Unmet need for healthcare services in adolescents and young adults with cancer and their parent carers.

Science.gov (United States)

Sawyer, Susan M; McNeil, Robyn; McCarthy, Maria; Orme, Lisa; Thompson, Kate; Drew, Sarah; Dunt, David

2017-07-01

Cancer in adolescents in and young adults (AYA) has the potential to disrupt health, well-being and developmental trajectories. This study aimed to describe the healthcare support service needs of AYAs with cancer and parent carers and to explore the association of unmet need and emotional distress. As part of a national Australian survey of 15-25 year olds with cancer and a nominated parent carer, 196 AYAs reported total and unmet need for 10 clinical services and 204 parents reported on their child's and their own healthcare service needs. Proportions of total and unmet need for specific clinical services are reported. The association of unmet service needs and distress (measured using the Posttraumatic Stress Disorder Checklist) was also examined. AYAs and parent carers expressed high total need for clinical services during treatment. Leading AYA unmet needs were for an exercise therapist (37%), genetic counsellor (30%), dietitian (26%), peer support group (26%) and educational and vocational advisor (24%). After treatment, AYAs and parents had fewer total needs. However, 60% of AYA and 38% of parents had two or more unmet needs, similar to during treatment. Female gender and receiving treatment in an adult setting were significantly associated with unmet need for clinical services. After treatment, higher distress levels in AYAs and parents were associated with two or more unmet service needs. AYAs and parents had high levels of total and unmet service need, which were associated with greater emotional distress. These results highlight opportunities to re-orientate services to better meet AYA and parent needs.

Experiences and preferences for end of life care for young adults with cancer and their informal carers: a narrative synthesis

OpenAIRE

Ngwenya, N; Kenten, C; Jones, L; Gibson, Faith; Pearce, S; Flatley, M; Hough, R; Stirling, LC; Taylor, R; Wong, G; Whelan, J

2017-01-01

Purpose To review the qualitative literature on experiences of and preferences for end of life care of people with cancer aged 16-40 years (young adults) and their informal carers. Methods A systematic review using narrative synthesis of qualitative studies using the 2006 UK Economic and Social Research Council research methods programme guidance. Seven electronic bibliographic databases, two clinical trials databases, and three relevant theses databases were searched from January 2004 to Oct...

The importance of respite in everyday life of young carers

DEFF Research Database (Denmark)

Jørgensen, Sanne Ellegaard; Michelsen, Susan Ishøy; Due, Pernille

carers' well-being. Material and methods: The analysis will be based on data from a large representative survey among Danish 13-19 year olds, conducted in October 2016. Data will be collected by electronic questionnaires completed during a school lesson. Serious parental illness will be measured by self...

Balancing satisfaction and stress: carer burden among White and British Asian Indian carers of stroke survivors.

Science.gov (United States)

Katbamna, Savita; Manning, Lisa; Mistri, Amit; Johnson, Mark; Robinson, Thompson

2017-08-01

This paper presents the findings of a qualitative study exploring White and British Indian informal stroke carers' experiences of caring, factors contributing to their stress, and strategies used to overcome stress. A qualitative approach involving in-depth interviews was used to explore informal carers' experiences of caring for stroke survivors and the stress of caring at one and three to six months from the onset of stroke. Interviewers bilingual in English and Gujarati or Punjabi conducted interviews with carers. Socio-demographic data of carers and stroke survivors were collected at one, and three to six months by dedicated stroke research nurses. A total of 37 interviews with carers caring for stroke survivors with a wide range of physical and mental impairments were completed. A majority of carers had assumed the task of caring within a few weeks of the stroke. Irrespective of ethnicity, carers' emotional and physical well-being was undermined by the uncertainty and unpredictability of caring for stroke survivors, and meeting their expectations and needs. The strain of managing social obligations to care was common to all carers irrespective of gender and ethnicity, but the higher levels of anxiety and depression reported by Indian British female carers appeared to stem from the carers' pre-existing physical ailments, their cultural and religious beliefs, and household arrangements. Carers' strain in extended households was exacerbated by the additional responsibility of caring for other dependent relatives. Since the role of carers is clearly indispensable in the successful rehabilitation of survivors, it is vital to ensure that their well-being is not undermined by a lack of information and training, and that their need for professional support is prioritised.

Using Multimedia to Reveal the Hidden Code of Everyday Behaviour to Children with Autistic Spectrum Disorders (ASDs)

Science.gov (United States)

Doyle, Theresa; Arnedillo-Sanchez, Inmaculada

2011-01-01

This paper describes a framework which was developed for carers (teachers and parents) to help them create personalised social stories for children with autistic spectrum disorders (ASDs). It explores the social challenges experienced by individuals with ASDs and outlines an intervention aimed at revealing the hidden code that underpins social…

Yoga for carers of addicted patients: a carer's self-report | George ...

African Journals Online (AJOL)

Caring for those addicted to drugs and/or alcohol can adversely affect carers and this can manifest as stress, anxiety, depression, insomnia, substance misuse and a range of physical health problems. In most health care settings, be it primary care or secondary care, more often than not carers' needs go undetected and ...

Telepsychiatry and carer education for schizophrenia.

LENUS (Irish Health Repository)

Haley, C

2011-01-01

Despite the scientific evidence, most families of people with schizophrenia in Europe never receive a carer education programme. We evaluated whether a carer education course delivered by telepsychiatry was as effective as a carer education course delivered in situ.

Effect of Perceived Stigmatisation on the Quality of Life among Ageing Female Family Carers: A Comparison of Carers of Adults with Intellectual Disability and Carers of Adults with Mental Illness

Science.gov (United States)

Chou, Y. C.; Pu, C. Y.; Lee, Y. C.; Lin, L. C.; Kroger, T.

2009-01-01

Background: Little account has been taken of quality of life (QoL) among family carers of adults with an intellectual disability (ID) and family carers of adults with a mental illness (MI), particularly the female ageing carers' perceived stigma. We explore whether there are differences in the significant predictors of female ageing family carers'…

Death from cancer at home: the carers' perspective.

Science.gov (United States)

Jones, R V; Hansford, J; Fiske, J

1993-01-23

To collect information from principal carers of people who had died at home with cancer; to identify areas of support which need improvement. Semistructured interviews with carers two to four months after the death. 38 general practices in the Exeter, Torbay, and Plymouth health districts. 207 carers. Services received by carers and quality of support. 161 of 207 patients were aged 60 or over. 88 carers were aged under 60, 110 were 60-80, and 9 were > 80. Carers had difficulty in getting urgent professional help in only 15 out of 177 cases. 124 carers were not given advice on financial help and 174 were not told of support available from local charities. Although pain was well controlled, 25% of patients had no relief of other symptoms. Overall, 150 carers considered the support excellent, 45 good, 8 moderate, 2 poor, and 2 had no comment. Although care has improved in recent years, health professionals need to give carers more advice about help available outside health services. Domestic help was often needed earlier. Better appreciation of carers' problems is needed.

General practitioners and carers: a questionnaire survey of attitudes, awareness of issues, barriers and enablers to provision of services

Directory of Open Access Journals (Sweden)

Atkins Christine

2010-12-01

Full Text Available Abstract Background Approximately one in ten of the UK population are unpaid carers supporting a family member or friend who could not manage without their help, saving the UK economy an estimated £87 billion. This role is known to sometimes have a negative impact on carers and to require support both informally and from statutory services. General practice is a first point of contact for carers but research investigating general practitioners' (GPs' attitudes towards carers and awareness of issues facing carers is rare. This study therefore aimed to identify GPs' attitudes, awareness of issues, and perceptions of the barriers and enablers to provision of services. Methods Using a self-completion questionnaire distributed at a series of workshops, this study investigates GPs' attitudes to carers; awareness and knowledge of carers' issues; services offered in general practice and barriers to supporting carers. Results Seventy eight out of a total of 95 GPs (82% response rate from a variety of areas in England completed the questionnaires. The GPs identified time, resources and lack of knowledge as barriers, but only 9% agreed with the statement that there is little support they can offer carers. However, nine in ten GPs (89% feel they have insufficient training here and approximately half of them (47% lack confidence that they are meeting carers' needs. Confidence in identifying carers is also low (45%. Issues that GPs would look out for amongst carers include emotional and physical health problems and financial and isolation difficulties. GPs specifically highlighted educational and isolation issues for young carers. Few services were described that targeted carers. Conclusions GPs recognise that they have an important role to play in supporting carers but would like training and support. Further investigation is needed both to determine how best to train and facilitate GPs and general practice teams in their role in supporting carers and to

Young Money

DEFF Research Database (Denmark)

Roelsgaard Obling, Anne

2015-01-01

Book review of: Kevin Roose: "Young Money: Inside the Hidden World of Wall Street's Post-Crash Recruits". New York: Grand Central Publishing, 2014. 320 pp.......Book review of: Kevin Roose: "Young Money: Inside the Hidden World of Wall Street's Post-Crash Recruits". New York: Grand Central Publishing, 2014. 320 pp....

[Information needs of physicians, professional carers and family carers for an evidence-based dementia website].

Science.gov (United States)

Komarahadi, Fely L; Ruf, Daniela; Hüll, Michael; Härter, Martin

2012-01-01

Despite the demographically driven rapid growth of the number of persons with dementia, in Germany a website is lacking that provides evidence based information about the disease, its burden and therapeutic options to family and professional carers as well as physicians. A website was developed with the objective to give free access to evidence based information concerning the disease and care for patients with dementia. In order to meet the expectations of the user groups an analysis of information needs was performed with 80 physicians, 163 professional carers and 104 family carers. All user groups rated information on symptoms, course and treatment of dementia and support for family carers as important topics. Group differences were found for the need to be informed on financial support, daily care and interaction with patients. The contents of the website will be accommodated to the specific needs of the user groups. © Georg Thieme Verlag KG Stuttgart · New York.

The influence of institutional discourses on the work of informal carers: an institutional ethnography from the perspective of informal carers.

Science.gov (United States)

Øydgard, Guro Wisth

2017-09-07

The growing numbers of seniors worldwide and the need for support and services that follow from a higher standard of living have led to an increased focus on scarce benefits and limited human resources. At the same time, many western countries have had to make welfare cuts to balance budgets. This has brought the contributions of informal carers to the fore. Thus far, the focus has generally been on the need for the informal carers to receive information and support; to enable them to contribute. The study is designed as an institutional ethnography. The article describes the social processes of informal caregiving and how it interacts with formal caregiving, from the perspective of informal carers. The research question for the study is How do institutional discourses on the work of informal carers influence informal carework? Data for the article comes from qualitative semi-structured interviews with 26 informal carers caring for persons with dementia in Norway, and with 7 administrators working in the allocation divisions of five different municipalities. The results demonstrate how three institutional discourses of informal carers' work influence the allocation divisions' practices and the work of informal carers in caring for their next of kin. The three discourses are categorised as moral and family obligation, shared care and task specificity. The informal carers want to contribute, as they feel a family and moral obligation to their next of kin. In the interaction with the allocation division, they find that the expectation that they will share in the carework and perform specific tasks forces them to perform care within a framework set by the public services. The findings suggest that further research should challenge how services are distributed and allocated rather than focus on how to enable informal carers to fulfil their role better. Because of their moral and family obligation, the informal carers do not have to be forced to perform certain tasks or

An emotive subject: insights from social, voluntary and healthcare professionals into the feelings of family carers for people with mental health problems.

Science.gov (United States)

Gray, Ben; Robinson, Catherine A; Seddon, Diane; Roberts, Angela

2009-03-01

Caring for people with mental health problems can generate a whole range of positive and negative emotions, including fear, disbelief, guilt and chaos as well as a sense of purpose, pride and achievement. This paper explores the emotions of family carers from the perspectives of social, voluntary and healthcare professionals. Sixty-five participants were interviewed, the sample included directors, managers and senior staff from social, voluntary and healthcare organisations. Participants were encouraged to talk in detail about their understanding of the emotions of family carers. Findings highlight a rich understanding of the broad spectrum of carer emotions and the huge emotional adjustments that are often involved. Diagnosis was seen to be imbued with negative emotions, such as fear, anger and denial. However, feelings of hopelessness and desolation were often counterbalanced by feelings of hope, satisfaction and the emotional rewards of caring for a loved one. Participants noted a clear lack of emotional support for family carers, with accompanying feelings of marginalisation, particularly during transitions and especially involving young carers as well as ethnic minorities. By way of contrast, carer support groups were suggested by professionals to be a holistic, effective and economical way of meeting carers' emotional needs. This paper explores the challenge of family carer emotions from the perspective of managers and practitioners and draws out implications for research, policy and practice.

Social exclusion in adult informal carers: A systematic narrative review of the experiences of informal carers of people with dementia and mental illness.

Science.gov (United States)

Greenwood, Nan; Mezey, Gillian; Smith, Raymond

2018-06-01

Social exclusion has a negative impact on quality of life. People living with dementia or mental health disorders as well as informal carers have been separately described as socially excluded. The objective of this systematic narrative review was to examine the extent to which social exclusion experienced by adult informal carers of people living with dementia or severe mental health disorders has been identified and described in research literature. It synthesised qualitative and quantitative evidence and included the perspectives of carers themselves and of professionals. Eight electronic databases (1997-2017) were searched. Five relevant studies published between 2010 and 2016 were identified. All were qualitative and used interviews and focus groups. Study quality was variable and most were European. Two focused on carers of people living with dementia and three on carers of people with mental health disorders. Four investigated carers' perspectives and experiences of social exclusion directly (total of 137 carer participants, predominantly parents, spouses and adult children), while the fifth focused on the perceptions of 65 participants working in health and social care. Stigma, financial difficulties and social isolation were highlighted in four studies and the challenges for carers in engaging in leisure activities were described in the fifth. Most conceptualised social exclusion as a form of stigma, or as resulting from stigma. One presented social exclusion as an element of carer burden. Two explicitly discussed the negative effects of social exclusion on carers. The dearth of research and the lack of specificity about social exclusion in carers was surprising. Future research should investigate aspects of social exclusion that may adversely affect carer wellbeing. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Do patients and carers agree on symptom burden in advanced COPD?

Science.gov (United States)

Mi, Emma; Mi, Ella; Ewing, Gail; White, Patrick; Mahadeva, Ravi; Gardener, A Carole; Farquhar, Morag

2018-01-01

Accurate informal carer assessment of patient symptoms is likely to be valuable for decision making in managing the high symptom burden of COPD in the home setting. Few studies have investigated agreement between patients and carers in COPD. We aimed to assess agreement between patients and carers on symptoms, and factors associated with disagreement in a population-based sample of patients with advanced COPD. This was a prospective, cross-sectional analysis of data from 119 advanced COPD patients and their carers. Patients and carers separately rated symptoms on a 4-point scale. Wilcoxon signed-rank tests and weighted Cohen's kappa determined differences in patient and carer scores and patient-carer agreement, respectively. We identified characteristics associated with incongruence using Spearman's rank correlation and Mann-Whitney U tests. There were no significant differences between group-level patient and carer scores for any symptom. Patient-carer individual-level agreement was moderate for constipation (k=0.423), just below moderate for diarrhea (k=0.393) and fair for depression (k=0.341), fatigue (k=0.294), anxiety (k=0.289) and breathlessness (k=0.210). Estimation of greater patient symptom burden by carers relative to patients themselves was associated with non-spousal patient-carer relationship, non-cohabitating patients and carers, carer symptoms of anxiety and depression and more carer unmet support needs. Greater symptom burden estimation by the patient relative to the carer was associated with younger patients and longer duration of COPD. Overall, agreement between patients and carers was fair to moderate and was poorer for more subjective symptoms. There is a need to encourage open dialogue between patients and carers to promote shared understanding, help patients express themselves and encourage carers to draw attention to symptoms that patients do not report. The findings suggest a need to screen for and address both the psychological morbidities

Do patients and carers agree on symptom burden in advanced COPD?

Directory of Open Access Journals (Sweden)

Mi E

2018-03-01

Full Text Available Emma Mi,1 Ella Mi,1 Gail Ewing,2 Patrick White,3 Ravi Mahadeva,4 A Carole Gardener,5 Morag Farquhar6 On behalf of the Living with Breathlessness Study Team 1School of Clinical Medicine, 2Centre for Family Research, University of Cambridge, Cambridge, 3Primary Care and Public Health Sciences, King’s College London, London, 4Department of Respiratory Medicine, Cambridge NIHR BRC, Addenbrookes Hospital, 5Department of Public Health and Primary Care, University of Cambridge, Cambridge, 6School of Health Sciences, University of East Anglia, Norwich, UK Objective: Accurate informal carer assessment of patient symptoms is likely to be valuable for decision making in managing the high symptom burden of COPD in the home setting. Few studies have investigated agreement between patients and carers in COPD. We aimed to assess agreement between patients and carers on symptoms, and factors associated with disagreement in a population-based sample of patients with advanced COPD. Patients and methods: This was a prospective, cross-sectional analysis of data from 119 advanced COPD patients and their carers. Patients and carers separately rated symptoms on a 4-point scale. Wilcoxon signed-rank tests and weighted Cohen’s kappa determined differences in patient and carer scores and patient–carer agreement, respectively. We identified characteristics associated with incongruence using Spearman’s rank correlation and Mann–Whitney U tests. Results: There were no significant differences between group-level patient and carer scores for any symptom. Patient–carer individual-level agreement was moderate for constipation (k=0.423, just below moderate for diarrhea (k=0.393 and fair for depression (k=0.341, fatigue (k=0.294, anxiety (k=0.289 and breathlessness (k=0.210. Estimation of greater patient symptom burden by carers relative to patients themselves was associated with non-spousal patient–carer relationship, non-cohabitating patients and carers, carer

Gaining consensus on family carer needs when caring for someone dying at home to develop the Carers' Alert Thermometer (CAT): a modified Delphi study.

Science.gov (United States)

Knighting, Katherine; O'Brien, Mary R; Roe, Brenda; Gandy, Rob; Lloyd-Williams, Mari; Nolan, Mike; Jack, Barbara A

2016-01-01

To report a multi-phase modified Delphi study conducted with carers and professionals to identify the priority areas for inclusion in an alert screening tool for carers providing support to someone dying at home. Internationally, there is a growing emphasis on increasing choice for patients who wish to die at home which relies heavily on care provided by the unpaid family carers. Family carers can have high levels of unmet needs comprising their psychological and physical health and their ability to provide effective care and support. Development of an alert tool to identify carers' needs in everyday practice required identification and consensus of the priority areas of need for inclusion. Multi-phase modified Delphi study and instrument development. Qualitative and quantitative data collection took place between 2011-2013 with 111 carers and 93 professionals to identify carers' needs and gain consensus on the priority areas for inclusion in the alert tool. An expert panel stage and final evidence review post-Delphi were used. The Delphi panels had high levels of agreement and consensus. Ten areas of carer need across two themes of 'the current caring situation' and 'the carer's own health and well-being' were prioritized for inclusion in the alert tool. An optional end-of-life planning question was included following the final stages. The results provide evidence of carers' needs to be assessed, areas for consideration in the education of those who support carers and someone dying at home and targeting of services, while demonstrating the usefulness and adaptability of the Delphi method. © 2015 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Depressive symptoms in older female carers of adults with intellectual disabilities.

Science.gov (United States)

Chou, Y C; Pu, C-Y; Fu, L-Y; Kröger, T

2010-12-01

This survey study aims to examine the prevalence and factors associated with depressive symptoms among primary older female family carers of adults with intellectual disabilities (ID). In total, 350 female family carers aged 55 and older took part and completed the interview in their homes. The survey package contained standardised scales to assess carer self-reported depressive symptoms, social support, caregiving burden and disease and health, as well as adult and carer sociodemographic information. Multiple linear regressions were used to identify the factors associated with high depressive symptoms in carers. Between 64% and 72% of these carers were classified as having high depressive symptoms. The factors associated with carer self-reported depressive symptoms were carer physical health, social support and caregiving burden; overall, the carer self-reported physical health was a stronger factor associated with depressive symptoms than their physical disease status. The level of the adult with ID's behavioural functioning and the carer age, marital status, employment status, education level and the family income level were not significantly associated with carer depressive symptoms. The factors identified in this study as correlating with self-reported depressive symptoms suggest that researchers and mental health professionals should collaborate to help improve the physical health and social support networks of the most vulnerable older female family carers. This should reduce depressive symptoms directly among this high-risk group. © 2010 The Authors. Journal of Intellectual Disability Research © 2010 Blackwell Publishing Ltd.

Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review.

Directory of Open Access Journals (Sweden)

Anam Parand

Full Text Available Medications are mostly taken in patients' own homes, increasingly administered by carers, yet studies of medication safety have been largely conducted in the hospital setting. We aimed to review studies of how carers cause and/or prevent medication administration errors (MAEs within the patient's home; to identify types, prevalence and causes of these MAEs and any interventions to prevent them.A narrative systematic review of literature published between 1 Jan 1946 and 23 Sep 2013 was carried out across the databases EMBASE, MEDLINE, PSYCHINFO, COCHRANE and CINAHL. Empirical studies were included where carers were responsible for preventing/causing MAEs in the home and standardised tools used for data extraction and quality assessment.Thirty-six papers met the criteria for narrative review, 33 of which included parents caring for children, two predominantly comprised adult children and spouses caring for older parents/partners, and one focused on paid carers mostly looking after older adults. The carer administration error rate ranged from 1.9 to 33% of medications administered and from 12 to 92.7% of carers administering medication. These included dosage errors, omitted administration, wrong medication and wrong time or route of administration. Contributory factors included individual carer factors (e.g. carer age, environmental factors (e.g. storage, medication factors (e.g. number of medicines, prescription communication factors (e.g. comprehensibility of instructions, psychosocial factors (e.g. carer-to-carer communication, and care-recipient factors (e.g. recipient age. The few interventions effective in preventing MAEs involved carer training and tailored equipment.This review shows that home medication administration errors made by carers are a potentially serious patient safety issue. Carers made similar errors to those made by professionals in other contexts and a wide variety of contributory factors were identified. The home care

Hidden Markov model tracking of continuous gravitational waves from young supernova remnants

Science.gov (United States)

Sun, L.; Melatos, A.; Suvorova, S.; Moran, W.; Evans, R. J.

2018-02-01

Searches for persistent gravitational radiation from nonpulsating neutron stars in young supernova remnants are computationally challenging because of rapid stellar braking. We describe a practical, efficient, semicoherent search based on a hidden Markov model tracking scheme, solved by the Viterbi algorithm, combined with a maximum likelihood matched filter, the F statistic. The scheme is well suited to analyzing data from advanced detectors like the Advanced Laser Interferometer Gravitational Wave Observatory (Advanced LIGO). It can track rapid phase evolution from secular stellar braking and stochastic timing noise torques simultaneously without searching second- and higher-order derivatives of the signal frequency, providing an economical alternative to stack-slide-based semicoherent algorithms. One implementation tracks the signal frequency alone. A second implementation tracks the signal frequency and its first time derivative. It improves the sensitivity by a factor of a few upon the first implementation, but the cost increases by 2 to 3 orders of magnitude.

Intelligent assistant carer for active aging

Science.gov (United States)

Bizjak, Jani; Gradišek, Anton; Stepančič, Luka; Gjoreski, Hristijan; Gams, Matjaž

2017-12-01

We present the concept of an Intelligent Assistant Carer system for the elderly, designed to help with active aging and to facilitate the interactions with carers. The system is modular, allowing the users to choose the appropriate functions according to their needs, and is built on an open platform in order to make it compatible with third-party products and services. Currently, the system consists of a wearable device (a smartwatch) and an internet portal that manages the data and takes care of the interactions between the user, the carers, and the support services. We present in detail one of the modules, i.e., fall detection, and the results of a pilot study for the system on 150 users over the course of 3 months.

Ambiguity in practice? Carers' roles in personalised social care in England.

Science.gov (United States)

Glendinning, Caroline; Mitchell, Wendy; Brooks, Jenni

2015-01-01

Carers play an ambiguous role within the personalisation paradigm currently shaping adult social care practice in England. Although carers have rights to assessments and support in their own right, these rights sit uneasily alongside the practices of assessment, support planning and personal budget (PB) allocation for older and disabled people. This paper reports how 14 dyads of older and learning disabled people with cognitive and/or communication impairments and their carers viewed the roles - desired and actual - played by carers in PBs. Interviews with carers and with older and disabled people were conducted during 2012 as part of a wider study into carers' roles in assessment, support planning and managing PBs. The interviews complemented a survey of reported practice in two English regions - interviews with adult social care services senior managers and focus groups with front-line care managers. Talking Mats(©) were used to support interviews with some service users. Interviews were transcribed and data analysed using the Framework approach. The interviews indicated that carers played important roles in service users' assessments and support planning, but were less likely to report receiving assessments or support of their own. While carers had the potential to benefit from PBs and support arrangements for service users, this did not reflect practice that aimed to enhance choice and control for carers. The paper draws on Twigg's typology of service conceptualisations of family carers and concludes that, despite the important social rights won by carers in England, current practice continues to regard carers primarily as a resource or a co-worker, rather than a co-client. © 2014 John Wiley & Sons Ltd.

Enabling the health and wellbeing of carers through district nursing support.

Science.gov (United States)

Laing, Michelle; Sprung, Sally

2014-07-01

Carers provide care because they want to help the people they care about, and because their care recipient could not manage without them. For many carers, looking after their own health, combining caring with work, getting access to training or having time off can be a major challenge. Patients' and carers' experiences of home-based care are a key factor in the appraisal of the quality of the professional care services they receive. This article presents the evidence from a literature review that builds a substantial body of knowledge to inform district nursing teams and community nurses to develop a supportive approach towards carers' needs. The aim of the study was to appraise the published evidence base relating to carers' needs and how professionals can support carers' needs when providing care to patients in the community. The studies consistently reported carers' requirements of practical support and information as a theme across studies, suggesting that effective ways of delivering information and support to caregivers need to be developed and implemented as a matter of priority. It also highlighted the needs of the professionals providing support to carers, to ensure the health and wellbeing needs of carers, to include signposting and referral to avoid reaching crisis point and resultant burnout.

