Day-to-Day Decision Making by Adolescents and Young Adults with Cancer

Background: Adolescents and young adults (AYAs) with cancer must negotiate the transition between childhood and adulthood while dealing with a life-threatening illness. AYA involvement in decision making varies depending on the type of decision and when decisions occur during treatment, and evidence suggests that AYAs want to be involved in decision making. Objective: To explore involvement of AYAs with cancer in day-to-day decisions affected by their cancer and treatment. Methods: This qualitative study used interpretive focused ethnography within the sociologic tradition, informed by symbolic interactionism. Semi-structured interviews and informal participant observation took place at two quaternary pediatric oncology programs. Results: Thirty-one interviews were conducted with 16 AYAs ages 15 to 20 years. Major day to day decision-making categories identified included: (1) mental mindset, (2) self-care practices, (3) self-advocacy, and (4) negotiating relationships. Participants described how they came to grips with their illness early on and decided to fight their cancer. They described decisions they made to protect their health, how they advocated for themselves and decisions they made about relationships with family and friends. Conclusions: Through day-to-day decisions, participants managed the impact of cancer and its treatment on their daily lives. Research should focus on developing and implementing interventions to empower AYAs to participate in day-to-day decisions that will affect how they manage their cancer, its treatment and ultimately their outcomes. Implications for Practice: Healthcare providers can facilitate AYA's participation in day-to-day decision making through encouraging autonomy and self-efficacy by providing support and through effective communication.

Case Report on Mucormycotic Osteomyelitis of Maxilla

Introduction: The upper jaw is formed by the maxilla, one of the basic bones of the face. It is a crucial viscerocranium structure that aids in the creation of the palate, nose, and orbit. The upper teeth are held in place by the alveolar process of the maxilla, which is vital for mastication and speaking. Because of its substantial vascular supply, maxillary necrosis is uncommon compared to mandible necrosis [1]. Maxillary necrosis can be caused by bacterial infections like osteomyelitis, viral infections like herpes zoster, or fungal infections like mucormycosis, as well as trauma, radiation, and other factors [2]. Long-term use of antibiotics or corticosteroids, on the other hand, may result in an opportunistic infection. Mucormycosis is a fungal infection that mostly affects immunocompromised persons. These fungi are widespread in many people, although the symptoms have been linked to a weakened immune system. Mucormycosis is a life-threatening illness that frequently affects immunocompromised individuals due to diabetic ketoacidosis, neutropenia, organ transplantation, and elevated blood iron levels. Clinical Findings: The patient have a complaint of discomfort in the upper left side of the jaw was rapid in start, dull hurting, intermittent in character, and worse on mastication. A radiating headache on the left side is also a complaint. Diagnostic Evaluation: CRP - 12.48 m/ L, Calcium 8.1 mg/dl, KFT-Ser (urea – 29 mg/dl, Creatinine 0.4 mg/dl, Sodium 138 mmol/L, Potassium -4.3 mmol/L, Albumin 2.6 g/dl,) Urine exam routine Pus cells 1-2 cells, urine albumin nil, Crystal 3-4 calcium oxalate Crystal, 2D echo was done on dated 31/5/21, MRI was done, Cardiac call was done. Therapeutic Intervention: If not recognised and treated early, fungal osteomyelitis is more invasive than bacterial osteomyelitis. Treatment is given to the patient as a follow-up. Debridement of necrotic tissue on a local level. Antibiotics - Tab Augmentine 625 mg, Tab paracetamols 500 mg, Inj T. T 0.5 ml in a single dosage, Antifungal treatment, and Betadine gargle twice a day. Conclusion: On 04/06/2021, a 58-year-old male was hospitalised to AVBR Hospital's Oral Surgery Ward 35 after being diagnosed with Mucormycotic Osteomyelitis of the Maxilla. The patient is being counselled on how to proceed with his treatment.

Imagining of Acute Respiratory Distress Syndrome: A Review

Acute respiratory distress syndrome (ARDS) is a life-threatening disorder marked by low oxygen levels and rigid or non-compliant lungs. In the absence of any indication of cardiogenic pulmonary edema, ARDS is defined as an acute disease that begins within 7 days of the triggering event and is marked by bilateral lung infiltrates and severe progressive hypoxemia. ARDS has a significant death rate, and there are few effective treatment options for this life-threatening illness. The management of these severely ill patients in the intensive care unit relies heavily on imaging. Chest radiography, bedside lung ultrasonography, and computed tomography scans can all help with patient care and prognostic variables identification. However, imaging results are not always specific, and other diagnosis should be considered.

