Acceptability of mindfulness from the perspective of stroke survivors and caregivers: a qualitative study

Background: Depression is very common among stroke survivors with estimated prevalence rates of approximately 33% among stroke survivors, but treatment options are limited. Mindfulness-Based Stress Reduction (MBSR) is an effective treatment for depression generally, but benefits in stroke patients are unclear. The aim of this study was to determine the feasibility of delivering MBSR to stroke survivors and their caregivers in the community. We conducted a study to gain views of MBSR as a potential treatment option among stroke survivors and their caregivers in the community. Methods: Participants were recruited from an urban community in Scotland (UK) using newspaper adverts, social media and support groups run by health charities. A 2-h MBSR taster session was delivered by two experienced mindfulness instructors, followed by focus group sessions with all participants on their user experience and suggestions for MBSR modifications for stroke survivors. The focus group sessions were audio recorded and transcribed verbatim. Transcript data were analysed thematically using the framework approach. Results: The study sample consisted of 28 participants (16 females); there were 21 stroke survivors (11 females) and 7 caregivers (5 females). The median age for participants was 60 years. Most participants described the MBSR taster session as a positive experience. The main challenge reported was trying to maintain focus and concentration throughout the MBSR session. Some participants expressed reservations about the duration of standard mindfulness course sessions, suggesting a preference for shorter sessions. The potential for achieving better control over negative thoughts and emotions was viewed as a potential facilitator for future MBSR participation. Participants suggested having an orientation session prior to starting an 8-week course as a means of developing familiarity with the MBSR instructor and other participants. Conclusion: It was feasible to recruit 21 stroke survivors and 7 caregivers for MBSR taster sessions in the community. A shorter MBSR session and an orientation session prior to the full course are suggestions for potential MBSR modifications for stroke survivors, which needs further research and evaluation

Quasars are more luminous than radio galaxies - so what?

Surveys to find high-redshift radio galaxies deliberately exclude optically-bright objects, which may be distant radio-loud quasars. In order to properly determine the space density of supermassive black holes, the fraction of such objects missed must be determined within a quantitative framework for AGN unification. I briefly describe the receding torus model, which predicts that quasars should have more luminous ionizing continua than radio galaxies of similar radio luminosity, and present evidence to support it. I also suggest two further tests of the model which should constrain some of its parameters.Comment: 6 pages. To appear in "Radio galaxies: past, present and future", eds M. Jarvis et al., Leiden, Nov 200

Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials

Objective: Impairment of mental well-being (anxiety, depression, stress) is common among people with multiple sclerosis (PwMS). Treatment options are limited, particularly for anxiety. The aim of this study was to update our previous systematic review (2014) and evaluate via meta-analysis the efficacy of mindfulness-based interventions (MBIs) for improving mental well-being in PwMS. Methods: Systematic searches for eligible randomised controlled trials (RCTs) were carried out in seven major databases (November 2017, July 2018), using medical subject headings and key words. Studies were screened, data extracted, quality appraised and analysed by two independent reviewers, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Mental well-being was the primary outcome. Random effects model meta-analysis was performed, with effect size reported as standardised mean difference (SMD). Results: Twelve RCTs including 744 PwMS were eligible for inclusion in the systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6–9 weeks, delivered individually and via groups, both in person and online. Overall SMD for mental well-being (eight studies) was 0.40 (0.28–0.53), p<0.01, I2=28%; against active comparators only (three studies) SMD was 0.17 (0.01–0.32), p<0.05, I2 =0%. Only three adverse events were reported. Conclusions: MBIs are effective at improving mental well-being in PwMS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness

Riding the Wave: Spirituality, Creative Expression, and Adult Learning

This paper explores the relationship between creative expression and spirituality, examining ways in which adults seek knowledge and/or make meaning through these connections. Four themes emerged from this research: trust and letting go of control, a sense of connectedness, flow and devotion, and creativity as a healing force

Prevalence of Borrelia burgdorferi, the Lyme Disease Spirochete, in Ticks and Rodents in Northeast Arkansas

Lyme disease, caused by the spirochete, Borrelia burgdorferi, has been reported from 36 of Arkansas\u27 75 counties. Ticks and wild rodents from nine northeast Arkansas counties were surveyed to determine the prevalence of Borrelia infection in potential tick vectors and reservoir host populations. In direct immunofluorescent assays with murine monoclonal antibody H5332, specific for B. burgdorferi, detected a 2.1% rate of infection for the 638 ticks surveyed and an 11.8% infectivity rate for the 102 rodents surveyed