Patients' and carers' perception of needs in a Polish sample.

Science.gov (United States)

Cialkowska-Kuzminska, Magdalena; Misiak, Blazej; Kiejna, Andrzej

2014-03-01

The assessment of patients' needs is an essential element of psychiatric health care planning and evaluation. Not much interest has been paid to the study of psychiatric patients' needs in Poland so far. To assess the relation between inpatients' and their key carers' perception of needs in a Polish sample. Out of 324 inpatients invited to take part in the study, 60 sets were finally included. Patients and their carers were examined by means of CANSAS to rate patients' and carers' perception of needs. The mean number of general needs indicated by patients themselves was 7.11 (± 2.98), and those indicated by carers equalled 9.53 (± 3.92). The more unmet needs identified by the patient, the more met and general needs of the patient identified by their carer (r = .27, p = .03; r = .38, p = .02, respectively). The more general needs perceived by the patient themself, the higher the indicator of unmet and general needs scored by their carer (r = .32, p = .01; r = .39, p = .001, respectively). There is a significant association between the inpatients' and their carers' perception of needs. Patients' perspective should serve as a high priority in developing treatment plans.

User-friendly technology to help family carers cope.

Science.gov (United States)

Chambers, Mary; Connor, Samantha L

2002-12-01

Increases in the older adult population are occurring simultaneously with a growth in new technology. Modern technology presents an opportunity to enhance the quality of life and independence of older people and their family carers through communication and access to health care information. To evaluate the usability of a multimedia software application designed to provide family carers of the elderly or disabled with information, advice and psychological support to increase their coping capacity. The interactive application consisted of an information-based package that provided carers with advice on the promotion of psychological health, including relaxation and other coping strategies. The software application also included a carer self-assessment instrument, designed to provide both family and professional carers with information to assess how family carers were coping with their care-giving role. Usability evaluation was carried out in two stages. In the first stage (verification), user trials and an evaluation questionnaire were used to refine and develop the content and usability of the multimedia software application. In the second (demonstration), stage evaluation questionnaires were used to appraise the usability of the modified software application. The findings evidenced that the majority of users found the software to be usable and informative. Some areas were highlighted for improvement in the navigation of the software. The authors conclude that with further refinement, the software application has the potential to offer information and support to those who are caring for the elderly and disabled at home.

[Carers and the policy for autonomy].

Science.gov (United States)

Naiditch, Michel

2016-03-01

Long-time invisible, the role of informal carers in providing assistance to elderly patients losing their autonomy is gaining recognition. A policy in favour of carers coordinated with that aimed at the people being cared for is necessary, but it is struggling to establish itself in France. Some progress can however be seen with the French bill on adapting society to the ageing of the population. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

'It's the system working for the system': carers' experiences of learning disability services in Ireland.

Science.gov (United States)

Power, Andrew

2009-02-01

The aim of this article is to examine the experiences of families with young adults with learning disabilities trying to access services. The landscape of disability services for this group is made up of day care, special vocational training and respite places. It aims to identify the extent of an implementation gap between government rhetoric and the degree to which services are characterised as being non-supportive interactions on the ground. Using Ireland as a case study, during a time when the economy is booming and government rhetoric claims unparalleled developments in allocating resources and extra respite 'places', this article identifies the main challenges faced by family carers associated with accessing appropriate services for their disabled adult child, in their attempt to achieve greater independence. This article reports the findings of a qualitative study in which individual semistructured interviews were held with family carers (n = 25) and representatives from national carer organisations (n = 6) in Ireland. These were people caring for an adult (18-30 years) with a learning disability and their experiences were also useful in cross-checking the carer organisation interviews. The findings show that there is limited flexibility, choice and availability in meeting the preferences of the service-users, and throughout the study, services were characterised as being non-supportive interactions. This is not simply symptomatic of a lack of resources. Despite improved funding, supportive attitudes and flexibility are still crucial in meeting user requirements at the level of delivery; thus highlighting that often the system works for the system, not for the user.

Humor-A Rehabilitative Tool in the Post-Intensive Care of Young Adults With Acquired Brain Injury.

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O'Reilly, Kate

The aim of the study was to describe how paid carers use humor in providing compassionate post-intensive rehabilitation care to young adults with acquired brain injury (ABI) who are unable to perform or direct their own care. This is a qualitative study underpinned by symbolic interactionism. Paid carers in a residential aged care facility were interviewed. Interview data were analyzed using grounded theory methods of coding, comparative analysis, memoing, and theoretical sampling. With young adult's assent, paid carers appropriately used humor, at times even crude humor, as a rehabilitative tool to activate and elicit responses from young people with ABI who could not perform or direct their own care. The use of humor while caring for this population demonstrated that compassion still exists within nursing; however, it may not always be reverent. Humor may be an effective way to provide compassionate care and can be used as a rehabilitative tool to elicit responses from young people with ABI who have no means of verbal communication.

Understanding the experience of "burnout" in first-episode psychosis carers.

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Onwumere, Juliana; Sirykaite, Sandra; Schulz, Joerg; Man, Emma; James, Gareth; Afsharzadegan, Roya; Khan, Sanna; Harvey, Raythe; Souray, Jonathan; Raune, David

2018-05-01

The first onset of psychosis can exert a significant negative impact on the functioning and positive wellbeing of family carers. Carer reports of "burnout" have recently been recorded in early psychosis carers, though the literature is scarce detailing our understanding of how burnout relates to the primary experience of caregiving. The current study investigated reports of burnout and its relationship with beliefs about caregiving and wellbeing in a large group of early psychosis carers who were routinely assessed within an early intervention team. Using a cross-sectional design, 169 early psychosis carers completed the Maslach Burnout Inventory alongside measures of caregiving experiences, affect and wellbeing. The mean illness length for patients with psychosis was 18 months. Their mean age was 24.4 years and most was male (65%). The majority of carer participants were parental caregivers and living with their relative with psychosis. Across the three key burnout dimensions, 58% of the sample reported high levels of emotional exhaustion; 31% endorsed high levels of depersonalization; and 43% reported low levels personal accomplishment. The most severe level of burnout, reflecting elevated rates across all three dimensions, was observed in 16% of the sample. Carer burnout was positively associated with negative caregiving experiences (i.e. burden), poor affect, and reduced levels of positive wellbeing and perception of being in good health. Reports by early psychosis carers of exhaustion, feeling inadequate and expressing negativity towards the relative they care for is not uncommon and are closely associated with their overall negative appraisals of caregiving. The results underscore the importance of developing targeted interventions during the early phase, which are designed to reduce the development and entrenchment of burnout responses in carers, but to also mitigate its negative sequelae. Copyright © 2018. Published by Elsevier Inc.

The Effectiveness of Paid Services in Supporting Unpaid Carers' Employment in England.

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Pickard, Linda; King, Derek; Brimblecombe, Nicola; Knapp, Martin

2015-07-01

This paper explores the effectiveness of paid services in supporting unpaid carers' employment in England. There is currently a new emphasis in England on 'replacement care', or paid services for the cared-for person, as a means of supporting working carers. The international evidence on the effectiveness of paid services as a means of supporting carers' employment is inconclusive and does not relate specifically to England. The study reported here explores this issue using the 2009/10 Personal Social Services Survey of Adult Carers in England . The study finds a positive association between carers' employment and receipt of paid services by the cared-for person, controlling for covariates. It therefore gives support to the hypothesis that services for the cared-for person are effective in supporting carers' employment. Use of home care and a personal assistant are associated on their own with the employment of both men and women carers, while use of day care and meals-on-wheels are associated specifically with women's employment. Use of short-term breaks are associated with carers' employment when combined with other services. The paper supports the emphasis in English social policy on paid services as a means of supporting working carers, but questions the use of the term 'replacement care' and the emphasis on 'the market'.

Why carers use adult day respite: a mixed method case study.

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Stirling, Christine M; Dwan, Corinna A; McKenzie, Angela R

2014-06-06

We need to improve our understanding of the complex interactions between family carers' emotional relationships with care-recipients and carers use of support services. This study assessed carer's expectations and perceptions of adult day respite services and their commitment to using services. A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation's day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow's hierarchy of needs during analysis. Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow's hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers' use of day respite services.

Associations between the psychological health of patients and carers in advanced COPD

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Mi E

2017-09-01

Full Text Available Ella Mi,1 Emma Mi,1 Gail Ewing,2 Ravi Mahadeva,3 A Carole Gardener,4 Hanne Holt Butcher,4 Sara Booth,5 Morag Farquhar6 On behalf of the Living with Breathlessness Study Team 1School of Clinical Medicine, 2Centre for Family Research, University of Cambridge, 3Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, 4Department of Public Health and Primary Care, Institute of Public Health, 5Department of Oncology, University of Cambridge, Cambridge, 6School of Health Sciences, University of East Anglia, Norwich, UK Objective: Anxiety and depression are highly prevalent in patients with COPD and their informal carers, and associated with numerous risk factors. However, few studies have investigated these in primary care or the link between patient and carer anxiety and depression. We aimed to determine this association and factors associated with anxiety and depression in patients, carers, and both (dyads, in a population-based sample.Materials and methods: This was a prospective, cross-sectional study of 119 advanced COPD patients and their carers. Patient and carer scores ≥8 on the Hospital Anxiety and Depression Scale defined symptoms of anxiety and depression, χ2 tests determined associations between patient and carer symptoms of anxiety/depression, and χ2 and independent t-tests for normally distributed variables (otherwise Mann–Whitney U tests were used to identify other variables significantly associated with these symptoms in the patient or carer. Patient–carer dyads were categorized into four groups relating to the presence of anxious/depressive symptoms in: both patient and carer, patient only, carer only, and neither. Factors associated with dyad symptoms of anxiety/depression were determined with χ2 tests and one-way analysis of variance for normally distributed variables (otherwise Kruskal–Wallis tests.Results: Prevalence of symptoms of anxiety and depression was 46.4% (n=52 and 42.9% (n=48

Supporting frail older people and their family carers at home using information and communication technology: cost analysis.

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Magnusson, Lennart; Hanson, Elizabeth

2005-09-01

This paper describes a cost analysis of a home-based support service for frail older people and their family carers in two municipalities in West Sweden and using information and communication technology. A key challenge facing nurse managers across Europe is an increasingly aged population, combined with reduced numbers of young adults of working age. New solutions are needed to provide quality, cost-effective community care services to frail older people and their family carers. A case study methodology involving five families was used, and included a detailed cost description of the technology-based service compared with usual services. Cost data were collected in June 2002. This work formed part of a larger project exploring the impact of a technology-based service known as, Assisting Carers using Telematics Interventions to meet Older Persons' Needs (ACTION). In addition to cost data, information was gathered on the quality of life of frail older people and their family carers, and the job satisfaction and work methods of nurses and other practitioners based in the community. The cost analysis comprised a description of the family and their caring situation, the perceived benefits of the telematic based support service and an assessment of its impact on the use of other care services. These analyses were carried out with the help of needs assessors who were known to the families, and nurses working in the ACTION call centre. All results were validated by the five participating families. Cost savings were achieved in all cases, and the benefits to older people and their carers were also considerable. As a result of the cost analysis and overall evaluation data, ACTION has been implemented as a mainstream service in the municipalities involved. Researchers, nurses, other practitioners and community care managers can work together with frail older people and their family carers to develop quality, cost-effective support services that reduce demands on staff

In Their Own Words: How Family Carers of People with Dementia Understand Resilience.

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O'Dwyer, Siobhan T; Moyle, Wendy; Taylor, Tara; Creese, Jennifer; Zimmer-Gembeck, Melanie

2017-08-21

There is a growing body of research on resilience in family carers of people with dementia, but carers' voices are noticeably absent from it. The aim of this study was to explore carers' definitions of resilience and their opinions on the factors associated with resilience. Twenty-one in-depth interviews were conducted in Australia with people who were currently, or had previously been, caring for a family member with dementia. Transcripts were analysed thematically and three themes emerged: the presence of resilience, the path to resilience, and characteristics of the resilient carer. Although carers struggled to define resilience, the vast majority considered themselves resilient. Carers identified a range of traits, values, environments, resources, and behaviours associated with resilience, but there was no consensus on the relative importance or causal nature of these factors. Carers also considered resilience to be domain- and context-specific, but did not agree on whether resilience was a trait or a process. These findings highlight both the importance of including carers' voices in resilience research and the limitations of the extant literature. There is much to be done to develop a field of carer resilience research that is theoretically sound, methodologically rigorous, and reflects the lived experience of carers. A model is provided to prompt future research.

Exploring the Care Relationship between Grandparents/Older Carers and Children Infected with HIV in South-Western Uganda: Implications for Care for Both the Children and Their Older Carers

Directory of Open Access Journals (Sweden)

Rwamahe Rutakumwa

2015-02-01

Full Text Available The care of children orphaned by HIV/AIDS in sub-Saharan Africa is often undertaken by grandparents, yet little is known about the care relationship between grandparent and grandchild. Our aim was to examine this relationship to understand the needs and responsibilities of both the HIV positive child and older carer and the nature of the relationship, and to assess the implications for care for the children and the older carers. A qualitative study was conducted with 40 purposively sampled children (13–17 years and their older carers (50 years and above. Participants were recruited from two clinics in south-western Uganda. Up to three semi-structured interviews were held with each participant. Data were analysed using a thematic framework approach. We found that the care relationship was mostly reciprocal: HIV positive children depended on carers for basic and health needs and carers counted on the children for performing tedious household tasks. The relationship was also characterised by challenges, sometimes causing tension between child and carer. We conclude that: (1 interventions targeting HIV positive children need to also address the needs of older carers, and (2 carers and children would benefit from psychosocial support and social protection.

Interventional studies in childhood dystonia do not address the concerns of children and their carers.

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Lumsden, Daniel E; Gimeno, Hortensia; Tustin, Kylee; Kaminska, Margaret; Lin, Jean-Pierre

2015-05-01

This study aimed to determine the main concerns/priorities of the parents and carers of children with dystonia referred to our service and whether medical interventional studies addressed these concerns. Records of children assessed by our service from June 2005-December 2012 were reviewed and expressed parental/carer concerns at initial assessment categorized using the International Classification of Functioning (ICF) Framework. Medline, CINAHL and Embase databases were searched for outcome measures of medical and surgical interventional studies in childhood dystonia. Data was collected from 273 children and young people with dystonia. The most commonly expressed concerns were: pain (104/273, 38.1%); difficulties in delivering activities of daily-living (66/273, 24.2%), difficulties with hand-use (59/273, 21.6%) and seating (41/273, 15.0%). Literature review identified 70 interventional studies, 46 neurosurgical and 24 pharmacological. The majority of neurosurgical studies (34/46) used impairment scales to measure change, with pharmacological studies typically reporting more subjective changes in motor symptoms. Only a minority of studies used assessments or scales capable of objectively addressing the concerns reported by our cohort. Existing interventional studies in childhood dystonia poorly address the main concerns of children with dystonia and their carers, limiting the conclusions which may be drawn as to true impact of these interventions in childhood. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Communication problems between dementia carers and general practitioners: effect on access to community support services.

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Bruce, David G; Paley, Glenys A; Underwood, Peter J; Roberts, David; Steed, Duncan

2002-08-19

To investigate the circumstances that led general practitioners to refer dementia sufferers and their carers to community support services. Qualitative study using semi-structured interviews, carried out between 1 September 1999 and 30 April 2000. 21 live-in carers of patients with dementia referred for the first time to a Western Australian metropolitan Aged Care Assessment Team, and 19 of their referring general practitioners. Most referrals occurred after the carers had been experiencing carer stress, and were precipitated by crisis situations. Carers failed to discuss their difficulties with the referring GP for a variety of reasons, including the belief that they should cope because it was their duty. The doctors found it difficult to know how the carers were coping or when to intervene, and some carers tended to resist their attempts to help. Time constraints were a significant problem for both groups. Attitudinal barriers in both carers of patients with dementia and GPs, combined with time constraints, often lead to inadequate assessment of carer problems. While it is important that strategies to improve communication between carers and GPs are developed, it would be sensible for GPs to assume that dementia carers are at risk of carer stress and should be encouraged to use community care services.

Physical health and mental illness: listening to the voice of carers.

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Happell, Brenda; Wilson, Karen; Platania-Phung, Chris; Stanton, Robert

2017-04-01

Shortened life expectancy of people with mental illness is now widely known and the focus of research and policy activity. To date, research has primarily reflected perspectives of health professionals with limited attention to the views and opinions of those most closely affected. The voice of carers is particularly minimal, despite policy stipulating carer participation is required for mental health services. To present views and opinions of carers regarding physical health of the people they care for. Qualitative exploratory. Two focus groups and one individual interview were conducted with 13 people identifying as carers of a person with mental illness. Research was conducted in the Australian Capital Territory. Data analysis was based on the thematic framework of Braun and Clarke. Two main themes were interaction between physical and mental health; and, carers' own physical and mental health. Participants described the impact of mental illness and its treatments on physical health, including their own. Carers are acknowledged as crucial for the delivery of high quality mental health services. Therefore they have an important role to play in addressing the poor physical health of people with mental illness. Hearing their views and opinions is essential.

Schizophrenia through the carers' eyes: results of a European cross-sectional survey.

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Svettini, A; Johnson, B; Magro, C; Saunders, J; Jones, K; Silk, S; Hargarter, L; Schreiner, A

2015-09-01

Schizophrenia is a serious mental disorder affecting approximately 29 million people worldwide. The ideal treatment and care of patients with schizophrenia should be provided by a multidisciplinary 'team' involving psychiatrists, nurses and other healthcare professionals, together with carers and patients. In light of the key role carers play in the care of patients with schizophrenia, the present survey was designed to assess the opinions of family members and friends of patients with schizophrenia across Europe and to ascertain their attitudes towards the illness, medication and adherence to medication. Among carers participating in this survey, there was widespread awareness of the issues involved in supporting patients with schizophrenia and the importance of their role in improving poor adherence to medication. Three differences in opinion emerged between the views of carers and psychiatrists; psychiatrists rely more on the patient themselves when assessing adherence than carers would recommend; in contrast to psychiatrists, many carers believe the illness itself contributes to non-adherence; two thirds of carers think that schizophrenia medication damages health (higher than estimated by psychiatrists). The findings from the present survey, taken together with the results from the Adherencia Terapéutica en la Esquizofrenia surveys of psychiatrists and nurses, support the need for a collaborative approach to the issue of treatment nonadherence. In particular, healthcare professionals should recognize the valuable contribution that family carers can make to improve treatment adherence and consequently clinical outcomes for patients with schizophrenia. Schizophrenia carries a significant burden for families providing care. The Adherencia Terapéutica en la Esquizofrenia (ADHES) carers' survey was designed to assess the opinions of family and friends of patients with schizophrenia across Europe and ascertain their attitudes towards the illness, medication and

Carer Knowledge and Perceptions of Healthy Lifestyles for Adults with Intellectual Disabilities

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Melville, Craig A.; Hamilton, Sarah; Miller, Susan; Boyle, Susan; Robinson, Nicola; Pert, Carol; Hankey, Catherine R.

2009-01-01

Background: Carers can have a significant impact supporting people with intellectual disabilities to make healthy lifestyle choices. This study examines carers' training needs on diet and physical activity. Methods: A cross-sectional survey was undertaken of the knowledge and perceptions of carers supporting adults with intellectual disabilities.…

What are the roles of carers in decision-making for amyotrophic lateral sclerosis multidisciplinary care?

Directory of Open Access Journals (Sweden)

Hogden A

2013-02-01

Full Text Available Anne Hogden,1 David Greenfield,1 Peter Nugus,1 Matthew C Kiernan21Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, 2Prince of Wales Clinical School, University of New South Wales and Neuroscience Research Australia, Sydney, NSW, AustraliaPurpose: Family carers of patients with amyotrophic lateral sclerosis (ALS are presumed to have frequent involvement in decision-making for symptom management and quality of life. To better understand and improve decision-making, we investigated the range and extent of carer participation in decision-making. By focusing on the perspectives of ALS support carers, the study aimed to explore carer participation in decision-making, to identify carer roles, and determine the facilitators and barriers to carer participation in decision-making for ALS multidisciplinary care.Participants and methods: An exploratory, in-depth study was conducted with eight carers of ALS patients from two specialized ALS multidisciplinary clinics. Carers participated in semi-structured interviews that were audio recorded and transcribed then coded and analyzed for emergent themes.Results: Carers made a significant contribution to ALS decision-making. Their roles were: promoting the patient voice, promoting patient health literacy, and providing emotional support and logistical assistance. Facilitators of carer participation in decision-making were perceived to be: health professional endorsement of patients' decision-making style; access to credible information sources; evidence-based information from the ALS clinic, ALS support association, and health practitioners; supportive relationships with family and friends; spiritual faith; ease of contact with ALS services; and availability of physical and practical support for carers. Barriers to carer participation included: changes to patient communication and cognition; conflict between respect for patients' independence and

Burden and happiness in head and neck cancer carers: the role of supportive care needs.

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Hanly, Paul; Maguire, Rebecca; Balfe, Myles; Hyland, Philip; Timmons, Aileen; O'Sullivan, Eleanor; Butow, Phyllis; Sharp, Linda

2016-10-01

Our study aimed to investigate the relationship between unmet supportive care needs and carer burden and happiness, in head and neck cancer (HNC). Two hundred eighty-five HNC informal carers were sent a postal questionnaire between January and June 2014, which included the supportive care needs survey for partners and caregivers of cancer survivors (SCNS-P&C) and the CarerQol, which assesses burden and happiness. Multiple regression analysis was conducted to examine the association of (i) carer characteristics, (ii) carer situation, and (iii) unmet supportive care needs, with carer burden and happiness One hundred ninety-seven carers completed the questionnaire (response rate = 69 %), 180 of whom were included in the analysis. The majority were female (76 %), not in paid employment (68 %) and caring for their spouse (67 %). On average, carers reported relatively low levels of burden and relatively high levels of happiness. Carer factors explained 42 % of variance in levels of burden and 24 % of variance in levels of happiness. Healthcare service needs were associated with carer burden (β = .28, p = .04), while psychological needs (β = -.38, p = .028), health care service needs (β = -.30, p = .049), information needs (β = .29, p = .028), carer comorbidity (β = -.18, p = .030), and gender (β = -.16, p = .045) were associated with happiness. Our results indicate that different aspects of carer characteristics and unmet needs are associated with carer burden and happiness. Efforts directed at reducing unmet healthcare service needs in particular are merited given their associations with both aspects of carer quality of life.

Who cares for the carers at hospital discharge at the end of life? A qualitative study of current practice in discharge planning and the potential value of using The Carer Support Needs Assessment Tool (CSNAT) Approach.

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Ewing, Gail; Austin, Lynn; Jones, Debra; Grande, Gunn

2018-05-01

Carer factors prevent patients achieving timely and appropriate hospital discharge. There is a lack of research into interventions to support carers at hospital discharge. To explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers. Qualitative. Three National Health Service Trusts in England: focus groups with 40 hospital and community-based practitioners and 22 carer interviews about experiences of carer support during hospital discharge and views of The CSNAT Approach. Two workshops brought together 14 practitioners and five carers to discuss implementation issues. Framework analysis was conducted. Current barriers to supporting carers at hospital discharge were an organisational focus on patients' needs, what practitioners perceived as carers' often 'unrealistic expectations' of end-of-life caregiving at home and lack of awareness of patients' end-of-life situation. The CSNAT Approach was viewed as enabling carer support and addressing difficulties of discussing the realities of supporting someone at home towards end of life. Implementation in hospital required organisational considerations of practitioner workload and training. To enhance carer support, a two-stage process of assessment and support (hospital with community follow-up) was suggested using the CSNAT as a carer-held record to manage the transition. This study identifies a novel intervention, which expands the focus of discharge planning to include assessment of carers' support needs at transition, potentially preventing breakdown of care at home and patient readmissions to hospital.

An investigation of models of illness in carers of schizophrenia patients using the Illness Perception Questionnaire.

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Barrowclough, C; Lobban, F; Hatton, C; Quinn, J

2001-11-01

Although carers' reactions to schizophrenic illness in a close family member may have important implications for the patient and for themselves, little is known of factors that influence the way carers respond. In the area of physical health problems, people's models of their illness or illness representations have been found to be related to the ways they react and cope with their illness. This study examines the use of a modified form of the Illness Perception Questionnaire (IPQ) to investigate illness models in a sample of carers of schizophrenia patients. Forty-seven carers participated. The psychometric properties of the modified IPQ were examined, and a number of carer and patient outcomes were investigated in relation to carer scores on the illness identity, consequences, control-cure and timeline subscales of the modified IPQ. These outcomes included measures of carer distress and burden, expressed emotion dimensions, and patient functioning. The modified IPQ was found to be a reliable measure of carers' perceptions of schizophrenia. Carer functioning, the patient-carer relationship and patient illness characteristics were associated with different dimensions of illness perceptions. The findings support the proposal that carer cognitive representations of the illness may have important implications for both carer and patient outcomes in schizophrenia.

Are carer attitudes toward medications related to self-reported medication adherence amongst people with mental illness?

