They did explain everything, but I can't remember : the search for relevant information following a heart attack : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Arts in Nursing at Massey University

This qualitative descriptive study was undertaken to find out what information patients and their partners wanted following a heart attack. There were 17 participants, of whom 11 were patients and six were partners. Semi-structured interviews were conducted with participants and then thematic content analysis was used to identify the four main themes. The first two themes relate to the experience of having a heart attack and question the widely held belief that it is a dramatic experience and that patients deny what is happening. It seems more likely that the non-specific and insidious onset leaves patients genuinely not knowing what is happening. Women have an additional problem in that once they seek professional help, the medical staff often fail to correctly diagnose that they are having a heart attack. The third and fourth themes relate to the recovery period and show that in spite of a plethora of information provided during cardiac rehabilitation, there is strong evidence that patients and partners fail to receive information that meets their own needs in relation to social, physical and psychological issues. This has an impact on the major adjustments to be made after a heart attack and the coping strategies that are a part of this. An additional problem following discharge is poor communication between health professionals, resulting in anxiety for patient and partners. The role of the cardiac educator emerged as extremely useful and valuable to patients and partners as a support and source of relevant information after discharge. Further support and training for these nurses and expansion of the service would increase their availability to patients and partners. It would also be in line with the World Health Organisation (WHO) (1997) recommendations to provide an environment, which supports and motivates people to make lifestyle changes. An additional recommendation is increased flexibility in cardiac rehabilitation with a shift into the primary care setting, thus offering wider opportunities for patients and partners to obtain support and hopefully facilitate the process of adjustment following a heart attack

Building and Strengthening State Data Systems to Measure Community College and Workforce Outcomes

Calls for creating state data systems on postsecondary, adult education, and workforce development programs and employment outcomes in order to better serve low-income, low-skilled workers. Outlines barriers, effective systems, and policy recommendations

Austin's high-tech industry: played out or just beginning?

Recessions ; High technology industries

Between Philosophy and Art

Similarity and difference, patterns of variation, consistency and coherence: these are the reference points of the philosopher. Understanding experience, exploring ideas through particular instantiations, novel and innovative thinking: these are the reference points of the artist. However, at certain points in the proceedings of our Symposium titled, Next to Nothing: Art as Performance, this characterisation of philosopher and artist respectively might have been construed the other way around. The commentator/philosophers referenced their philosophical interests through the particular examples/instantiations created by the artist and in virtue of which they were then able to engage with novel and innovative thinking. From the artists’ presentations, on the other hand, emerged a series of contrasts within which philosophical and artistic ideas resonated. This interface of philosopher-artist bore witness to the fact that just as art approaches philosophy in providing its own analysis, philosophy approaches art in being a co-creator of art’s meaning. In what follows, we discuss the conception of philosophy-art that emerged from the Symposium, and the methodological minimalism which we employed in order to achieve it. We conclude by drawing out an implication of the Symposium’s achievement which is that a counterpoint to Institutional theories of art may well be the point from which future directions will take hold, if philosophy-art gains traction

Ageing, depression, anxiety, social support and the diurnal rhythm and awakening response of salivary cortisol

The present study compared the cortisol awakening response and diurnal rhythm in 24 young healthy students and 48 community-dwelling older adults. The associations with diurnal cortisol and depression, anxiety and social support were also examined in relation to age. Salivary cortisol was measured over the course of one day: immediately upon awakening, 30 min later, and then 3 h, 6 h, 9 h and 12 h post-awakening. Participants completed a questionnaire measuring symptoms of anxiety and depression and social support was assessed. Older adults exhibited a significantly reduced awakening response, overall cortisol levels, area under the curve (AUC) and diurnal slopes than younger adults, resulting in a flatter diurnal rhythm. Younger adults with higher depression scores had significantly higher overall cortisol and higher levels upon awakening and 30 min post-awakening. In the younger adults, anxiety and depression correlated positively with AUC and the cortisol awakening response (CAR). Older adults with lower social support had a reduced AUC where younger adults with lower social support displayed a larger AUC. These findings suggest that the diurnal rhythm and awakening response of salivary cortisol are significantly reduced in older adults and the associations between anxiety, depression and social support and diurnal cortisol vary with age.\ud \u

Predictors of response to cognitive-behavioral therapy for body dysmorphic disorder

Body dysmorphic disorder (BDD) is a common and distressing or impairing preoccupation with a perceived defect in physical appearance. Individuals with BDD engage in time-consuming rituals to check, hide, or "fix" their appearance or alleviate distress. BDD is associated with substantial psychosocial impairment and high rates of depression, hospitalization, and suicidality. Cognitive-behavioral therapy (CBT) is the treatment of choice for BDD, but not everyone benefits. We examined predictors of CBT-related improvement, an important topic that has received very limited investigation. Treatment was delivered in weekly individual sessions over 18-22 weeks. Results indicated that greater motivation/readiness to change (University of Rhode Island Change Assessment Questionnaire), greater treatment expectancy (Treatment Credibility/Expectancy Questionnaire), and better baseline BDD-related insight (Brown Assessment of Beliefs Scale) significantly predicted better CBT response at posttreatment. Baseline BDD symptom severity and depression did not predict outcome, suggesting that even patients with more severe BDD and depressive symptoms can benefit from CBT for BDD. Efforts should be aimed at enhancing readiness to change and confidence in the treatment at treatment onset as well as addressing the poor insight that often characterizes BDD.R34 MH070490 - NIMH NIH HHSAccepted manuscrip

Community acquired acute kidney injury: findings from a large population cohort

Background: The extent of patient contact with medical services prior to development of community acquired-acute kidney injury (CA-AKI)is unknown. Aim: We examined the relationship between incident CA-AKI alerts, previous contact with hospital or primary care and clinical outcomes. Design: A prospective national cohort study of all electronic AKIalerts representing adult CA-AKI. Methods: Data were collected for all cases of adult (≥18 years of age) CA-AKI in Wales between 1 November 2013 and 31 January 2017. Results: There were a total of 50 560 incident CA-AKI alerts. In 46.8% there was a measurement of renal function in the 30 days prior to the AKI alert. In this group, in 63.8% this was in a hospital setting, of which 37.6% were as an inpatient and 37.5% in Accident and Emergency. Progression of AKI to a higher AKI stage (13.1 vs. 9.8%, P  50% from the creatinine value generating the alert), the proportion of patients admitted to Intensive Care (5.5 vs. 4.9%, P = 0.001) and 90-day mortality (27.2 vs. 18.5%, P < 0.001) was significantly higher for patients with a recent test. 90-day mortality was highest for patients with a recent test taken in an inpatient setting prior to CA-AKI (30.9%). Conclusion: Almost half of all patients presenting with CA-AKI are already known to medical services, the majority of which have had recent measurement of renal function in a hospital setting, suggesting that AKI for at least some of these may potentially be predictable and/or avoidable

Bilateral Avulsion Fracture

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Randomised controlled trial of exercise for low back pain : clinical outcomes, costs and preferences

Objective: To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities. Design: Randomised controlled trial of progressive exercise programme compared with usual primary care management. Patients' preferences for type of management were elicited independently of randomisation. Participants: 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration. Interventions: Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used. Main outcome measures: Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Roland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services. Results: At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences. Conclusions: The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective