Cancer-related trauma, stigma and growth: the 'lived' experience of head and neck cancer

Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme - Distress, Stigma and Psychological Growth - encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on 'self'. Acceptance allowed a new sense of identity that recognised cancer-related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer-related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic 'self' for psychological growth. Implications are discussed

Integration of remote sensing and ground-based non-destructive methods in transport infrastructure monitoring: advances, challenges and perspectives

High temporal frequency monitoring of transport infrastructures is crucial for implementing effective maintenance prioritisation strategies and prevent major failures. To this extent, ground-based non-destructive testing (NDT) methods have been successfully applied for decades, reaching very high standards of data quality and accuracy. However, routine and systematic campaigns are required over relatively long inspection times for data collection and implementation into reliable infrastructure management systems (IMSs). On the other hand, satellite remote sensing techniques, such as the Multi-Temporal Interferometric Synthetic Aperture Radar (MT-InSAR) method, have proven effective in monitoring ground displacements of transport infrastructures (roads, railways and airfields), with a much higher temporal frequency of investigation and wider inspection catchment areas. Nevertheless, the integration of information from i) satellite remote sensing and ii) ground-based NDT methods is still an area to be explored in civil engineering. Within this framework, this paper aims to review significant stand-alone applications in these two areas of technology for transport infrastructure monitoring. Furthermore, recent advances, main challenges and future perspectives arising from their integration are discussed. Contents of this paper are organised within the context of an invited keynote talk given at the 2021 IEEE Asia-Pacific Conference on Geoscience, Electronics and Remote Sensing (AGERS – 2021)

Monitoring of bridges by satellite remote sensing using multi-source and multi-resolution data integration techniques: a case study of the Rochester bridge

Monitoring of bridges and viaducts has become a priority for asset owners due to progressive infrastructure ageing and its impact on safety and management costs. Advancement in data processing and interpretation methods and the accessibility of Synthetic Aperture Radar (SAR) datasets from different satellite missions have contributed to raise interest for use of near-real time bridge assessment methods. In this context, the Multi-temporal Interferometric Synthetic Aperture Radar (MT-InSAR) space-borne monitoring technique has proven to be effective for detection of cumulative surface displacements with a millimetre accuracy [1-3]. This research aims to investigate the viability of using satellite remote sensing for structural assessment of the Rochester Bridge in Rochester, Kent, UK. To this purpose, high-resolution SAR datasets are used as the reference information and complemented by additional data from different sensing technologies (e.g., medium-resolution SAR datasets and ground-based (GB) nondestructive testing (NDT)). In detail, high-resolution SAR products of the COSMO-SkyMed (CSK) mission (2017-2019) provided by the Italian Space Agency (ASI) in the framework of the Project “Motib - ID 742”, approved by ASI, are processed using a MT-InSAR approach. The method allowed to identify several Persistent Scatterers (PSs) – which have been associated to different structural elements (e.g., the bridges piers) over the four main bridge decks – and monitor bridge displacements during the observation time. The outcomes of this study demonstrate that information from the use of high-resolution InSAR data can be successfully integrated to datasets of different resolution, scale and source technology. Compared to standalone technologies, a main advantage of the proposed approach is in the provision of a fully comprehensive (i.e., surface and subsurface) and dense array of information with a larger spatial coverage and a higher time acquisition frequency. This results in a more effective identification and monitoring of decays at reduced costs, paving the way for implementation into next generation Bridge Management Systems (BMSs)

Evaluation and Comparison of a Habitat Suitability Model for Postdrift Larval Lake Sturgeon in the St. Clair and Detroit Rivers

We evaluated composition and spatial distribution of riverine nursery habitat for larval Lake Sturgeon Acipenser fulvescens in the Middle Channel of the St. Clair River, Michigan, and Fighting Island Channel of the Detroit River, Ontario, using a habitat suitability model (HSM) and fish collections. Although model outputs indicated similar portions of high‐quality habitat in the Middle Channel (16.9%) and Fighting Island Channel (15.7%), larval abundance and dispersal patterns varied between these systems. Analysis with Akaike’s information criterion indicated that a regression model using sand–silt substrate performed best at predicting the observed water‐volume‐standardized CPUE (number of larvae·h−1·m−3) in the Middle Channel. Of 93 larvae that were collected in the Middle Channel, most were found to cluster at three distinct areas of high‐ and moderate‐quality habitat, which was composed predominately of sand–silt substrate. Lengths of larvae varied by as much as 9 mm, and the degree of yolk sac absorption also varied, indicating that larvae in the Middle Channel remained within the channel after a short drift downstream. Of the 25 larvae that were collected in Fighting Island Channel, distribution was sporadic, and occurrence did not significantly correlate with measured habitat variables. Larvae were relatively homogeneous in size and yolk sac stage, indicating that newly emerged larvae did not utilize available habitat in Fighting Island Channel but instead drifted into the main channel of the Detroit River. Dispersal patterns indicate variability in young Lake Sturgeon ecology, which is dependent on local habitat conditions—most notably, substrate composition. Furthermore, modeled larval–habitat associations found in this study were compared to a similar study on larval Lake Sturgeon from the North Channel of the St. Clair River. Model outputs from all three systems accurately accounted for observed larval dispersal patterns among both rivers. This supports the transferability of an HSM parameterized for Lake Sturgeon from individual river reaches within two large river systems.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146299/1/nafm10217.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146299/2/nafm10217_am.pd

