An exploration of care-burden experienced by older caregivers of adults with intellectual disabilities, in Ireland.

Background: People with intellectual disabilities are experiencing increased longevity, and in parallel, their family caregivers are also ageing. The literature identifies that these caregivers are at risk of burden. The aim of this study was to measure the level of caregiver burden among older carers of adults with intellectual disabilities in an Irish sample and to analyse the effect of socio‐demographic factors upon experiences of caregiver burden. Materials and Methods: Thirty caregivers completed a survey questionnaire. Data were collected based upon participants’ self‐reports of burden using the Zarit Burden Interview (ZBI) and a socio‐demographic questionnaire. Data were analysed using SPSS version 24. Results: Over 57% of carers indicated a mild‐to‐moderate level of burden. Analysis indicated that younger caregivers experience significantly higher levels of burden, when compared to older caregivers. Conclusions: This study contributes to our understanding of burden among an Irish population of older caregivers supporting an adult with an intellectual disability. It identified that carers do experience burden. The importance of proactive assessments and supports for these caregivers was revealed. This study highlights a lack of Irish research in this area and may pave the way for future research which could build upon its findings

Sexual behaviour of international backpackers in the context of travel in Australia

This study is the first to collect detailed empirical data on sexual practice among backpackers while exploring the material and social context of backpacking using an ethnographic framework. The theoretical concepts of liminality and sexual scripts were drawn on to analyse the findings. Backpackers were recruited from hostels in Sydney and Cairns; 559 backpackers (243 women, 316 men) completed an anonymous self-administered questionnaire. In addition, 25 in-depth one-to-one interviews with backpackers and 25 semi-structured interviews were conducted with sexual health and travel clinic staff and hostel service providers. Participant and non-participant observation in backpacker hostels also informed the analysis. Drinking alcohol, often to excess, was central to the backpacking setting and was both a reason for and a post-facto justification of unprotected sex. The backpacking setting encouraged transient liaisons. More than half (55%) of backpackers had sex with someone new during their trip and for 71% of them it was with someone that they had just met that day. Twenty-five per cent of those with no expectations to have casual sex on their trip and 22% of those with no previous experience of casual sex had casual sex during their trip. More than half (53%) of those who had sex with a someone new did so while other people were in the room. Only 55% always used a condom with their last new partner. While most backpackers carried condoms and intended to use them, unprotected sex was common. Perception of risk was low: 78% of those who did not use a condom the last time they had casual sex on the trip perceived their risk of getting HIV to be “low” to “nil”. Three participants acquired HIV during their trip. The culture of backpacking encourages more sexually permissive attitudes but does not encourage condom use, especially for those who did not consistently use condoms at home. These findings highlight the need for more broad-based dissemination of information on STIs to young people, and for future sexual health campaigns to specifically target backpackers in the context in which they travel

Sum of the Parts: The Trilogy in McCarthy, Roth, and Morrison

This dissertation examines the function of the trilogy form in Cormac McCarthy's Border Trilogy, Philip Roth's American Trilogy, and Toni Morrison's Love Trilogy. The Border Trilogy is comprised of All the Pretty Horses, The Crossing, and Cities of the Plain; the American Trilogy is comprised of American Pastoral, I Married a Communist, and The Human Stain; and the Love Trilogy is comprised of Beloved, Jazz, and Paradise. Written in the waning years of the twentieth century, McCarthy's, Roth's, and Morrison's use of the trilogy ran counter to the formal practices of postmodern fiction and to the ideological predilections of contemporary criticism. They used the trilogy form to apprehend an extensive history out of the rubble of postmodernism, which often militated against such large-scale attempts at representation. What the three authors end up producing are contemporary versions of grand narratives, appropriate for the end of the twentieth century: individual novels that are discrete, localized, and contained within themselves, but also epic cultural geographies whose breadth exceeds the limits of the single novels. Taken as a whole, the three books in each trilogy demonstrate that history must be diversely narrated and the storytelling structures that constitute that history should be shuffled, alternated, and changed up as necessary. No one single novel is sufficient to the task of encapsulating that multiplicity of narrative approaches--not even literary monoliths like Beloved or American Pastoral. The three novels in each trilogy must be read together in order to comprehend the narrative largess of late twentieth century American history. To paraphrase Hayden White, the authors in this study use the trilogy form in order to investigate how histories get invented, not found. McCarthy, Roth, and Morrison deploy the trilogy to configure--to invent--this history as a problem of scale, identifying coordinates and providing a way to cognitively map the past so that we gain a sense of its totality, to use Frederic Jameson's word. Once we can apprehend the totality of he past, we can begin to make sense of it

