Barriers to mental health service use among distressed family caregivers of lung cancer patients

Although family caregivers of patients with lung and other cancers show high rates of psychological distress, they underuse mental health services. This qualitative study aimed to identify barriers to mental health service use among 21 distressed family caregivers of lung cancer patients. Caregivers had not received mental health services during the patient's initial months of care at a comprehensive cancer centre in New York City. Thematic analysis of interview data was framed by Andersen's model of health service use and Corrigan's stigma theory. Results of our analysis expand Andersen's model by providing a description of need variables (e.g. psychiatric symptoms), enabling factors (e.g. finances), and psychosocial factors associated with caregivers' non-use of mental health services. Regarding psychosocial factors, caregivers expressed negative perceptions of mental health professionals and a desire for independent management of emotional concerns. Additionally, caregivers perceived a conflict between mental health service use and the caregiving role (e.g. prioritising the patient's needs). Although caregivers denied stigma associated with service use, their anticipated negative self-perceptions if they were to use services suggest that stigma may have influenced their decision to not seek services. Findings suggest that interventions to improve caregivers' uptake of mental health services should address perceived barriers

Education for Experience: One View of Tibetan Tantric Initiation

The ethnographic treatment of "rites de Passage" is discussed with reference to material relating to religious initiation. It is suggested that the major transitions engendered through the Tibetan Buddhist Tantric W a n g Kur rituals may be profitably analyzed not simply as changes in social status but rather as tools for the re-ordering of phenomenology which are designed to engender long-term alterations in the initiates' experience of the world. The initiation provides a rationale and instruction conjunctive with ritual technique which is consciously designed to globally and permanently alter the consciousness of the practitioner. Suggestions for studies of rites of passage which take into account this dimension of the ritual control of experience are offered

Development of an antimicrobial blended white LED system containing pulsed 405-nm LEDs for decontamination applications

This study details the design, build and testing of a prototype antimicrobial blended white light unit containing pulsed red, yellow, green and 405nm LEDs. With a push for alternative methods of disinfection, optical methods have become a topic of interest. Ultra-violet (UV) light is widely known for its antimicrobial properties however; 405nm light has demonstrated significant antimicrobial properties against many common hospital acquired pathogens. In this study, a pulsed, blended, white-light prototype with a high content of 405 nm antimicrobial light, was designed, built and tested. Antimicrobial efficacy testing of the prototype was conducted using Staphylococcus aureus and Pseudomonas. aeruginosa, two bacteria which are common causes of hospital acquired infections. These were exposure to 3 different light outputs from the prototype and the surviving bacteria enumerated. Results showed that the mixed light output provided a much better CRI and light output under which to work. Also, the light output containing 405 nm light provided an antimicrobial effect, with decontamination of 103 CFUml-1 populations of both bacterial species. The other light content (red, yellow, green) had no beneficial or adverse effects on the antimicrobial properties of the 405nm light. The results suggest that with further development, it could be possible to produce an antimicrobial blended white light containing pulsed 405nm light that could supplement or even replace standard white lighting in certain environments

Cancer Carepartners: Improving patients' symptom management by engaging informal caregivers

<p>Abstract</p> <p>Background</p> <p>Previous studies have found that cancer patients undergoing chemotherapy can effectively manage their own symptoms when given tailored advice. This approach, however, may challenge patients with poor performance status and/or emotional distress. Our goal is to test an automated intervention that engages a friend or family member to support a patient through chemotherapy.</p> <p>Methods/Design</p> <p>We describe the design and rationale of a randomized, controlled trial to assess the efficacy of 10 weeks of web-based caregiver alerts and tailored advice for helping a patient manage symptoms related to chemotherapy. The study aims to test the primary hypothesis that patients whose caregivers receive alerts and tailored advice will report less frequent and less severe symptoms at 10 and 14 weeks when compared to patients in the control arm; similarly, they will report better physical function, fewer outpatient visits and hospitalizations related to symptoms, and greater adherence to chemotherapy. 300 patients with solid tumors undergoing chemotherapy at two Veteran Administration oncology clinics reporting any symptom at a severity of ≥4 and a willing informal caregiver will be assigned to either 10 weeks of automated telephonic symptom assessment (ATSA) alone, or 10 weeks of ATSA plus web-based notification of symptom severity and problem solving advice to their chosen caregiver. Patients and caregivers will be surveyed at intake, 10 weeks and 14 weeks. Both groups will receive standard oncology, hospice, and palliative care.</p> <p>Discussion</p> <p>Patients undergoing chemotherapy experience many symptoms that they may be able to manage with the support of an activated caregiver. This intervention uses readily available technology to improve patient caregiver communication about symptoms and caregiver knowledge of symptom management. If successful, it could substantially improve the quality of life of veterans and their families during the stresses of chemotherapy without substantially increasing the cost of care.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00983892">NCT00983892</a></p

"Women's work" : an exploration of the impact of women's learning experiences on their life expectations and aspirations

This study explores the processes involved in the construction of female aspirations and expectations. Early research has a male centrality that excludes female experience which is seen as deviant. More recent research makes aspirational predictions based on single variables such as education or class, or works with single cohorts of participants. My interest lies not in what a woman's aspirations and expectations are, nor with making predictions, rather, I am concerned with the processes involved in how aspirations and expectations develop, in how these processes remain stable or change over time. By processes I am referring to knowledge constructions. Taken-for-granted knowledge has asserted that women naturally aspire to wife and motherhood. Regardless of the seeming inviolability of such knowledge, it does not represent absolute truth; it is constructed from discourses imbued with vested interest, power and control. Thus, from a social constructionist perspective, I explore the discourses instrumental in the construction of women's aspirations and expectations and the associated power structures that limit or expand women's options. I show that discourses are not static, that constructions change and are socio-politically historically relative. Survey data provide broad views that inform in-depth interviews. Voices from the literature form an integral part of the account and are not presented separately. A narrative analytic strategy synthesises all the voices to form a multi-layered socio¬political, historically situated oral history of two generational cohorts' aspirationallexpectational development, cohorts I have designated mature women and teenage women. In conclusion I show that legislative changes alone are insufficient to change women's aspirations and expectations. The mature women in the study illustrate how traditional discourses impacted on their lives and how, although individual agency is difficult, it is possible to bring about change which influences the options available to future generations of women. The teenage women in the study, whilst cognizant of increased opportunity and equality discourses, illustrate the persistence of traditional discourses and the conflicts they face in navigating their own lives.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Spontaneous symmetry breaking: exact results for a biased random walk model of an exclusion process

It has been recently suggested that a totally asymmetric exclusion process with two species on an open chain could exhibit spontaneous symmetry breaking in some range of the parameters defining its dynamics. The symmetry breaking is manifested by the existence of a phase in which the densities of the two species are not equal. In order to provide a more rigorous basis to these observations we consider the limit of the process when the rate at which particles leave the system goes to zero. In this limit the process reduces to a biased random walk in the positive quarter plane, with specific boundary conditions. The stationary probability measure of the position of the walker in the plane is shown to be concentrated around two symmetrically located points, one on each axis, corresponding to the fact that the system is typically in one of the two states of broken symmetry in the exclusion process. We compute the average time for the walker to traverse the quarter plane from one axis to the other, which corresponds to the average time separating two flips between states of broken symmetry in the exclusion process. This time is shown to diverge exponentially with the size of the chain.Comment: 42 page

Efficacy of Pulsed 405-nm LEDs for antimicrobial photodynamic inactivation : effects of intensity, frequency, and duty cycle

Objective: This study investigates possible advantages in pulsed over continuous 405-nm LED-light for bacterial inactivation and energy efficiency. Background: Alternative non-antibiotic methods of disinfection and infection control have become of significant interest. Recent studies have demonstrated the application of systems using 405-nm light-emitting diodes for continuous disinfection of the clinical environment, and also for potential treatment of contaminated wounds. Methods: Liquid suspensions of 103 CFU/ml populations of Staphylococcus aureus were subject to pulsed 405-nm light of different frequencies, duty cycles and intensities, and for different lengths of time. Results: Pulsed exposures with the same average irradiance of 16 mWcm2 and varying duty cycle (25%, 50%, 75%), showed very similar performance compared with continuous exposures, with 95-98% reduction of S. aureus achieved for all duty cycles. The pulsing frequency was varied in intervals from 100 Hz - 10 kHz and appeared to have little effect on antimicrobial efficacy. However, when comparing pulsed with continuous exposure, an improvement in inactivation per unit optical energy was achieved, with results showing an increase of approximately 83% in optical efficiency. Conclusions: These results suggest that under pulsed conditions a lower energy consumption and lower perceived brightness could be achieved, thus potentially providing improved operating conditions for medical/infection-control applications without compromising antimicrobial efficacy