A phenomenological investigation of the experience of taking part in 'Extreme Sports'

This article is concerned with what it may mean to individuals to engage in practices that are physically challenging and risky. The article questions the assumptions that psychological health is commensurate with maintaining physical safety, and that risking one's health and physical safety is necessarily a sign of psychopathology. The research was based upon semi-structured interviews with eight extreme sport practitioners. The interviews were analysed using Colaizzi's version of the phenomenological method. The article explicates the themes identified in the analysis, and discusses their implications for health psychology theory and practice

Developing and evaluating JIApp: Acceptability and usability of a smartphone app system to improve self-management in young people with juvenile idiopathic arthritis

Background: Flare-ups in juvenile idiopathic arthritis (JIA) are characterized by joint pain and swelling and often accompanied with fatigue, negative emotions, and reduced participation in activities. To minimize the impact of JIA on the physical and psychosocial development and well-being of young people (YP), it is essential to regularly monitor disease activity and side effects, as well as to support self-management such as adherence to treatment plans and engagement in general health-promoting behaviors. Smartphone technology has the potential to engage YP with their health care through convenient self-monitoring and easy access to information. In addition, having a more accurate summary of self-reported fluctuations in symptoms, behaviors, and psychosocial problems can help both YP and health care professionals (HCPs) better understand the patient’s condition, identify barriers to self-management, and assess treatment effectiveness and additional health care needs. No comprehensive smartphone app has yet been developed in collaboration with YP with JIA, their parents, and HCPs involved in their care. Objectives: The objective of this study was to design, develop, and evaluate the acceptability and usability of JIApp, a self-management smartphone app system for YP with JIA and HCPs. Methods: We used a qualitative, user-centered design approach involving YP, parents, and HCPs from the rheumatology team. The study was conducted in three phases: (1) phase I focused on developing consensus on the features, content, and design of the app; (2) phase II was used for further refining and evaluating the app prototype; and (3) phase III focused on usability testing of the app. The interview transcripts were analyzed using qualitative content analysis. Results: A total of 29 YP (aged 10-23, median age 17) with JIA, 7 parents, and 21 HCPs were interviewed. Major themes identified as the ones that helped inform app development in phase I were: (1) remote monitoring of symptoms, well-being, and activities; (2) treatment adherence; and (3) education and support. During phase II, three more themes emerged that informed further refinement of the app prototype. These included (4) adapting a reward system to motivate end users for using the app; (5) design of the app interface; and (6) clinical practice integration. The usability testing during phase III demonstrated high rates of overall satisfaction and further affirmed the content validity of the app. Conclusions: We present the development and evaluation of a smartphone app to encourage self-management and engagement with health care for YP with JIA. The app was found to have high levels of acceptability and usability among YP and HCPs and has the potential to improve health care and outcomes for this age group. Future feasibility testing in a prospective study will firmly establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with arthritis

Resistance gene expression determines the in vitro chemosensitivity of non-small cell lung cancer (NSCLC)

Background NSCLC exhibits considerable heterogeneity in its sensitivity to chemotherapy and similar heterogeneity is noted in vitro in a variety of model systems. This study has tested the hypothesis that the molecular basis of the observed in vitro chemosensitivity of NSCLC lies within the known resistance mechanisms inherent to these patients' tumors. Methods The chemosensitivity of a series of 49 NSCLC tumors was assessed using the ATP-based tumor chemosensitivity assay (ATP-TCA) and compared with quantitative expression of resistance genes measured by RT-PCR in a Taqman Array™ following extraction of RNA from formalin-fixed paraffin-embedded (FFPE) tissue. Results There was considerable heterogeneity between tumors within the ATP-TCA, and while this showed no direct correlation with individual gene expression, there was strong correlation of multi-gene signatures for many of the single agents and combinations tested. For instance, docetaxel activity showed some dependence on the expression of drug pumps, while cisplatin activity showed some dependence on DNA repair enzyme expression. Activity of both drugs was influenced more strongly still by the expression of anti- and pro-apoptotic genes by the tumor for both docetaxel and cisplatin. The doublet combinations of cisplatin with gemcitabine and cisplatin with docetaxel showed gene expression signatures incorporating resistance mechanisms for both agents. Conclusion Genes predicted to be involved in known mechanisms drug sensitivity and resistance correlate well with in vitro chemosensitivity and may allow the definition of predictive signatures to guide individualized chemotherapy in lung cancer

Offers of assistance in politician–constituent interaction

This paper was accepted in the journal Discourse Studies [© Sage] and the definitive version is available at http:dx.doi.org/10.1177/1461445615602376How do politicians engage with and offer to assist their constituents; the people who vote them into power? We address the question by analyzing a corpus of 80 interactions recorded at the office of a Member of Parliament (MP) in the United Kingdom, and comprising telephone calls between constituents and the MP’s clerical ‘caseworkers’ as well as face to face encounters with MPs in their fortnightly ‘surgeries’. The data were transcribed, then analysed using conversation analysis, focusing on the design and placement of offers of assistance. We identified three types of offers within a longer ‘offering’ sequence: 1) ‘proposal offers’, which typically appear first in any offering sequence, in which politicians and caseworkers make proposals to help their constituents using formats that request permission to do so, or check that the constituent does indeed want help (e.g., “do you want me to”; “we could…”); 2) ‘announcement offers’, which appear second, and indicate that something has been decided and confirm the intention to act (e.g., “I will do X”), and 3) ‘request offers’, which appear third, and take for form “let me do X”. Request offers indicate that the offer is available but cannot be completed until the current conversation is closed; they also appear in environments in which the constituent reissues their problems and appears dissatisfied with the offers so far. The paper contributes to what we know about making offers in institutional settings, as well as shedding the first empirical light on the workings of the constituency office: the site of engagement between everyday members of the public and their elected representatives

Occupational exposure to anti-cancer drugs: A review of effects of new technology.

Because anti-cancer drugs are non-selective, they affect both cancerous and non-cancerous cells. Being carcinogenic and mutagenic, many anticancer drugs therefore present a major health risk to healthcare staff working with them. This paper reviews the means by which exposure to anti-cancer drugs in the workplace may be monitored, assessed and reduced. Both biological monitoring, using non-selective methods or compound-selective methods, and environmental monitoring have provided information on the nature and degree of exposure in the workplace. Pharmaceutical isolators, used for the compounding of cytotoxic IV infusions and the preparation of injectable drugs, provide a physical barrier between pharmacists and cytotoxic drugs and reduce direct exposure. However, the interior of isolators and the contents thereof (e.g. infusion bags and syringes) are readily contaminated by aerosols and spillages and afford a secondary source of exposure to pharmacists, nurses and cleaning staff. Closed system transfer devices (CSTDs), designed to prohibit the transfer of contaminants into the working environment during drug transfer between the vial and syringe, have been successful in further reducing, but not eliminating surface contamination. Given that the number of patients requiring treatment with chemotherapeutic agents is predicted to increase, further efforts to reduce occupational exposure to anti-cancer drugs, including the refinement and wider use of CTSDs, are recommended