Social problem-solving ability as a predictor of distress in caregiving partners to men with HIV and AIDS

HIV and AIDS pose myriad challenges to the individuals who live with it, their families, and the medical and mental health communities who serve them. Frequently, men who are in primary relationships with men living with HIV and AIDS function as their partners’ primary caregivers. The purpose of this investigation was to investigate variables that significantly contribute to the distress experienced by this group of caregivers. In this study, variables related to the caregiver (negative life events during the past year, physical health functioning, availability of and satisfaction with social support), care recipient (functional impairment), and caregiver/care recipient dyad (dyadic adjustment) were evaluated. Four hierarchical multiple regression analyses were conducted on data collected from the 44 participating caregivers. Results indicated that caregivers’ satisfaction with social support resources and social problem-solving ability significantly contributed to the prediction of their level of depressive symptomatology. However, none of the aforementioned variables reliably improved the prediction of caregiver anxiety, hopelessness, or burden. The limitations of this study, its clinical implications, and suggestions for future research are discussed.Ph.D., Biology & Biomedical Sciences -- Drexel University, 200

Two Qubits in the Dirac Representation

A general two qubit system expressed in terms of the complete set of unit and fifteen traceless, Hermitian Dirac matrices, is shown to exhibit novel features of this system. The well-known physical interpretations associated with the relativistic Dirac equation involving the symmetry operations of time-reversal T, charge conjugation C, parity P, and their products are reinterpreted here by examining their action on the basic Bell states. The transformation properties of the Bell basis states under these symmetry operations also reveal that C is the only operator that does not mix the Bell states whereas all others do. In a similar fashion, expressing the various logic gates introduced in the subject of quantum computers in terms of the Dirac matrices shows for example, that the NOT gate is related to the product of time-reversal and parity operators.Comment: 11 page

The Duties of Love: The Vocation of the Child in the Household Manual Tradition

This Article analyzes the little explored late medieval and early modern household manuals that provided European and North American parents, children, and other household members with detailed instructions on their domestic, spiritual, emotional, and social responsibilities to God, neighbor, and self. The manuals outlined the duties of love, respect, recompense, and life-long honor that children owed to parents, and the duties of love, support, education, nurture, emancipation, and inheritance that parents owed to their children. Some of these early household manuals proved to be important prototypes for later theories of catechesis, education, children’s rights, and books of etiquette and deportment that were common in Catholic and Protestant circles on both sides of the Atlantic

Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: a randomised, double-blind controlled trial.

OBJECTIVES:Methotrimeprazine is commonly used for the management of nausea but never tested formally against other drugs used in this setting. The aim was to demonstrate superior antiemetic efficacy. DESIGN:Double-blind, randomised, controlled trial of methotrimeprazine versus haloperidol. SETTING:11 palliative care sites in Australia. PARTICIPANTS:Participants were >18 years, had cancer, an average nausea score of ≥3/10 and able to tolerate oral medications. Ineligible patients had acute nausea related to treatment, nausea for which a specific antiemetic was indicated, were about to undergo a procedure or had received either of the study drugs or a change in glucocorticoid dose within the previous 48 hours. INTERVENTIONS:Based on previous studies, haloperidol was used as the control. Participants were randomised to encapsulated methotrimeprazine 6·25 mg or haloperidol 1·5 mg one time or two times per day and assessed every 24 hours for 72 hours. MAIN OUTCOME MEASURES:A ≥two-point reduction in nausea score at 72 hours from baseline. Secondary outcome measures were as follows: complete response at 72 hours (end nausea score less than 3), response at 24 and 48 hours, vomiting episodes, use of rescue antiemetics, harms and global impression of change. RESULTS:Response to treatment at 72 hours was 75% (44/59) in the haloperidol (H) arm and 63% (36/57) in the methotrimeprazine (M) arm with no difference between groups (intention-to-treat analysis). Complete response rates were 56% (H) and 51% (M). In the per protocol analysis, there was no difference in response rates: (85% (44/52) (H) and 74% (36/49) (M). Complete per protocol response rates were 64% (H) and 59% (M). Toxicity worse than baseline was minimal with a trend towards greater sedation in the methotrimeprazine arm. CONCLUSION:This study did not demonstrate any difference in response rate between methotrimeprazine and haloperidol in the control of nausea. TRIAL REGISTRATION NUMBER:ACTRN 12615000177550

Systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults

BACKGROUND: Dyspnoea is a common symptom in advanced cancer, with a prevalence of up to 70% among patients at end of life. The cause of dyspnoea is often multifactorial, and may cause considerable psychological distress and suffering. Dyspnoea is often undertreated and good symptom control is less frequently achieved in people with dyspnoea than in people with other symptoms of advanced cancer, such as pain and nausea. The exact mechanism of action of corticosteroids in managing dyspnoea is unclear, yet corticosteroids are commonly used in palliative care for a variety of non-specific indications, including pain, nausea, anorexia, fatigue and low mood, despite being associated with a wide range of adverse effects. In view of their widespread use, it is important to seek evidence of the effects of corticosteroids for the management of cancer-related dyspnoea. OBJECTIVES: To assess the effects of systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, Science Citation Index Web of Science, Latin America and Caribbean Health Sciences (LILACS) and clinical trial registries, from inception to 25 January 2018. SELECTION CRITERIA: We included randomised controlled trials that included adults aged 18 years and above. We included participants with cancer-related dyspnoea when randomised to systemic corticosteroids (at any dose) administered for the relief of cancer-related dyspnoea or any other indication, compared to placebo, standard or alternative treatment. DATA COLLECTION AND ANALYSIS: Five review authors independently assessed trial quality and three extracted data. We used means and standard deviations for each outcome to report the mean difference (MD) with 95% confidence interval (CI). We assessed the risk of bias and quality of evidence using GRADE. We extracted primary outcomes of sensory-perceptual experience of dyspnoea (intensity of dyspnoea), affective distress (quality of dyspnoea) and symptom impact (burden of dyspnoea or impact on function) and secondary outcomes of serious adverse events, participant satisfaction with treatment and participant withdrawal from trial. MAIN RESULTS: Two studies met the inclusion criteria, enrolling 157 participants (37 participants in one study and 120 in the other study), of whom 114 were included in the analyses. The studies compared oral dexamethasone to placebo, followed by an open-label phase in one study. One study lasted seven days, and the duration of the other study was 15 days.We were unable to conduct many of our predetermined analyses due to different agents, dosages, comparators and outcome measures, routes of drug delivery, measurement scales and time points. Subgroup analysis according to type of cancer was not possible.Primary outcomesWe included two studies (114 participants) with data at one week in the meta-analysis for change in dyspnoea intensity/dyspnoea relief from baseline. Corticosteroid therapy with dexamethasone resulted in an MD of lower dyspnoea intensity compared to placebo at one week (MD -0.85 lower dyspnoea (scale 0-10; lower score = less breathlessness), 95% CI -1.73 to 0.03; very low-quality evidence), although we were uncertain as to whether corticosteroids had an important effect on dyspnoea as results were imprecise. We downgraded the quality of evidence by three levels from high to very low due to very serious study limitations and imprecision.One study measured affective distress (quality of dyspnoea) and results were similar between groups (29 participants; very low-quality evidence). We downgraded the quality of the evidence three times for imprecision, inconsistency, and serious study limitations.Both studies assessed symptom impact (burden of dyspnoea or impact on function) (113 participants; very low-quality evidence). In one study, it was unclear whether dexamethasone had an effect on dyspnoea as results were imprecise. The second study showed more improvement for physical well-being scores at days eight and 15 in the dexamethasone group compared with the control group, but there was no evidence of a difference for FACIT social/family, emotional or functional scales. We downgraded the quality of the evidence three times for imprecision, inconsistency, and serious study limitations.Secondary outcomesDue to the lack of homogenous outcome measures and inconsistency in reporting, we could not perform quantitative analysis for any secondary outcomes. In both studies, the frequency of adverse events was similar between groups, and corticosteroids were generally well tolerated. The withdrawal rates for the two studies were 15% and 36%. Reasons for withdrawal included lost to follow-up, participant or carer (or both) refusal, and death due to disease progression. We downgraded the quality of evidence for these secondary outcomes by three levels from high to very low due to serious study limitations, inconsistency and imprecision.Neither study examined participant satisfaction with treatment. AUTHORS' CONCLUSIONS: There are few studies assessing the effects of systemic corticosteroids on cancer-related dyspnoea in adults with cancer. We judged the evidence to be of very low quality that neither supported nor refuted corticosteroid use in this population. Further high-quality studies are needed to determine if corticosteroids are efficacious in this setting

Temporal Stability of the Location of the Esophagus in Patients Undergoing a Repeat Left Atrial Ablation Procedure for Atrial Fibrillation or Flutter

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71884/1/j.1540-8167.2007.01051.x.pd

Effect of Catheter Ablation on Progression of Paroxysmal Atrial Fibrillation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90181/1/j.1540-8167.2011.02137.x.pd

Utility of Atrial and Ventricular Cycle Length Variability in Determining the Mechanism of Paroxysmal Supraventricular Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72411/1/j.1540-8167.2007.00860.x.pd