Hubble Space Telescope Bi-Stem Thermal Shield Analyses

The Hubble Space Telescope (HST) was launched April 24, 1990, and was deployed April 25 into low Earth orbit (LEO). It was soon discovered that the metal poles holding the solar arrays were expanding and contracting as the telescope orbited the Earth passing between the sunlight and the Earth s shadow. The expansion and contraction, although very small, was enough to cause the telescope to shake because of thermal-induced jitters, a detrimental effect when trying to take pictures millions of miles away. Therefore, the European Space Agency (ESA, the provider of the solar arrays) built new solar arrays (SA-11) that contained bi-stem thermal shields which insulated the solar array metal poles. These thermal shields were made of 2 mil thick aluminized-Teflon fluorinated ethylene propylene (FEP) rings fused together into a circular bellows shape. The new solar arrays were put on the HST during an extravehicular activity (EVA), also called an astronaut space walk, during the first servicing mission (SM1) in December 1993. An on-orbit photograph of the HST with the SA-11, and a close up of the bellows-like structure of the thermal shields is provided in Figure 1

Passing the time when in pain: investigating the role of musical valence

The effective management of pain outside of clinical settings represents a significant challenge to health services. Music listening has been successfully used as a method of pain management, with the greatest benefits to listeners evident if the music is familiar, preferred and has emotional resonance. This study examined the role of self-selected emotion-inducing music used for pain management (pain tolerance, intensity, perceived control, distraction and anxiety reduction) during the cold pressor test. In a repeated-measures design, four cold pressor tests were used to induce short-term, acute pain, whilst 41 participants listened either to happy, sad, relaxing or no music. Findings indicated that music enhanced pain tolerance over no music, and happy and relaxing music increased pain tolerance and altered time perception to a greater extent than sad music. Happy and relaxing music facilitated distraction from pain and enhanced perceived pain control. Relaxing music additionally had anxiolytic properties and reduced pain intensity. Results suggest that music’s inclusion in pain management is justified and that music with happy and relaxing components can be used to facilitate coping with pain in a non-clinical context

Developing successful social support: An interpretative phenomenological analysis of mechanisms and processes in a chronic pain support group

Objective. The experience of long-term membership of a successful Chronic Pain Support Group (CPSG) was explored to identify; i) factors associated with social support, and; ii) ways that health-care professionals (HCPs) could help CPSGs become more effective and supportive. Design. Interpretative Phenomenological Analysis enabled exploration of participants’ experiences of membership and rationales for continued attendance. Main outcome measures. Twelve participants (four males, eight females), recruited from a regional CPSG, completed semi-structured interviews lasting from 45-120 minutes. Following verbatim transcription, idiographic then cross-case analyses were undertaken. Results. Three superordinate themes emerged: (1) Investing in the new normal; (2) The nurturing environment; (3) Growth facilitation through social evolution. Increased investment and identification with membership, generated snowballing social engagement, enhancing pain management/well-being through collective humour and peer-to-peer support. Explicit guidance by HCPs in early stages of group formation/development, and subsequent implicit influences on group attitudes and actions, promoted the group’s development into its current healthy, supportive state. Conclusion. Contrary to stereotypes, membership offered positive respite from chronic pain through collective coping. Successful CPSGs forge an independent identity, fostering strong group investment and an ability to live well with chronic pain. HCPs can provide a stabilising foundation for CPSGs to develop positively and supportively

Living with chronic neuropathic pain after spinal cord injury: an interpretative phenomenological analysis of community experience.

Purpose: This article presents an in-depth, idiographic study examining the lived experience of chronic pain following spinal cord injury (SCI). Neuropathic pain (NP) occurs in a large majority of the SCI population and is particularly intractable to treatment. It can be both psychologically and physically debilitating. This study examines how the experience of NP is mediated by its meaning to the sufferer. Methods: Semi-structured interviews were conducted with eight people with SCI and chronic NP, attending outpatient clinics at a specialist SCI Centre in the UK. Verbatim transcripts were subjected to interpretative phenomenological analysis to further understand the experience. Results: Analysis suggested that NP has powerful consequences upon the sufferer's physical, psychological and social well-being, in line with a biopsychosocial understanding of pain. Three super-ordinate themes were identified: a perceived gap between treatments received and participants' views of what they wanted and needed; a fight for life control and acceptance; and feeling understood by others with SCI, but isolated from the non-understanding able-bodied. Conclusions: The results are discussed in terms of the possible application of acceptance-based therapy to NP and the potential for the alleviation of the debilitating consequences of NP. Implications for Rehabilitation Chronic NP after SCI is often described as worse than the injury itself, often impacting upon the sufferers physical and psychological health. The experiences of persons with SCI-specific NP highlight the impact of pain on their physical, psychological and social health. This indicates that healthcare professionals should incorporate a biopsychosocial approach for managing pain post-SCI. Routine clinical follow-up of SCI patients with chronic NP, as well as comprehensive pain management treatment programmes, could address the three themes evidenced in the current study, by moving routine intervention with NP away from pain relief, towards pain management. Continued education for patients, friends, family members and healthcare professionals may be beneficial in promoting understanding and awareness of NP and its consequences following SCI