Shaken Identities, Reserve Masculine Capital, and the Lived Experiences of Aging Men with Breast Cancer

A question that begs to be examined is: How does aging men’s discovery they have breasts as a result of their breast cancer diagnosis and having a breast removed through a mastectomy, affect their masculine subjectivities and practices, as they also go about also living with a life-threatening illness? The present study aimed to better understand how men come to live with the knowledge that they have both breasts and cancer. Interviews with seventeen men in the U.S. (mean age 62.8) with a breast cancer diagnosis, mastectomy, and, most often, post-surgical hormonal treatment uncovered stories of body-self disruption and identity dilemmas. All the men’s identities had been shaken. After their mastectomy, they were reminded every morning that the body reflected in the mirror differed significantly from who they once were. Their stories revealed strategic themes: how they lived with cancer by slightly modifying conventional masculinities; and how others interacted with them, with the exception of mammography technologists, in terms of their gender, not their atypical illness. Only a few men initially felt their breast cancer was a gendered stigma. Noticeable was how the historical era when diagnosed and the age of the man at diagnosis contextualized their illness stories. In this presentation, three cases are used to exemplify the men’s varied experiences with their non-normative bodies and their commonality in finding reserves of masculine capital to rebuke the existential loneliness of a man with breast cancer.

Computer Assisted System for Detecting Pulmonary Embolism in Lungs

A pulmonary embolism (PE) occurs when a blood artery in the lungs becomes suddenly blocked, generally owing to a blood clot. PE is a frequent life-threatening illness that should be diagnosed as soon as possible. A novel approach for automatically detecting PE in contrast-enhanced CT images is suggested in this research. To identify PE, computerized tomography (CT) is the main test to capture images. It is quick test, incursive with good quality images, enhanced contrast and multi-sliced images can be obtained. Candidate identification, feature calculation, and classification are all part of the system. The major aims of candidate detection are to include PE with even entire occlusions and to eliminate erroneous diagnosis of tissue and parenchymal disorders. When calculating characteristics, the location and structure of the pulmonary vascular tree, as well as the severity, form, and size of an embolus, are all taken into consideration. The ability of the CAD tool to identify emboli in the sectional and sub sectional pulmonary Arterial Tree (PAT) was examined.

Body Boundaries and Discursive Practices in Life Threatening Illness: Narratives of the Self

<p>This thesis tells a story from within and between the boundaries of my professional work as a nurse and my private life as the wife of a patient with life threatening illness. The events related in the thesis are told using a technique I have called writing back to myself, where my own journals and stories of the experience of living with life threatening illness provide data for analysis. The reader is invited to participate in these representations and to consider the potential for the skilful practice of nursing which may be read in the stories, and the analysis I have developed from them. I have developed the theoretical and methodological positionings for the thesis from the work of Foucault (1975,1979,1982,1988), Deleuze (1988), Ellis (1995), Richardson (1998) and other writers who utilise genealogical or narrative approaches. The analysis of my own stories in the thesis explores the philosophical and contextual positionings of the nurse as a knowledge worker through genealogies of practice and the specific intellectual work of the nurse. Local and contextual epistemologies are considered as ways of theorising nursing practice through personal knowledge, which is surfaced through the critical analysis of contextual positionings and the process of writing as inquiry. The idea of harmonising nursing practice in the patient's local world through contingent and thinking responses, and the recognition of one's own agency as the nurse, are considered in terms of what might constitute ethical practice. The thinking nurse is a specific intellectual, who critically engages with the context of her/his own practice to form new discourses derived from local and contextual 'truths' about illness, suffering and dying. The capacities for vision that are developed through the stories in the thesis, are explored as having the potential to present new possibilities for the practice of professional nursing. Notions of what constitutes ethical practice are negotiated and contested through local conversations, which privilege the capacities of the patient and the nurse in taking up new discursive positionings as alternatives to those prescribed through the sovereignty of expert power. In the local and contextual world of the patient, visions for practice may be negotiated moment by moment through careful exploration of discursive tensions and the critical appraisal of the utility of alternative possibilities. This development of local knowledge relies on the ability of the nurse to explore and trust her/his own judgement and nursing responses in situations where visions for practice may not be clear. The 'un-picking' and 're-sewing' of stories related in the analysis of the discursive production of the cancer patient and the 'private nurse' present new possibilities for the ethical substance of nursing. This ethical substance creates the potential for new conceptualisations of practice, where nurses and other health professionals take responsibility for the effects of their activities with patients. In this 'un-picking' of the stories in the thesis, I am concerned with the discursive positionings that are taken up by the patient and the health professional in the story. I identify the means through which subjects become visible in discursive statements and the effects of these subject positionings on specific moments of practice with the patient. The 're-sewing' of events involves the telling of alternative stories, negotiated between the actors in the events, to produce a more ethically desirable outcome in the specific contexts of nursing practice.</p>