Transitioning into long term care for older adults with intellectual disabilities: A concept analysis

Aim: To undertake a concept analysis of transitioning to long-term care for older adults with intellectual disabilities. Background: Individuals with an intellectual disability are experiencing increased longevity which is associated with an increase in transitions in later life to long-term care. Their experience of later life transitions is likely to be different to the general older population. Methodology: Concept Analysis was undertaken using the Walker and Avant framework. Results: Eight studies met the inclusion criteria. Defining attributes are an older person with intellectual disability; a planned relocation to a long-term care facility; person-centred; and supported decision-making. Conclusion: There is a dearth of empirical evidence and theorisation on this concept. Transitions of this nature have been inadequately informed by the perspective of the older person with an intellectual disability, and future research and practice requires greater efforts to include their voice

Art, Artifact, Archive: African American Experiences in the Nineteenth Century

Angelo Scarlato’s extraordinary and vast collection of art and artifacts related to the Civil War, and specifically to the Battle of Gettysburg, the United States Colored Troops, slavery and the African American struggle for emancipation, citizenship and freedom has proved to be an extraordinary resource for Gettysburg College students. The 2012-14 exhibition in Musselman Library’s Special Collections, curated by Lauren Roedner ’13, entitled Slaves, Soldiers, Citizens: African American Artifacts of the Civil War Era and its corresponding catalogue provided a powerful and comprehensive historical narrative of the period. This fall, students in my course at Gettysburg College “Art and Public Policy”—Diane Brennan, Maura Conley, Abigail Conner, Nicole Conte, Victoria Perez-Zetune, Savannah Rose, Kaylyn Sawyer, Caroline Wood and Zoe Yeoh—selected additional objects of material and print culture from Angelo’s private collection and drew from Lauren’s expertise for the exhibition Art, Artifact, Archive: African American Experiences in the Nineteenth Century to investigate public representations of a newly freed population as well as their more personal perspectives. [excerpt]https://cupola.gettysburg.edu/artcatalogs/1015/thumbnail.jp

Shared decision making with adults transitioning to long-term care: A scoping review

Background: Transitions to long-term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions involve the individual in a person-centred way which are respectful of the person's human rights. One approach which facilitates self-determination during a transitional period is shared decision-making, but there is a lack of clarity on the nature and extent of research evidence in this area. Objective: The purpose of this scoping review is to identify and document research related to shared decision-making and transitioning to long-term care. Methods: A comprehensive search in CINAHL, Medline and Psych-info identified papers which included evidence of shared decision-making during transitions to a long-term care setting. The review following the JBI and PAGER framework for scoping reviews. Data were extracted, charted and analysed according to patterns, advances, gaps, research recommendations and evidence for practice. Results: Eighteen papers met the inclusion criteria. A body of knowledge was identified encompassing the pattern advancements in shared decision-making during transitions to long-term care, representing developments in both the evidence base and methodological approaches. Further patterns offer evidence of the facilitators and barriers experienced by the person, their families and the professional's involved. Conclusions: The evidence identified the complexity of such decision-making with efforts to engage in shared decision-making often constrained by the availability of resources, the skills of professionals and time. The findings recognise the need for partnership and person-centred approaches to optimise transitions. The review demonstrates evidence of approaches that can inform future practice and research to support all adult populations who may be faced with a transitional decision to actively participate in decision-making

Towards Stratified Medicine in Plasma Cell Myeloma

Plasma cell myeloma is a clinically heterogeneous malignancy accounting for approximately one to 2% of newly diagnosed cases of cancer worldwide. Treatment options, in addition to long-established cytotoxic drugs, include autologous stem cell transplant, immune modulators, proteasome inhibitors and monoclonal antibodies, plus further targeted therapies currently in clinical trials. Whilst treatment decisions are mostly based on a patient’s age, fitness, including the presence of co-morbidities, and tumour burden, significant scope exists for better risk stratification, sub-classification of disease, and predictors of response to specific therapies. Clinical staging, recurring acquired cytogenetic aberrations, and serum biomarkers such as β-2 microglobulin, and free light chains are in widespread use but often fail to predict the disease progression or inform treatment decision making. Recent scientific advances have provided considerable insight into the biology of myeloma. For example, gene expression profiling is already making a contribution to enhanced understanding of the biology of the disease whilst Next Generation Sequencing has revealed great genomic complexity and heterogeneity. Pathways involved in the oncogenesis, proliferation of the tumour and its resistance to apoptosis are being unravelled. Furthermore, knowledge of the tumour cell surface and its interactions with bystander cells and the bone marrow stroma enhance this understanding and provide novel targets for cell and antibody-based therapies. This review will discuss the development in understanding of the biology of the tumour cell and its environment in the bone marrow, the implementation of new therapeutic options contributing to significantly improved outcomes, and the progression towards more personalised medicine in this disorder

Impact of perioperative infarcts after cardiac surgery

Background and Purpose: Brain injury after cardiac surgery is a serious concern for patients and their families. The purpose of this study was to use 3-T fluid attenuated inversion recovery MRI to characterize new and preexisting cerebral ischemic lesions in patients undergoing cardiac surgery and to test whether the accumulation of new ischemic lesions adversely affects cognition. Methods: Digital comparison of before and after fluid attenuated inversion recovery MRI images was performed for 77 cardiac surgery patients. The burden of preexisting versus new ischemic lesions was quantified and compared with the results of baseline and postoperative neuropsychological testing. Results: After surgery, new lesions were identified in 31% of patients, averaging 0.5 lesions per patient (67 mm3 [0.004%] of brain tissue). Patients with preexisting lesions were 10× more likely to receive new lesions after surgery than patients without preexisting lesions. Preexisting ischemic lesions were observed in 64% of patients, averaging 19.4 lesions (1542 mm3 [0.1%] of brain tissue). New lesions in the left hemisphere were significantly smaller and more numerous (29 lesions; median volume, 44 mm3; volume range, 5–404 mm3) than those on the right (10 lesions; median volume, 128 mm3; volume range, 13–1383 mm3), which is consistent with a cardioembolic source of particulate emboli. Overall, the incidence of postoperative cognitive decline was 46% and was independent of whether new lesions were present. Conclusions: New lesions after cardiac surgery added a small (≈4%) contribution to the burden of preexisting cerebrovascular disease and did not seem to affect cognitive function

The genomic road to invasion - examining the similarities and differences in the genomes of associated oral pre-cancer and cancer samples.

Background: It is frequently assumed that pre-invasive lesions are simpler precursors of cancer, and will contain a limited subset of the genomic changes seen in their associated invasive disease. Driver mutations are thought to occur early, but it is not known how many of these are present in pre-invasive lesions. These assumptions need to be tested with the increasing focus on both personalised cancer treatments, and early detection methodologies. Methods: We examined genomic copy number changes in 256 pre-invasive and invasive samples from 69 oral cancer patients. Forty-eight samples from 16 patients were further examined using exome sequencing. Results: Evidence of a shared ancestor of both dysplasia and carcinoma was seen in all but one patient. One third of dysplasias showed independent copy number events. The remainder had a similar or simpler copy number pattern to the carcinoma. All dysplasias examined contained somatic mutations absent in the related carcinoma. Previously observed copy number changes and TP53 mutations were very frequently observed, and almost always shared between dysplasia and carcinoma. Other gene changes were more sporadic. Pathway analysis confirmed that each patient’s disease developed in a different way. Examining the numbers of shared mutations, and the rate of accumulation of mutations showed evidence that all samples contain a population of sub-clones, with little evidence of selective advantage of a subset of these. Conclusions: These findings suggest that most of the genomic changes driving oral cancer occur in the pre-cancerous state by way of gradual random accumulation rather than a dramatic single event

Conversion and Colonial History in Icíar Bollaín’s También la lluvia (2010)

This study concerns the representation of colonial Latin American history and the characterisation of Daniel/Hatuey in the 2010 film-about-a-film También la lluvia. A metacinematic work comprising historical study and political commentary, También la lluvia has received mixed critical reactions regarding its portrayal of the historical and social inequalities it analyses. This article examines the ambiguous nature of the work by analysing the motif of conversion. It argues that, by foregrounding the contemporary conversion story of Costa, the film sacrifices both nuanced historical attention to the colonial past it dramatises and sustained development of one of its apparently central characters: Daniel/Hatuey, who is repeatedly converted into narrative and symbolic figures of secondary prominence, despite their importance to the development and legibility of the work as a whole