OBJECTIVE: To date no research has examined the potential influence of acute stress symptoms (ASD) on subsequent development of post-traumatic stress disorder (PTSD) symptoms in stroke survivors. Our objective was to examine whether acute stress symptoms measured 1-2 weeks post-stroke predicted the presence of post-traumatic stress symptoms measured 6-12 weeks later. DESIGN: Prospective within-groups study. METHODS: Fifty four participants who completed a measure of acute stress disorder at 1-2 weeks following stroke (time 1) and 31 of these participants completed a measure of posttraumatic stress disorder 6-12 weeks later (time 2). Participants also completed measures of stroke severity, functional impairment, cognitive impairment, depression, anxiety, pre-morbid intelligence and pain across both time points. RESULTS: Some 22% met the criteria for ASD at baseline and of those, 62.5% went on to meet the criteria for PTSD at follow-up. Meanwhile two of the seven participants (28.6%) who met the criteria for PTSD at Time 2, did not meet the ASD criteria at Time 1 (so that PTSD developed subsequently). A hierarchical multiple regression analysis indicated that the presence of acute stress symptoms at baseline was predictive of post-traumatic stress symptoms at follow-up (R2 = .26, p < .01). Less severe stroke was correlated with higher levels of post-traumatic stress symptoms at Time 2 (rho = .42, p < .01). CONCLUSIONS: The results highlight the importance of early assessment and identification of acute stress symptoms in stroke survivors as a risk factor for subsequent PTSD. Both ASD and PTSD were prevalent and the presence of both disorders should be assessed.

National study of hearing preservation rates and outcomes after cochlear implantation in Ireland.

OBJECTIVE: To study the rate of hearing preservation and outcomes of hearing preservation candidates in a national cochlear implant centre. The HEARRING criteria was used. METHODS: All cochlear implant candidates with preserved low frequency pure tone average (PTA) were included. All patients underwent cochlear implantation using a standard 'soft-surgery' technique. PTA was assessed at switch-on, 3, 6, 9 and 12 months postoperatively. The primary outcome was hearing preservation at 12 months. RESULTS: Sixty six patients were included in the study between 2015 and 2020. Seventy one ears were implanted including 33 adults and 33 children with 5 bilateral implantations. Mean preoperative PTA was 74.8 dB (range 52.3-92 dB), mean postoperative PTA was 95.3 dB corresponding to a mean shift of 20.5 dB. In the adult population, HP rates were as follows: complete HP in 13%, partial HP in 39.1%, minimal HP in 30.4%, loss of hearing in 17.4%. In the paediatric population: complete HP in 20.7%, partial HP in 51.7%, minimal HP in 13.8% and loss of hearing in 13.8%. After the initial postoperative shift, there was no significant worsening of residual hearing during follow-up between 3 and 12 months. There were no significant prognostic factors for hearing preservation. CONCLUSION: Hearing preservation rates using the HEARRING criteria are described. This study will help counselling and decision making in patients eligible for cochlear implantation with hearing preservation. Further studies are required to assess the performances and outcomes of electronatural and electroacoustic stimulation.

Over-the-counter antacids linked to severe hypokalaemia in the context of threatened preterm labour.

A healthy multiparous woman presented at 35 weeks and 4 days' gestation with threatened preterm labour on multiple occasions. An incidental finding of severe hypokalaemia (2.4 mmol/L) was detected on routine blood tests. The cause of this hypokalaemia was not initially obvious. It was eventually linked to overuse of over-the-counter antacids for pregnancy-associated heartburn. The patient was managed with parenteral and then oral electrolyte replacement which corrected a pH of 7.55, bicarbonate of 36.7 mEq/L and a base excess 13.1. In this case report we consider whether hypokalaemia could be linked to uterine irritability and threatened preterm labour, whether antacids were being abused in the context of an eating disorder and the importance of taking a full drug history.

The Correlative Strength of Objective Physical Assessment Against the ECOG Performance Status Assessment in Individuals Diagnosed With Cancer.

BACKGROUND: Individuals with cancer experience loss of function and disability due to disease and cancer-related treatments. Physical fitness and frailty influence treatment plans and may predict cancer outcomes. Outcome measures currently used may not provide sufficiently comprehensive assessment of physical performance. OBJECTIVE: The objectives of this study are to: (1) describe the development of a functional measure, the Bellarmine Norton Assessment Tool (BNAT), for individuals with cancer; and (2) assess the relationship between the BNAT and the Eastern Cooperative Oncology Group (ECOG) Performance Status, a commonly used classification system by oncologists. DESIGN: This was a prospective cohort correlation study. METHODS: The BNAT encompasses 1 self-reported physical activity question and 4 objective tests: 2-Minute Step Test, 30-Second Sit to Stand, Timed Arm Curl, and Timed Up and Go. The BNAT score and its components were compared with ECOG Performance Status scores assigned by oncologists and analyzed for correlation and agreement. RESULTS: A total of 103 male and female individuals (ages 33-87 years) with various cancer diagnoses participated. The mean (SD) ECOG Performance Status score was 0.95 (0.87), range 0 to 3, and the mean BNAT score was 14.9 (4.3), range 5 to 24. Spearman agreement association of BNAT and ECOG Performance Status scores revealed a significant moderate negative relationship (r = -0.568). LIMITATIONS: The BNAT was compared with the ECOG Performance Status, a commonly used but subjective measure. Additionally, a common data set was used for both deriving and evaluating the BNAT performance scale. CONCLUSIONS: There was a moderate negative linear relationship of BNAT to ECOG Performance Status scores across all participants. Utilization of the BNAT may reflect overall physical performance and provide comprehensive and meaningful detail to influence therapeutic decisions.

