Pediatric Oncology Palliative Care: Experiences of General Practitioners and Bereaved Parents

Objective: This qualitative study set in the West Midlands region of the United Kingdom, aimed to examine the role of the general practitioner (GP) in children's oncology palliative care from the perspective of GPs who had cared for a child with cancer receiving palliative care at home and bereaved parents. Methods: One-to-one semi-structured interviews were undertaken with 18 GPs and 11 bereaved parents following the death. A grounded theory data analysis was undertaken; identifying generated themes through chronological comparative data analysis. Results: Similarity in GP and parent viewpoints was found, the GPs role seen as one of providing medication and support. Time pressures GPs faced influenced their level of engagement with the family during palliative and bereavement care and their ability to address their identified learning deficits. Lack of familiarity with the family, coupled with an acknowledgment that it was a rare and could be a frightening experience, also influenced their level of interaction. There was no consistency in GP practice nor evidence of practice being guided by local or national policies. Parents lack of clarity of their GPs role resulted in missed opportunities for support. Conclusions: Time pressures influence GP working practices. Enhanced communication and collaboration between the GP and regional childhood cancer centre may help address identified GP challenges, such as learning deficits, and promote more time-efficient working practices through role clarity. Parents need greater awareness of their GP's wide-ranging role; one that transcends palliative care incorporating bereavement support and on-going medical care for family member

Development of an integrated cognitive behavioral therapy for anxiety and opioid use disorder: Study protocol and methods

Opioid use disorder is a highly disabling psychiatric disorder, and is associated with both significant functional disruption and risk for negative health outcomes such as infectious disease and fatal overdose. Even among those who receive evidence-based pharmacotherapy for opioid use disorder, many drop out of treatment or relapse, highlighting the importance of novel treatment strategies for this population. Over 60% of those with opioid use disorder also meet diagnostic criteria for an anxiety disorder; however, efficacious treatments for this common co-occurrence have not be established. This manuscript describes the rationale and methods for a behavioral treatment development study designed to develop and test an integrated cognitive-behavioral therapy for those with co-occurring opioid use disorder and anxiety disorders. The aims of the study are (1) to develop and pilot test a new manualized cognitive behavioral therapy for co-occurring opioid use disorder and anxiety disorders, (2) to test the efficacy of this treatment relative to an active comparison treatment that targets opioid use disorder alone, and (3) to investigate the role of stress reactivity in both prognosis and recovery from opioid use disorder and anxiety disorders. Our overarching aim is to investigate whether this new treatment improves both anxiety and opioid use disorder outcomes relative to standard treatment. Identifying optimal treatment strategies for this population are needed to improve outcomes among those with this highly disabling and life-threatening disorder.This study was funded by NIDA grant DA035297. The funding source had no involvement in the study design, analysis and interpretation of data, writing of the report, or the decision to submit the article for publication. (DA035297 - NIDA)Accepted manuscrip

Living the divine divide: A phenomenological study of Mormon mothers who are career-professional women

The Church of Jesus Christ of Latter-day Saints – the Mormon Church – upholds a cultural expectation for women of their community to remain unemployed outside the home and to dedicate their early adulthood to bearing and raising children. This paper reports on a phenomenological exploration, using Smith and Osborn’s (2008) model of interpretative phenomenological analysis, of the use, as a conflict-controlling strategy, of sanctification, or the sacred aspects of life, in the religious cultural navigation of 16 religious Mormon women who maintain full-time professional careers in the fields of law, medicine, education, science, administration or engineering, and who simultaneously mother one or more children under the age of 12. The findings of this study document significant demographic, values-based and experiential differences between the study participants and their Latter-day Saints (LDS) peers who live within the subculture’s norm

Diversity, Dilemmas and Transformation in Post-Compulsory Education: an Introduction to the Special Issue on Work Based Research

As governments recognize the central place of post-compulsory education in regenerating and modernizing the economic and social fabric of society (BIS 2008), it is appropriate for us as educational researchers to question whether this recognition beckons a different role for research in post-compulsory education. Much of this research is work based, using a broad interpretation of this term, and the majority of articles received by this journal (though the proportion published is a lower one) reflect this balance. Work based research in education poses particular challenges for the researcher and the practitioner, whether the focus is practitioner research, in which case the dilemmas can centre on potential role conflict between practitioner and researcher roles, or whether the work based research is observational – analyzing others’ professional practice, in which case the dilemmas can centre on power relations between researcher and researched, the politics of research, and ethical questions around care for participants and the degree of their involvement or non-involvement in the total research enterprise. This article reviews the prospects for work based research in post-compulsory education and introduces the articles in this special issue

Slicing Strategies for the Generalised Type-2 Mamdani Fuzzy Inferencing System

The final publication is available at Springer via http://dx.doi.org/[insert DOI]".As a three-dimensional object, there are a number of ways of slicing a generalised type-2 fuzzy set. In the context of the Mamdani Fuzzy Inferencing System, this paper concerns three accepted slicing strategies, the vertical slice, the wavy slice, and the horizontal slice or alpha -plane. Two ways of de ning the generalised type-2 fuzzy set, vertical slices and wavy slices, are presented. Fuzzi cation and inferencing is presented in terms of vertical slices. After that, the application of all three slicing strategies to defuzzi cation is described, and their strengths and weaknesses assessed

Sending femtosecond pulses in circles: highly non-paraxial accelerating beams

We use caustic beam shaping on 100 fs pulses to experimentally generate non-paraxial accelerating beams along a 60 degree circular arc, moving laterally by 14 \mum over a 28 \mum propagation length. This is the highest degree of transverse acceleration reported to our knowledge. Using diffraction integral theory and numerical beam propagation simulations, we show that circular acceleration trajectories represent a unique class of non-paraxial diffraction-free beam profile which also preserves the femtosecond temporal structure in the vicinity of the caustic