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Deane, Frank P; McAlpine, Elizabeth; Byrne, Mitchell K; Davis, Esther L; Mortimer, Christine

2017-11-22

Medication nonadherence among consumers with psychiatric disorders can significantly affect the health and wellbeing of the consumer and their family. Previous research has suggested that carers have an impact on consumer attitudes toward medication and adherence. Yet, how carer attitudes toward medication may be related to consumer attitudes and adherence has received little investigation. This exploratory study aimed to investigate the relationships between carer and consumer attitudes toward medication and consumer adherence behaviour. A cross-sectional survey assessing consumer and carer attitudes toward medication and consumer adherence was conducted amongst 42 consumer-carer dyads. Correlation analyses showed a positive association between consumer and carer attitudes toward medication and between consumer and carer attitudes with adherence. There was a general indication that the greater the difference between consumer and carer attitudes, the lower the level of adherence. Regression analyses revealed that while neither consumer nor carer attitudes were significant predictors of adherence, carer attitudes appeared to have a stronger role in adherence than consumer attitudes. These preliminary results highlight the importance of carer attitudes in relation to patient perceptions and behaviours toward medication, and thus the potential benefits of addressing both consumer and carer attitudes in any intervention for improving adherence. Copyright © 2017 Elsevier B.V. All rights reserved.

Carer preferences for home support services in later stage dementia.

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Kampanellou, Eleni; Chester, Helen; Davies, Linda; Davies, Sue; Giebel, Clarissa; Hughes, Jane; Challis, David; Clarkson, Paul

2017-11-01

To examine the relative importance of different home support attributes from the perspective of carers of people with later-stage dementia. Preferences from 100 carers, recruited through carers' organisations, were assessed with a Discrete Choice Experiment (DCE) survey, administered online and by paper questionnaire. Attributes were informed by an evidence synthesis and lay consultations. A conditional logit model was used to estimate preference weights for the attributes within a home support 'package'. The most preferred attributes were 'respite care, available regularly to fit your needs' (coefficient 1.29, p = home care provided regularly for as long as needed' (coefficient 0.93, p = home support interventions for dementia. Respite care, home care and training on managing difficulties provided at home are important components. Carers' preferences revealed the daily challenges of caring for individuals with later stage dementia and the need for tailored and specialised home support.

People into Employment: supporting people with disabilities and carers into work.

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Arksey, Hilary

2003-05-01

Carers and people with disabilities are two disadvantaged groups at risk of social exclusion. Work is an important route to social inclusion, but carers and people with disabilities are under-represented in the work force. The present paper reports key findings from a new study that evaluated People into Employment (PIE), a pilot employment project in the north-east of England designed to support people with disabilities, carers and former carers in gaining mainstream work. The study aimed to identify what clients, partner agencies and employers perceived to be PIE's most important services, its strengths and areas where there was scope for further development. The study collected quantitative and qualitative data at the mid-point and at the end of the project through two questionnaire surveys, and interviews with PIE clients, the project development officer, partner agencies and employers. Drawing on the 'pathway model', the findings show that PIE's interventions included mobilising, matching, mediating and supporting activities. Key ingredients in PIE's success include: tailor-made job-search activities and training; adjusting the pace at which people move towards sustained employment; recognising and responding to the differing needs of people with disabilities, carers and former carers; confidence boosting; accompanying clients to job interviews; good job matching; and ongoing practical and emotional support for both clients and employers. Rudimentary calculations suggest that the cost per job to the project is less than the cost per job for large national projects. Overall, these findings illustrate how access to employment via flexible job-search services geared up to the local labour market can successfully promote social inclusion for carers and people with disabilities.

Love stories: understanding the caring journeys of aged Greek-Australian carers.

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Horsfall, Debbie; Blignault, Ilse; Perry, Astrid; Antonopoulos, Penny

2016-03-01

This article documents the findings of a short-term longitudinal study that explored the caring journeys of aged Greek carers providing in-home care for their spouse. Through a deeper understanding of carers' decisions and decision-making and insights from service providers and community leaders, we aimed to inform policy makers, service managers and providers about how to develop and promote culturally appropriate support services, and negotiate them with carers and care recipients in a timely way. Initially, we conducted three focus groups and one follow-up forum with service providers and Greek community leaders. Then, over a 6-month period, we conducted two in-home interviews and two telephone interviews with 12 older Greek carers. We sought to understand factors influencing carers' decision-making regarding service uptake, and we provided information about services as required. Through our thematic analysis, we found that most carers wanted to remain as independent as possible and to avoid forced separation from the one they loved, through institutionalisation. They placed great value on their caring role which, while a struggle at times, gave them a sense of meaning, purpose and belonging. We also found that carers had great resourcefulness, strength and competence. They were all in long-term relationships, had negotiated coming to a foreign country and establishing themselves and were now in the process of negotiating old age and increasing frailty while at the same time providing care and support to family and friends. Our findings suggest that services need to be communicated in ways which support what carers value, not on outdated assumptions about cultural groups, otherwise providers will perpetuate exclusion. We propose an outreach in-home service model with an emphasis on ageing well and staying at home. This model of service provision is a model of care which emphasises relationships and community, and seeks to build social and cultural capital. �

Factors associated with the quality of life of family carers of people with dementia: A systematic review.

Science.gov (United States)

Farina, Nicolas; Page, Thomas E; Daley, Stephanie; Brown, Anna; Bowling, Ann; Basset, Thurstine; Livingston, Gill; Knapp, Martin; Murray, Joanna; Banerjee, Sube

2017-05-01

Family carers of people with dementia are their most important support in practical, personal, and economic terms. Carers are vital to maintaining the quality of life (QOL) of people with dementia. This review aims to identify factors related to the QOL of family carers of people with dementia. Searches on terms including "carers," "dementia," "family," and "quality of life" in research databases. Findings were synthesized inductively, grouping factors associated with carer QOL into themes. A total of 909 abstracts were identified. Following screening, lateral searches, and quality appraisal, 41 studies (n = 5539) were included for synthesis. A total of 10 themes were identified: demographics; carer-patient relationship; dementia characteristics; demands of caring; carer health; carer emotional well-being; support received; carer independence; carer self-efficacy; and future. The quality and level of evidence supporting each theme varied. We need further research on what factors predict carer QOL in dementia and how to measure it. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Caring for dementia carers: the role of general practitioners in Ireland.

LENUS (Irish Health Repository)

O'Connor, C

2012-02-01

BACKGROUND: Dementia patients in Ireland live 8 years on average after diagnosis and health policy aims to ensure patients are cared for in the home for as long as possible. AIM: To assess the role of general practitioners in Ireland caring for dementia carers. METHODS: A PubMed search (1980-2010) was performed using MeSH terms "caregivers or carers", "Dementia or Alzheimer\\'s disease", "family physician or general practitioner". An English language restriction was imposed and the search continued to June 24th 2010. RESULTS: Psychosocial multidisciplinary interventions that unite education, skills training, management of psychological problems and family support in the community are effective in managing the problems of carers and should be facilitated by general practitioners. CONCLUSIONS: Dementia carers form an important yet understated patient group who present unique challenges for general practitioners in Ireland.

Caring for dementia carers: the role of general practitioners in Ireland.

LENUS (Irish Health Repository)

O'Connor, C

2011-01-29

BACKGROUND: Dementia patients in Ireland live 8 years on average after diagnosis and health policy aims to ensure patients are cared for in the home for as long as possible. AIM: To assess the role of general practitioners in Ireland caring for dementia carers. METHODS: A PubMed search (1980-2010) was performed using MeSH terms "caregivers or carers", "Dementia or Alzheimer\\'s disease", "family physician or general practitioner". An English language restriction was imposed and the search continued to June 24th 2010. RESULTS: Psychosocial multidisciplinary interventions that unite education, skills training, management of psychological problems and family support in the community are effective in managing the problems of carers and should be facilitated by general practitioners. CONCLUSIONS: Dementia carers form an important yet understated patient group who present unique challenges for general practitioners in Ireland.

Development and psychometric properties of the Carer - Head Injury Neurobehavioral Assessment Scale (C-HINAS) and the Carer - Head Injury Participation Scale (C-HIPS): patient and family determined outcome scales.

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Deb, Shoumitro; Bryant, Eleanor; Morris, Paul G; Prior, Lindsay; Lewis, Glyn; Haque, Sayeed

2007-06-01

Develop and assess the psychometric properties of the Carer - Head Injury Participation Scale (C-HIPS) and its biggest factor the Carer - Head Injury Neurobehavioral Assessment Scale (C-HINAS). Furthermore, the aim was to examine the inter-informant reliability by comparing the self reports of individuals with traumatic brain injury (TBI) with the carer reports on the C-HIPS and the C-HINAS. Thirty-two TBI individuals and 27 carers took part in in-depth qualitative interviews exploring the consequences of the TBI. Interview transcripts were analysed and key themes and concepts were used to construct a 49-item and 58-item patient (Patient - Head Injury Participation Scale [P-HIPS]) and carer outcome measure (C-HIPS) respectively, of which 49 were parallel items and nine additional items were used to assess carer burden. Postal versions of the P-HIPS, C-HIPS, Mayo Portland Adaptability Inventory-3 (MPAI-3), and the Glasgow Outcome Scale-Extended (GOSE) were completed by a cohort of 113 TBI individuals and 80 carers. Data from a sub-group of 66 patient/carer pairs were used to compare inter-informant reliability between the P-HIPS and the C-HIPS, and the P-HINAS and the C-HINAS respectively. All individual 49 items of the C-HIPS and their total score showed good test-retest reliability (0.95) and internal consistency (0.95). Comparisons with the MPAI-3 and GOSE found a good correlation with the MPAI-3 (0.7) and a moderate negative correlation with the GOSE (-0.6). Factor analysis of these items extracted a 4-factor structure which represented the domains 'Emotion/Behavior' (C-HINAS), 'Independence/Community Living', 'Cognition', and 'Physical'. The C-HINAS showed good internal consistency (0.92), test-retest reliability (0.93), and concurrent validity with one MPAI subscale (0.7). Assessment of inter-informant reliability revealed good correspondence between the reports of the patients and the carers for both the C-HIPS (0.83) and the C-HINAS (0.82). Both the C

Hidden Liquidity

OpenAIRE

Cebiroglu, Gökhan; Horst, Ulrich

2012-01-01

We cross-sectionally analyze the presence of aggregated hidden depth and trade volume in the S&P 500 and identify its key determinants. We find that the spread is the main predictor for a stock’s hidden dimension, both in terms of traded and posted liquidity. Our findings moreover suggest that large hidden orders are associated with larger transaction costs, higher price impact and increased volatility. In particular, as large hidden orders fail to attract (latent) liquidity to the market, hi...

A palliative care resource for professional carers of people with learning disabilities.

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Reddall, C

2010-07-01

People with learning disabilities who have a life-threatening illness, are as entitled as other members of the population to receive good palliative care in their home of choice. However, professional carers of people with learning disability are generally unaware of the meaning of palliative care, and how they can access palliative care support. More importantly, they may feel they are not capable of caring for a resident with a life-threatening illness in the home environment. This article uses a case study to help illustrate the value of compiling a resource booklet for professional carers of people with learning disabilities. By providing information on palliative care, that is easy to understand and easily accessible, professional carers of these people can have a valuable resource which will enable them to provide general palliative care when needed. (I use the term professional carers to refer to carers who are paid to look after people with learning disabilities either in care homes, or in supported living homes in the general community).

THE HIDDEN MAGNETIC FIELD OF THE YOUNG NEUTRON STAR IN KESTEVEN 79

International Nuclear Information System (INIS)

Shabaltas, Natalia; Lai Dong

2012-01-01

Recent observations of the central compact object in the Kesteven 79 supernova remnant show that this neutron star (NS) has a weak dipole magnetic field (a few × 10 10 G) but an anomalously large (∼64%) pulse fraction in its surface X-ray emission. We explore the idea that a substantial sub-surface magnetic field exists in the NS crust, which produces diffuse hot spots on the stellar surface due to anisotropic heat conduction, and gives rise to the observed X-ray pulsation. We develop a general-purpose method, termed 'Temperature Template with Full Transport' (TTFT), that computes the synthetic pulse profile of surface X-ray emission from NSs with arbitrary magnetic field and surface temperature distributions, taking into account magnetic atmosphere opacities, beam pattern, vacuum polarization, and gravitational light bending. We show that a crustal toroidal magnetic field of order a few × 10 14 G or higher, varying smoothly across the crust, can produce sufficiently distinct surface hot spots to generate the observed pulse fraction in the Kes 79 NS. This result suggests that substantial sub-surface magnetic fields, much stronger than the 'visible' dipole fields, may be buried in the crusts of some young NSs, and such hidden magnetic fields can play an important role in their observational manifestations. The general TTFT tool we have developed can also be used for studying radiation from other magnetic NSs.

Perceptions of the role of general practice and practical support measures for carers of stroke survivors: a qualitative study

Directory of Open Access Journals (Sweden)

Harris Ruth

2011-06-01

Full Text Available Abstract Background Informal carers frequently suffer adverse consequences from caring. General practice teams are well positioned to support them. However, what carers of stroke survivors want and expect from general practice, and the practical support measures they might like, remain largely unexplored. The aims of this study are twofold. Firstly it explores both the support stroke carers would like from general practice and their reactions to the community based support proposed in the New Deal. Secondly, perceptions of a general practice team are investigated covering similar topics to carer interviews but from their perspective. Methods Semi-structured interviews were conducted with 13 stroke carers and 10 members of a general practice team. Carers' experiences and expectations of general practice and opinions of support measures from recent government policy were explored. General practice professionals were asked about their perceived role and their perceptions of carers' support needs. Interviews were content analysed. Results Carers' expectations of support from general practice were low and they neither received nor expected much support for themselves. General practice was seen as reactive primarily because of time constraints. Some carers would appreciate emotional support but others did not want additional services. Responses to recent policy initiatives were mixed with carers saying these might benefit other carers but not themselves. General practice professionals' opinions were broadly similar. They recognise carers' support needs but see their role as reactive, focussed on stroke survivors, rather than carers. Caring was recognised as challenging. Providing emotional support and referral were seen as important but identification of carers was considered difficult. Time constraints limit their support. Responses to recent policy initiatives were positive. Conclusions Carers' expectations of support from general practice for

Carers' experiences of dysphagia in people treated for head and neck cancer: a qualitative study.

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Nund, Rebecca L; Ward, Elizabeth C; Scarinci, Nerina A; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V

2014-08-01

The implication of dysphagia for people treated nonsurgically for head and neck cancer (HNC) and its detrimental effects on functioning and quality of life has been well documented. To date, however, there has been a paucity of research on the effects of dysphagia following HNC on carers, independent of the consequences of a gastrostomy. The objective of this qualitative study was to report on the experiences of carers of people with dysphagia (non-gastrostomy dependent) following nonsurgical treatment for HNC and to identify the support needs of this group. A purposive, maximum-variation sampling technique was adopted to recruit 12 carers of people treated curatively for HNC since 2007. Each participated in an in-depth interview, detailing their experience of caring for someone with dysphagia and the associated impact on their life. Thematic analysis was adopted to search the transcripts for key phases and themes that emerged from the discussions. Analysis of the transcripts revealed four themes: (1) dysphagia disrupts daily life, (2) carers make adjustments to adapt to their partner's dysphagia, (3) the disconnect between carers' expectations and the reality of dysphagia, and (4) experiences of dysphagia-related services and informal supports. Carers generally felt ill-prepared for their role in dysphagia management. The qualitative methodology successfully described the impact of dysphagia on the everyday lives of carers, particularly in regard to meal preparation, social events, and family lifestyle. Clinicians should provide adequate and timely training and support to carers and view carers as copartners in dysphagia management.

Improving the interface between informal carers and formal health and social services: a qualitative study.

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McPherson, K M; Kayes, N K; Moloczij, N; Cummins, C

2014-03-01

Reports about the impact of caring vary widely, but a consistent finding is that the role is influenced (for better or worse) by how formal services respond to, and work with informal carers and of course the cared for person. We aimed to explore the connection between informal and formal cares and identify how a positive connection or interface might be developed and maintained. We undertook a qualitative descriptive study with focus groups and individual interviews with informal carers, formal care service providers and representatives from carer advocacy groups. Content analysis was used to identify key factors impacting on the interface between informal and formal carers and propose specific recommendations for service development. Community setting including urban and rural areas of New Zealand. Seventy participants (the majority informal carers) took part in 13 focus groups and 22 individual interviews. Four key themes were derived: Quality of care for the care recipient; Knowledge exchange (valuing carer perspectives); One size does not fit all (creating flexible services); and A constant struggle (reducing the burden services add). An optimum interface to address these key areas was proposed. In addition to ensuring quality care for the care recipient, specific structures and processes to support a more positive interface appear warranted if informal carers and services are to work well together. An approach recognising the caring context and carer expertise may decrease the additional burden services contribute, and reduce conflicting information and resultant confusion and/or frustration many carers experience. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cultural differences are reflected in variables associated with carer burden in FTD: a comparison study between India and Australia

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Mekala, Shailaja; Alladi, Suvarna; Chandrasekar, Kammammettu; Fathima, Safiya; M.O.'Connor, Claire; McKinnon, Colleen; Hornberger, Michael; Piguet, Olivier; Hodges, John R.; Mioshi, Eneida

2013-01-01

There is great need to understand variables behind carer burden, especially in FTD. Carer burden is a complex construct, and its factors are likely to vary depending on the type of dementia, carer characteristics and cultural background. OBJECTIVE The present study aimed to compare profiles and severity of carer burden, depression, anxiety and stress in carers of FTD patients in India in comparison to Australia; to investigate which carer variables are associated with carer burden in each country. METHODS Data of 138 participants (69 dyads of carers-patients) from India and Australia (India, n=31; Australia, n=38). Carer burden was assessed with the short Zarit Burden Inventory; carer depression, anxiety and stress were measured with the Depression, Anxiety and Stress-21. Dementia severity was determined with the Frontotemporal Dementia Rating Scale (FTD-FRS), and a range of demographic variables regarding the carer and patient were also obtained. RESULTS Overall, levels of carer burden were not significantly different across India and Australia, despite more hours delivering care and higher dementia severity in India. Variables associated with burden, however, differed between countries, with carer depression, anxiety and stress strongly associated with burden in India. By contrast, depression, stress, and dementia severity were associated with burden in Australia. CONCLUSION This study demonstrated that variables associated with carer burden in FTD differ between cultures. Consequently, cultural considerations should be taken into account when planning for interventions to reduce burden. This study suggests that addressing carers' skills and coping mechanisms are likely to result in more efficacious outcomes than targeting patient symptoms alone. PMID:29213826

Supporting South Asian carers and those they care for: the role of the primary health care team.

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Katbamna, Savita; Bhakta, Padma; Ahmad, Waqar; Baker, Richard; Parker, Gillian

2002-04-01

Demographic and socioeconomic changes have increased policy interest in informal carers. However, despite the multicultural nature of British society, most research in this field has been in majority communities. To explore the role of the primary health care team (PHCT) in supporting carers from British South Asian communities. Qualitative study. Four South Asian communities in Leicestershire and West Yorkshire. Focus groups and in-depth interviews were used to assess male and female carers, supported by a literature review. Failure to recognise carers' needs, gaps in service provision, and communication and language issues compromised carers' ability to care. While some carers were positive about the PHCT role, the main weaknesses concerned poor consultation, PHCT attitudes towards carers, and access to appropriate services. South Asian carers' experiences largely parallel those of others, but there are some issues that are distinct, namely, language and communication barriers, culturally inappropriate services, and implicit or explicit racism. The multi-ethnic nature of Great Britain requires that professional practice enhances the ability of minority ethnic communities to provide informal care. The findings underline the important role of the PHCT in ensuring that carers' needs are taken seriously and that appropriate services reach them.

Absolutely fabulous--but are we? Carers' perspectives on satisfaction with a palliative homecare service.

Science.gov (United States)

O'Connor, Lera; Gardner, Anne; Millar, Lynne; Bennett, Peter

2009-01-01

People with terminal diagnoses are increasingly encouraged to stay at home for the trajectory of their illness. Consequently, relatives and friends are progressively undertaking the informal carer role more frequently in conjunction with formal palliative care teams. Although there is international literature on the efficacy of and satisfaction with publicly funded palliative homecare, to date, there is scant literature reporting satisfaction with privately funded palliative homecare especially in Australia. Survey and focus group methods were used to explore carers' levels of satisfaction with a private Australian palliative homecare service and to uncover unmet carer needs. There were 300 (41.7%) responses to the survey. Three focus groups were conducted, separately comprising current carers, past carers and palliative homecare staff. While there was a high level of satisfaction with the service generally, carers identified a lack of knowledge about aspects of the illness and treatment course. A desire to have time with nursing staff independent of the patient, including continued contact after the death of the patient, was also expressed. Themes relating to service delivery concerned lack of continuity of attending nursing staff and a perceived inadequate number of service visits. These findings were similar to results reported in the literature for publicly funded services. Therefore interventions used in the public sector to meet carer needs are likely to be successful if applied in the private sector.

Carer Knowledge and Experiences with Menopause in Women with Intellectual Disabilities

Science.gov (United States)

Willis, Diane S.; Wishart, Jennifer G.; Muir, Walter J.

2010-01-01

Overall life expectancy for women with intellectual disabilities (ID) is now significantly extended, and many will live long enough to experience menopause. Little is known about how carers support women with ID through this important stage in their lives. This study investigated carer knowledge of how menopause affects women with ID under their…

End-of-life training for paid carers working with people with learning disabilities.

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Codling, Mary; Knowles, Jane; Vevers, Ann

2014-04-01

People with learning disabilities are living longer lives. Over the past few years, research has explored the needs of people with learning disabilities, their families and learning disability professionals in relation to end-of-life care and death. However, little is known about the needs of paid carers and their experience of end-of-life care. This article discusses the development, implementation and evaluation of a study day about end-of-life care that was delivered to paid carers on two separate occasions in Berkshire Healthcare NHS Foundation Trust. A total of 43 paid carers attended and the days were well evaluated. The need for further training for paid carers who work with people with learning disabilities at the end of life was highlighted.

Carers' experiences of home enteral feeding: A survey exploring medicines administration challenges and strategies.

Science.gov (United States)

Alsaeed, D; Furniss, D; Blandford, A; Smith, F; Orlu, M

2018-06-01

The use of enteral tube feeding at home is becoming more widespread, with patients ranging in age and diseases. Dysphagia and swallowing difficulties can compromise nutritional intake and the administration of oral medications, affecting therapeutic outcomes negatively. Carers' experiences of medicines administration and medicines optimization have not been explored fully. The objectives of this study were to identify issues carers experience in medicines administration; the strategies they have developed to cope; and suggestions to improve the medicines administration process. An online survey was promoted nationally; 42 carers completed it. Descriptive statistical analysis was applied, as well as thematic analysis of open-ended responses. Results were compared against the 4 principles of medicines optimization. 93% of respondents administered medications with enteral feeding tubes, but only 62% had received advice from healthcare professionals and only 8% had received written information on how to do so. Responses identified 5 medicines administration issues experienced by carers; 4 strategies they developed to cope; and 3 main areas of suggestions to improve medicines administration via enteral feeding at home. The 4 principles of medicines optimization have not previously been applied to enteral feeding. We present a novel account of carers' experiences, for example coping with ill-suited formulations and a lack of training and support, which should inform better practice (Principle 1). Carers sometimes experience suboptimal choice of medicines (Principle 2). Carers' practices are not always well-informed and may affect therapeutic outcomes and safety (Principle 3). There is scope for improvement in carer training, education and support to better support medicines optimization (Principle 4). © 2018 The Authors. Journal of Clinical Pharmacy and Therapeutics Published by John Wiley & Sons Ltd.

Burden of illness in systemic lupus erythematosus: results from a UK patient and carer online survey.

Science.gov (United States)

Kent, T; Davidson, A; Newman, D; Buck, G; D'Cruz, D

2017-09-01

Objective The objective of this study was to assess the impact of systemic lupus erythematosus (SLE) on patients and carers. Methods Adults with SLE and carers of SLE patients completed a UK-specific online survey covering many aspects of the disease. Surveys were developed in collaboration with an NHS lupus unit and a lupus patient organization. Results A total of 121 patients and 31 carers completed the surveys. Of the 70% of patients initially misdiagnosed with another condition, 59% received treatment for the misdiagnosis. Fatigue was the most debilitating symptom, experienced daily by 79% of patients. The proportion of patients not reporting flares to healthcare providers varied with flare severity: mild flares (43%), moderate flares (15%) and severe flares (5%). Most patients (89%) reported reduced ability to socialize, and 76% had changed employment; of these, 52% stopped working completely. Over one-half (52%) of carers in paid employment missed time from work, and 55% of carers reported a worsened financial status. Most carers (87%) experienced interference with social activities. Conclusion SLE is commonly misdiagnosed and has a considerable impact on the physical, social and financial status of patients and carers. Increased awareness of the disease among healthcare providers and employers of patients and their carers is needed.

Extending “Continuity of Care” to include the Contribution of Family Carers

Directory of Open Access Journals (Sweden)

Cecilia Wong-Cornall

2017-06-01

Full Text Available Background: Family carers, as a “shadow workforce”, are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty’s model of continuity of care to explore the contribution of family carers’ to the provision of care and support for an older family member’s chronic condition within the context of health service delivery.  Methods: We analysed data from interviews of 13 family carers in a case study of primary health care in New Zealand – a Maori Provider Organisation – to determine the alignment of family caregiving with the three levels of continuity of care (relational continuity, informational continuity, and management continuity.  Results: We found alignment of family caregiving tasks, responsibilities, and relationships with the three levels of continuity of care. Family carers 1 partnered with providers to extend chronic care to the home; 2 transferred and contributed information from one provider/service to another; 3 supported consistent and flexible management of care.  Discussion: The Maori Provider Organisation supported family carer-provider partnership enabled by shared Maori cultural values and social mandate of building family-centred wellbeing. Relational continuity was the most important level of continuity of care; it sets precedence for family carers and providers to establish the other levels – informational and management – continuity of care for their family member cared for. Family carers need to be considered as active partners working alongside responsive primary health care providers and organisation in the implementation of chronic care.

