Multimorbidity, frailty and COPD: are the challenges for pulmonary rehabilitation in the name?

The overwhelming majority of people with chronic obstructive pulmonary disease (COPD) have at least one coexisting medical condition often conceptualized as ‘comorbidities’. These coexisting conditions vary in severity and impact; it is likely that for some patients, COPD is not their most important or severe condition. The concepts of multimorbidity and frailty may be useful to understand the broader needs of people with COPD undergoing pulmonary rehabilitation. Multimorbidity describes the coexistence of two or more chronic conditions, without reference to a primary condition. Best care for people with multimorbidity has been described as a shift from providing disease-focused to patient-centred care. Pulmonary rehabilitation is well placed to deliver such care as it focuses on optimizing function, encourages integration across care settings, values input from multidisciplinary teams and measures patient-important outcomes. When designing optimal pulmonary rehabilitation services for people with multimorbidity, the concept of frailty may be useful. Frailty focuses on impairments rather than medical conditions including impairments in mobility, strength, balance, cognition, nutrition, endurance, mood and physical activity. Emerging data suggest that frailty may be modifiable with pulmonary rehabilitation. The challenge for pulmonary rehabilitation clinicians is to broaden our perspective on the role and outcomes of pulmonary rehabilitation for people with multimorbidity. </jats:p

Access to the vote in the 2006 midterm election : evidence from the 2006 Cooperative Congressional Election Study

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Political Science, 2007.MIT Institute Archives copy: pages 41-56 bound in reverse order.Includes bibliographical references (p. 53-56).The 2000 and 2004 U.S. national elections were plagued by problems which caused a significant number of citizens to be effectively denied access to the vote. This paper uses data from the 2006 Cooperative Congressional Election Study (CCES) public opinion poll to measure whether certain electoral problems persisted in the 2006 midterm elections. Of particular concern are whether voters were asked to show photo ID in order to vote, whether voters experienced problems with their registrations upon attempting to vote, what demographic groups experienced these problems most frequently, and what remedies were offered to such voters. Additionally, public opinion on whether all voters should be required to show photo IDs in order to vote and on whether polling stations were well operated in this election is also examined. The data shows that while significant percentages of CCES respondents experienced registration problems when voting and/or were asked to show photo ID before voting almost no respondents were prevented from casting ballots. Respondents showed overwhelming support for measures which would require all voters to show photo ID before voting, though this support varied significantly by party ID. Finally, respondents were overwhelmingly pleased with how their polling stations were operated during this election and very few of them were forced to wait in long lines before voting.by Samantha Green-Atchley.S.M

Binge eating behaviours : experiences associated with tertiary education : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Psychology at Massey University, by distance, New Zealand

Transitioning and adjusting to tertiary education is often a very challenging time for students. As a result of various personal, social, and academic pressures, many students develop maladaptive behaviours, such as binge eating behaviours, to cope with the stress and anxiety associated with tertiary education. In this qualitative study, I explored experiences of binge eating behaviours and tertiary education and how they impacted one another. The ways in which one view themselves, others, and tertiary education, as well as their subjective experiences of both binge eating behaviours and tertiary education, were also explored. Fifty-five participants completed a survey about their experiences of binge eating behaviours in the context of tertiary education. I analysed the survey responses using reflexive thematic analysis through a social constructionist theoretical lens. Two key themes and six subthemes were identified and explored within the data set. The two key themes were: The Interaction between Binge Eating and Emotional and Psychological States; and Contextual Factors that Impact Tertiary Education and Binge Eating Behaviours. Each theme highlighted the ways in which participants’ experiences of tertiary education and binge eating behaviours were negatively impacted by the personal, academic, and social challenges associated with the transition and adjustment to tertiary-level study. Through each of the six subthemes, I explore how participants experienced a paradoxical cycle in which negative experiences further encouraged more negative experiences. This resulted in a cycle that had a considerable impact on their social, physical, and mental well-being. The findings also indicated that the ways in which an individual views their personal experience are strongly related to their own social and cultural understanding of the world. The implications of these findings include that tertiary institutions could develop strategies for better assisting their students in transitioning and adjusting to tertiary education, such as pre-transition and extended transition programmes, food education and food preparation classes, affordable and appealing healthy food in campus dining halls, and easily accessible and available psychological interventions to ensure student success

Shift-life interactive art: mixed-reality artificial ecosystem simulation

This article presents a detailed design, development and implementation of a Mixed Reality Art-Science collaboration project which was exhibited during Darwin’s bicentenary exhibition at Shrewsbury, England. As an artist-led project the concerns of the artist were paramount, and this article presents Shift-Life as part of an on-going exploration into the parallels between the non-linear human thinking process and computation using semantic association to link items into ideas, and ideas into holistic concepts. Our art explores perceptions and states of mind as we move our attention between the simulated world of the computer and the real-world we inhabit, which means that any viewer engagement is participatory rather than passive. From a Mixed Reality point of view, the lead author intends to explore the convergence of the physical and virtual, therefore the formalization of the Mixed Reality system, focusing on the integration of artificial life, ecology, physical sensors and participant interaction through an interface of physical props. It is common for digital media artists to allow viewers to activate a work either through a computer screen via direct keyboard or mouse manipulation, or through immersive means to activate their work, for “Shift-Life” the artist was concerned with a direct “relational” approach where viewers would intuitively engage with the installation’s everyday objects, and with each other, to fully experience the piece. The Mixed Reality system is mediated via physical environmental sensors, which affect the virtual environment and autonomous agents, which in turn reacts and is expressed as virtual pixels projected onto a physical surface. The tangible hands-on interface proved to be instinctive, attractive and informative on many levels, delivering a good example of collaboration between the Arts and Science

Exploring self-conscious emotions in individuals with chronic obstructive pulmonary disease:A mixed-methods study

This study aimed to explore the extent to which self-conscious emotions are expressed, to explore any associations with adverse health outcomes, and to compare self-conscious emotions in individuals with chronic obstructive pulmonary disease (COPD) to healthy controls. A two-stage mixed-methods study design was employed. Interviews with 15 individuals with COPD informed the choice of questionnaires to assess self-conscious emotions which were completed by individuals with COPD and healthy controls. Five overarching themes were abstracted: grief, spectrum of blame, concern about the view of others, concealment, and worry about the future. The questionnaires were completed by 70 patients (mean( SD) age 70.8(9.4) years, forced expiratory volume in one second predicted 40.5(18.8), 44% male) and 61 healthy controls (mean( SD) age 62.2(12.9) years, 34% male]. Self-conscious emotions were associated with reduced mastery, heightened emotions, and elevated anxiety and depression (all p &lt; 0.001). Individuals with COPD reported lower self-compassion, higher shame, and less pride than healthy controls (all p ≤ 0.01). There is a need to increase awareness of self-conscious emotions in individuals with COPD. Therapies to target such emotions may improve mastery, emotions, and psychological symptoms. </jats:p