The relative effectiveness of psychotherapeutic techniques and delivery modalities for chronic pain: a protocol for a systematic review and network meta-analysis.

Introduction: There is increasing evidence for the use of psychotherapies, including cognitive behavioural therapy, acceptance and commitment therapy, and mindfulness based stress reduction therapy, as an approach to management of chronic pain. Similarly, online psychotherapeutic interventions have been shown to be efficacious, and to arguably overcome practical barriers associated with traditional face-to-face treatment for chronic pain. This is a protocol for a systematic review and network meta-analysis aiming to evaluate and rank psychotherapies (delivered in person and online) for chronic pain patients. Methods/ design: Four databases, namely the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO will be searched from inception. Randomised controlled trials that have evaluated psychological interventions for pain management delivered online or in person will be included in the review. Data will be independently extracted in duplicate and the Cochrane Collaboration Risk of Bias Tool will be used to assess study quality. Measures of pain interference will be extracted as the primary outcome and measures of psychological distress will be extracted as the secondary outcome. A network meta-analysis will generate indirect comparisons of psychotherapies across treatment trials. Rankings of psychotherapies for chronic pain will be made available.   Discussion: A variety of psychotherapies, delivered both online and in person, have been used in an attempt to help manage chronic pain. Although occasional head to head trials have been conducted, little evidence exists to help identify which psychotherapy is most effective in reducing pain interference. The current review will address this gap in the literature and compare the psychotherapies used for internet delivered and in person interventions for chronic pain in relation to the reduction of pain interference and psychological distress. Results will provide a guide for clinicians when determining treatment course and will inform future research into psychotherapies for chronic pain. PROSPERO registration: CRD42016048518 01/11/16.

Reactions of N2O5 with Salty and Surfactant-Coated Glycerol: Interfacial Conversion of Br- to Br2 Mediated by Alkylammonium Cations.

Gas-liquid scattering and product-yield experiments are used to investigate reactions of N2O5 with glycerol containing Br- and surfactant ions. N2O5 oxidizes Br- to Br2 for every solution tested: 2.7 M NaBr, 0.03 M tetrahexylammonium bromide (THABr), 0.03 M THABr + 0.5 M NaBr, 0.03 M THABr + 0.5 M NaCl, 0.03 M THABr + 0.01 M sodium dodecyl sulfate (SDS), and 0.01 M cetyltrimethylammonium bromide (CTABr). N2O5 also reacts with glycerol itself to produce mono- and dinitroglycerin. Surface tension measurements indicate that 0.03 M THABr and 2.7 M NaBr have similar interfacial Br- concentrations, though their bulk Br- concentrations differ by 90-fold. We find that twice as much Br2 is produced in the presence of THA+, implying that the conversion of Br- to Br2 is initiated at the interface, perhaps mediated by the charged, hydrophobic pocket within the surface THA+ cation. The addition of 0.5 M NaBr, 0.5 M NaCl, or 0.01 M SDS to 0.03 M THABr lowers the Br2 production rate by 23%, 63%, and 67% of the THABr value, respectively. When CTA+ is substituted for THA+, Br2 production drops to 12% of the THABr value. The generation of Br2 under such different conditions implies that trace amounts of surface-active alkylammonium ions can catalyze interfacial N2O5 reactions, even when salts and other surfactants are present.

Impact of an evidence-based practice course on occupational therapist's confidence levels and goals.

Confidence levels of 136 Irish occupational therapists were measured before and after an evidence based practice training course. Ranked scores on the evidence based practice confidence scale showed statistically significant improvement in all areas between pre and post course. Goals set by therapists to integrate EBP into their practice following the course were analysed and grouped into categories which included: 1) getting ready to use evidence based practice, 2) examining current and best practices, and 3) promoting a culture of evidence based practice in the workplace. Course feedback using Likert scales identified satisfaction with course content and delivery method.

The transformation of morals in markets: death, benefits, and the exchange of life insurance policies.

This article adopts an institutional approach to describe the changing secondary market for life insurance in the United States. Since the 1990s, this market, in which investors buy strangers' life insurance policies, has grown in the face of considerable moral ambivalence. The author uses news reports and interviews to identify and describe three conceptions of this market: sacred revulsion, consumerist consolation, and rationalized reconciliation. Differences among the conceptions are considered in view of the institutional legacy of life insurance and its success in organizing practices, perceptions, and understandings about markets and death. From this case, the author draws implications for analyses of morals in markets, an important and emergent topic within economic sociology.

Performance of an imaging system vs. manual screening in the detection of squamous intraepithelial lesions of the uterine cervix.

OBJECTIVE: To compare the ThinPrep Imaging System (Cytyc Corp., Boxborough Massachusetts, U.S.A) to manual screening in the detection of cervical squamous epithelial lesion (SIL). STUDY DESIGN: A total of 27,525 manually screened ThinPrep Pap tests were compared with 27,725 imaged ThinPrep Pap tests for: (1) diagnostic rates of atypical squamous cells of undetermined significance; atypical squamous cells of undetermined significance, cannot rule out high grade SIL (ASC-H); low grade SIL and high grade SIL (HSIL); (2) ASC/SIL ratio; (3) high-risk HPV positivity for ASC; and (4) biopsy follow-up for ASC-H and HSIL. RESULTS: There were significant increases in the percentage of cytologic diagnoses in all categories with the imager. The ASC/SIL ratios of both groups were comparable. There was a significant decrease in HPV positivity in the imager group of ASC. Biopsy results confirmed a significant increase in the detection of HSIL in both the ASC-H and HSIL groups of the imaged cohort. CONCLUSION: The ThinPrep Imaging System is significantly better than manual screening in the detection of cervical SIL.