Awareness of dementia by family carers of nursing home residents dying with dementia: a post-death study.

Science.gov (United States)

Penders, Yolanda W H; Albers, Gwenda; Deliens, Luc; Vander Stichele, Robert; Van den Block, Lieve

2015-01-01

High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. To describe how often family carers of nursing home residents who died with dementia are aware that their relative has dementia, and study resident, family carer, and care characteristics associated with awareness. Post-death study using random cluster sampling. Structured questionnaires were completed by family carers, nursing staff, and general practitioners of deceased nursing home residents with dementia in Flanders, Belgium (2010). Of 190 residents who died with dementia, 53.2% of family carers responded. In 28% of cases, family carers indicated they were unaware their relative had dementia. Awareness by family carers was related to more advanced stages of dementia 1 month before death (odds ratio = 5.4), with 48% of family carers being unaware when dementia was mild and 20% unaware when dementia was advanced. The longer the onset of dementia after admission to a nursing home, the less likely family carers were aware (odds ratio = 0.94). Family carers are often unaware that their relative has dementia, that is, in one-fourth of cases of dementia and one-fifth of advanced dementia, posing considerable challenges for optimal care provision and end-of-life decision-making. Considering that family carers of residents who develop dementia later after admission to a nursing home are less likely to be aware, there is room for improving communication strategies toward family carers of nursing home residents. © The Author(s) 2014.

"It's All Changed:" Carers' Experiences of Caring for Adults Who Have Down's Syndrome and Dementia

Science.gov (United States)

McLaughlin, Katrina; Jones, Aled

2011-01-01

A qualitative interview study was undertaken to determine the information and support needs of carers of adults who have Down's syndrome and dementia. The data were analysed thematically. Carers' information and support needs were seen to change at pre-diagnosis, diagnosis and post-diagnosis. Helping carers to manage the changing nature of the…

A Pilot, Multicentre Pragmatic Randomised Trial to Explore the Impact of Carer Skills Training on Carer and Patient Behaviours: Testing the Cognitive Interpersonal Model in Adolescent Anorexia Nervosa.

Science.gov (United States)

Hodsoll, John; Rhind, Charlotte; Micali, Nadia; Hibbs, Rebecca; Goddard, Elizabeth; Nazar, Bruno Palazzo; Schmidt, Ulrike; Gowers, Simon; Macdonald, Pamela; Todd, Gillian; Landau, Sabine; Treasure, Janet

2017-11-01

The aim of the study is to establish the acceptability, feasibility and approximate size of the effect of adding a carer intervention [Experienced Caregivers Helping Others (ECHO)] to treatment as usual (TAU) for adolescents with anorexia nervosa. The study is a pilot randomised trial comparing TAU (n = 50) alone or TAU plus ECHO with (n = 50) or without (n = 49) telephone guidance. Effect sizes (ESs) were regression coefficients standardised by baseline standard deviations of measure. Although engagement with ECHO was poor (only 36% of carers in the ECHO group read over 50% of the book), there were markers of intervention fidelity, in that caregivers in the ECHO group showed a moderate increase in carer skills (ES = 0.4) at 12 months and a reduction in accommodating and enabling behaviour at 6 months (ES = 0.17). In terms of efficacy, in the ECHO group, carers spent less time care giving (ES = 0.40, p = 0.04) at 1 year, and patients had a minor advantage in body mass index (ES = 0.17), fewer admissions, decreased peer problems (ES = -0.36) and more pro-social behaviours (ES = 0.53). The addition of telephone guidance to ECHO produced little additional benefit. The provision of self-management materials for carers to standard treatment for adolescent anorexia nervosa shows benefits for both carers and patients. This could be integrated as a form of early intervention in primary care. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

On the production of hidden-flavored hadronic states at high energy

Science.gov (United States)

Wang, Wei

2018-04-01

I discuss the production mechanism of hidden-flavored hadrons at high energy. Using e+e‑ collisions and light-meson pair production in high energy exclusive processes, I demonstrate that hidden quark pairs do not necessarily participate in short-distance hard scattering. Implications are then explored in a few examples. Finally, I discuss the production mechanism of X(3872) in hadron collisions, where some misunderstandings have arisen in the literature. Supported by the Thousand Talents Plan for Young Professionals, National Natural Science Foundation of China (11575110, 11655002, 11735010, 11747611), Natural Science Foundation of Shanghai (15DZ2272100) and Scientific Research Foundation for Re- turned Overseas Chinese Scholars, Ministry of Education

Supporting activity engagement by family carers at home: maintenance of agency and personhood in dementia.

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Chung, Pat Yin Fan; Ellis-Hill, Caroline; Coleman, Peter

2017-12-01

An explorative paper to describe how family carers, through the caregiving journey, reaffirm and promote the agency of people with dementia. Agency is an important concept in dementia care and is crucial to the promotion of wellbeing and the delivery of person-centred care. This article is based on one of the key findings of a study that explored family carers' experiences of engaging their relatives in daily activities in domestic settings. Following research governance and ethical approval, 30 in-depth interviews (initial and follow-up) were carried out with 15 resident-carers of people with dementia who were recruited via local community mental health teams. Then five focus groups were conducted with 21 participants accessed through carers support groups. Interviews and focus groups were transcribed, coded and analysed using a grounded theory method. Findings showed the process in which family carers encouraged and sustained a sense of autonomy and control (agency) in their relative's daily activities. Key strategies used by carers included: being non-judgemental; facilitating a sense of worth; taking calculated risks; maintaining the continuity of their relative's identity; enhancing a sense of connection with their relative's role and identity using enjoyable activities; preventing inactivity and attending to the bodily source of the agency. Lack of support for carers could ultimately pose a risk to the maintenance of the agency of people with dementia. This study provides a deeper insight into the process used by home carers to support the agency of people with dementia. This is essential if practitioners are to identify and develop more realistic intervention strategies and to work in effective partnership with family carers. The implications for the creation of dementia-friendly communities are discussed.

Paid carers' experiences of caring for mechanically ventilated children at home: implications for services and training.

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Maddox, Christina; Pontin, David

2013-06-01

UK survival rates for long-term mechanically ventilated children have increased and paid carers are trained to care for them at home, however there is limited literature on carers' training needs and experience of sharing care. Using a qualitative abductive design, we purposively sampled experienced carers to generate data via diaries, semi-structured interviews, and researcher reflexive notes. Research ethics approval was granted from NHS and University committees. Five analytical themes emerged - Parent as expert; Role definition tensions; Training and Continuing Learning Needs; Mixed Emotions; Support Mechanisms highlighting the challenges of working in family homes for carers and their associated learning needs. Further work on preparing carers to share feelings with parents, using burnout prevention techniques, and building confidence is suggested. Carers highlight the lack of clinical supervision during their night-working hours. One solution may be to provide access to registered nurse support when working out-of-office hours.

Sociology of Hidden Curriculum

Directory of Open Access Journals (Sweden)

Alireza Moradi

2017-06-01

Full Text Available This paper reviews the concept of hidden curriculum in the sociological theories and wants to explain sociological aspects of formation of hidden curriculum. The main question concentrates on the theoretical approaches in which hidden curriculum is explained sociologically.For this purpose it was applied qualitative research methodology. The relevant data include various sociological concepts and theories of hidden curriculum collected by the documentary method. The study showed a set of rules, procedures, relationships and social structure of education have decisive role in the formation of hidden curriculum. A hidden curriculum reinforces by existed inequalities among learners (based on their social classes or statues. There is, in fact, a balance between the learner's "knowledge receptions" with their "inequality proportion".The hidden curriculum studies from different major sociological theories such as Functionalism, Marxism and critical theory, Symbolic internationalism and Feminism. According to the functionalist perspective a hidden curriculum has a social function because it transmits social values. Marxists and critical thinkers correlate between hidden curriculum and the totality of social structure. They depicts that curriculum prepares learners for the exploitation in the work markets. Symbolic internationalism rejects absolute hegemony of hidden curriculum on education and looks to the socialization as a result of interaction between learner and instructor. Feminism theory also considers hidden curriculum as a vehicle which legitimates gender stereotypes.

Development and psychometric properties of the Carer – Head Injury Neurobehavioral Assessment Scale (C-HINAS) and the Carer – Head Injury Participation Scale (C-HIPS): patient and family determined outcome scales

Science.gov (United States)

Deb, Shoumitro; Bryant, Eleanor; Morris, Paul G; Prior, Lindsay; Lewis, Glyn; Haque, Sayeed

2007-01-01

Objective Develop and assess the psychometric properties of the Carer – Head Injury Participation Scale (C-HIPS) and its biggest factor the Carer – Head Injury Neurobehavioral Assessment Scale (C-HINAS). Furthermore, the aim was to examine the inter-informant reliability by comparing the self reports of individuals with traumatic brain injury (TBI) with the carer reports on the C-HIPS and the C-HINAS. Method Thirty-two TBI individuals and 27 carers took part in in-depth qualitative interviews exploring the consequences of the TBI. Interview transcripts were analysed and key themes and concepts were used to construct a 49-item and 58-item patient (Patient – Head Injury Participation Scale [P-HIPS]) and carer outcome measure (C-HIPS) respectively, of which 49 were parallel items and nine additional items were used to assess carer burden. Postal versions of the P-HIPS, C-HIPS, Mayo Portland Adaptability Inventory-3 (MPAI-3), and the Glasgow Outcome Scale-Extended (GOSE) were completed by a cohort of 113 TBI individuals and 80 carers. Data from a sub-group of 66 patient/carer pairs were used to compare inter-informant reliability between the P-HIPS and the C-HIPS, and the P-HINAS and the C-HINAS respectively. Results All individual 49 items of the C-HIPS and their total score showed good test-retest reliability (0.95) and internal consistency (0.95). Comparisons with the MPAI-3 and GOSE found a good correlation with the MPAI-3 (0.7) and a moderate negative correlation with the GOSE (−0.6). Factor analysis of these items extracted a 4-factor structure which represented the domains ‘Emotion/Behavior’ (C-HINAS), ‘Independence/Community Living’, ‘Cognition’, and ‘Physical’. The C-HINAS showed good internal consistency (0.92), test-retest reliability (0.93), and concurrent validity with one MPAI subscale (0.7). Assessment of inter-informant reliability revealed good correspondence between the reports of the patients and the carers for both the C

A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa.

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Salerno, Laura; Rhind, Charlotte; Hibbs, Rebecca; Micali, Nadia; Schmidt, Ulrike; Gowers, Simon; Macdonald, Pamela; Goddard, Elizabeth; Todd, Gillian; Tchanturia, Kate; Lo Coco, Gianluca; Treasure, Janet

2016-12-01

Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient-carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer (n = 149; mostly mothers) were randomised to receive a carer skills intervention (ECHO) in addition to treatment as usual (TAU), or TAU alone, as part of a larger clinical trial. Carers and patients completed a standardised measure of psychological distress (The Depression, Anxiety, and Stress Scale) at baseline and 12 months post-treatment. The Actor Partner Interdependence Model was used to examine longitudinal changes in interdependence by treatment group. As expected, post-treatment levels of distress were related to baseline levels in both groups (actor effects). Moreover, carer distress at 12 months was related to patient distress at baseline for the TAU (partner effects), but not for the ECHO group. Finally, carers' distress change was not a significant predictor of patients' body mass index (BMI) change in the two treatment conditions. These findings are limited to predominantly mother-offspring dyads and may not generalise to other relationships. The ECHO intervention which is designed to teach carers skills in illness management and emotion regulation may be an effective addition to TAU for ameliorating interdependence of distress in patients and their primary carers over time.

Occupational therapy influence on a carer peer support model in a clinical mental health service.

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Bourke, Cate; Sanders, Bronwyn; Allchin, Becca; Lentin, Primrose; Lang, Shannon

2015-10-01

Current policy frameworks call for the participation of consumers and carers in all levels of mental health service delivery in Australia. Such inclusion leads to better outcomes for all, however, it is recognised that carers have needs and occupations beyond their carer role. The aim of this article is to describe an innovative carer peer support program developed by a group of occupational therapists. The article describes the rationale, phases of development and the role that occupational therapists played in developing and sustaining the model. This is followed by an exploration of the occupational therapy attitudes, knowledge and skills that contributed to the conceptualisation and implementation of the model. Five occupational therapists engaged in a review process involving documentation, literature review, evaluation, reflection and discussion. Four of the occupational therapists had either coordinated or managed the service described. The fifth author facilitated the process. Review of the model indicates it equips carers to perform their caring occupation and helps carers recognise the need for occupations beyond caring, for their health and wellbeing. Employing carers as paid workers values their 'real life' experience in their caring occupation. Findings also illustrate that the attitudes, knowledge, skills and competency standards of occupational therapists are well suited in enabling this emerging area of service delivery. Although this model has been developed in a clinical mental health setting, the key principles could be applied with carers or consumers across a variety of settings in which occupational therapists are employed. © 2015 Occupational Therapy Australia.

Hidden measurements, hidden variables and the volume representation of transition probabilities

OpenAIRE

Oliynyk, Todd A.

2005-01-01

We construct, for any finite dimension $n$, a new hidden measurement model for quantum mechanics based on representing quantum transition probabilities by the volume of regions in projective Hilbert space. For $n=2$ our model is equivalent to the Aerts sphere model and serves as a generalization of it for dimensions $n \\geq 3$. We also show how to construct a hidden variables scheme based on hidden measurements and we discuss how joint distributions arise in our hidden variables scheme and th...

Perceived needs of carers of people with psychosis: An Australian longitudinal population-based study of caregivers of people with psychotic disorders.

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Poon, Abner Weng Cheong; Joubert, Lynette; Harvey, Carol

2018-05-01

Studies have documented the perceived needs of carers of people with psychosis but most recruitment has utilised convenience sampling resulting in limited understanding of carers' needs. This longitudinal study was conducted within the second Australian prevalence study of psychosis, aiming to obtain generalisable findings regarding perceived needs of carers of people with psychosis. Semi-structured interviews were conducted with 98 carers of people with psychosis recruited in the Australian prevalence study of psychosis. Seventy-eight of the carers were reinterviewed 1 year later to measure changes in their perceived needs. Correlational and paired T tests were conducted to identify relationships between perceived needs and carer's health and well-being, and changes in levels of perceived needs over time. Qualitative responses were structurally coded by segmentation according to the Carers' and Users' Expectations of Services-Carer version. Thematic analysis of common words and phrases was undertaken to identify key themes concerning carers' perceived needs. There was minimal improvement in carers' perceived needs over time and their needs were closely related to their perception of their own social connectedness, psychological health and quality of life. Five themes were identified: Greater involvement of carers in the treatment plan, provision of relevant information to carers, multiple biopsychosocial support for carers, well-being and independence interventions for people with psychosis, and choice to care and alternate caring arrangements. Although policy recognises the need to support carers, findings show that focused interventions are required to address carers' perceived needs more holistically in current mental health services. To support carers' recovery, services need to include carers in treatment planning, and consider ways to address their needs and improve their own health and well-being. © 2017 John Wiley & Sons Ltd.

Carers' interactions with patients suffering from severe dementia: a difficult balance to facilitate mutual togetherness.

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Hansebo, Görel; Kihlgren, Mona

2002-03-01

1. A phenomenological-hermeneutic approach was used to illuminate carers' video-recorded interactions in connection with supervision for individualized nursing care. 2. In order to disclose any changes in the carers' interactions with patients suffering from severe dementia the video recordings were conducted before, during and after the intervention. 3. The content of the videos was transcribed as a text, mainly verbal communication. Due to the rich data the videos and text were kept together as a whole in every step of the analysis. 4. After an initial naïve understanding, different subthemes emerged in the structural analyses: promoting competence, struggling for co-operation, deep communication for communion, showing respect for the unique person, skills in balancing power, distance in a negative point of view, and fragmentary nursing situations. 5. The overall theme was 'Carers' balancing in their interactions, verbal as well as non-verbal, to promote a sense of mutual togetherness with the patient'. 6. The supervision intervention contributed to an improvement in carers' skills in balancing in their interactions. In the caring process carers' and patients' shared experiences and, due to patients' disabilities, interactions depended mainly on carers' qualities and capabilities for this confirming nursing care.

Skilled interaction among professional carers in special accommodations for adult people with learning disabilities.

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Antonsson, H; Aström, S; Lundström, M; Graneheim, U H

2013-09-01

Communicative difficulties affect interactions between people with learning disabilities and their carers. Despite such difficulties, however, some carers seem to interact successfully with people who have limited ability to communicate verbally and exhibit challenging behaviour. This study aims to illuminate skilled interaction among carers working in special accommodations for people with learning disabilities. Interactions between 16 caregivers and 11 residents with learning disabilities were recorded on video. Verbal and non-verbal interaction skills among the carers were identified. Four caring situations with people with learning disabilities were chosen to illuminate skilled interaction. The transcribed text was subjected to qualitative content analysis and core stories were created. The results show that skilled interaction between the carers and the people with learning disabilities is based upon being confirming, sharing daily life experience, giving time and space, and using congruent and distinct language. In this paper we present examples that offer concrete suggestions of how to promote successful interaction and create meaning in the shared day-to-day life in special accommodations for people with learning disabilities. © 2012 John Wiley & Sons Ltd.

Facilitating change and adaptation: the experiences of current and bereaved carers of patients with severe chronic obstructive pulmonary disease.

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Philip, Jennifer; Gold, Michelle; Brand, Caroline; Miller, Belinda; Douglass, Jo; Sundararajan, Vijaya

2014-04-01

Patients with severe chronic obstructive pulmonary disease (COPD) experience substantial symptom burden, psychological and social morbidity. The experience of this illness has an impact beyond the patient. This study seeks to understand the experiences and needs of family carers of people with severe COPD. Semistructured interviews were held with current and bereaved carers of people with severe COPD. Several areas of content were targeted in the interviews, including the experience of caring for someone with COPD, views of treatment and prognosis, information and communication needs, and the understanding of palliative care. Data were analyzed thematically. The carers' and bereaved carers' experiences and needs around COPD are best understood as a dynamic of change, recognition, and adaptation. Carers faced many changes as the patients' general condition deteriorated. These were changes in the nature of caring tasks, in their relationships, and their own expectations. Carers usually recognized change had happened and sought to adapt through new approaches, new equipment, a new stance of thinking, and in most cases, continued caring. Within this theme of change, recognition, and adaptation were a series of subthemes: (1) the impact of caring, (2) recognizing the role of the carer, and (3) the needs of the carer including their needs from palliative care services. The impact of caring borne by family carers is substantial and life changing. Health professionals may assist carers in their role through acknowledgement, facilitating recognition of the changes that have occurred (and their implications), and enabling creative adaptive responses for carers. Such assistance is likely to enhance the ability of carers to continue in this demanding role.

An evaluation of Cognitive Stimulation Therapy sessions for people with dementia and a concomitant support group for their carers.

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Bailey, Jan; Kingston, Paul; Alford, Simon; Taylor, Louise; Tolhurst, Edward

2017-11-01

This research aimed to ascertain the impact of a pragmatic Cognitive Stimulation Therapy course of 10 sessions on the cognitive function of people living with dementia and whether attending a concomitant carers support group was beneficial to carers. A mixed method quasi-experimental approach was adopted; data were collected pre- and post-intervention. The quantitative arm utilised three validated questionnaires rated by the carers. Qualitative data were collected via semi-structured interviews with carers regarding their perceptions of the impact of Cognitive Stimulation Therapy and the carers support group. Quantitative data analysis found no statistically significant differences within or between groups. The qualitative data demonstrated that carers perceived Cognitive Stimulation Therapy had some benefits for the people living with dementia, especially social benefits. Carers also perceived that attending the carers support group was beneficial for them in terms of gaining a better understanding of dementia, developing coping skills and having peer support. The study was limited in scale and further research with a larger sample, using direct measures of the impact of Cognitive Stimulation Therapy with people living with dementia and supplementary research exploring which characteristic of carers support groups are effective would be worthwhile.

Caring for children with physical disability in Kenya: potential links between caregiving and carers' physical health.

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Geere, J L; Gona, J; Omondi, F O; Kifalu, M K; Newton, C R; Hartley, S

2013-05-01

The health of a carer is a key factor which can affect the well-being of the child with disabilities for whom they care. In low-income countries, many carers of children with disabilities contend with poverty, limited public services and lack assistive devices. In these situations caregiving may require more physical work than in high-income countries and so carry greater risk of physical injury or health problems. There is some evidence that poverty and limited access to health care and equipment may affect the physical health of those who care for children with disabilities. This study seeks to understand this relationship more clearly. A mixed methods study design was used to identify the potential physical health effects of caring for a child with moderate-severe motor impairments in Kilifi, Kenya. Qualitative data from in-depth interviews were thematically analysed and triangulated with data collected during structured physiotherapy assessment. Carers commonly reported chronic spinal pain of moderate to severe intensity, which affected essential activities. However, carers differed in how they perceived their physical health to be affected by caregiving, also reporting positive benefits or denying detrimental effects. Carers focussed on support in two key areas; the provision of simple equipment and support for their children to physically access and attend school. Carers of children with moderate-severe motor impairments live with their own physical health challenges. While routine assessments lead to diagnosis of simple musculoskeletal pain syndromes, the overall health status and situation of carers may be more complex. As a consequence, the role of rehabilitation therapists may need to be expanded to effectively evaluate and support carers' health needs. The provision of equipment to improve their child's mobility, respite care or transport to enable school attendance is likely to be helpful to carers and children alike. © 2012 Blackwell Publishing Ltd.

The Role of Nurse Leaders in Advancing Carer Communication Needs across Transitions of Care: A Call to Action.

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Udod, Sonia A; Lobchuk, Michelle

2017-01-01

This paper focuses on the central role of senior nurse leaders in advancing organizational resources and support for communication between healthcare providers and carers that influences patient and carer outcomes during the transition from hospital to the community. A Think Tank (Lobchuk 2012) funded by the Canadian Institutes of Health Research (CIHR) gathered interdisciplinary and intersectoral stakeholders from local, national and international levels to develop a Family Carer Communication Research Collaboration. Workshop stakeholders addressed critical challenges in meeting communication needs of carers as partners with clinicians in promoting safe care for the elderly, chronically or seriously ill or disabled individuals in the community. Key priority areas identified the need to uncover nurse leader perspectives at the system, nurse leader, healthcare provider and patient levels where communication with carers occurs. The overarching outcome from the workshop focuses on the need for nurse leaders to advocate for patients and their families in meeting carer communication needs. The authors' "call to action" requires commitment and investment from nurse leaders in the critical juncture of healthcare delivery to strengthen communication between healthcare providers and carers that influence patient and carer outcomes in seamless transitions of care.

The development and evaluation of a multimedia resource for family carers of patients receiving palliative care: a consumer-led project.

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Thomas, Kristina; Moore, Gaye

2015-06-01

Previous intervention research has shown that group education sessions for carers are effective but not always feasible due to the demands of the caregiving role and the difficulty in getting carers to attend. This project was a consumer-led research initiative to develop and evaluate a multimedia resource (DVD) providing information and support for carers of people receiving palliative care. Eight carers were recruited from a community palliative care service to form a steering committee for the project. In collaboration with two researchers, the committee discussed the topics that would be included in the resource, developed an interview guide, participated in the filmed interviews, and developed the evaluation program. The steering committee participated in a focus group as part of the evaluation to elicit their experiences of the project. An evaluation was conducted that included the following: questionnaires for 29 carers and 17 palliative care health professionals; follow-up telephone interviews with carers; a focus group with health professionals; and a focus group with the Carer Steering Committee. The carers and health professionals reported that the DVD was informative (93 and 94%, respectively), realistic (96 and 88%), supportive (93 and 88%), and helpful (83 and 100%). All health professionals and carers reported that they would recommend the resource to carers. Carers on the steering committee reported substantial benefits that involved the opportunity to help others and to openly discuss and reflect on their experiences. This is an important resource that can be utilized to support family carers and introduce palliative care. Currently, 1500 copies have been distributed to palliative care services and professionals nationwide and is available online at centreforpallcare.org/index.php/resources/carer_dvd/. Development of this DVD represents a strong collaboration between carers and researchers to produce a resource that is informative, supportive, and

Involving healthcare professionals and family carers in setting research priorities for end-of-life care.

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Diffin, Janet; Spence, Michael; Spencer, Rebecca; Mellor, Peter; Grande, Gunn

2017-02-02

It is important to ensure regional variances are considered when setting future end-of-life research priorities, given the differing demographics and service provision. This project sought to identify end-of-life research priorities within Greater Manchester (United Kingdom). Following an initial scoping exercise, six topics within the 10 national priorities outlined by The Palliative and end-of-life care Priority Setting Partnership were selected for exploration. A workshop involving 32 healthcare professionals and a consultation process with 26 family carers was conducted. Healthcare professionals and carers selected and discussed the topics important to them. The topics selected most frequently by both healthcare professionals and carers were 'Access to 24 hour care', 'Planning end-of-life care in advance' and 'Staff and carer education'. Healthcare professionals also developed research questions for their topics of choice which were refined to incorporate carers' views. These questions are an important starting point for future end-of-life research within Greater Manchester.

Stressors and common mental disorder in informal carers--an analysis of the English Adult Psychiatric Morbidity Survey 2007.

