Mapping the Quality of Life and Unmet Needs of Urban Women with Metastatic Breast Cancer.

Enhancing quality of life and reducing the unmet needs of women are central to the successful management of advanced breast cancer. The objective of this study was to investigate the quality of life and support and information needs of urban women with advanced breast cancer. This study was conducted at four large urban hospitals in Melbourne, Australia. A consecutive sample of 105 women with advanced breast cancer completed a questionnaire that contained the European Organization of Research and Treatment of Cancer Quality of Life Q-C30 and the Supportive Care Needs Survey. Between one quarter and a third of the women reported difficulties with their physical, role and social functioning, and a little over a quarter of the women reported poor global health status. Fatigue was a problem for most women. The highest unmet needs were in the psychological and health information domains. Almost no differences in unmet needs were detected when comparing different demographic and disease characteristics of women. Health care providers should routinely monitor the quality of life and needs of women with advanced breast cancer to ensure that appropriate treatment, information or supportive services are made available

Mental disturbances and perceived complexity of nursing care in medical inpatients: results from a European study.

AIMS AND OBJECTIVES: The relationship between mental disturbances - anxiety and depression, somatization and alcohol abuse - on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal was to study the utility of short screeners for mental disturbances to select patients for case-management on admission. DESIGN: The study had a cohort design: patients were included on admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor study. RESEARCH METHODS AND INSTRUMENTS: In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL-8D, a somatization questionnaire based on the Whiteley-7 and the CAGE. At discharge, nurses rated the complexity of the patient's care. RESULTS: Patients with high scores on anxiety and depression (SCL-8D) and on somatization received higher ratings on perceived nursing complexity than those with low scores, with and without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, could not explain these relations. No differences were found between patients with high or low scores on alcohol abuse. CONCLUSIONS: The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case-management programmes

Persistent physical symptoms: definition, genesis, and management

Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face

Low-Cost Attitude Determination and Control for Small Satellites

This paper addresses the need to develop small satellite technology which will enable small satellites to perform large satellite missions. The Center for Aerospace Technology (CAST) at Weber State University (WSU) has an 18 year history of small satellite innovation. Previous satellites include: NUSAT, WEBERSAT, and PHASE 3d. CAST is currently fabricating two new small satellites with advanced capabilities. CATSAT, a USRA program, will determine the origin of gamma-ray bursts and is a joint project with the University of New Hampshire and the University of Leicister in England. JAWSAT, a joint project with the U.S. Air Force Academy, will be the first payload launched by a converted minuteman missile. Both missions require active attitude determination and control previously unavailable for satellites of this class. In support of these two missions CAST has undertaken the task of developing satellite instrumentation designed specifically for small satellite applications. Size, weight, power consumption and cost minimization were incorporated into the design philosophy. New enabling technology includes the use of the State-Sampled Network for sensor integration, attitude determination and attitude control. The overall development history is chronicled with emphasis relating to issues of reliability and acceptance testing

Evaluating affective feedback of the 3D agent Max in a competitive cards game

Becker-Asano C, Prendinger H, Ishizuka M, Wachsmuth I. Evaluating affective feedback of the 3D agent Max in a competitive cards game. In: Tao J, Tan T, Picard RW, eds. Affective Computing and Intelligent Interaction. LNCS 3784. Berlin: Springer; 2005: 466-473.Within the field of Embodied Conversational Agents (ECAs), the simulation of emotions has been suggested as a means to enhance the believability of ECAs and also to effectively contribute to the goal of more intuitive human–computer interfaces. Although various emotion models have been proposed, results demonstrating the appropriateness of displaying particular emotions within ECA applications are scarce or even inconsistent. Worse, questionnaire methods often seem insufficient to evaluate the impact of emotions expressed by ECAs on users. Therefore we propose to analyze non-conscious physiological feedback (bio-signals) of users within a clearly arranged dynamic interaction scenario where various emotional reactions are likely to be evoked. In addition to its diagnostic purpose, physiological user information is also analyzed online to trigger empathic reactions of the ECA during game play, thus increasing the level of social engagement. To evaluate the appropriateness of different types of affective and empathic feedback, we implemented a cards game called Skip-Bo, where the user plays against an expressive 3D humanoid agent called Max, which was designed at the University of Bielefeld [6] and is based on the emotion simulation system of [2]. Work performed at the University of Tokyo and NII provided a real-time system for empathic (agent) feedback that allows one to derive user emotions from skin conductance and electromyography [13]. The findings of our study indicate that within a competitive gaming scenario, the absence of negative agent emotions is conceived as stress-inducing and irritating, and that the integration of empathic feedback supports the acceptance of Max as a co-equal humanoid opponent