Body Boundaries and Discursive Practices in Life Threatening Illness: Narratives of the Self

<p>This thesis tells a story from within and between the boundaries of my professional work as a nurse and my private life as the wife of a patient with life threatening illness. The events related in the thesis are told using a technique I have called writing back to myself, where my own journals and stories of the experience of living with life threatening illness provide data for analysis. The reader is invited to participate in these representations and to consider the potential for the skilful practice of nursing which may be read in the stories, and the analysis I have developed from them. I have developed the theoretical and methodological positionings for the thesis from the work of Foucault (1975,1979,1982,1988), Deleuze (1988), Ellis (1995), Richardson (1998) and other writers who utilise genealogical or narrative approaches. The analysis of my own stories in the thesis explores the philosophical and contextual positionings of the nurse as a knowledge worker through genealogies of practice and the specific intellectual work of the nurse. Local and contextual epistemologies are considered as ways of theorising nursing practice through personal knowledge, which is surfaced through the critical analysis of contextual positionings and the process of writing as inquiry. The idea of harmonising nursing practice in the patient's local world through contingent and thinking responses, and the recognition of one's own agency as the nurse, are considered in terms of what might constitute ethical practice. The thinking nurse is a specific intellectual, who critically engages with the context of her/his own practice to form new discourses derived from local and contextual 'truths' about illness, suffering and dying. The capacities for vision that are developed through the stories in the thesis, are explored as having the potential to present new possibilities for the practice of professional nursing. Notions of what constitutes ethical practice are negotiated and contested through local conversations, which privilege the capacities of the patient and the nurse in taking up new discursive positionings as alternatives to those prescribed through the sovereignty of expert power. In the local and contextual world of the patient, visions for practice may be negotiated moment by moment through careful exploration of discursive tensions and the critical appraisal of the utility of alternative possibilities. This development of local knowledge relies on the ability of the nurse to explore and trust her/his own judgement and nursing responses in situations where visions for practice may not be clear. The 'un-picking' and 're-sewing' of stories related in the analysis of the discursive production of the cancer patient and the 'private nurse' present new possibilities for the ethical substance of nursing. This ethical substance creates the potential for new conceptualisations of practice, where nurses and other health professionals take responsibility for the effects of their activities with patients. In this 'un-picking' of the stories in the thesis, I am concerned with the discursive positionings that are taken up by the patient and the health professional in the story. I identify the means through which subjects become visible in discursive statements and the effects of these subject positionings on specific moments of practice with the patient. The 're-sewing' of events involves the telling of alternative stories, negotiated between the actors in the events, to produce a more ethically desirable outcome in the specific contexts of nursing practice.</p>

Serious Life Events in People with Visual Impairment Versus the General Population

The present study aimed to examine the lifetime exposure to serious life events in people with visual impairment compared with the general population. Data were derived from a telephone survey including a probability sample of 736 adults with visual impairment (response rate: 61%). The lifetime prevalence of direct experiences with seventeen different categories of serious life events (Life Events Checklist for DSM-5 (LEC-5)) were compared to that obtained from the general Norwegian population (N = 1792, 36% response rate). Altogether, 68% of people with visual impairment had been directly exposed to at least one serious life event, with equal rates among males and females (p = 0.59). The prevalence of serious life events was higher than for the general population (60%, p < 0.001), especially for fire or explosions, serious accidents, sexual assaults, life-threatening illness or injury, and severe human suffering. In conclusion, our results indicate that people with visual impairment are more prone to experiencing serious life events. This highlights the need for preventive strategies that reduce the risk of serious life events in this population.

Extensive Translational Regulation through the Proliferative Transition of Trypanosoma cruzi Revealed by Multi-Omics

Trypanosoma cruzi is an ancient eukaryotic unicellular parasite causing Chagas disease, a potentially life-threatening illness that affects 6 to 7 million people, mostly in Latin America. The antiparasitic treatments for the disease have incomplete efficacy and adverse reactions; thus, improved drugs are needed.