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Stansfeld, Stephen; Smuk, Melanie; Onwumere, Juliana; Clark, Charlotte; Pike, Cleo; McManus, Sally; Harris, Jenny; Bebbington, Paul

2014-11-01

This study investigates potential explanations of the association between caring and common mental disorder, using the English Adult Psychiatric Morbidity Survey 2007. We examined whether carers are more exposed to other stressors additional to caring--such as domestic violence and debt--and if so whether this explains their elevated rates of mental disorder. We analysed differences between carers and non-carers in common mental disorders (CMD), suicidal thoughts, suicidal attempts, recent stressors, social support, and social participation. We used multivariate models to investigate whether differences between carers and non-carers in identifiable stressors and supports explained the association between caring and CMD, as measured by the revised Clinical Interview Schedule. The prevalence of CMD (OR=1.64 95% CI 1.37-1.97), suicidal thoughts in the last week (OR=2.71 95% CI 1.31-5.62) and fatigue (OR=1.33 95% CI 1.14-1.54) was increased in carers. However, caring remained independently associated with CMD (OR=1.58 1.30-1.91) after adjustment for other stressors and social support. Thus caring itself is associated with increased risk of CMD that is not explained by other identified social stressors. Carers should be recognized as being at increased risk of CMD independent of the other life stressors they have to deal with. Interventions aimed at a direct reduction of the stressfulness of caring are indicated. However, carers also reported higher rates of debt problems and domestic violence and perceived social support was slightly lower in carers than in non-carers. So carers are also more likely to experience stressors other than caring and it is likely that they will need support not only aimed at their caring role, but also at other aspects of their lives. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Healthy Parent Carers programme: development and feasibility of a novel group-based health-promotion intervention

Directory of Open Access Journals (Sweden)

Aleksandra J. Borek

2018-02-01

Full Text Available Abstract Background Parent carers of disabled children report poor physical health and mental wellbeing. They experience high levels of stress and barriers to engagement in health-related behaviours and with ‘standard’ preventive programmes (e.g. weight loss programmes. Interventions promoting strategies to improve health and wellbeing of parent carers are needed, tailored to their specific needs and circumstances. Methods We developed a group-based health promotion intervention for parent carers by following six steps of the established Intervention Mapping approach. Parent carers co-created the intervention programme and were involved in all stages of the development and testing. We conducted a study of the intervention with a group of parent carers to examine the feasibility and acceptability. Standardised questionnaires were used to assess health and wellbeing pre and post-intervention and at 2 month follow up. Participants provided feedback after each session and took part in a focus group after the end of the programme. Results The group-based Healthy Parent Carers programme was developed to improve health and wellbeing through engagement with eight achievable behaviours (CLANGERS – Connect, Learn, be Active, take Notice, Give, Eat well, Relax, Sleep, and by promoting empowerment and resilience. The manualised intervention was delivered by two peer facilitators to a group of seven parent carers. Feedback from participants and facilitators was strongly positive. The study was not powered or designed to test effectiveness but changes in measures of participants’ wellbeing and depression were in a positive direction both at the end of the intervention and 2 months later which suggest that there may be a potential to achieve benefit. Conclusions The Healthy Parent Carers programme appears feasible and acceptable. It was valued by, and was perceived to have benefited participants. The results will underpin future refinement of the

The relevance of recovery to carers of people who have schizophrenia

OpenAIRE

Fox, Joanna Ruth

2013-01-01

Recovery is a new concept positing that people with schizophrenia can lead fulfilling, satisfying, and productive lives. Family carers often play a helpful but largely unacknowledged role in the support of service users with schizophrenia, and the nature of their contribution to and their role in recovery has hitherto not been investigated. This original PhD explores whether learning about the recovery approach through participation in a training intervention changes the way carers view recov...

Examining the support needs of ageing family carers in developing future plans for a relative with an intellectual disability.

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Taggart, Laurence; Truesdale-Kennedy, Maria; Ryan, Assumpta; McConkey, Roy

2012-09-01

Planning for the future care of adults with an intellectual disability after the main family carer ceases their care, continues to be a sensitive and difficult time posing challenges for service providers internationally. Limited research has been undertaken on this topic because until recently, people with intellectual disability usually pre-deceased their parents. This study examined ageing carers' preferences for future care and the support systems required to make such future plans. The study was conducted in one region of the United Kingdom with a high proportion of family carers. A mixed methods design was employed. In Stage 1, a structured questionnaire was used to collate information on the health, caregiving demands and future planning preferences of 112 parent and sibling carers; aged 60-94 years. In Stage 2, 19 in-depth semistructured interviews were undertaken with a sample of carers to explore a range of issues around future planning. Over half of the carers were lone carers, mainly female, with many reporting a wide range of health problems. A third of these carers reported that their caregiving resulted in high levels of anxiety. The main preference of the carers was for the person to remain in the family home, with either the family and/or paid staff to support them. A minority of parent carers preferred the person to move into the home of a sibling, although some favoured the person moving to a residential facility with other people with intellectual disabilities. The majority of carers did not want their relative to move into an older people's residential/nursing facility. In the qualitative data, four main themes were identified around future planning: unremitting apprehension, the extent of planning, obstacles encountered and solutions for future planning. Avoidance, lack of guidance and a lack of appropriate residential provision were cited as obstacles to making future plans compounded by the emotional upset experienced by carers in thinking

Psychometric properties of carer-reported outcome measures in palliative care: A systematic review

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Michels, Charlotte TJ; Boulton, Mary; Adams, Astrid; Wee, Bee; Peters, Michele

2016-01-01

Background: Informal carers face many challenges in caring for patients with palliative care needs. Selecting suitable valid and reliable outcome measures to determine the impact of caring and carers’ outcomes is a common problem. Aim: To identify outcome measures used for informal carers looking after patients with palliative care needs, and to evaluate the measures’ psychometric properties. Design: A systematic review was conducted. The studies identified were evaluated by independent reviewers (C.T.J.M., M.B., M.P.). Data regarding study characteristics and psychometric properties of the measures were extracted and evaluated. Good psychometric properties indicate a high-quality measure. Data sources: The search was conducted, unrestricted to publication year, in the following electronic databases: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, EMBASE, PubMed, PsycINFO, Social Sciences Citation Index and Sociological Abstracts. Results: Our systematic search revealed 4505 potential relevant studies, of which 112 studies met the inclusion criteria using 38 carer measures for informal carers of patients with palliative care needs. Psychometric properties were reported in only 46% (n = 52) of the studies, in relation to 24 measures. Where psychometric data were reported, the focus was mainly on internal consistency (n = 45, 87%), construct validity (n = 27, 52%) and/or reliability (n = 14, 27%). Of these, 24 measures, only four (17%) had been formally validated in informal carers in palliative care. Conclusion: A broad range of outcome measures have been used for informal carers of patients with palliative care needs. Little formal psychometric testing has been undertaken. Furthermore, development and refinement of measures in this field is required. PMID:26407683

Palliative care for Parkinson's disease: Patient and carer's perspectives explored through qualitative interview.

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Fox, Siobhan; Cashell, Alison; Kernohan, W George; Lynch, Marie; McGlade, Ciara; O'Brien, Tony; O'Sullivan, Sean S; Foley, Mary J; Timmons, Suzanne

2017-07-01

Palliative care is recommended for non-malignant illnesses, including Parkinson's disease. However, past research with healthcare workers highlights unmet palliative needs in this population and referral rates to Specialist Palliative Care are low. Some healthcare workers perceive a 'fear' in their patients about introducing palliative care. However, less is known about the views of people with Parkinson's disease and their carers about palliative care. (1) To explore the palliative care and related issues most affecting people with Parkinson's disease and their families and (2) to examine perceptions about/understanding of palliative care. This was a qualitative study; semi-structured interviews were conducted, transcribed and analysed using thematic analysis. A total of 31 people participated, both people with Parkinson's disease ( n = 19) and carers ( n = 12), across three Movement Disorder Clinics in the Republic of Ireland. People with Parkinson's disease and their carers were unfamiliar with the term palliative care. When informed of the role of palliative care, most felt that they would benefit from this input. People with Parkinson's disease and carers experienced a high illness burden and wanted extra support. Crises requiring Specialist Palliative Care involvement may occur at diagnosis and later, with advancing illness. Participants wanted more information about palliative care and especially further supports to address their psychosocial needs. A holistic palliative care approach could address the complex physical and psychosocial symptoms experienced by people with Parkinson's disease and their carers, and people with Parkinson's disease and their carers are open to palliative care. Further research needs to explore how palliative care can be introduced into the routine care for people with Parkinson's disease.

Consumer and carer perspectives in the development of a mental health research, treatment and teaching facility: A thematic analysis.

Science.gov (United States)

Katsikitis, M; Lane, B R; Ozols, I; Statham, D

2017-09-01

WHAT IS KNOWN ON THE SUBJECT?: Around the world, recovery has become a focus in mental health policy. The participation of people accessing mental health services (consumers) and carers of such individuals in decision-making related to services forms part of this recovery orientation and studies suggest positive outcomes following such participation. However, little is known about consumer and carer desires at the earliest stages of development of new services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Consumers and carers desire changes to how mental health services are provided. Many factors affect consumer and carer experiences, including language use, physical design of spaces, accessibility, consideration of individual needs, practical help and how well care is continued from hospital to community settings. Carers may feel sidelined in treatment and be distressed as a result. They wish to be respected and involved in recovery. Consumers and carers wish for focus on broader health, with care taken to address physical health, psychological needs, social needs and treatment of the whole person rather than just an illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Consumers and carers desire partnership with professionals in recovery. Tokenistic participation should be avoided. Flexibility in how services are provided and less formality may help engage consumers and carers. Specifically, professionals may help by linking consumers and carers to services that address practical needs. Professionals should communicate with carers to draw on their expertise about the individual accessing the mental health service and help carers understand how they can assist the individual's recovery. Introduction Recovery-oriented mental health policies recognize consumer and carer participation in service decision-making as essential, but little is known about the views of these individuals in the earliest stages of service development. Aim This study sought consumer and carer

Decision aids for respite service choices by carers of people with dementia: development and pilot RCT

Directory of Open Access Journals (Sweden)

Stirling Christine

2012-03-01

Full Text Available Abstract Background Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care. Methods A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later. Results The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants. Conclusions While these results must be interpreted with

Residential Carers' Knowledge and Attitudes towards Physiotherapy Interventions for Adults with Learning Disabilities

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Stewart, Stephen; Macha, Ruth; Hebblethwaite, Amy; Hames, Annette

2009-01-01

Through the use of face-to-face interviews, this article explores residential carers' perceptions and understanding of a physiotherapy service provided to patients with a learning disability, with the aim of highlighting potential areas for improvement in the service. Carers involved in the study reported a good relationship with the…

A dementia first aid course for family carers.

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Pogson, Richard

Many people with dementia are cared for by family members, who may receive little advice or support. This article describes a course developed to help carers deal with frustrating and challenging behaviour.

Supporting Carers of People with Dementia : A mixed methods evaluation and feasibility study (January 2018)

OpenAIRE

Gridley, Kate; Aspinal, Fiona Jane; Parker, Gillian Mary; Weatherly, Helen Louise Ann; Neves De Faria, Rita Isabel; Longo, Francesco; Van Den Berg, Bernard

2018-01-01

Unpaid carers are the mainstay of the UK care system for people with dementia. Yet caring can have an impact on the well-being and health of the carer. Admiral Nursing is the only specialist nursing service in the UK that specifically focuses on supporting carers of people with dementia, but evidence of its effectiveness, costs, and relationships to other services is limited. This project aimed to address this gap and explore the feasibility of full-scale formal evaluation.

Risk factor characteristics in carers who physically abuse or neglect their elderly dependants.

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Reay, A M; Browne, K D

2001-02-01

This study investigates the prevalence of, and differences in, risk factor characteristics in a sample of two select populations of carers, one of which physically abused their elderly dependants and one of which neglected them. Nineteen carers (nine who had physically abused and 10 who had neglected their elderly relatives), who were referred to clinical psychology by either their general practitioner or their psychiatrist, were invited to take part in this study. A detailed history of risk factors was obtained, including history of alcohol dependency, type and history of mental ill health, history of maltreatment earlier in life, who they were caring for, how long they had been a carer and whether they felt isolated as a carer. Subjects were then given five assessments to determine whether there were any differences between the two groups. These were the Conflict Tactic Scale, Strain Scale, Beck Depression Inventory, Beck Anxiety Inventory and Cost of Care Index. An examination of the risk factors suggests that heavy alcohol consumption and past childhood abuse by fathers were likely to lead to physical abuse. Significantly higher conflict and depression scores were also present in the physical abuse group, while the neglect group had significantly higher anxiety scores. It is suggested that these findings should be incorporated into an assessment of future risk of abuse or neglect by the carer.

General Nutrition Knowledge among Carers at Group Homes for People with Intellectual Disability

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Hamzaid, N. H.; Flood, V. M.; Prvan, T.; O'Connor, H. T.

2018-01-01

Background: Good nutrition knowledge among carers of people with intellectual disability (ID) living in group homes is essential as they have a primary role in food provision for residents. Research on the nutrition knowledge of carers is limited. Method: This cross-sectional study assessed the level of general nutrition knowledge in a convenience…

What do parents and preschool staff tell us about young children's physical activity: a qualitative study

Directory of Open Access Journals (Sweden)

Baur Louise A

2008-12-01

Full Text Available Abstract Background Physical activity and small screen recreation are two modifiable behaviours associated with childhood obesity and the development of chronic health problems. Parents and preschool staff shape behaviour habits in young children. The aims of this qualitative study were to explore the attitudes, values, knowledge and understanding of parents and carers of preschool-age children in relation to physical activity and small screen recreation and to identify influences upon these behaviours. Methods This research involved a focus group study with parents and carers of the target population. A purposive sample of 39 participants (22 parents, 17 carers participated in 9 focus groups. Participants were drawn from three populations of interest: those from lower socioeconomic status, and Middle-Eastern and Chinese communities in the Sydney (Australia metropolitan region. Results All participants understood the value of physical activity and the impact of excessive small screen recreation but were unfamiliar with national guidelines for these behaviours. Participants described the nature and activity patterns of young children; however, the concept of activity 'intensity' in this age group was not a meaningful term. Factors which influenced young children's physical activity behaviour included the child's personality, the physical activity facilities available, and the perceived safety of their community. Factors facilitating physical activity included a child's preference for being active, positive parent or peer modelling, access to safe play areas, organised activities, preschool programs and a sense of social connectedness. Barriers to physical activity included safety concerns exacerbated by negative media stories, time restraints, financial constraints, cultural values favouring educational achievement, and safety regulations about equipment design and use within the preschool environment. Parents considered that young children are

Variances in family carers' quality of life based on selected relationship and caregiving indicators: A quantitative secondary analysis.

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Naef, Rahel; Hediger, Hannele; Imhof, Lorenz; Mahrer-Imhof, Romy

2017-06-01

To determine subgroups of family carers based on family relational and caregiving variables and to explore group differences in relation to selected carer outcomes. Family caregiving in later life holds a myriad of positive and negative outcomes for family members' well-being. However, factors that constitute family carers' experience and explain variances are less well understood. A secondary data analysis using cross-sectional data from a controlled randomised trial with community-dwelling people 80 years or older and their families. A total of 277 paired data sets of older persons and their family carers were included into the analysis. Data were collected via mailed questionnaires and a geriatric nursing assessment. A two-step cluster analysis was performed to determine subgroups. To discern group differences, appropriate tests for differences with Bonferroni correction were used. Two family carer groups were identified. The low-intensity caregiver group (57% of carers) reported high relationship quality and self-perceived ease of caregiving. In contrast, the high-intensity caregiver group (43% of carers) experienced significantly lower relationship quality, felt less prepared and appraised caregiving as more difficult, time intensive and burdensome. The latter cared for older, frailer and more dependent octogenarians and had significantly lower levels of quality of life and self-perceived health compared to the low-intensity caregiver group. A combination of family relational and caregiving variables differentiates those at risk for adverse outcomes. Family carers of frailer older people tend to experience higher strain, lower relationship quality and ability to work together as a family. Nurses should explicitly assess family carer needs, in particular when older persons are frail. Family carer support interventions should address caregiving preparedness, demand and burden, as well as concerns situated in the relationship. © 2016 John Wiley & Sons Ltd.

eHealth interventions for family carers of people with long term illness: A promising approach?

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Sin, Jacqueline; Henderson, Claire; Spain, Debbie; Cornelius, Victoria; Chen, Tao; Gillard, Steve

2018-03-01

Family carers of people who have long term illness often experience physical and mental health morbidities, and burden. While there is good evidence to suggest that carers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group-formats. eHealth interventions offer a novel, accessible and self-paced approach to care delivery. Whether these are effective for carers' wellbeing has been little explored. This paper reports the first comprehensive systematic review in this area. A total of 78 studies, describing 62 discrete interventions, were identified. Interventions commonly aimed to promote carers' knowledge, self-efficacy, caregiving appraisal, and reduce global health morbidities. Interventions were offered to carers of people with a wide range of long term illness; dementia has been the most researched area, as reported in 40% of studies. Clinical and methodological heterogeneity in interventions precluded meta-analyses, and so data were analysed narratively. The most popular approach has comprised psychoeducational interventions delivered via an enriched online environment with supplementary modes of communication, such as network support with professionals and peers. Overall, carers appreciate the flexibility and self-paced nature of eHealth interventions, with high rates of satisfaction and acceptability. More studies using robust designs are needed to extend the evidence base. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

The experience of family carers attending a joint reminiscence group with people with dementia: A thematic analysis.

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Melunsky, Nina; Crellin, Nadia; Dudzinski, Emma; Orrell, Martin; Wenborn, Jennifer; Poland, Fiona; Woods, Bob; Charlesworth, Georgina

2015-11-01

Reminiscence therapy has the potential to improve quality of life for people with dementia. In recent years reminiscence groups have extended to include family members, but carers' experience of attending joint sessions is undocumented. This qualitative study explored the experience of 18 family carers attending 'Remembering Yesterday Caring Today' groups. Semi-structured interviews were transcribed and subjected to thematic analysis. Five themes were identified: experiencing carer support; shared experience; expectations (met and unmet), carer perspectives of the person with dementia's experience; and learning and comparing. Family carers' experiences varied, with some experiencing the intervention as entirely positive whereas others had more mixed feelings. Negative aspects included the lack of respite from their relative, the lack of emphasis on their own needs, and experiencing additional stress and guilt through not being able to implement newly acquired skills. These findings may explain the failure of a recent trial of joint reminiscence groups to replicate previous findings of positive benefit. More targeted research within subgroups of carers is required to justify the continued use of joint reminiscence groups in dementia care. © The Author(s) 2013.

An integrative review of information and communication technology based support interventions for carers of home dwelling older people.

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Bergström, Aileen L; Hanson, Elizabeth

2018-02-05

A growing number of studies of informal carers of older people reveal positive results concerning support via Information and Communication Technologies (ICT). Systematic examination of factors that have a potential impact on carer outcomes are needed to inform future research. To explore studies concerning ICT support of adult carers of older people and to identify study characteristics that have a potential impact on carer outcomes. This integrative review includes 123 studies published since 2005. Fundamental questions for designing sensitive support interventions; ' who, what, and how ' were applied to a synthesis of the results. Identified characteristics from the studies responding to the who question included variables of the carers, such as their relationship with the care recipient or their ethnicity. Characteristics related to the what question related to the types of interventions, and the how question concerned the different services or programs offered, the idiosyncratic needs of the carers, and the types of technologies used. Results are discussed according to micro, meso and macro levels of analysis. This extensive review can inform future studies and highlight the evidence in the area for decision makers, practitioners and/or NGOs working with innovative forms of support for carers of older people.

Advance Care Planning in Dementia: Do Family Carers Know the Treatment Preferences of People with Early Dementia?

Directory of Open Access Journals (Sweden)

Karen Harrison Dening

Full Text Available When a person with dementia (PWD has lost the ability to make treatment decisions, clinicians often rely on family carers to know and articulate these preferences with assumed accuracy. This study used the Life Support Preferences Questionnaire (LSPQ to explore whether family carers' choices show agreement with the end of life care preferences of the person with dementia for whom they care and what factors influence this.A cross-sectional study interviewing 60 dyads (a person with early dementia and preserved capacity and their family carer each completing a modified LSPQ. We assessed how closely carers' choices resembled the PWD's preferences for treatment in three proposed health states: the here and now; severe stroke with coma; terminal cancer. Agreement between the PWD and their family carer responses was assessed using Kappa and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK statistics. We examined whether carer burden and distress, and relationship quality, influenced agreement.In interviews PWD were able to indicate their treatment preferences across all three scenarios. In the here-and-now most wanted antibiotics (98%, fewer cardio-pulmonary resuscitation (CPR (50% and tube feeding (47%. In severe stroke and coma antibiotics remained the more preferred treatment (88%, followed by CPR (57% and tube feeding (30%. In advanced cancer PWD expressed lower preferences for all treatments (antibiotics 68%; CPR 50%; tube feeding 37%. Carers' choices were similar to the PWDs' preferences in the here-and-now (71% (k = 0.03; PABAK = 0.4 with less agreement for future hypothetical health states. In severe stroke and coma carers tended wrongly to suggest that the PWD preferred more intervention (antibiotic, 67%; k = -0.022; PABAK = -0.60; CPR, 73%; k = 0.20; PABAK = -0.20, tube feeding, 66%; k = 0.25; PABAK = -0.12. In advanced cancer the agreement between PWD and carers was low (antibiotics; k = -0.03; PABAK = -0.52; CPR, k = -0.07; PABAK = -0

Is the qualitative research interview an acceptable medium for research with palliative care patients and carers?

Directory of Open Access Journals (Sweden)

Shipman Cathy

2008-04-01

Full Text Available Abstract Background Contradictory evidence exists about the emotional burden of participating in qualitative research for palliative care patients and carers and this raises questions about whether this type of research is ethically justified in a vulnerable population. This study aimed to investigate palliative care patients' and carers' perceptions of the benefits and problems associated with open interviews and to understand what causes distress and what is helpful about participation in a research interview. Methods A descriptive qualitative study. The data were collected in the context of two studies exploring the experiences of care of palliative care patients and carers. The interviews ended with questions about patients' and carers' thoughts on participating in the studies and whether this had been a distressing or helpful event. We used a qualitative descriptive analysis strategy generated from the interviews and the observational and interactional data obtained in the course of the study. Results The interviews were considered helpful: sharing problems was therapeutic and being able to contribute to research was empowering. However, thinking about the future was reported to be the most challenging. Consent forms were sometimes read with apprehension and being physically unable to sign was experienced as upsetting. Interviewing patients and carers separately was sometimes difficult and not always possible. Conclusion The open interview enables the perspectives of patients and carers to be heard, unfettered from the structure of closed questions. It also enables those patients or carers to take part who would be unable to participate in other study designs. The context is at least as important as the format of the research interview taking into account the relational circumstances with carers and appropriate ways of obtaining informed consent. Retrospective consent could be a solution to enhancing participants control over the interview.

Is the qualitative research interview an acceptable medium for research with palliative care patients and carers?

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Gysels, Marjolein; Shipman, Cathy; Higginson, Irene J

2008-04-24

Contradictory evidence exists about the emotional burden of participating in qualitative research for palliative care patients and carers and this raises questions about whether this type of research is ethically justified in a vulnerable population. This study aimed to investigate palliative care patients' and carers' perceptions of the benefits and problems associated with open interviews and to understand what causes distress and what is helpful about participation in a research interview. A descriptive qualitative study. The data were collected in the context of two studies exploring the experiences of care of palliative care patients and carers. The interviews ended with questions about patients' and carers' thoughts on participating in the studies and whether this had been a distressing or helpful event. We used a qualitative descriptive analysis strategy generated from the interviews and the observational and interactional data obtained in the course of the study. The interviews were considered helpful: sharing problems was therapeutic and being able to contribute to research was empowering. However, thinking about the future was reported to be the most challenging. Consent forms were sometimes read with apprehension and being physically unable to sign was experienced as upsetting. Interviewing patients and carers separately was sometimes difficult and not always possible. The open interview enables the perspectives of patients and carers to be heard, unfettered from the structure of closed questions. It also enables those patients or carers to take part who would be unable to participate in other study designs. The context is at least as important as the format of the research interview taking into account the relational circumstances with carers and appropriate ways of obtaining informed consent. Retrospective consent could be a solution to enhancing participants control over the interview.

Is the qualitative research interview an acceptable medium for research with palliative care patients and carers?

Science.gov (United States)

Gysels, Marjolein; Shipman, Cathy; Higginson, Irene J

2008-01-01

Background Contradictory evidence exists about the emotional burden of participating in qualitative research for palliative care patients and carers and this raises questions about whether this type of research is ethically justified in a vulnerable population. This study aimed to investigate palliative care patients' and carers' perceptions of the benefits and problems associated with open interviews and to understand what causes distress and what is helpful about participation in a research interview. Methods A descriptive qualitative study. The data were collected in the context of two studies exploring the experiences of care of palliative care patients and carers. The interviews ended with questions about patients' and carers' thoughts on participating in the studies and whether this had been a distressing or helpful event. We used a qualitative descriptive analysis strategy generated from the interviews and the observational and interactional data obtained in the course of the study. Results The interviews were considered helpful: sharing problems was therapeutic and being able to contribute to research was empowering. However, thinking about the future was reported to be the most challenging. Consent forms were sometimes read with apprehension and being physically unable to sign was experienced as upsetting. Interviewing patients and carers separately was sometimes difficult and not always possible. Conclusion The open interview enables the perspectives of patients and carers to be heard, unfettered from the structure of closed questions. It also enables those patients or carers to take part who would be unable to participate in other study designs. The context is at least as important as the format of the research interview taking into account the relational circumstances with carers and appropriate ways of obtaining informed consent. Retrospective consent could be a solution to enhancing participants control over the interview. PMID:18435846

Interprofessional teamwork in stroke care: Is it visible or important to patients and carers?