Implications for unified schemes from submillimetre and far-infrared follow-up of radio-selected samples

We extend our previous analysis which used generalized luminosity functions (GLFs) to predict the number of quasars and galaxies in low-radio-frequency-selected samples as a function of redshift, radio luminosity, narrow-emission-line luminosity and type of unified scheme. Our extended analysis incorporates the observed submillimetre (850 micron) flux densities of radio sources, employs a new method which allows us to deal with non detections, and focuses on the high-luminosity population. First, we conclude that the submillimetre luminosity L_{850} of low-frequency-selected radio sources is correlated with the bolometric luminosity L_{Bol} of their quasar nuclei via an approximate scaling relation L_{850} \propto L_{Bol}^{0.7 \pm 0.2}. Second, we conclude that there is quantitative evidence for a receding-torus-like physical process for the high-luminosity population within a two-population unified scheme for radio sources; this evidence comes from the fact that radio quasars are brighter in both narrow emission lines and submillimetre luminosity than radio galaxies matched in radio luminosity and redshift. Third, we note that the combination of a receding-torus-like scheme and the assumption that the observed submillimetre emission is dominated by quasar-heated dust yields a scaling relation L_{850} \propto L_{Bol}^{0.5} which is within the errors of that determined here for radio-selected quasars, and consistent with that inferred for radio-quiet quasars by Willott, Rawlings & Grimes (2003).Comment: 13 pages (including an appendix), 5 figures, to appear in MNRA

The role of the city in expanding and preserving political autonomy: A capability theory

The late twentieth and early twenty-first century saw a rapid expansion of city populations. Concurrently, a wave of intensified globalisation occurred, propelled in good part by the confluence of substantial technological development and ideological shifts that affected the relationships of nation-states and capital. Together, these phenomena indicate a radical reshaping of power, which threatens the possibility of holding political autonomy locally. This thesis draws on theoretical and empirical material to illustrate why this is the case, and also why it is so problematic. The city is shown to be a key site involved in this shift of power as well as having an impact on human flourishing. By reframing the goals of the city in light of this shifting landscape, we can develop the ability of the city to preserve and expand space for opportunities necessary for the practice and development of political autonomy. The thesis uses the capability approach to frame the importance of political autonomy. By showing this, we can see why the current global phenomenon is problematic and in turn how we might reframe the ends of the city. The capability approach highlights why such an ability to have some control over one’s political environment is important and thus a concern that requires greater scholarly attention. To ground these conceptual ideas in practice, this thesis will further examine how global forces have affected the capacity of individuals in London as well as through an exploration of housing policy from other cities. By doing so, this thesis shows alternatives to the London and similar city models, indicating the importance of cities for citizens’ wellbeing, how political autonomy in cities is under threat from globalisation, and how a refraining of the city in light of capability theory might help mitigate this threat

Self-management support for chronic disease in primary care: frequency of patient self-management problems and patient reported priorities, and alignment with ultimate behavior goal selection.

BackgroundTo enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients' identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients' reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.MethodsCTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal. SM-Problems included: BMI, diet (fruits and vegetables, salt, fat, sugar sweetened beverages), physical activity, missed medications, tobacco and alcohol use, health-related distress, general life stress, and depression symptoms. Descriptive analyses documented SM-Problems and SM-Priorities, and alignment between SM-Priorities and Goal Selection, followed by mixed models adjusting for clinic.Results446 participants with ≥ one chronic diseases (mean age 55.4 ± 12.6; 58.5% female) participated. On average, participants reported experiencing challenges in 7 out of the 12 SM-Problems areas; with the most frequent problems including: BMI, aspects of diet, and physical activity. Patient SM-Priorities were variable across the self-management areas. Patient- Healthcare team member Goal selection aligned well with patient SM-Priorities when patients prioritized weight loss or physical activity, but not in other self-management areas.ConclusionParticipants reported experiencing multiple SM-Problems. While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas. Aggregated results can assist with the identification of high frequency patient SM-Problems and SM-Priority areas, and in turn inform resource allocation to meet patient needs.Trial registrationClinicalTrials.gov ID: NCT01945918