Evaluating the feasibility and potential impacts of a recovery-oriented psychosocial rehabilitation toolkit in a health care setting in Kenya: A mixed-methods study

OBJECTIVES: This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya. METHOD: This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before and after the intervention. Qualitative data were collected from focus groups with patients and family members, and individual interviews with facilitators, after the intervention. RESULTS: Quantitative findings indicated that patients experienced moderate improvement in illness management and, in contrast to qualitative findings, family members experienced moderate worsening in attitudes toward recovery. Qualitative findings revealed positive outcomes for both patients and family members, as reflected in greater feelings of hope and mobilization to reduce stigma. Factors that facilitated participation included: helpful and accessible learning materials; committed and involved stakeholders; and flexible solutions to promote continued involvement. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This pilot study found that delivery of the Psychosocial Rehabilitation Toolkit was feasible within a health care setting in Kenya and associated with overall positive outcomes among patients with serious mental illness. Further research on its effectiveness on a larger scale and using culturally validated measures is needed

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Performance of hidden services in Tor

In this thesis we will provide an overview of the Tor hidden service protocol. We will demonstrate the steps of setting up Tor hidden services and a private Tor network for testing purposes. The performance of the hidden services will be measured with regards to throughput, initial access time, connection latency, and reliability. The results show that hidden services on the public network can be used for web servers and instant messaging. On a private network, voice over IP and video streaming can be used as well. The hidden services are currently limited by the public network performance of Tor, but we obtained significantly higher performance on a private Tor network

Nonlinear Waves in Multimode Fibers

International audienc

Versatile supercontinuum generation in parabolic multimode optical fibers

We demonstrate that the pump's spatial input profile can provide additional degrees of freedom in tailoring at will the nonlinear dynamics and the ensuing spectral content of supercontinuum generation in highly multimoded optical fibers. Experiments and simulations carried out at 1550 nm indicate that the modal composition of the input beam can substantially alter the soliton fission process as well as the resulting Raman and dispersive wave generation that eventually lead to supercontinuum in such a multimode environment. Given the multitude of conceivable initial conditions, our results suggest that it is possible to pre-engineer the supercontinuum spectral content in a versatile manner. (C) 2017 Optical Society of AmericaOffice of Naval Research (ONR) [MURI N00014-13-1-0649]; HEL-JTO [W911NF-12-1-0450]; Army Research Office (ARO) [W911NF-12-1-0450]; Air Force Office of Scientific Research (AFOSR) [FA9550-15-10041]; Qatar National Research Fund [NPRP 9-020-1-006]Open access journal.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]