Movements and distribution of adult Lake Sturgeon from their spawning site in the St. Clair River, Michigan

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89541/1/j.1439-0426.2011.01827.x.pd

A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis

BACKGROUND: To examine the effectiveness and acceptability of an 8-week individual tailored cognitive behavioural therapy (CBT) intervention for the treatment of depressive symptoms in those newly diagnosed with multiple sclerosis. METHODS: The current study presents a pilot, parallel group randomized controlled trial (RCT) with an allocation ratio of 1:1 conducted in a large research and teaching hospital in Melbourne, Australia. 30 individuals with a mean age of 36.93 years (SD = 9.63) who were newly diagnosed with multiple sclerosis (MS) (X = 24.87 months, SD = 15.61) were randomized to the CBT intervention (n = 15) or treatment as usual (TAU) (n = 15). The primary outcome was level of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Secondary outcomes were level of anxiety, fatigue and pain impact, sleep quality, coping, acceptance of MS illness, MS related quality of life, social support, and resilience. Tertiary outcomes were acceptability and adherence to the intervention. RESULTS: Large between group treatment effects were found for level of depressive symptoms at post and at 20 weeks follow-up (d = 1.66–1.34). There were also small to large group treatment effects for level of anxiety, fatigue and pain impact, sleep quality, MS related quality of life, resilience, and social support at post and at 20 weeks follow-up (d = 0.17–1.63). There were no drop-outs and participants completed all treatment modules. All participants reported the treatment as ‘very useful’, and most (73.4%) reported that the intervention had addressed their problems ‘completely’. CONCLUSIONS: These data suggest that the tailored early intervention is appropriate and clinically effective for the treatment of depressive symptoms in those newly diagnosed with MS. A larger RCT comparing the CBT intervention with an active comparative treatment with longer term follow-up and cost effectiveness analyses is warranted. The pilot trial has been retrospectively registered on 28/04/2016 with the ISRCTN registry (trial ID ISRCTN10423371)

Integration of oncology and palliative care : a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care

An investigation of cancer stigma and its impact on posttraumatic growth among cancer patients

Increased cancer incidence and decreased disease mortality has resulted in higher rates of cancer diagnosis, treatment and survivorship. Therefore, understanding the psychological impact of coping with cancer is paramount. Stigma can be among the challenges associated with the cancer experience but research into the specific causes and consequences is limited. Stigma reflects a devalued identity, which results in lowered self-esteem and strained social relationships. In addition to these negative changes, positive experiences such as posttraumatic growth (PTG) have also been documented among cancer patients. PTG refers to psychological development in an individual's life after a traumatic event that surpasses their pre-trauma level of functioning. While the benefits of PTG are noteworthy, cancer-related stigma may lead some patients without the support and validation they need to develop PTG. The present program of research presents an examination of cancer-related stigma, by considering the perceptions of community members and the experience of cancer patients. The research also examines and how stigma may impact on the positive and negative changes following cancer diagnosis. The first two studies examined perceptions of cancer stigma among community members (n = 373). Study 1 presents the results of experimental research, which investigated three potential causes of cancer stigma. Findings demonstrated consistent support for the role of blameworthy attributions, some support for the role of physical changes associated with cancer treatment, and minimal support for the role of poor prognosis in eliciting stigmatising responses. Guided by attribution theory, Study 2 assessed community perceptions of cancers perceived to be blameworthy versus non-blameworthy. Using Structural Equation Modelling, controllability in the blameworthy cancer groups (i.e., lung, throat and skin cancers) was found to directly impact on sympathy and hypothetical charitable donation. Study 3 presents the results of a questionnaire that was administered to cancer patients (n = 113), to examine the potential pathways, namely through social support and stigma, that ultimately contribute to well-being among cancer patients. Findings demonstrated the positive effect of social support, and the deleterious effect of stigma, on influencing post-diagnosis psychological change. Core belief examination was found to be a protective factor against any negative effects. Study 4 examined the 'lived experience' of nine head and neck cancer patients who had undergone facial surgical treatment. Using Interpretative Phenomenological Analysis, this study explored participants' journey of coping with a range of stigmas, how they were able to find meaning, and the unique growth that developed from their experiences. Findings of the four studies contribute to cancer-related stigma literature and provides evidence for the ways in which stigma contributes to positive and negative changes among cancer patients. The discussion considers how this program of research augments our understanding of cancer-related stigma, from both community and cancer patients' perspective. Using both quantitative and qualitative methodology, the research demonstrated how stigma can have deleterious consequences, but also how some patients have used their stigmatising experience to promote positive change. Finally, this program of research proposes areas for future research and promising implications for clinical practice in relation to stigma and posttraumatic growth