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Hewitt, Gillian; Sims, Sarah; Greenwood, Nan; Jones, Fiona; Ross, Fiona; Harris, Ruth

2015-01-01

Interprofessional teamwork is seen in healthcare policy and practice as a key strategy for providing safe, efficient and holistic healthcare and is an accepted part of evidence-based stroke care. The impact of interprofessional teamwork on patient and carer experience(s) of care is unknown, although some research suggests a relationship might exist. This study aimed to explore patient and carer perceptions of good and poor teamwork and its impact on experiences of care. Critical incident interviews were conducted with 50 patients and 33 carers in acute, inpatient rehabilitation and community phases of care within two UK stroke care pathways. An analytical framework, derived from a realist synthesis of 13 'mechanisms' (processes) of interprofessional teamwork, was used to identify positive and negative 'indicators' of teamwork. Participants identified several mechanisms of teamwork, but it was not a subject most talked about readily. This suggests that interprofessional teamwork is not a concept that is particularly important to stroke patients and carers; they do not readily perceive any impacts of teamwork on their experiences. These findings are a salient reminder that what might be expected by healthcare professionals to be important influences on experience may not be perceived to be so by patients and carers.

Management of fear of radiation exposure in carers of outpatients treated with iodine-131.

Science.gov (United States)

Calais, Phillipe J; Page, Andrew C; Turner, J Harvey

2012-07-01

To characterise potential fear of radiation exposure in a normal population of individuals who have volunteered to care for a radioactive family member or friend after outpatient radioimmunotherapy (RIT) treatment for cancer, and obtain their knowing and willing acceptance of the risk. Over 750 carers of 300 patients confined to their homes for 1 week following outpatient iodine-131 rituximab RIT of lymphoma were interviewed by a nuclear medicine physicist according to a multi-visit integrated protocol designed to minimise radiation exposure, define risk and gain informed consent. Median radiation exposure of carers was 0.49 mSv (range 0.01-3.7 mSv) which is below the Western Australian regulatory limit of 5 mSv for consenting adult carers of radioactive patients. After signing a declaration of consent, only 2 carers of 750 abrogated their responsibility and none of those who carried out their duties expressed residual concerns at the end of the exit interview with respect to their radiation exposure. Fear of radiation exposure in a normal population may be characterised as a normal emotional response. In the special case of carers of radioactive patients, this fear may be successfully managed by rational, authoritative and empathic explanation to define the risk and gain willing acceptance within the context of domiciliary patient care.

Coaching in self-efficacy improves care responses, health and well-being in dementia carers: a pre/post-test/follow-up study.

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Chenoweth, Lynn; Stein-Parbury, Jane; White, Danielle; McNeill, Georgene; Jeon, Yun-Hee; Zaratan, Beverley

2016-05-04

Maintaining the health and well-being of family carers of people with dementia is vital, given their potential for experiencing burden associated with the role. The study aimed to help dementia carers develop self-efficacy, be less hassled by the caring role and improve their health and well-being with goal-directed behaviour, by participating in an eight module carer coaching program. The study used mixed methods in a pre/post-test/follow-up design over 24 months, with assignment of consented dementia carers to either individualised (n = 16) or group coaching (n = 32), or usual carer support services (n = 43), depending on preference. Care-giving self-efficacy and hassles, carer health, well-being and goal-directed behaviours were assessed over time. Analysis of Variance (ANOVA) was used to compare changes over time and the effects of coaching on carer self-efficacy, hassles and health, using the Univariate General Linear Model (GLM). All carers were hassled by many aspects of caring at baseline. Participants receiving coaching reported non-significant improvements in most areas of self-efficacy for caring, hassles associated with caring and self-reported health at post-test and follow-up, than did carers receiving usual carer support. Group coaching had greater success in helping carers to achieve their goals and to seek help from informal and formal support networks and services. The study outcomes were generally positive, but need to be interpreted cautiously, given some methodological limitations. It has been shown, however, that health staff can assist dementia carers to develop self-efficacy in better managing their family member's limitations and behaviour, seek help from others and attend to their health. Teaching carers to use goal-directed behaviour may help them achieve these outcomes.

Cognitive reframing for carers of people with dementia

NARCIS (Netherlands)

Vernooij-Dassen, M.J.F.J.; Draskovic, I.; McCleery, J.; Downs, M.

2011-01-01

BACKGROUND: The balance of evidence about whether psychosocial interventions for caregivers of people with dementia could reduce carers' psychological morbidity and delay their relatives' institutionalisation is now widely regarded as moderately positive (Brodaty 2003; Spijker 2008).

Residential respite care is associated with family carers experiencing financial strain.

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Aggar, Christina; Ronaldson, Susan; Cameron, Ian D

2014-06-01

Care services for older people are provided with the expectation of supporting carers in their caregiving role. The aim of the study is to investigate the association between the utilisation of care services by older people and the caregiving experience. Cross-sectional design, involving a cohort of family carers (n = 119) of frail older people (≥70 years) enrolled in a clinical trial of frailty treatment in metropolitan Sydney from 2008 to 2011. The caregiving experience was measured in five domains: health, daily schedule, finance, family support and self-esteem (Caregiver Reaction Assessment tool). Multivariate regression analysis demonstrated an association between the utilisation of residential respite care and financial strain (β = -0.613, P = 0.049), after controlling for functional ability, co-residence and age. There is a need to consider carers' financial barriers and concerns in regards to the utilisation of respite care services. © 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.

The effects of informal carers' characteristics on their information needs: The information needs state approach.

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Alzougool, Basil; Chang, Shanton; Gray, Kathleen

2017-09-01

There has been little research that provides a comprehensive account of the nature and aspects of information needs of informal carers. The authors have previously developed and validated a framework that accounts for major underlying states of information need. This paper aims to apply this framework to explore whether there are common demographic and socioeconomic characteristics that affect the information needs states of carers. A questionnaire about the information needs states was completed by 198 carers above 18 years old. We use statistical methods to look for similarities and differences in respondents' information needs states, in terms of the demographic and socioeconomic variables. At least one information needs state varies among carers, in terms of seven demographic and socioeconomic variables: the age of the patient(s) that they are caring for; the condition(s) of the patient(s) that they are caring for; the number of patients that they are caring for; their length of time as a carer; their gender; the country that they live in; and the population of the area that they live in. The findings demonstrate the utility of the information needs state framework. We outline some practical implications of the framework.

Australian "Play School": Viewing and Post-Viewing Behaviours in Young Children

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Harrison, Cathie Anne; van Vliet, Helen Elizabeth; Anderson, Tracy

2012-01-01

Australian "Play School" is a children's television programme developed in collaboration with early childhood educators. It is screened free to air across Australia. Two hundred and twenty-four adult carers of young children aged 1-8 years completed an online survey via a link on the "Play School" website. The survey addressed…

The 'wayfinding' experience of family carers who learn to manage technical health procedures at home: a grounded theory study.

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McDonald, Janet; McKinlay, Eileen; Keeling, Sally; Levack, William

2017-12-01

With more care taking place in the home, family carers play an important role in supporting patients. Some family carers undertake technical health procedures generally managed by health professionals in hospital settings (e.g. managing a tracheostomy or enteral feeding). To explore how family carers learn to manage technical health procedures in order to help health professionals better understand and support this process. A grounded theory study using data from interviews with 26 New Zealand family carers who managed technical health procedures including nasogastric or gastrostomy feeding, stoma care, urinary catheterisation, tracheostomy management, intravenous therapy, diabetes management and complex wound dressings. Most (20 participants) were caring for their child and the remaining six for their spouse, parent or grandparent. Following grounded theory methods, each interview was coded soon after completion. Additional data were compared with existing material, and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was developed. Interviewing continued until no new ideas emerged and concepts were well defined. The core concept of 'wayfinding' indicates that the learning process for family carers is active, individualised and multi-influenced, developing over time as a response to lived experience. Health professional support was concentrated on the initial phase of carers' training, reducing and becoming more reactive as carers took responsibility for day-to-day management. Wayfinding involves self-navigation by carers, in contrast to patient navigator models which provide continuing professional assistance to patients receiving cancer or chronic care services. Wayfinding by carers raises questions about how carers should be best supported in their initial and ongoing learning as the management of these procedures changes over time. © 2017 Nordic College of Caring Science.

An analysis of the experiences of radiography and radiotherapy students who are carers at one UK university

International Nuclear Information System (INIS)

Hussain, Zainab; Pickering, Vicki; Percy, Dave; Crane, Julie; Bogg, Jan

2011-01-01

Purpose: This is a mixed methods study of the experiences and attendance of radiography and radiotherapy students who are carers at one UK university, Undergraduate radiography and radiotherapy programmes are attracting increasing numbers of mature students. It is therefore likely that the number of students with carer responsibilities is also increasing. This study explores the experiences of higher education of students with caring responsibilities. The aim of the study is to identify possible strategies and practices to enhance the student experience and so to work towards compliance with the recent Equality Act 2010. Method: All students on the radiography (n = 130) and radiotherapy (n = 97) programmes were invited to complete a short questionnaire. Students who identified themselves as carers on the questionnaire were invited to participate in focus group sessions. Due to the issues raised in the focus groups by students with regard to attendance at university and clinical placement, student absence rates were also investigated for students with and without caring responsibilities. Results: 215 students completed the questionnaire. 30 of the 215 students identified themselves as carers. 18 carers agreed to take part in focus groups. Carers reported that having fees paid by the NHS was an important choice factor for higher education. Carers' main concerns were: timetabling, finances, support after exam failures, understanding from academic staff and attendance issues. Examination of absence rates demonstrated carers had significantly (p = 0.000) less absence than non-carers for radiography and no significant differences for radiotherapy (p = 0.105). Conclusion: The NHS states it must be reflective of the community it serves. Thus those responsible for delivering health professional programmes have a duty to recruit and retain a diverse student population. The introduction of the Equality Act 2010 means higher education institutions must consider the needs of

Management of fear of radiation exposure in carers of outpatients treated with iodine-131

International Nuclear Information System (INIS)

Calais, P.J.; Turner, J.H.

2012-01-01

The objective of this study was to characterise potential fear of radiation exposure in a normal population of individuals who have volunteered to care for a radioactive family member or friend after outpatient radioimmunotherapy (RIT) treatment for cancer, and obtain their knowing and willing acceptance of the risk. Over 750 carers of 300 patients confined to their homes for 1 week following outpatient iodine-131 rituximab RIT of lymphoma were interviewed by a nuclear medicine physicist according to a multi-visit integrated protocol designed to minimise radiation exposure, define risk and gain informed consent. Median radiation exposure of carers was 0.49 mSv (range 0.01-3.7 mSv) which is below the Western Australian regulatory limit of 5 mSv for consenting adult carers of radioactive patients. After signing a declaration of consent, only 2 carers of 750 abrogated their responsibility and none of those who carried out their duties expressed residual concerns at the end of the exit interview with respect to their radiation exposure. Fear of radiation exposure in a normal population may be characterised as a normal emotional response. In the special case of carers of radioactive patients, this fear may be successfully managed by rational, authoritative and empathic explanation to define the risk and gain willing acceptance within the context of domiciliary patient care. (author)

Double deprivation: a phenomenological study into the experience of being a carer during a mental health crisis.

Science.gov (United States)

Albert, Rikke; Simpson, Alan

2015-12-01

To explore carers' experience of caring during a mental health crisis. Community mental health care including crisis care relies increasingly on carers. The relationship between carers and professionals is at times fraught due to issues of what constitutes a crisis, confidentiality and a perception of lack of empathy. The caring experience can lead carers to feel isolated and neglected. A qualitative study with a phenomenological approach. Eight carers participated and were interviewed individually using a semi-structured approach. Analysis used the Interpretive Phenomenological Analysis method including transcribing of interviews, initial noting, searching for connections and patterns across the transcripts and cases. The themes were checked with the participants for their views on the emerging themes. The data were collected from November 2011-May 2012. Carers experienced 'double deprivation' by not receiving support from professionals and protecting their social network from the trauma of the crisis. The caring in crisis invoked complex feelings of guilt and loyalty which made discussing aggression difficult. Caring was described as a terrifying experience not just because of the aggression but also because of the perception of abandonment by professionals. The experience was an overwhelmingly negative one with a wish for acknowledgement of the crisis and support from mental health services. For most of the participants the caring during crisis was traumatic which left the carer feeling isolated and unsupported. The study should be used to help educate professionals on the complexities of caring during a crisis. © 2015 John Wiley & Sons Ltd.

A study of family carers of people with a life-threatening illness. 2: Implications of the needs assessment.

Science.gov (United States)

Scott, G

2001-07-01

This is the second of two articles that consider the findings of a Carers' Assessment of Difficulties Index (CADI) (Nolan et al, 1998) delivered in a palliative care context. It analyses the implications of these findings for practitioners concerned with the delivery of palliative care to such carers and their families. The development of support strategies and services addressing their needs are also presented against a backdrop of transactional stress theory. For people new to caring, recommendations for the local service include early intervention through informational support and validation of their emotional responses to caring; for longer-term carers they include assistance with cognitive reappraisal of the stressfulness of caring and regular 'respite' and socializing opportunities. These are taking place in a political climate that finally recognizes the contribution and value of carers (Department of Health, 1999). The research behind these carer identity and recognition initiatives aims to apply the spirit of public recognition and practical wisdom of palliative care expertise by responding sensitively to the specific needs of carers of people with a life-threatening illness.

Good caring and vocabularies of motive among foster carers

Directory of Open Access Journals (Sweden)

Jennifer Doyle

2013-12-01

Full Text Available Employing C. Wright Mills’ concept of vocabulary of motives, this article examines the motives and attitudes of people who volunteer to foster children with high support needs. Data is drawn from a larger qualitative study involving indepth interviewing of 23 carers. When asked why they had become foster carers participants produced conventional accounts of child-centred altruistic motives–an acceptable vocabulary of motives which satisfied institutional and cultural expectations regarding caregiving. However, closer examination of participants’ experiences and attitudes revealed the likelihood that economic motives were also factors in decisions to foster. It is argued that participants chose to exclude economic motives from their accounts so as to avoid the risk of being seen to be ‘doing it for the money’.

Foster carer experience in Spain: Analysis of the vulnerabilities of a permanent model.

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López López, Mónica; Del Valle, Jorge F

2016-05-01

The voice of foster families is a valuable tool in the development and improvement of foster family services. Regularly evaluating the satisfaction of foster carers can facilitate the early identification of a range of problems that might pose a risk to the placement. This article reports the experience of 200 Spanish foster families (kinship and non-kinship) with foster services in relation to motivation for becoming foster carers, sources of stress and reward, satisfaction with the services and needs. Semi-structured interviews were performed. The aims of the research are principally of a descriptive character, so each group of variables was examined using frequency analysis. The foster carers interviewed demonstrated a high degree of satisfaction with the foster programs, although some areas seem more problematic, such as financial compensation, information provided about the fostered child, contact with the birth family and the sensitivity of professionals. This study reveals several differences with regard to international literature, that are related to particularities of the Spanish child care system. The results may be extremely useful for the implementation of policy changes which could contribute to raised levels of satisfaction for the foster carers, and increased effectiveness of the programs.

A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder.

LENUS (Irish Health Repository)

Madigan, K

2012-05-01

In a RCT of family psychoeducation, 47 carers of 34 patients were allocated to one of three groups; Multifamily Group Psychoeducation, Solution Focussed Group Therapy or Treatment as Usual. Carers in both the MFGP intervention and the SFGP arm demonstrated greater knowledge and reduction in burden than those in the TAU arm.

Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial.

Science.gov (United States)

Brazil, Kevin; Carter, Gillian; Cardwell, Chris; Clarke, Mike; Hudson, Peter; Froggatt, Katherine; McLaughlin, Dorry; Passmore, Peter; Kernohan, W George

2018-03-01

In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. To evaluate the effectiveness of advance care planning with family carers in dementia care homes. Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff. A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions. The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.

Supporting "Young Carers" in Kenya: From Policy Paralysis to Action

Science.gov (United States)

Skovdal, Morten; Campbell, Catherine; Onyango, Vincent

2013-01-01

African children who care for sick or dying adults are receiving less than optimal support due to confusion about whether or not young caregiving constitutes a form of child labour and the tendency of the authorities to play it "safe" and side with more abolitionist approaches to children's work, avoiding engagement with support…

Carers' experiences of involvement in care planning: a qualitative exploration of the facilitators and barriers to engagement with mental health services.

Science.gov (United States)

Cree, Lindsey; Brooks, Helen L; Berzins, Kathryn; Fraser, Claire; Lovell, Karina; Bee, Penny

2015-08-29

Formal recognition and involvement of carers in mental health services has been the focus of recent policy and practice initiatives as well as being supported by carers themselves. However, carers still report feeling marginalised and distanced from services. A prominent theme is that that they are not listened to and their concerns are not taken seriously. Compared to service user views, the reasons underpinning carers' dissatisfaction with care-planning procedures have been relatively neglected in the research literature, despite the substantial and significant contribution that they make to mental health services. The aim of the study was to explore carers' experiences of the care planning process for people with severe mental illness. Qualitative interviews and focus groups were undertaken with carers. Data were combined and analysed using framework analysis. Whilst identifying a shared desire for involvement and confirming a potential role for carers within services, our data highlighted that many carers perceive a lack of involvement in care planning and a lack of recognition and appreciation of their role from health professionals. Barriers to involvement included structural barriers, such as the timing and location of meetings, cultural barriers relating to power imbalances within the system and specific barriers relating to confidentiality. This qualitative study led by a researcher who was a carer herself has developed the understanding of the potential role of carers within the care planning process within mental health services, along with the facilitators and barriers to achieving optimal involvement.

A systematic review of the economic evidence for interventions for family carers of stroke patients.

Science.gov (United States)

Heslin, Margaret; Forster, Anne; Healey, Andy; Patel, Anita

2016-02-01

To examine the economic evidence for interventions aimed at family carers of stroke patients. Searches (limited to those published in English since 1990) were performed in key databases along with hand searches of relevant papers. Papers were restricted to studies including any economic data (broadly defined) for any intervention targeting carers explicitly or explicitly referring to a carer element, beyond involving carers in the care or intervention for patients (i.e. more than just carers being invited to observe an intervention targeted at the patient). Two reviewers independently screened full papers and extracted data using guidance from the National Institute for Health and Care Excellence, and quality assessment using the Newcastle-Ottawa Quality Assessment Scale (cohort studies), the Delphi list (randomised controlled trials) and guidelines on economic quality from the British Medical Journal. Data were reviewed descriptively as meta analyses were inappropriate due to non-comparability of studies. Ten papers were included in the review. These were heterogeneous in their design, intervention and economic analyses making comparison difficult. Only three of the ten papers included economic evaluations. All three reported that the intervention was less costly and had better or equivalent outcomes than the control comparator although two of these were based on the same intervention using the same dataset. There is some limited evidence that interventions for family carers of stroke patients are effective and cost effective. However, due to variation in the types of interventions examined, little can be concluded regarding implications for clinical practice. © The Author(s) 2015.

What does the literature suggest about what carers need from mental health services for their own wellbeing? A Systematic Review.

Science.gov (United States)

Susanti, Herni; Lovell, Karina; Mairs, Hilary

2018-02-01

The aim of this study was to examine prior studies relating to carers' needs from mental health services for their own wellbeing. A systematic approach was adopted for the literature review. The databases searched included MEDLINE, PSycINFO, EMBASE, and CINAHL, involving the use of search terms such as carers, mental health, and needs. The search was conducted in April 2012 and updated in December 2015. In total, 40 published papers were included in the review and were subsequently assessed for quality. For the data synthesis, a thematic analysis approach was employed to integrate the quantitative and qualitative evidence relating to carers' needs. Twenty-five of the reviewed studies were qualitative, 12 were quantitative, and 3 were mixed. Four major carer needs emerged from the synthesis: (1) holistic wellbeing of service users, (2) holistic wellbeing of carers, (3) supportive attitudes of professionals, and (4) carer involvement. All four of these needs, in fact, revolved around the carers' ill relatives. The studies reviewed suggest that while carers of people suffering from mental illness have a range of needs, they generally fail to offer straightforward information about their own needs. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Experiences with using information and communication technology to build a multi-municipal support network for informal carers.

Science.gov (United States)

Torp, Steffen; Bing-Jonsson, Pia C; Hanson, Elizabeth

2013-09-01

This multi-municipal intervention study explored whether informal carers of frail older people and disabled children living at home made use of information and communication technology (ICT) to gain knowledge about caring and to form informal support networks, thereby improving their health. Seventy-nine informal carers accessed web-based information about caring and an e-based discussion forum via their personal computers. They were able to maintain contact with each other using a web camera and via normal group meetings. After the first 12 months, 17 informal carers participated in focus group interviews and completed a short questionnaire. Four staff members were also interviewed. Participant carers who had prior experiences with a similar ICT-based support network reported greater satisfaction and more extensive use of the network than did participants with no such prior experience. It seems that infrequent usage of the service may be explained by too few other carers to identify with and inappropriate recruitment procedures. Nevertheless, carers of disabled children reported that the intervention had resulted in improved services across the participant municipalities. To achieve optimal effects of an ICT-based support network due attention must be given to recruitment processes and social environment building for which care practitioners require training and support.

Not sick enough: Experiences of carers of people with mental illness negotiating care for their relatives with mental health services.

Science.gov (United States)

Olasoji, M; Maude, P; McCauley, K

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: Existing literature provides insight into the general experience of carers of people with a mental illness. Previous studies have found that carers experience a range of emotions when looking after their relatives with a mental illness. However, experiences of carers as they engage with the healthcare system is largely absent from the literature. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper identified the experiences of carers when their relatives are experiencing a crisis or acutely unwell. Carers found themselves in the middle between mental health services and their relatives. Strategies employed by carers to ensure their relatives receive adequate care were identified from this study. This paper identified how carers needed to become more assertive in order to receive adequate care for their relatives, and this finding has implications for any future carer education. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The participants identified the need to work more collaboratively with carers of people with a mental illness as they seek treatment for their relatives in order to achieve better health outcomes for the patients. Improved health service engagement of carers was seen by participants to assist them to better care for their relative. The study also found that there needs to be a clearer definition as to what constitutes mental health crisis and how carers are able to intervene during this period. Services could provide clear information concerning crisis services and in particular triage. Aim The literature reporting experiences of relatives of people with mental illness regarding their interactions with mental health services identifies many commonalities. However, the actual experience of carers engaging the services and understanding healthcare systems remains a gap in the literature. The aim of this study was to explore the experiences of carers (of people with a severe mental illness) in a major area mental health

Missed opportunities for impact in patient and carer involvement: a mixed methods case study of research priority setting.

Science.gov (United States)

Snow, R; Crocker, J C; Crowe, S

2015-01-01

Healthcare workers want to listen more to patients and their carers in all sorts of areas of healthcare. This can include choosing topics for medical research. We looked at how patients and carers have helped to choose topics for research about type I diabetes. We aimed to find out if, and why, researchers often rejected their choices. We looked at a project which brought together patients, carers and healthcare workers to choose topics for research about type 1 diabetes. The group first asked patients, carers and healthcare workers to suggest ideas for research questions. But the group had to follow rules about what counted as a good research question. Some people's ideas did not count as good research questions, and they were rejected at the start. We looked at who were most likely to have their ideas rejected at the start. We found that patients and carers were most likely to have a suggestion rejected. Then we looked at the rejected questions in detail. They were mostly about curing diabetes, preventing diabetes and understanding how diabetes works. There were also some questions about access to medicines and the quality of care. Researchers should ask patients and carers for help deciding what counts as a good research question from the start of projects like these. We should also think about what might be getting in the way of patients and carers making more of a difference in research. Background Patients and carers are increasingly involved in deciding on topics for medical research. However, so far, it has been difficult to gain an accurate picture of the impact of such involvement because of poor reporting and evaluation in published studies to date. This study aimed to explore how a partnership of patients, carers, healthcare professionals and organisations identified questions for future research and why patients and carers had a limited impact on this process. Methods In the first stage of the partnership process, relevant service users and providers

Older family carers in rural areas: experiences from using caregiver support services based on Information and Communication Technology (ICT).

Science.gov (United States)

Blusi, Madeleine; Asplund, Kenneth; Jong, Mats

2013-09-01

The aim of this intervention study was to illuminate the meaning of ICT-based caregiver support as experienced by older family carers living in vast rural areas, caring for a spouse at home. In order to access, the support service participants were provided with a computer and high speed Internet in their homes. Semi structured webcam-interviews were carried out with 31 family carers. A strategy for webcam interviewing was developed to ensure quality and create a comfortable interview situation for the family carers. Interviews were analysed using content analyses, resulting in the themes: Adopting new technology with help from others and Regaining social inclusion . The results indicate that ICT-based support can be valuable for older family carers in rural areas as it contributes to improve quality in daily life in a number of ways. In order to fully experience the benefits, family carers need to be frequent users of the provided support. Adequate training and encouragement from others were essential in motivating family carers to use the support service. Access to Internet and webcamera contributed to reducing loneliness and isolation, strengthening relationships with relatives living far away and enabled access to services no longer available in the area. Use of the ICT-service had a positive influence on the relationship between the older carer and adult grandchildren. It also contributed to carer competence and promote feelings of regaining independence and a societal role.

Hidden gauge symmetry

International Nuclear Information System (INIS)

O'Raifeartaigh, L.

