Incivility and the clinical learner

The impact of incivility in terms of individual and team performance in clinical environments is increasingly acknowledged and supported by a growing evidence base. However, clinical environments are not just areas where patient care is delivered, they are also rich, key learning arenas for healthcare professionals. To date, the potential impact of incivility in clinical environments on healthcare professional learning and development has not been comprehensively explored. This article provides an overview of the physiological mechanisms that inhibit learning and memory recall in individuals experiencing or observing incivility and social stress. It establishes a clear need for focus on the impact of incivility on clinical learners and educators and further evidence for the need for clinical environments in which civility is firmly rooted into the pervading culture.

Administration of a novel high affinity PICK1 PDZ domain inhibitor attenuates cocaine seeking in rats

Protein interacting with C kinase-1 (PICK1) regulates intra-cellular trafficking of GluA2-containing AMPA receptors, a process known to play a critical role in cocaine-seeking behavior. This suggests that PICK1 may represent a molecular target for developing novel pharmacotherapies to treat cocaine craving-induced relapse. Emerging evidence indicates that inhibition of PICK1 attenuates the reinstatement of cocaine-seeking behavior, an animal model of relapse. Here, we show that systemic administration of TAT-P4-(DATC5)2, a novel high-affinity peptide inhibitor of the PICK1 PDZ domain, dose-dependently attenuated the reinstatement of cocaine seeking in rats at doses that did not produce operant learning deficits or suppress locomotor activity. We also show that systemic TAT-P4-(DATC5)2 penetrated the brain where it was visualized in the nucleus accumbens shell. Consistent with these effects, infusions of TAT-P4-(DATC5)2 directly into the accumbens shell reduced cocaine, but not sucrose, seeking. The effects of TAT-P4-(DATC5)2 on cocaine seeking are likely due, in part, to inhibition of PICK1 in medium spiny neurons (MSNs) of the accumbens shell as TAT-P4-(DATC5)2 was shown to accumulate in striatal neurons and bind PICK1. Taken together, these findings highlight a novel role for PICK1 in the reinstatement of cocaine seeking and support future studies examining the efficacy of peptide inhibitors of PICK1 in animal and human models of cocaine relapse.

Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review

Food environment research is increasingly gaining prominence in low- and middle-income countries (LMICs). However, in the absence of a systematic review of the literature, little is known about the emerging body of evidence from these settings. This systematic scoping review aims to address this gap. A systematic search of 6 databases was conducted in December 2017 and retrieved 920 records. In total, 70 peer-reviewed articles met the eligibility criteria and were included. Collectively, articles spanned 22 LMICs, including upper-middle-income countries (n = 49, 70%) and lower-middle-income countries (n = 18, 26%). No articles included low-income countries. Articles featured quantitative (n = 45, 64%), qualitative (n = 17, 24%), and mixed-method designs (n = 11, 8%). Studies analyzed the food environment at national, community, school, and household scales. Twenty-three articles (55%) assessed associations between food environment exposures and outcomes of interest, including diets (n = 14), nutrition status (n = 13), and health (n = 1). Food availability was associated with dietary outcomes at the community and school scales across multiple LMICs, although associations varied by vendor type. Evidence regarding associations between the food environment and nutrition and health outcomes was inconclusive. The paucity of evidence from high-quality studies is a severe limitation, highlighting the critical need for improved study designs and standardized methods and metrics. Future food environment research must address low-income and lower-middle-income countries, and include the full spectrum of dietary, nutrition, and health outcomes. Improving the quality of food environment research will be critical to the design of feasible, appropriate, and effective interventions to improve public health nutrition in LMICs.

Silica fouling during groundwater RO treatment: The effect of colloids' radius of curvature on dissolution and polymerisation

Silica fouling during groundwater reverse osmosis (RO) treatment can have a significant impact on filtration performance. To better understand this phenomenon, the equilibrium kinetics of amorphous colloidal silica were studied at conditions relevant to RO of silica-rich alkaline groundwater. The impact of particle size was investigated using synthetic monodisperse silica nanoparticles. Bench scale experiments were conducted by monitoring dissolved silica concentration of aqueous suspensions of colloids of 100 and 300 nm diameter and pH 8.5 to 9.5. The equilibrium data was determined from existing established rate law equations. This study concluded that surface energy has a major impact on silica dissolution rate constant, particularly for colloidal silica. Observations of Ostwald ripening in bidisperse silica dispersions further confirmed these results, which indicate that dissolution and redeposition is responsible for the problematic silica fouling behaviour during RO treatment. 2D modelling based on inferred equilibrium data allows visualization of scale layer growth in agreement with cross-sectional scanning electron micrographs of autopsied membranes.

HOME VIDEO TELEHEALTH TO SUPPORT RURAL VETERAN CAREGIVERS

VA offers multiple programs and services to support caregivers of US military Veterans. However, access for rural Veterans and caregivers is challenging due to distance from VA medical facilities. VA Video Connect (VVC) is a remote healthcare platform that enables Veterans to connect directly with VA clinicians through a secure, encrypted video connection. Rural caregivers and Veterans can participate in caregiver services through their own computer or another device from their home, reducing the need for travel to distant VA facilities. In 2018, VA’s Caregiver Support Program and Office of Rural Health developed an implementation pilot to engage eighteen VA Caregiver Support Coordinators (CSCs) in using VVC to monitor and support 180 Veteran/caregiver dyads enrolled in VA’s Program of Comprehensive Assistance for Family Caregivers. The presentation will provide an overview of each phase of implementation, report usability and outcome data from CSCs and caregivers, and discuss implications for broader implementation.

