Critical Illness Survivors’ Perceptions of Their Recovery: An Interpretive Phenomenological Inquiry

Surviving critical illness with its physical, cognitive, and psychosocial morbidities is a growing clinical and research challenge and an important public health concern. Currently, there are few interventions for survivors of critical illness after hospital discharge. Potential interventions include rehabilitation services, Intensive Care Unit (ICU) diaries and ICU follow-up clinics, however, most survivors do not have access to these post-hospital interventions. The purpose of this study is to gain a better understanding of how critical illness survivors experience their recovery, interventions they use, and what they perceive as facilitators and barriers to their recovery. A better understanding of these factors, as reported by critical illness survivors, may lead to identification and development of interventions that can be more broadly implemented in the community setting. This multi-site study was guided by interpretive phenomenology, using semi-structured interviews. Purposive sampling was used to identify study participants from six different ICUs. Eighteen participants were recruited for the study. Interpretive phenomenological analysis (IPA) was used to analyze interview transcripts. Six major themes emerged from the interviews; Experiences of Recovery, Self-Managing Recovery, Following Recommendations, Support, Barriers to Recovery, and Unmet Needs. Major findings of this study included participants’ reports of unmet needs of mental health and psychological recovery that were not addressed by healthcare providers. In addition, participants also lacked appropriate knowledge of what to expect during their recovery, which contributed to frustration and anxiety. Findings from this study have implications for nursing practice, education, and research. Nurses are in a unique position to help patients cope with their emotions prior to discharge and provide them with anticipatory guidance once they are discharged. Carefully planned discharge should include a discussion of barriers that critical illness survivors may encounter once they are discharged and also include guidance on how to problem solve those challenges

Patients’ Experiences of Recovery: Beyond the Intensive Care Unit and into the Community

Aims To understand barriers and facilitators of recovery for critical illness survivors’, who are discharged home from the hospital and do not have access to dedicated outpatient care. Design Multi-site descriptive study guided by interpretive phenomenology using semi-structured interviews. Methods Interviews were conducted between December 2017 -July 2018. Eighteen participants were included. Data were collected from interview recordings, transcripts, field notes, and a retrospective chart review for sample demographics. Analysis was completed using Interpretive Phenomenological Analysis which provided a unique view of recovery through the survivors’ personal experiences and perception of those experiences. Results Participants encountered several barriers to their recovery; however, they were resilient and initiated ways to overcome these barriers and assist with their recovery. Facilitators of recovery experienced by survivors included seeking support from family and friends, lifestyle adaptations, and creative management of their multiple medical needs. Barriers included unmet needs experienced by survivors such as mental health issues, coordination of care, and spiritual needs. These unmet needs left participants feeling unsupported from healthcare providers during their recovery. Conclusion This study highlights important barriers and facilitators experienced by critical illness survivors during recovery that need be addressed by healthcare providers. New ways to support critical illness survivors, that can reach a broader population, must be developed and evaluated to support survivors during their recovery in the community. Impact This study addressed ICU survivors’ barriers and facilitators to recovery. Participants encountered several barriers to recovery at home, such as physical, cognitive, psychosocial, financial, and transportation barriers, however, these survivors were also resilient and resourceful in the development of strategies to try to manage their recovery at home. These results will help healthcare providers develop interventions to better support ICU survivors in the community

Objective and subjective measures of sleep among preschoolers: Disentangling attachment security and dependency

Many scholars have proposed that parent-child attachment security should favor child sleep. Research has yet, however, to provide convincing support for this hypothesis. The current study used objective measures of sleep and attachment to assess the longitudinal links between mother-child attachment security and subsequent sleep, controlling for child dependency. Sixty-two middle-class families (30 girls) were met twice, when children were 15 months (Wave 1; W1) and 2 years of age (Wave 2; W2). At W1, mother-child attachment was assessed with the observer version of the Attachment Q-Sort. At W2, children wore an actigraph monitor for 72 hours. Results indicated that children more securely attached to their mothers subsequently slept more at night and had higher sleep efficiency, and these predictions were not confounded by child dependency. These findings suggest a unique role for secure attachment relationships in the development of young children’s sleep regulation, while addressing methodological issues that have long precluded consensus in this literature