1979-01-01

This review describes the principles of hidden gauge symmetry and of its application to the fundamental interactions. The emphasis is on the structure of the theory rather than on the technical details and, in order to emphasise the structure, gauge symmetry and hidden symmetry are first treated as independent phenomena before being combined into a single (hidden gauge symmetric) theory. The main application of the theory is to the weak and electromagnetic interactions of the elementary particles, and although models are used for comparison with experiment and for illustration, emphasis is placed on those features of the application which are model-independent. (author)

Variational Infinite Hidden Conditional Random Fields

NARCIS (Netherlands)

Bousmalis, Konstantinos; Zafeiriou, Stefanos; Morency, Louis-Philippe; Pantic, Maja; Ghahramani, Zoubin

2015-01-01

Hidden conditional random fields (HCRFs) are discriminative latent variable models which have been shown to successfully learn the hidden structure of a given classification problem. An Infinite hidden conditional random field is a hidden conditional random field with a countably infinite number of

How family carers engage with technical health procedures in the home: a grounded theory study.

Science.gov (United States)

McDonald, Janet; McKinlay, Eileen; Keeling, Sally; Levack, William

2015-07-06

To explore the experiences of family carers who manage technical health procedures at home and describe their learning process. A qualitative study using grounded theory. New Zealand family carers (21 women, 5 men) who managed technical health procedures such as enteral feeding, peritoneal dialysis, tracheostomy care, a central venous line or urinary catheter. In addition, 15 health professionals involved in teaching carers were interviewed. Semistructured interviews were coded soon after completion and preliminary analysis influenced subsequent interviews. Additional data were compared with existing material and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was described. Interviewing continued until no new ideas emerged and concepts were well defined. The response of carers to the role of managing technical health procedures in the home is presented in terms of five dispositions: (1) Embracing care, (2) Resisting, (3) Reluctant acceptance, (4) Relinquishing and (5) Being overwhelmed. These dispositions were not static and carers commonly changed between them. Embracing care included cognitive understanding of the purpose and benefits of a procedure; accepting a 'technical' solution; practical management; and an emotional response. Accepting embrace is primarily motivated by perceived benefits for the recipient. It may also be driven by a lack of alternatives. Resisting or reluctant acceptance results from a lack of understanding about the procedure or willingness to manage it. Carers need adequate support to avoid becoming overwhelmed, and there are times when it is appropriate to encourage them to relinquish care for the sake of their own needs. The concept of embracing care encourages health professionals to extend their attention beyond simply the practical aspects of technical procedures to assessing and addressing carers' emotional and behavioural responses to health technology during the training process

Carers' perceptions of the impact of home telehealth monitoring on the provision of care and sustainability of use.

Science.gov (United States)

Wade, Rachael; Cartwright, Colleen; Shaw, Kelly

2015-06-01

This paper aims to report carers' perceptions of the impact of home telehealth on the provision of care and the sustainability of home telehealth use. This paper is reporting on a sample of 15 carers who were involved in the telehealth arm of a larger controlled trial. Carers primarily believed that telehealth helped to provide better care. None of the carers had organised, or planned to organise, ongoing telehealth monitoring beyond the study. The main reason given for non-sustained usage was the belief that the person they cared for no longer required, or would benefit from, the monitoring. As the person being cared for was a frail older person with multiple chronic diseases and a history of recent hospitalisation, the non-sustained usage of home telehealth by carers raises questions about what is needed to ensure sustainability of use; this requires further investigation. © 2014 AJA Inc.

The experiences of working carers of older people regarding access to a web-based family care support network offered by a municipality.

Science.gov (United States)

Andersson, Stefan; Erlingsson, Christen; Magnusson, Lennart; Hanson, Elizabeth

2017-09-01

Policy makers in Sweden and other European Member States pay increasing attention as to how best support working carers; carers juggling providing unpaid family care for older family members while performing paid work. Exploring perceived benefits and challenges with web-based information and communication technologies as a means of supporting working carers' in their caregiving role, this paper draws on findings from a qualitative study. The study aimed to describe working carers' experiences of having access to the web-based family care support network 'A good place' (AGP) provided by the municipality to support those caring for an older family member. Content analysis of interviews with nine working carers revealed three themes: A support hub, connections to peers, personnel and knowledge; Experiencing ICT support as relevant in changing life circumstances; and Upholding one's personal firewall. Findings indicate that the web-based family care support network AGP is an accessible, complementary means of support. Utilising support while balancing caregiving, work obligations and responsibilities was made easier with access to AGP; enabling working carers to access information, psychosocial support and learning opportunities. In particular, it provided channels for carers to share experiences with others, to be informed, and to gain insights into medical and care issues. This reinforced working carers' sense of competence, helping them meet caregiving demands and see positive aspects in their situation. Carers' low levels of digital skills and anxieties about using computer-based support were barriers to utilising web-based support and could lead to deprioritising of this support. However, to help carers overcome these barriers and to better match web-based support to working carers' preferences and situations, web-based support must be introduced in a timely manner and must more accurately meet each working carer's unique caregiving needs. © 2016 Nordic College

Hidden charged dark matter

International Nuclear Information System (INIS)

Feng, Jonathan L.; Kaplinghat, Manoj; Tu, Huitzu; Yu, Hai-Bo

2009-01-01

Can dark matter be stabilized by charge conservation, just as the electron is in the standard model? We examine the possibility that dark matter is hidden, that is, neutral under all standard model gauge interactions, but charged under an exact (\\rm U)(1) gauge symmetry of the hidden sector. Such candidates are predicted in WIMPless models, supersymmetric models in which hidden dark matter has the desired thermal relic density for a wide range of masses. Hidden charged dark matter has many novel properties not shared by neutral dark matter: (1) bound state formation and Sommerfeld-enhanced annihilation after chemical freeze out may reduce its relic density, (2) similar effects greatly enhance dark matter annihilation in protohalos at redshifts of z ∼ 30, (3) Compton scattering off hidden photons delays kinetic decoupling, suppressing small scale structure, and (4) Rutherford scattering makes such dark matter self-interacting and collisional, potentially impacting properties of the Bullet Cluster and the observed morphology of galactic halos. We analyze all of these effects in a WIMPless model in which the hidden sector is a simplified version of the minimal supersymmetric standard model and the dark matter is a hidden sector stau. We find that charged hidden dark matter is viable and consistent with the correct relic density for reasonable model parameters and dark matter masses in the range 1 GeV ∼ X ∼< 10 TeV. At the same time, in the preferred range of parameters, this model predicts cores in the dark matter halos of small galaxies and other halo properties that may be within the reach of future observations. These models therefore provide a viable and well-motivated framework for collisional dark matter with Sommerfeld enhancement, with novel implications for astrophysics and dark matter searches

Localization of hidden Chua's attractors

International Nuclear Information System (INIS)

Leonov, G.A.; Kuznetsov, N.V.; Vagaitsev, V.I.

2011-01-01

The classical attractors of Lorenz, Rossler, Chua, Chen, and other widely-known attractors are those excited from unstable equilibria. From computational point of view this allows one to use numerical method, in which after transient process a trajectory, started from a point of unstable manifold in the neighborhood of equilibrium, reaches an attractor and identifies it. However there are attractors of another type: hidden attractors, a basin of attraction of which does not contain neighborhoods of equilibria. In the present Letter for localization of hidden attractors of Chua's circuit it is suggested to use a special analytical-numerical algorithm. -- Highlights: → There are hidden attractors: basin doesn't contain neighborhoods of equilibria. → Hidden attractors cannot be reached by trajectory from neighborhoods of equilibria. → We suggested special procedure for localization of hidden attractors. → We discovered hidden attractor in Chua's system, L. Chua in his work didn't expect this.

Lone voices have an emotional content: focussing on mental health service user and carer involvement.

Science.gov (United States)

Hitchen, Sherrie; Watkins, Mary; Williamson, Graham R; Ambury, Susan; Bemrose, Gillian; Cook, David; Taylor, Maureen

2011-01-01

The purpose of this paper is to describe learning gained from involving service users and carers as researchers in an action research study. The researchers aimed to introduce self-directed support in mental health services--part of the government's personalisation agenda, which requires a move from current social care commissioning, where a person is matched to available services, to one where a person self-assesses, has an agreed support plan and then with appropriate help, purchases his or her own services to lead as independent a life as possible. This development is allied closely with the mental health service recovery approach. Three service users and two carers were recruited to work alongside the lead researcher. Service users were fully involved in the steering group - part of participatory action research project. Data were collected from: debriefing meetings with co-researchers between April and December 2007; a group interview held by the lead researcher; and participants' journal comments and self-reflections. The main areas in which service users and carers found involvement difficult were: overcoming professional language barriers; emotional impact; and power imbalances between themselves and professionals. Findings suggest that considerable improvement is required by mental health professionals and managers if service users and carers are successfully involved in projects. This is a small study within a larger action research project. Findings are not generalisable owing to the small sample; however, findings are supported by the service-user involvement literature. Few studies explore participation effects on service users and carers from their perspective. This research provides insights into what needs to be addressed to improve service user and carer involvement to improve mental health services.

A Mindfulness-Based Group for Young People with Learning Disabilities: A Pilot Study

Science.gov (United States)

Thornton, Victoria; Williamson, Rachel; Cooke, Bronwen

2017-01-01

Background: Mindfulness is becoming increasingly reported as an effective way to support well-being and reduce mental health difficulties. Materials and Methods: This study reports on the development and pilot of a mindfulness-based group for young people with learning disabilities and their carers. Results: Group participants reported that the…

Lung cancer, caring for the caregivers. A qualitative study of providing pro-active social support targeted to the carers of patients with lung cancer.

Science.gov (United States)

Ryan, P J; Howell, V; Jones, J; Hardy, E J

2008-04-01

Carers of patients with lung cancer often have a short time to access the support they require. The Macmillan Carers Project (MCP) was set up to provide non-clinical social support targeted in the community to the carers of patients with lung cancer and this study describes its evaluation. Prospective case study using interviews with the carers, project workers and health and social care professionals to obtain qualitative data for thematic analysis. 81 patients' carers received support from the MCP; 20 carers, 2 MCP workers and their manager and 10 other professionals (chest consultant physician, lung cancer clinical nurse specialist, GP, four Macmillan nurses, hospice social worker and two community social workers) were interviewed. Patients were predominantly male (62%), mean age 71 years and carers were predominantly female (70%) mean age 63 years. Carers identified the MCP as providing emotional support, more time, practical help, financial advice, information and back-up for a myriad of problems. Although there was some overlap with other services, the MCP was valued by carers and professionals as filling a gap in social care. The unique aspect of this study was support targeted to the carers of a single cancer site (lung) rather than generic cancer support. As lung cancer may progress rapidly, patients and their carers have a short time to gather new information, access services and adjust to their new circumstances and roles. By focusing on the needs of carers from the time of lung cancer diagnosis, we have shown that the MCP was a valued additional service, well received by carers, patients and professionals.

Perceptions of overweight by primary carers (mothers/grandmothers) of under five and elementary school-aged children in Bandung, Indonesia: a qualitative study.

Science.gov (United States)

Rachmi, Cut Novianti; Hunter, Cynthia Louise; Li, Mu; Baur, Louise Alison

2017-07-27

The prevalence of childhood overweight has increased in the past two decades in Indonesia. Even though prevalence is escalating, there is a lack of qualitative evidence to assist in the design and implementation of strategies to tackle this issue. This study aimed to explore the view of primary carers (mothers and grandmothers) from different socio-economic-status groups, on childhood overweight in the Greater Bandung Area, Indonesia. We conducted 12 focus groups discussions with a total of 94 carers of under-five and 7-12 years children, from June to October 2016. We used the grounded theory approach in our analysis. Three main categories emerged: the concept of overweight, factors contributing to overweight, and awareness and feelings towards overweight children. Most carers from all SES groups defined overweight subjectively, while a few from the low SES group defined it objectively. Most carers from low and high SES groups agreed with the concept "chubbier is healthier". All carers had some knowledge of the main factors that contribute to childhood overweight: dietary factors, activity levels and sedentary behavior, and hereditary factors. Carers from all SES groups described similar characteristics of overweight; carers from low and intermediate SES groups had mixed feelings while all high SES carers have negative feelings about overweight children, mostly related to stigma. However, carers who identified their own children as being overweight expressed sensitivity about this weight status, especially their physical abilities. Almost all carers knew their children's current weight while less than two thirds knew their children's height. There are several policy implications. Firstly, health-related knowledge of the primary carers is of great importance and needs augmenting. To increase that knowledge, there is a role for front-line health practitioners (doctors/midwives/nurses) to be more active in educating the community. Secondly, simpler and more effective

The impact of befriending and peer support on family carers of people living with dementia: A mixed methods study.

Science.gov (United States)

Smith, Raymond; Drennan, Vari; Mackenzie, Ann; Greenwood, Nan

Volunteer led befriending and peer support is provided to a wide range of people with varying needs. Despite large numbers of such schemes for carers of people with dementia, there is little evidence for any benefits they may offer. The aim of this research was to investigate the impact of befriending and peer support on carers of people with dementia and to explore their experiences of receiving the interventions using a mixed methods approach. Nineteen carers of people with dementia were recruited from befriending and peer support services. Carers completed the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Scale of Perceived Social Support (MSPSS) and UCLA Loneliness Scale at baseline, three months and six months. Of the 16 carers who completed the quantitative phase, eight took part in depth semi-structured interviews. A statistically significant increase in perceived social support from a significant other between baseline and three months was found (Z = 2.487, p = 0.013). Qualitative findings showed befriending and peer support to be important sources of emotional and social support for carers, which was facilitated by the volunteers' experiential similarity. Volunteer led befriending and peer support offers carers of people with dementia emotional and social support which enables them to cope better with challenges and continue caring. This has important implications for potentially reducing breakdowns in carer mental and physical health. Future research should explore whether these finding are replicable in other locations and in more diverse populations. Copyright © 2018 Elsevier B.V. All rights reserved.

Hidden Liquidity: Determinants and Impact

OpenAIRE

Gökhan Cebiroglu; Ulrich Horst

2012-01-01

We cross-sectionally analyze the presence of aggregated hidden depth and trade volume in the S&P 500 and identify its key determinants. We find that the spread is the main predictor for a stock’s hidden dimension, both in terms of traded and posted liquidity. Our findings moreover suggest that large hidden orders are associated with larger transaction costs, higher price impact and increased volatility. In particular, as large hidden orders fail to attract (latent) liquidity to the market, ...

Carers' experiences of involvement in care planning: a qualitative exploration of the facilitators and barriers to engagement with mental health services.

OpenAIRE

Cree, Lindsey; Brooks, Helen L; Berzins, Kathryn; Fraser, Claire; Lovell, Karina; Bee, Penny

2015-01-01

BACKGROUND: Formal recognition and involvement of carers in mental health services has been the focus of recent policy and practice initiatives as well as being supported by carers themselves. However, carers still report feeling marginalised and distanced from services. A prominent theme is that that they are not listened to and their concerns are not taken seriously. Compared to service user views, the reasons underpinning carers' dissatisfaction with care-planning procedures have been rela...

A Polarimetric Search for Hidden Quasars in Three Radio-selected Ultraluminous Infrared Galaxies

International Nuclear Information System (INIS)

Tran, H.D.; Brotherton, M.S.; Stanford, S.A.; Breugel, W. van; Dey, A.; Stern, D.; Antonucci, R.

1999-01-01

We have carried out a spectropolarimetric search for hidden broad-line quasars in three ultraluminous infrared galaxies (ULIRGs) discovered in the positional correlations between sources detected in deep radio surveys and the IRAS Faint Source Catalog. Only the high-ionization Seyfert 2 galaxy TF J1736+1122 is highly polarized, displaying a broad-line spectrum visible in polarized light. The other two objects, TF J1020+6436 and FF J1614+3234, display spectra dominated by a population of young (A type) stars similar to those of open-quotes E+Aclose quotes galaxies. They are unpolarized, showing no sign of hidden broad-line regions. The presence of young starburst components in all three galaxies indicates that the ULIRG phenomenon encompasses both active galactic nuclei (AGNs) and starburst activity, but the most energetic ULIRGs do not necessarily harbor open-quotes buried quasars.close quotes We find that a luminous infrared galaxy is most likely to host an obscured quasar if it exhibits a high-ionization ([O iii] λ5007/Hβ approx-gt 5) spectrum typical of a 'classic' Seyfert 2 galaxy with little or no Balmer absorption lines, is 'ultraluminous' (L IR approx-gt 10 12 L circle-dot ), and has a 'warm' IR color (f 25 /f 60 approx-gt 0.25). The detection of hidden quasars in this group but not in the low-ionization, starburst-dominated ULIRGs (classified as LINERs or H ii galaxies) may indicate an evolutionary connection, with the latter being found in younger systems. copyright copyright 1999. The American Astronomical Society

Systematic review and meta-analysis of the impact of carer stress on subsequent institutionalisation of community-dwelling older people.

Directory of Open Access Journals (Sweden)

Nora-Ann Donnelly

Full Text Available In the caregiving literature there is a common assertion that a higher level of carer stress is a critical determinant of premature ending of homecare. However, this contention has not been systematically assessed. We therefore systematically reviewed and meta-analysed the prospective association between various forms of carer stress and subsequent institutionalisation of community-dwelling older people.Systematic literature search of prospective studies measuring carer stress at baseline and institutionalisation at follow-up. Given substantial interchangeability in the measurement of carer stress, we included a wide number of exposure measures, namely: carer stress, burden, depression, distress, anxiety, burnout, and strain. Institutionalisation included both acute and long-term care utilisation. The standardised mean difference between stressed and non-stressed carers was the primary measure of effect. We assessed study quality with the Crowe Critical Appraisal Tool (CCAT. Pre-planned sensitivity analysis included examination of estimates according to study size; decade published; study quality according to quartiles of CCAT scores; population; follow-up period; study design and impact of adjusted or unadjusted estimates.The search yielded 6,963 articles. After exclusions, we analysed data from 54 datasets. The meta-analysis found that while carer stress has a significant effect on subsequent institutionalisation of care recipients, the overall effect size was negligible (SMD = 0 · 05, 95% CI = 0 · 04-0 · 07. Sensitivity analyses found that, the effect size was higher for measurements of stress than for other measures, though still relatively small (SMD = 0 · 23, 95% CI = 0 · 09-0 · 38. Thus, whether analysing the association between carer stress, burden, distress, or depression with either acute or long-term care, the effect size remains small to negligible. Concurrently, we found estimates reduce over time and were smaller with larger

Complexities in the Provision of Respite Care to Family Carers of Persons with Intellectual Disabilities

Directory of Open Access Journals (Sweden)

Frieda Finlay

2011-10-01

Full Text Available PurposeRespite care is generally thought to benefit family carers of persons with intellectual disabilities and is regarded as an important component of family-centred services.  However, the complexities associated with the provision of such services, from the carer’s perspective, have been rarely investigated.MethodThis qualitative research study was carried out through a participatory action research process that involved collaboration among researchers and family members as co-researchers.  Seven focus groups, involving seventy family carers (fifty mothers, fifteen fathers and five sisters, were held in seven locations across the Republic of Ireland. ResultsThree main themes dominated the discussions.  The first theme related to the ambivalence of carers towards using respite services, as expressed in their reluctance to relinquish care-giving for even a short period; the feelings of guilt they experienced; and the greater needs of other carers.  The second theme related to the benefits of respite breaks, but these were solely with respect to the carer and other family members, rather than to the person with an intellectual disability.  The third theme regarding the quality of provision was dominated by concerns for the care the person received in using the services. ConclusionsRespite care has the potential to make a difference, and these findings call for building much- needed alliances between all members of the family and professionals.  This is in order to support one another through the difficulties associated with the redesign of existing respite provision, and the extension of these services to the growing number of carers who require respite breaks.doi 10.5463/DCID.v22i2.22Key wordsIntellectual disability, respite, family members, Ireland 

A systematic review and thematic synthesis of quality of life in the informal carers of cancer patients with cachexia.

Science.gov (United States)

Wheelwright, Sally; Darlington, Anne-Sophie; Hopkinson, Jane B; Fitzsimmons, Deborah; Johnson, Colin

2016-02-01

Informal carers of cancer patients with cachexia face additional challenges to those encountered by informal carers in general because of the central role food and eating play in everyday life. Patient weight loss and anorexia, core features of cancer cachexia, are frequent causes of distress in caregivers. Identification of quality of life issues can inform the development of interventions for both caregivers and patients and facilitate communication with healthcare professionals. To identify quality of life issues that are relevant to carers of cancer patients with cachexia. A systematic review and thematic synthesis of the qualitative literature were conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, ISI Web of Knowledge, EMBASE, MEDLINE, CINAHL, PsycINFO and PsycARTICLES were searched for publications dated from January 1980 to February 2015 using search terms relating to cancer, cachexia, quality of life and carers. Papers written in the English language, featuring direct quotes from the carers of adult patients with any cancer diagnosis and cachexia or problems with weight loss or anorexia, were included. Five themes were extracted from the 16 identified studies. These highlighted the impact on everyday life, the attempts of some carers to take charge, the need for healthcare professional's input, conflict with the patient and negative emotions. The complexity of caring for a cancer patient with cachexia translates into a range of problems and experiences for informal carers. By addressing the impact of caring for a patient with cancer cachexia on carers, both caregiver and patient quality of life may improve. © The Author(s) 2015.

'Pizza, patients and points of view': Involving young people in the design of a post registration module entitled the adolescent with cancer.

Science.gov (United States)

Fallon, Sue; Smith, Joanna; Morgan, Sue; Stoner, Mandy; Austin, Catriona

2008-03-01

Health policy and education directives emphasise the need to involve service users and carers in healthcare, from service design and delivery to the education of healthcare professionals. This paper describes a pilot project aimed at eliciting teenagers and young people with cancer views in relation to the content of a continuing professional development module entitled 'adolescents with cancer'. Seven young people participated in the project. The project design was based on the PARTICIPATION - spice it up [Shephard, C., Treseder, P., 2002. spice it up! Dynamix, Swansea] framework, which aims to ensure effective and appropriate involvement of service users and carers. 'Post-it ideas storm' 'diamond ranking' and 'dot voting' were used to elicit the young people's views. The teenagers and young people could clearly articulate the qualities they felt nurses should have when caring for adolescents with cancer. They also identified topics they felt were important to include in the module, with an understanding of, and using, humour being given the highest priority. This was not originally included in the module timetable but as a direct result of consulting with the young people changes were made to reflect their views.

Understanding carers' lived experience of stigma: the voice of families with a child on the autism spectrum.

Science.gov (United States)

Broady, Timothy R; Stoyles, Gerard J; Morse, Corinne

2017-01-01

Existing research suggests that there are several unique challenges associated with caring for a child on the autism spectrum. Despite a growing evidence base regarding autism spectrum disorders and their increasing prevalence, children on the autism spectrum and their families continue to perceive stigmatisation from various sources throughout the community. These perceptions of stigma can profoundly impact the quality of life of these children and their carers alike. This exploratory study sought to investigate carers' perceptions of stigma in caring for a child with high functioning autism. Fifteen carers from Sydney and the South Coast regions of New South Wales, Australia, participated in semi-structured interviews regarding their caring experiences and any perceived encounters with stigma. Four domains of stigmatising experiences were identified: (i) lack of knowledge, (ii) judgement, (iii) rejection and (iv) lack of support. These domains were each reported to exist in four main contexts: (i) school, (ii) public, (iii) family and (iv) friends. These domains and contexts established a framework which provided a detailed account of how and where carers felt stigmatised, including the suggestion of a stigmatising pathway through the four domains. The main contexts in which stigma was perceived also appeared to be related, with those carers who experienced stigma in one context being more likely to report similar experiences in other contexts. Any attempts to empower carers in the face of stigmatisation should therefore consider each of these domains, the pathway that connects them and the relationship between different social contexts. Through identifying this pathway, supportive services can be acutely aware of how carers may perceive potentially stigmatising experiences and therefore provide appropriate interventions or support for the relevant stage of the pathway. © 2015 John Wiley & Sons Ltd.

A new way home: Refugee young people and homelessness in Australia

OpenAIRE

Jen Couch

2011-01-01

Abstract This article gives voice to refugee young people experiencing homelessness. It is based on a project that conducted interviews with refugee young people and consultations with service providers. The research reveals that the profoundly under-recognised phenomenon of homelessness experienced by young people of refugee background is often hidden and does not match commonly held beliefs about homeless young people. The article examines the nexus between migration and homelessness in...

Impact of specialist palliative care on coping with Parkinson's disease: patients and carers.

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Badger, Nathan J; Frizelle, Dorothy; Adams, Debi; Johnson, Miriam J

2018-01-09

UK guidelines recommend palliative care access for people with Parkinson's disease; however, this remains sporadic, and it is unknown whether specialist palliative care helps patients and carers cope with this distressing condition. This study aimed to explore whether, and how, access to specialist palliative care services affected patients' and carers' coping with Parkinson's disease. Semistructured interviews were conducted, audio-recorded and verbatim transcribed. Data were analysed using interpretative phenomenological analysis. Participants were patients with advanced idiopathic Parkinson's disease (n=3), and carers of people with Parkinson's disease (n=5, however, one diagnosis was reviewed) receiving care from an integrated specialist palliative care and Parkinson's disease service in North East England. Access to specialist palliative care helped participants cope with some aspects of advanced Parkinson's disease. Three superordinate themes were developed:' managing uncertainty', 'impacts on the self' and 'specialist palliative care maintaining a positive outlook'. Specialist palliative care helped patients and carers cope with advanced Parkinson's disease. Specialist palliative care is a complex intervention that acknowledges the complex and holistic nature of Parkinson's disease, enabling health in some domains despite continued presence of pathology. These exploratory findings support the utility of this approach for people living with Parkinson's disease. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Salivary cortisol : A possible biomarker in evaluating interventions on stress reduction in young foster children

NARCIS (Netherlands)

Van Andel, H.W.H.; Jansen, L.M.C.; Grietens, Hans; Knorth, Erik J.; Van der Gaag, R.J.