Neighborhood physical food environment and cardiovascular risk factors in India: Cross-sectional evidence from APCAPS

There has been increasing interest in associations between neighborhood food environments and cardiovascular risk factors. However, results from high-income countries remain inconsistent, and there has been limited research from low- and middle-income countries. We conducted a cross-sectional analysis of the third wave follow-up of the Andhra Pradesh children and parents study (APCAPS) (n = 5764, median age 28.8 years) in south India. We examined associations between the neighborhood availability (vendor density per km2 within 400 m and 1600 m buffers of households) and accessibility (distance from the household to the nearest vendor) of fruit/vegetable and highly processed/take-away food vendors with 11 cardiovascular risk factors, including adiposity measures, glucose-insulin, blood pressure, and lipid profile. In fully adjusted models, higher density of fruit/vegetable vendors within 400 m of participant households was associated with lower systolic blood pressure [-0.09 mmHg, 95% confidence interval (CI): -0.17, -0.02] and diastolic blood pressure (-0.10 mmHg, 95% CI: -0.17, -0.04). Higher density of highly processed/take-away food vendors within 400 m of participant households was associated with higher Body Mass Index (0.01 Kg/m2, 95% CI: 0.00, 0.01), waist circumference (0.22 mm, 95% CI: 0.05, 0.39), systolic blood pressure (0.03 mmHg, 95% CI: 0.01, 0.06), and diastolic blood pressure (0.03 mmHg, 95% CI: 0.01, 0.05). However, within 1600 m buffer, only association with blood pressure remained robust. No associations were found for between neighborhood accessibility and cardiovascular risk factors. Lower density of fruit/vegetable vendors, and higher density of highly processed/take-away food vendors were associated with adverse cardiovascular risk profiles. Public health policies regarding neighborhood food environments should be encouraged in south India and other rural communities in south Asia.

TP1-3 Final phase of recruitment and statistics analysis plan for Dex-CSDH trial

Objectives

Review recruitment progression and statistical analysis plan for Dex-CSDH trial.

Design

A UK multi-centre, randomised, double-blind, placebo-controlled trial of dexamethasone versus placebo for CSDH.

Subjects

Symptomatic, adult CSDH patients admitted to a participating neurosurgical unit.

Methods

Trial participants receive a 2 week course of dexamethasone in addition to standard care, including surgery. The primary outcome measure is the modified Rankin Scale (mRS) at 6 months. An mRS of 0–3 requires the patient to be independently mobile and we have considered this a favourable outcome, with scores 4–6 (non-mobile) as unfavourable. The primary analysis will be performed on an intention-to-treat basis, estimating the absolute difference between the two treatment arms in the proportions achieving a favourable outcome. Secondary analysis will be done with an ordinal analysis of mRS scores and proportional odds logistic regression of the original mRS score adjusting for baseline covariates (age, GCS).

Results

629/750 patients (84%) have been recruited to the Dex-CSDH trial which is on-going as of 20-06-2018. Recruitment progress and follow-up at time of presentation will be reviewed alongside full statistical analysis plan.

Conclusions

The Dex-CSDH trial is drawing close to target following excellent recruitment across 22 UK centres. Transparent communication of the statistical analysis plan is essential prior to unblinding of the data. Up-to-date recruitment and primary endpoint completion rates will also be reviewed.

Mixed blessings: A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia

Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers’ experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) ‘Mixed blessings-balancing motherhood’s expectations’. While mothers identified positively with the social recognition and sense of fulfillment of being a ‘good mother’, they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) ‘Instabilities due to rampant urban sprawl’. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) ‘Anchored by faith: a source of resilience to cope with adversities’. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.

Can compressive thoracic cord lesions cause a pure lower motor neurone syndrome?

Compressive lesions of the spinal cord usually cause a syndrome of upper motor neurone weakness, spasticity and sensory loss below the level of the lesion. It has long been recognised that compressive cervical cord lesions may present as isolated lower motor neurone weakness of the upper limbs, a syndrome termed cervical spondylotic amyotrophy. We describe two patients presenting with isolated lower motor neurone weakness of the lower limbs in association with a compressive cord lesion at T11/12, a condition we have termed thoracic spondylotic amyotrophy.

What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia

Mothers carry the prime responsibility for childcare and feeding in low-income countries. Understanding their experiences in providing food for their children is paramount to informing efforts to improve the nutritional status of children. Such information is lacking in Sub-Saharan Africa. To understand what influences urban mothers' food acquisition and their motivations for selecting food for their children, 36 in-depth interviews were carried out with mothers having children under five years of age. Interviews were conducted in the local language, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis which led to the identification of four major themes: mothers give-in to a child-driven diet; quick-fix versus the privilege of planning; keen awareness on food safety, nutrition, and diet diversity; and social, familial, and cultural influences. The findings indicate that child feeding practices are influenced by interlinked social and environmental factors. Hence, nutrition education campaigns should focus on targeting not only families but also their children. Attention should also be given to food safety regulations, as well as to the much-needed support of mothers who are struggling to ensure their children's survival in low-income countries.