The Low-Velocity, Rapidly Fading Type Ia Supernova 2002es

SN 2002es is a peculiar subluminous Type Ia supernova (SN Ia) with a combination of observed characteristics never before seen in a SN Ia. At maximum light, SN 2002es shares spectroscopic properties with the underluminous SN 1991bg subclass of SNe Ia, but with substantially lower expansion velocities (~6000 km/s) more typical of the SN 2002cx subclass. Photometrically, SN 2002es differs from both SN 1991bg-like and SN 2002cx-like supernovae. Although at maximum light it is subluminous (M_B=-17.78 mag), SN 2002es has a relatively broad light curve (Dm15(B)=1.28 +/- 0.04 mag), making it a significant outlier in the light-curve width vs. luminosity relationship. We estimate a 56Ni mass of 0.17 +/- 0.05 M_sun synthesized in the explosion, relatively low for a SN Ia. One month after maximum light, we find an unexpected plummet in the bolometric luminosity. The late-time decay of the light curves is inconsistent with our estimated 56Ni mass, indicating that either the light curve was not completely powered by 56Ni decay or the ejecta became optically thin to gamma-rays within a month after maximum light. The host galaxy is classified as an S0 galaxy with little to no star formation, indicating the progenitor of SN 2002es is likely from an old stellar population. We also present a less extensive dataset for SN 1999bh, an object which shares similar observed properties. Both objects were found as part of the Lick Observatory Supernova Search, allowing us to estimate that these objects should account for ~2.5% of SNe Ia within a fixed volume. We find that current theoretical models are unable to explain the observed of characteristics of SN 2002es.Comment: 19 pages, 15 figures, Submitted to Ap

A Novel Model of Mixed Vascular Dementia Incorporating Hypertension in a Rat Model of Alzheimer's Disease.

Alzheimer's disease (AD) and mixed dementia (MxD) comprise the majority of dementia cases in the growing global aging population. MxD describes the coexistence of AD pathology with vascular pathology, including cerebral small vessel disease (SVD). Cardiovascular disease increases risk for AD and MxD, but mechanistic synergisms between the coexisting pathologies affecting dementia risk, progression and the ultimate clinical manifestations remain elusive. To explore the additive or synergistic interactions between AD and chronic hypertension, we developed a rat model of MxD, produced by breeding APPswe/PS1ΔE9 transgenes into the stroke-prone spontaneously hypertensive rat (SHRSP) background, resulting in the SHRSP/FAD model and three control groups (FAD, SHRSP and non-hypertensive WKY rats, n = 8-11, both sexes, 16-18 months of age). After behavioral testing, rats were euthanized, and tissue assessed for vascular, neuroinflammatory and AD pathology. Hypertension was preserved in the SHRSP/FAD cross. Results showed that SHRSP increased FAD-dependent neuroinflammation (microglia and astrocytes) and tau pathology, but plaque pathology changes were subtle, including fewer plaques with compact cores and slightly reduced plaque burden. Evidence for vascular pathology included a change in the distribution of astrocytic end-foot protein aquaporin-4, normally distributed in microvessels, but in SHRSP/FAD rats largely dissociated from vessels, appearing disorganized or redistributed into neuropil. Other evidence of SVD-like pathology included increased collagen IV staining in cerebral vessels and PECAM1 levels. We identified a plasma biomarker in SHRSP/FAD rats that was the only group to show increased Aqp-4 in plasma exosomes. Evidence of neuron damage in SHRSP/FAD rats included increased caspase-cleaved actin, loss of myelin and reduced calbindin staining in neurons. Further, there were mitochondrial deficits specific to SHRSP/FAD, notably the loss of complex II, accompanying FAD-dependent loss of mitochondrial complex I. Cognitive deficits exhibited by FAD rats were not exacerbated by the introduction of the SHRSP phenotype, nor was the hyperactivity phenotype associated with SHRSP altered by the FAD transgene. This novel rat model of MxD, encompassing an amyloidogenic transgene with a hypertensive phenotype, exhibits several features associated with human vascular or "mixed" dementia and may be a useful tool in delineating the pathophysiology of MxD and development of therapeutics

The Spectroscopic Diversity of Type Ia Supernovae

We present 2603 spectra of 462 nearby Type Ia supernovae (SN Ia) obtained during 1993-2008 through the Center for Astrophysics Supernova Program. Most of the spectra were obtained with the FAST spectrograph at the FLWO 1.5m telescope and reduced in a consistent manner, making data set well suited for studies of SN Ia spectroscopic diversity. We study the spectroscopic and photometric properties of SN Ia as a function of spectroscopic class using the classification schemes of Branch et al. and Wang et al. The width-luminosity relation appears to be steeper for SN Ia with broader lines. Based on the evolution of the characteristic Si II 6355 line, we propose improved methods for measuring velocity gradients, revealing a larger range than previously suspected, from ~0 to ~400 km/s/day considering the instantaneous velocity decline rate at maximum light. We find a weaker and less significant correlation between Si II velocity and intrinsic B-V color at maximum light than reported by Foley et al., owing to a more comprehensive treatment of uncertainties and host galaxy dust. We study the extent of nuclear burning and report new detections of C II 6580 in 23 early-time spectra. The frequency of C II detections is not higher in SN Ia with bluer colors or narrower light curves, in conflict with the recent results of Thomas et al. Based on nebular spectra of 27 SN Ia, we find no relation between the FWHM of the iron emission feature at ~4700 A and Dm15(B) after removing the two low-luminosity SN 1986G and SN 1991bg, suggesting that the peak luminosity is not strongly dependent on the kinetic energy of the explosion for most SN Ia. Finally, we confirm the correlation of velocity shifts in some nebular lines with the intrinsic B-V color of SN Ia at maximum light, although several outliers suggest a possible non-monotonic behavior for the largest blueshifts.Comment: 36 pages (emulateapj), 23 figures. Accepted for publication in AJ. Spectroscopic data available at http://www.cfa.harvard.edu/supernova/SNarchive.html . New SNID template set available at http://marwww.in2p3.fr/~blondin/software/snid/index.html . Minor changes from v1 to conform to published versio

Correlation of cycles in Lava Lake motion and degassing at Erebus Volcano, Antarctica

Several studies at Erebus volcano have recorded pulsatory behaviour in many of the observable properties of its active lava lake. A strong correlation between the variations in surface speed of the lake and the composition of gas emitted has previously been noted. While previous studies have shown that the SO2 flux and the surface elevation exhibit pulsatory behaviour with a similar period to that of the surface speed and gas composition, suggesting they are linked, a lack of overlap between the di erent measurements has prevented direct comparisons from being made. Using high time-resolution measurements of surface elevation, surface speed, gas composition and SO2 flux we demonstrate for the rst time an unambiguous link between the cyclic behaviour in each of these properties. We also show that the variation in gas composition may be explained by a subtle change in oxygen fugacity. The cycles are found to be in-phase with each other, with a small but consistent lag of 1-3 min between the peaks in surface elevation and surface speed. Explosive events are found to have no observable e ffect on the pulsatory behaviour beyond the ~5 min period required for lake refi ll. The close correspondences between the varying lake surface motion, gas flux and composition, and modelled oxygen fugacity suggest strong links between magma degassing, redox change and the fluid dynamics of the shallow magmatic system.This is the final version of the article. It was originally published by Wiley on behalf of the American Geophysical Union in Geochemistry, Geophysics, Geosystems here: http://onlinelibrary.wiley.com/doi/10.1002/2014GC005399/abstract. It will be embargoed until 19/1/15

Maternal Responsivity Predicts Language Development in Young Children With Fragile X Syndrome

The relationship between early maternal responsivity and later child communication outcomes in young children with fragile X syndrome was investigated. Data were obtained from 55 mother–child dyads over a 36-month period. Performance data were obtained at each measurement point from video observations of four different contexts. These were coded for (a) child communication behaviors, (b) parent responsivity, and (c) behavior management behaviors. Results indicate that early maternal responsivity predicts the level of four important child language outcomes at 36 months of age after controlling for child developmental level and autism symptomology

Geochemistry and mineralogy of the phonolite lava lake, Erebus volcano, Antarctica: 1972–2004 and comparison with older lavas

Author Posting. © Elsevier B.V., 2008. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Journal of Volcanology and Geothermal Research 177 (2008): 589-605, doi:10.1016/j.jvolgeores.2007.11.025.Mount Erebus, Antarctica, is a large (3794 m) alkaline open-conduit stratovolcano that hosts a vigorously convecting and persistently degassing lake of anorthoclase phonolite magma. The composition of the lake was investigated by analyzing glass and mineral compositions in lava bombs erupted between 1972 and 2004. Matrix glass, titanomagnetite, olivine, clinopyroxene, and fluor-apatite compositions are invariant and show that the magmatic temperature (~1000°C) and oxygen fugacity (ΔlogFMQ = -0.9) have been stable. Large temperature variations at the lake surface (ca. 400 - 500°C) are not reflected in mineral compositions. Anorthoclase phenocrysts up to 10 cm in length feature a restricted compositional range (An10.3-22.9Ab62.8-68.1Or11.4-27.2) with complex textural and compositional zoning. Anorthoclase textures and compositions indicate crystallization occurs at low degrees of effective undercooling. We propose shallow water exsolution causes crystallization to occur and shallow convection repeats this process multiple times, yielding extremely large anorthoclase crystals. Minor variations in eruptive activity from 1972 to 2004 are decoupled from magma compositions. The variations probably relate to changes in conduit geometry within the volcano and/or variable input of CO2-rich volatiles into the upper-level magma chamber from deeper in the system. Eleven bulk samples of phonolite lava from the summit plateau that range in age from 0 ± 4 ka to 17 ± 8 ka were analyzed for major and trace elements. Small compositional variations are controlled by anorthoclase content. The lavas are indistinguishable from modern bulk lava bomb compositions and demonstrate that Erebus volcano has been erupting lava and tephra from the summit region with the same bulk composition for ~17 ka.The work at Erebus volcano and the continued operation of the Mount Erebus Volcano Observatory is supported by grants (OPP-0229305, ANT-0538414) from the Office of Polar Programs, National Science Foundation

Jet energy measurement with the ATLAS detector in proton-proton collisions at root s=7 TeV

The jet energy scale and its systematic uncertainty are determined for jets measured with the ATLAS detector at the LHC in proton-proton collision data at a centre-of-mass energy of √s = 7TeV corresponding to an integrated luminosity of 38 pb-1. Jets are reconstructed with the anti-kt algorithm with distance parameters R=0. 4 or R=0. 6. Jet energy and angle corrections are determined from Monte Carlo simulations to calibrate jets with transverse momenta pT≥20 GeV and pseudorapidities {pipe}η{pipe}<4. 5. The jet energy systematic uncertainty is estimated using the single isolated hadron response measured in situ and in test-beams, exploiting the transverse momentum balance between central and forward jets in events with dijet topologies and studying systematic variations in Monte Carlo simulations. The jet energy uncertainty is less than 2. 5 % in the central calorimeter region ({pipe}η{pipe}<0. 8) for jets with 60≤pT<800 GeV, and is maximally 14 % for pT<30 GeV in the most forward region 3. 2≤{pipe}η{pipe}<4. 5. The jet energy is validated for jet transverse momenta up to 1 TeV to the level of a few percent using several in situ techniques by comparing a well-known reference such as the recoiling photon pT, the sum of the transverse momenta of tracks associated to the jet, or a system of low-pT jets recoiling against a high-pT jet. More sophisticated jet calibration schemes are presented based on calorimeter cell energy density weighting or hadronic properties of jets, aiming for an improved jet energy resolution and a reduced flavour dependence of the jet response. The systematic uncertainty of the jet energy determined from a combination of in situ techniques is consistent with the one derived from single hadron response measurements over a wide kinematic range. The nominal corrections and uncertainties are derived for isolated jets in an inclusive sample of high-pT jets. Special cases such as event topologies with close-by jets, or selections of samples with an enhanced content of jets originating from light quarks, heavy quarks or gluons are also discussed and the corresponding uncertainties are determined. © 2013 CERN for the benefit of the ATLAS collaboration