Psychological outcomes of MRSA isolation in spinal cord injury rehabilitation

Study design Retrospective secondary analysis with a quantitative, matched-pairs design. Patients isolated due to methicillin- Resistant Staphylococcus aureus (MRSA) were matched with controls without MRSA infection admitted to a multi-bedded ward, based on: gender, injury level, injury severity (AIS grade), age at the time of injury and year of admission. Objectives Determine the implications of MRSA-related infection isolation on spinal cord injury patients’ anxiety, depression, appraisals of disability, perceived manageability and pain intensity. Hypotheses predicted patients who were isolated due to MRSA during inpatient stay would demonstrate poorer psychological health outcomes at discharge in comparison with non-isolated matched controls. Setting National Spinal Injuries Centre, England, UK. Methods Secondary analyses were conducted on pre-existing data based on patients’ first admission for primary rehabili- tation. Psychometric scales were used to measure outcome variables. Assessments were repeated at the time of admission and discharge. Results Nonparametric longitudinal analyses using the nparLD package in R were conducted. Relative treatment effects demonstrated that there were no significant differences between groups across all outcome measures. There was a significant effect of time (admission vs discharge) on perceived manageability and pain intensity, indicating improved outcomes at discharge. There was no difference in the overall length of stay between the isolated and non-isolated groups. Conclusions Isolation experienced by rehabilitation inpatients with spinal cord injury with MRSA had no effect on a series of psychological outcomes. Engaging with rehabilitation had a positive impact in reducing pain unpleasantness and increasing perceived manageability of spinal cord injury, irrespective of infection isolation

Using the COM-B model to characterize the barriers and facilitators of pre-exposure prophylaxis (PrEP) uptake in men who have sex with men.

Using the COM-B model, this study aimed to characterize barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake amongst men who have sex with men (MSM). Semistructured interviews with 13 MSM who were non-PrEP users were conducted with a specific focus on barriers and facilitators to PrEP uptake. A 15-item interview schedule was created informed by the COM-B model. Transcripts were transcribed verbatim and inductively analysed using thematic analysis. To illustrate pathways for intervention design, inductive themes were then deductively mapped onto COM-B constructs. Results demonstrated that barriers to PrEP uptake were closely aligned with five (of six) COM-B components: psychological capability, physical opportunity, social opportunity, reflective motivation and automatic motivation. These COM-B subcomponents reflected seven thematized barriers: (1) limited information about PrEP, (2) restricted access to PrEP, (3) gay identity and sexual stigmatization, (4) social and cultural stigmatization, (5) capabilities in treatment adherence, (6) optimistic bias about sexual behaviours and (7) calculating risk. No facilitators or physical capability concerns were demonstrated. This study adopted a novel behaviour change-informed approach to understanding barriers and facilitators to PrEP uptake amongst MSM. Unrealistic optimism about self-protective individual behaviours, the physical accessibility of PrEP and (mis)information together interacted closely with perceptions of personal and social stigmatization to dynamically impact PrEP uptake decisions. Barriers to PrEP uptake mapped clearly to the COM-B; therefore, these results provide the foundation for Behaviour Change Wheel intervention development to improve rates of PrEP uptake and its acceptability for MSM. [Abstract copyright: © 2022 The British Psychological Society.

Lack of awareness, body confidence and connotations of sex: an interpretative phenomenological analysis of barriers affecting the decision to attend initial cervical cancer screening

This study sought to understand how cervical cancer screening (CCS) awareness, sexual connotations and body image influenced the likelihood of CCS uptake in women yet to attend. Eleven females, aged 23-24, yet to attend CCS, were purposefully sampled. Interview transcripts were analysed using interpretative phenomenological analysis, generating three superordinate themes: (1) building screening expectations, (2) confronting sexual connotations and (3) growing pains. Findings demonstrated how a lack of awareness of CCS and the sexual connotations implicit in CCS acted as a barrier to attendance, exacerbated by negative body image comparisons between oneself and online or social media-based images. The perceived sexual connotations of CCS, and the resulting embarrassment, bolsters the case for self-screening, removing the need to attend clinic screening appointments. Reconceptualising screening using a theoretical model of the relationship between body image disturbances and body-focused screening behaviours among women, could lead to the development of pro-screening social media interventions

Grieving a disrupted biography: an interpretative phenomenological analysis exploring barriers to the use of mindfulness after neurological injury or impairment

Background Mindfulness has demonstrated strong utility for enhancing self-management and health outcomes in chronic illness. However, sensation-focused mindfulness techniques may not be appropriate for clinical populations with neurological injury. This study aimed to identify how expert mindfulness teachers with sensory loss/impairment naturalistically adapt and experience mindfulness. We aimed to highlight the rationale for and barriers to mindfulness practice when living with sensory loss. Methods A qualitative, semi-structured interview design was used, analysed via Interpretative Phenomenological Analysis (IPA). Eight (5 females, 3 males) mindfulness teachers with neurological injury were recruited via a national registry of Mindfulness for Health teachers. Interviews (range: 50-93 min) were completed, transcribed verbatim and analysed idiographically for descriptive, linguistic and conceptual themes, before a cross-case analysis was completed. Results Two superordinate themes were identified: (1) Overcoming a disrupted biography; and (2) Proactive self-management. These themes considered the challenge of reconciling, through grief, a past health status with the present reality of living with sensory loss due to Spinal Cord Injury, Multiple Sclerosis or Functional Neurological Disorder. Mindfulness was experienced as a method by which proactive choices could be made to maintain control and autonomy in health, reducing perceptions of suffering, psychological distress, cognitive reactivity and rumination. Conclusions Mindfulness was found to support the self-management of health after neurological injury/impairment. Mindfulness meditation presented an initial challenge as trauma and grief processes were (re-)activated during mindfulness sessions. However, mindfulness was found to support the resolution of these grief processes and encourage adaptive approach-based coping and acceptance of health and neurological impairment/injury

Prehabilitation: the underutilised weapon for chronic pain management

Objective Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to ‘prehabilitate’ patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions. Methods Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed. Results Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention. Conclusions Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation

Sexual function and sexual satisfaction following spinal cord injury: an interpretative phenomenological analysis of partner experiences

Purpose This study explored how partners/spouses of people with Spinal Cord Injury (SCI) experienced intimacy, sexual function, and sexual satisfaction post-SCI. Materials and methods Qualitative, semi-structured interviews were conducted with the partners/spouses of people with SCI living in the community in the United Kingdom. Twelve participants (7 females; 5 males) were recruited using purposive sampling. A nine-item semi-structured interview design was used. Interviews were transcribed verbatim and analysed via Interpretative Phenomenological Analysis (IPA). Results Three superordinate themes were demonstrated: (1) Stolen sex through unpreparedness; (2) Redefining sex; and (3) Compromised commitment. Partners struggled to come to terms with the shock of radically altered post-SCI sexual relationships, questioning how their changed sexual relationship and sexual identity conflicted with caring requirements. To minimise post-SCI relationship changes, some partners engaged in strategies to protect against, distract from and avoid sexual intimacy, whereas others were able to retain adapted pre-injury patterns of intimate behaviour. Conclusion Compromised sexual function and satisfaction significantly disrupt relationship dynamics post-SCI, initiate voluntary celibacy, and limit the perceived viability of continued sexual intimacy. Specialist partner-support provisions are urgently needed, recognising that partner support needs are not restricted to the inpatient rehabilitation phase but importantly extend long past discharge into the community. Implications for Rehabilitation Sexual function and satisfaction are highly challenging areas for partners post-spinal cord injury (SCI). Support and education for the partner must be incorporated into SCI rehabilitation to help with both adjustment and acceptance to changes in sexual functioning post-SCI. Partner contributions to and experiences of sexual function and satisfaction should be given more value, as these aid in the sustainability of healthy sexual relationships and psychological wellbeing following SCI