Young foster children undergo an early separation from their caregiver(s) and often experience severe stress before placement. However, a considerable part of the children do not show apparent signs of distress, making it difficult for the foster carer to be aware of the amount of stress in their

Factors influencing indirect speech and language therapy interventions for adults with learning disabilities: the perceptions of carers and therapists.

Science.gov (United States)

Graves, Judy

2007-03-01

The working context for speech and language therapists (SLTs) delivering interventions to adults who have a learning disability has changed following the reorganization of care provision from hospitals to the community. Consequently, SLTs often deliver their care within a social model of disability through indirect intervention in collaboration with carers. However, there has been little research into how this approach works in practice. To gain insight into the working context by identifying the key factors that influence indirect SLT interventions as perceived by SLTs and by paid carers from a range of service providers. To explore the implications of the results for the delivery of indirect SLT interventions and provide direction for further research. Semi-structured interviews were used to collect data from an opportunistic sample of five SLTs working in Community Learning Disability Teams (CLDTs) and 12 carers from residential and day care services who had had experience of working with SLTs. The data were analysed inductively using a grounded theory framework. Two broad themes emerged for SLTs: roles and expectations, and changing carer behaviour through training. The key themes for carers were roles and values, awareness of communication needs, and motivation and opportunity to implement interventions. Four broad factors are suggested as having the potential to influence indirect interventions: diversity in the working context; possible conflict between the guiding values of SLTs and carers, particularly residential carers; collaboration and support for implementation; and SLT doubts about the effectiveness of formal carer communication training. The results add to the evidence that the delivery of indirect speech and language therapy interventions to people with learning disabilities is a complex activity demanding specialist skills from SLTs. The findings suggest that these should include expertise in professional collaborative and relational skills, and

Validation of the Verbal and Social Interaction questionnaire: carers' focus in the carer-resident relationship in supported housing facilities for persons with psychiatric disabilities (VSI-SH).

Science.gov (United States)

Brunt, D; Rask, M

2013-04-01

A questionnaire to measure the verbal and social interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities has been developed. It is an adaptation of a questionnaire originally used in a forensic psychiatric setting. The aim of the present study was thus to investigate the construct validity and the reliability of this new version of the Verbal and Social Interactions questionnaire for use in supported housing facilities (VSI-SH). Two hundred and twenty-three carers from municipal and privately run housing facilities completed the questionnaire. A factor analysis was performed, which resulted in six factors. The number of items was reduced from the original 47 to 30 in order to minimize factorial complexity and multiple loadings. The reliability was tested with Cronbach's alpha and good internal consistency for the questionnaire and five of the six factors was found. The resulting six factors and the items were compared to the conceptual model and four of the six factors corresponded well with the categories in this original theoretical model. The questionnaire can be a useful contribution to the study of interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities. © 2012 Blackwell Publishing.

The unique experience of home for parents and carers of children with disabilities.

Science.gov (United States)

Aplin, Tammy; Thornton, Heloise; Gustafsson, Louise

2017-01-24

The aim of this paper was to investigate the experience of home for parents and carers of children with disabilities in Australia. Data for this qualitative study were gathered using semi-structured interviews with four families living in their own homes. An inductive thematic analysis revealed two main themes. The first was titled 'Aspects making everyday life easier' explored the aspects of the home environment that facilitated home life for the child, including access to transport, services, family and home modifications. The second theme 'Decisions and efforts to create opportunities for the child' emphasized the efforts made by parents and carers to promote their child's independence and participation including a strong consideration for their children's future needs. The study indicated that the location of home, appropriate home modifications and planning for the future defined the experience of home for parents and carers. These findings identify some important considerations for occupational therapists when providing services in the homes of families with children who have a disability.

'Was it worth it?' Intrathecal analgesia for cancer pain: A qualitative study exploring the views of family carers.

Science.gov (United States)

Patel, Nishi; Huddart, Melanie; Makins, Helen; Mitchell, Theresa; Gibbins, Jane L; Graterol, Juan; Stevens, Deborah; Perkins, Paul

2018-01-01

Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer. Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer. Thematic analysis of qualitative interviews with carers of deceased individuals who received percutaneous external tunnelled intrathecal drug delivery as part of their pain management, within two UK centres. A total of 11 carers were recruited from two UK Palliative Care centres. Family carers of adult patients who had received external tunnelled intrathecal drug delivery analgesia for cancer pain and had died between 6 and 48 months prior to contact were included. Carer relatives who were considered likely to be too vulnerable or who had lodged a complaint about treatment within the recruiting department or who had been treated directly by the interviewer were excluded. In total, 11 interviews took place. The emerging themes were (1) making the decision to have the intrathecal - relatives described desperate situations with severe pain and/or sedation, meaning that the individual would try anything; (2) timing and knowing they were having the best - an increased access to pain and palliative care services, meant carers felt everything possible was being done, making the situation more bearable; (3) was it worth it? - the success of the external tunnelled intrathecal drug delivery was judged on its ability to enable the individual to be themselves through their final illness. Side effects were often considered acceptable, if the external tunnelled intrathecal drug delivery enabled improvements in quality of life. Carers perceived external tunnelled intrathecal drug delivery

Validation of the "Quality of Life in Life-Threatening Illness--Family Carer Version" (QOLLTI-F) in German-speaking carers of advanced cancer patients.

Science.gov (United States)

Schur, Sophie; Ebert-Vogel, Alexandra; Amering, Michaela; Masel, Eva Katharina; Neubauer, Marie; Schrott, Andrea; Sibitz, Ingrid; Watzke, Herbert; Schrank, Beate

2014-10-01

Palliative care is a multidisciplinary approach that focuses on the improvement of quality of life (QOL) of patients as well as their families. QOL research in palliative care has so far primarily focused on patients, but interest in the QOL of their relatives is increasing. For instruments measuring QOL in relatives, data on psychometric properties are often limited, and so far, none has been available in German. This study translates and validates the "Quality of Life in Life-Threatening Illness-Family Carer Version" (QOLLTI-F) in German-speaking carers of advanced cancer patients. The QOLLTI-F was translated from English into German according to the World Health Organisation's recommendations and validated in informal caregivers of terminally ill cancer patients of three Viennese hospitals. Hope was measured to assess concurrent validity; traumatic stress, anxiety, depression and subjective burden were measured to assess discriminant validity. Internal consistency, test-retest reliability and discriminative power were established. The scale's factor structure was explored using a set of factor analyses. Of the 308 caregivers participating in the study, 42 completed the QOLLTI-F retest after a mean of 5 days. The internal consistency was α = 0.85 for the overall scale, Pearson correlation between test and retest lay at r = 0.92. As expected, a significant positive correlation was found with hope (r = 0.40) and significant negative correlations with traumatic stress (r = -0.41), depression (r = -0.51), anxiety (r = -0.52) and overall subjective burden (r = -0.55). The original seven-factor structure was not reproduced, but the scale showed a stable four-factor structure with factors capturing (1) feelings about carers' own life, (2) professional care, (3) interaction with the patient and others and (3) carers' outlook on life. This study provides a sound translation and validation of the first QOL assessment tool for caregivers of

Family carers: A role in addressing chronic disease risk behaviours for people with a mental illness?

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Bailey, Jacqueline M; Wye, Paula M; Wiggers, John H; Bartlem, Kate M; Bowman, Jennifer A

2017-09-01

People with a mental illness experience greater chronic disease morbidity and mortality compared to those without mental illness. Family carers have the potential to promote the health behaviours of those they care for however factors which may influence the extent to which they do so have not been reported. An exploratory study was conducted to investigate carers': 1) promotion of fruit and vegetable consumption, physical activity, quitting smoking, and reducing alcohol consumption; 2) perceptions of their role and ability to promote such behaviours; 3) and the association between carer perceptions and the promotion of such behaviours. A cross-sectional survey was conducted with mental health carers ( N  = 144, 37.6% response rate) in New South Wales, Australia in 2013. Associations between current promotion of health behaviours and carer perceptions were explored through multivariate regression analysis in 2016. A majority of respondents promoted fruit and vegetable consumption (63.8%), physical activity (60.3%), quitting smoking (56.3%), and reducing alcohol consumption (56.2%) to the person they cared for. A perception that it was 'very important' to have a positive influence on these behaviours was positively related with promotion of each of the four behaviours, with those holding such a view being more likely to promote such behaviours, than those who did not (odds ratio: 9.47-24.13, p  mental illness.

Hidden Curriculum: An Analytical Definition

Directory of Open Access Journals (Sweden)

Mohammad Reza Andarvazh

2018-03-01

Full Text Available Background: The concept of hidden curriculum was first used by Philip Jackson in 1968, and Hafferty brought this concept to the medical education. Many of the subjects that medical students learn are attributed to this curriculum. So far several definitions have been presented for the hidden curriculum, which on the one hand made this concept richer, and on the other hand, led to confusion and ambiguity.This paper tries to provide a clear and comprehensive definition of it.Methods: In this study, concept analysis of McKenna method was used. Using keywords and searching in the databases, 561 English and 26 Persian references related to the concept was found, then by limitingthe research scope, 125 abstracts and by finding more relevant references, 55 articles were fully studied.Results: After analyzing the definitions by McKenna method, the hidden curriculum is defined as follows: The hidden curriculum is a hidden, powerful, intrinsic in organizational structure and culture and sometimes contradictory message, conveyed implicitly and tacitly in the learning environment by structural and human factors and its contents includes cultural habits and customs, norms, values, belief systems, attitudes, skills, desires and behavioral and social expectations can have a positive or negative effect, unplanned, neither planners nor teachers, nor learners are aware of it. The ultimate consequence of the hidden curriculum includes reproducing the existing class structure, socialization, and familiarizing learners for transmission and joining the professional world.Conclusion: Based on the concept analysis, we arrived at an analytical definition of the hidden curriculum that could be useful for further studies in this area.Keywords: CONCEPT ANALYSIS, HIDDEN CURRICULUM, MCKENNA’S METHOD

Hidden particle production at the ILC

International Nuclear Information System (INIS)

Fujii, Keisuke; Itoh, Hideo; Okada, Nobuchika; Hano, Hitoshi; Yoshioka, Tamaki

2008-01-01

In a class of new physics models, the new physics sector is completely or partly hidden, namely, a singlet under the standard model (SM) gauge group. Hidden fields included in such new physics models communicate with the standard model sector through higher-dimensional operators. If a cutoff lies in the TeV range, such hidden fields can be produced at future colliders. We consider a scalar field as an example of the hidden fields. Collider phenomenology on this hidden scalar is similar to that of the SM Higgs boson, but there are several features quite different from those of the Higgs boson. We investigate productions of the hidden scalar at the International Linear Collider (ILC) and study the feasibility of its measurements, in particular, how well the ILC distinguishes the scalar from the Higgs boson, through realistic Monte Carlo simulations.

Salivary cortisol: a possible biomarker in evaluating stress and effects of interventions in young foster children?

NARCIS (Netherlands)

van Andel, H.W.H.; Jansen, L.M.C.; Grietens, H.; Knorth, E.J.; van der Gaag, R.

2014-01-01

Young foster children undergo an early separation from their caregiver(s) and often experience severe stress before placement. However, a considerable part of the children do not show apparent signs of distress, making it difficult for the foster carer to be aware of the amount of stress in their

Probing hidden sector photons through the Higgs window

International Nuclear Information System (INIS)

Ahlers, M.

2008-07-01

We investigate the possibility that a (light) hidden sector extra photon receives its mass via spontaneous symmetry breaking of a hidden sector Higgs boson, the so-called hidden-Higgs. The hidden-photon can mix with the ordinary photon via a gauge kinetic mixing term. The hidden-Higgs can couple to the Standard Model Higgs via a renormalizable quartic term - sometimes called the Higgs Portal. We discuss the implications of this light hidden-Higgs in the context of laser polarization and light-shining-through-the-wall experiments as well as cosmological, astrophysical, and non-Newtonian force measurements. For hidden-photons receiving their mass from a hidden-Higgs we find in the small mass regime significantly stronger bounds than the bounds on massive hidden sector photons alone. (orig.)

Probing hidden sector photons through the Higgs window

International Nuclear Information System (INIS)

Ahlers, Markus; Jaeckel, Joerg; Redondo, Javier; Ringwald, Andreas

2008-01-01

We investigate the possibility that a (light) hidden sector extra photon receives its mass via spontaneous symmetry breaking of a hidden sector Higgs boson, the so-called hidden-Higgs. The hidden-photon can mix with the ordinary photon via a gauge kinetic mixing term. The hidden-Higgs can couple to the standard model Higgs via a renormalizable quartic term - sometimes called the Higgs portal. We discuss the implications of this light hidden-Higgs in the context of laser polarization and light-shining-through-the-wall experiments as well as cosmological, astrophysical, and non-Newtonian force measurements. For hidden-photons receiving their mass from a hidden-Higgs, we find in the small mass regime significantly stronger bounds than the bounds on massive hidden sector photons alone.

Insight: Exploring Hidden Roles in Collaborative Play

Directory of Open Access Journals (Sweden)

Tricia Shi

2015-06-01

Full Text Available This paper looks into interaction modes between players in co-located, collaborative games. In particular, hidden traitor games, in which one or more players is secretly working against the group mission, has the effect of increasing paranoia and distrust between players, so this paper looks into the opposite of a hidden traitor – a hidden benefactor. Rather than sabotaging the group mission, the hidden benefactor would help the group achieve the end goal while still having a reason to stay hidden. The paper explores what games with such a role can look like and how the role changes player interactions. Finally, the paper addresses the divide between video game and board game interaction modes; hidden roles are not common within video games, but they are of growing prevalence in board games. This fact, combined with the exploration of hidden benefactors, reveals that hidden roles is a mechanic that video games should develop into in order to match board games’ complexity of player interaction modes.

Hidden attractors in dynamical systems

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Dudkowski, Dawid; Jafari, Sajad; Kapitaniak, Tomasz; Kuznetsov, Nikolay V.; Leonov, Gennady A.; Prasad, Awadhesh

2016-06-01

Complex dynamical systems, ranging from the climate, ecosystems to financial markets and engineering applications typically have many coexisting attractors. This property of the system is called multistability. The final state, i.e., the attractor on which the multistable system evolves strongly depends on the initial conditions. Additionally, such systems are very sensitive towards noise and system parameters so a sudden shift to a contrasting regime may occur. To understand the dynamics of these systems one has to identify all possible attractors and their basins of attraction. Recently, it has been shown that multistability is connected with the occurrence of unpredictable attractors which have been called hidden attractors. The basins of attraction of the hidden attractors do not touch unstable fixed points (if exists) and are located far away from such points. Numerical localization of the hidden attractors is not straightforward since there are no transient processes leading to them from the neighborhoods of unstable fixed points and one has to use the special analytical-numerical procedures. From the viewpoint of applications, the identification of hidden attractors is the major issue. The knowledge about the emergence and properties of hidden attractors can increase the likelihood that the system will remain on the most desirable attractor and reduce the risk of the sudden jump to undesired behavior. We review the most representative examples of hidden attractors, discuss their theoretical properties and experimental observations. We also describe numerical methods which allow identification of the hidden attractors.

Managing childhood eczema: qualitative study exploring carers' experiences of barriers and facilitators to treatment adherence.

Science.gov (United States)

Santer, Miriam; Burgess, Hana; Yardley, Lucy; Ersser, Steven J; Lewis-Jones, Sue; Muller, Ingrid; Hugh, Catherine; Little, Paul

2013-11-01

To explore parents and carers' experiences of barriers and facilitators to treatment adherence in childhood eczema Childhood eczema is common and causes significant impact on quality of life for children and their families, particularly due to sleep disturbance and itch. Non-adherence to application of topical treatments is the main cause of treatment failure. Qualitative interview study. Qualitative interviews were carried out with 31 carers from 28 families of children with eczema. Participants were recruited through primary care and included if they had a child aged 5 or less with a diagnosis of eczema. Interviews were carried out between December 2010-May 2011. Data were analysed using a constant comparative approach. Barriers to treatment adherence included carer beliefs around eczema treatment, the time consuming nature of applying topical treatments, and child resistance to treatment. Families employed a range of strategies in an attempt to work around children's resistance to treatment with varying success. Strategies included involving the child in treatment, distracting the child during treatment, or making a game of it, using rewards, applying treatment to a sleeping child or, in a few cases, physically restraining the child. Some carers reduced frequency of applications in an attempt to reduce child resistance. Regular application of topical treatments to children is an onerous task, particularly in families where child resistance develops. Early recognition and discussion of resistance and better awareness of the strategies to overcome this may help carers to respond positively and avoid establishing habitual confrontation. © 2013 Blackwell Publishing Ltd.

Partially Hidden Markov Models

DEFF Research Database (Denmark)

Forchhammer, Søren Otto; Rissanen, Jorma

1996-01-01

Partially Hidden Markov Models (PHMM) are introduced. They differ from the ordinary HMM's in that both the transition probabilities of the hidden states and the output probabilities are conditioned on past observations. As an illustration they are applied to black and white image compression where...

Coping Well with Advanced Cancer: A Serial Qualitative Interview Study with Patients and Family Carers

Science.gov (United States)

Roberts, Diane; Appleton, Lynda; Calman, Lynn; Large, Paul; Lloyd-Williams, Mari; Grande, Gunn

2017-01-01

Objectives To understand successful strategies used by people to cope well when living with advanced cancer; to explore how professionals can support effective coping strategies; to understand how to support development of effective coping strategies for patients and family carers. Design Qualitative serial (4–12 week intervals) interview study with people with advanced cancer and their informal carers followed by focus groups. The iterative design had a novel focus on positive coping strategies. Interview analysis focused on patients and carers as individuals and pairs, exploring multiple dimensions of their coping experiences. Focus group analysis explored strategies for intervention development. Participants 26 people with advanced (stage 3–4) breast, prostate, lung or colorectal cancer, or in receipt of palliative care, and 24 paired nominated informal/family carers. Setting Participants recruited through outpatient clinics at two tertiary cancer centres in Merseyside and Manchester, UK, between June 2012 and July 2013. Results 45 patient and 41 carer interviews were conducted plus 4 focus groups (16 participants). People with advanced cancer and their informal/family carers develop coping strategies which enable effective management of psychological wellbeing. People draw from pre-diagnosis coping strategies, but these develop through responding to the experience of living with advanced cancer. Strategies include being realistic, indulgence, support, and learning from others, which enabled participants to regain a sense of wellbeing after emotional challenge. Learning from peers emerged as particularly important in promoting psychological wellbeing through the development of effective ‘everyday’, non-clinical coping strategies. Conclusions Our findings challenge current models of providing psychological support for those with advanced cancer which focus on professional intervention. It is important to recognise, enable and support peoples’ own

Hidden photons in connection to dark matter

Energy Technology Data Exchange (ETDEWEB)

Andreas, Sarah; Ringwald, Andreas [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); Goodsell, Mark D. [CPhT, Ecole Polytechnique, Palaiseau (France)

2013-06-15

Light extra U(1) gauge bosons, so called hidden photons, which reside in a hidden sector have attracted much attention since they are a well motivated feature of many scenarios beyond the Standard Model and furthermore could mediate the interaction with hidden sector dark matter.We review limits on hidden photons from past electron beam dump experiments including two new limits from such experiments at KEK and Orsay. In addition, we study the possibility of having dark matter in the hidden sector. A simple toy model and different supersymmetric realisations are shown to provide viable dark matter candidates in the hidden sector that are in agreement with recent direct detection limits.

Hidden photons in connection to dark matter

International Nuclear Information System (INIS)

Andreas, Sarah; Ringwald, Andreas; Goodsell, Mark D.

2013-06-01

Light extra U(1) gauge bosons, so called hidden photons, which reside in a hidden sector have attracted much attention since they are a well motivated feature of many scenarios beyond the Standard Model and furthermore could mediate the interaction with hidden sector dark matter.We review limits on hidden photons from past electron beam dump experiments including two new limits from such experiments at KEK and Orsay. In addition, we study the possibility of having dark matter in the hidden sector. A simple toy model and different supersymmetric realisations are shown to provide viable dark matter candidates in the hidden sector that are in agreement with recent direct detection limits.

The agency of patients and carers in medical care and self-care technologies for interacting with doctors.

Science.gov (United States)

Nunes, Francisco; Andersen, Tariq; Fitzpatrick, Geraldine

2017-06-01

People living with Parkinson's disease engage in self-care for most of the time but, two or three times a year, they meet with doctors to re-evaluate the condition and adjust treatment. Patients and (informal) carers participate actively in these encounters, but their engagement might change as new patient-centred technologies are integrated into healthcare infrastructures. Drawing on a qualitative study that used observations and interviews to investigate consultations, and digital ethnography to understand interactions in an online community, we describe how patients and carers living with Parkinson's participate in the diagnosis and treatment decisions, engage in discussions to learn about certain topics, and address inappropriate medication. We contrast their engagement with a review of self-care technologies that support interactions with doctors, to investigate how these artefacts may influence the agency of patients and carers. Finally, we discuss design ideas for improving the participation of patients and carers in technology-mediated scenarios.

A study of the effectiveness of MP3 players to support family carers of people living with dementia at home.

Science.gov (United States)

Lewis, Virginia; Bauer, Michael; Winbolt, Margaret; Chenco, Carol; Hanley, Francine

2015-03-01

Music can be therapeutic to people with dementia; however, little is known about its effect on the family carers. This project aimed to (1) assess the effects of MP3 player use by a person with dementia on caregivers' mental health and wellbeing, including their self-care and health-promoting behavior and (2) determine whether MP3 player use increases caregivers' self-reported capacity to cope with their role. A pre-post quantitative and qualitative design was used. Carers completed a survey prior to commencing and four weeks after using the player. The survey included validated measures to assess the level of stress and coping among carers. Carers also kept a diary of the way they used the MP3 player. Half of the carers were interviewed about their experiences at the end of the study. Of 59 people who started using the MP3 player, 51 carers completed the four-week study period and surveys. Use of the MP3 player significantly decreased psychological distress, significantly improved the mental health and wellbeing of carers, significantly increased caregiver self-efficacy to manage symptoms of dementia, and was reported to provide valued respite from the high level of vigilance required for caring for a person with dementia. An MP3 player loaded with music can be a low cost and relatively simple and effective additional strategy to support families caring for people with dementia in the community.

Evaluation of the Digital Alzheimer Center: Testing Usability and Usefulness of an Online Portal for Patients with Dementia and Their Carers.

Science.gov (United States)

Hattink, Bart; Droes, Rose-Marie; Sikkes, Sietske; Oostra, Ellen; Lemstra, Afina W

2016-07-21

Dementia is a progressive and highly disabling neurodegenerative disease that will likely become highly prevalent in the future due to the globally aging population. To improve health care efficiency and quality for dementia care, eHealth could help with, for example, an online portal, such as the Digital Alzheimer Center (DAC) of the Vrije Universiteit Medical Center Amsterdam. It provides up-to-date disease information, peer-to-peer contact, and methods for contacting the hospital and health professionals. We aimed to investigate the usability and usefulness of the DAC for patients with dementia and carers to get insight into the feasibility and value of this eHealth app in dementia care and to recommend potential improvements. A descriptive study among patients, carers, and health care professionals was performed. Mixed methods were used, consisting of observations (n=10, 4 people with dementia, 6 carers), an online survey (n=287; 88 patients, 199 carers), and semistructured interviews (n=18; 6 patients, 6 carers, 6 health care professionals). During the observations, participants performed a set of five different prescribed tasks on the portal. Speed, number of errors, and navigation were noted. The online survey aimed to assess users' opinions on the portal's usability and usefulness. Semistructured interviews were conducted in a subsample of patients, carers, and health care professionals to gain more in-depth information. In the usability assessment, eight categories of errors were distinguished, of which three were of critical, two of medium, and three of low severity. In the survey, 45% (40/88) of the patients and 53% (105/199) of the carers indicated they used the portal. In all, 33% (12/36) of patients and 61% (62/102) of carers found it easy to learn to work with the portal. Most considered the DAC generally useful: 65% (17/26) of patients and 78% (67/86) of carers found the DAC useful, especially for understanding dementia (patients: 64%, 16/25; carers

POVMs and hidden variables

International Nuclear Information System (INIS)

Stairs, Allen

2007-01-01

Recent results by Paul Busch and Adan Cabello claim to show that by appealing to POVMs, non-contextual hidden variables can be ruled out in two dimensions. While the results of Busch and Cabello are mathematically correct, interpretive problems render them problematic as no hidden variable proofs

Qualitative focus group study investigating experiences of accessing and engaging with social care services: perspectives of carers from diverse ethnic groups caring for stroke survivors.

Science.gov (United States)

Greenwood, Nan; Holley, Jess; Ellmers, Theresa; Mein, Gill; Cloud, Geoffrey

2016-01-29

Informal carers, often family members, play a vital role in supporting stroke survivors with post-stroke disability. As populations age, numbers of carers overall and those from minority ethnic groups in particular, are rising. Carers from all ethnic groups, but especially those from black and minority ethnic groups frequently fail to access support services, making understanding their experiences important. The study therefore explored the experiences of carers of stroke survivors aged 45+ years from 5 ethnic groups in accessing and receiving social care services after hospital discharge. This qualitative study used 7 recorded focus groups with informal carers of stroke survivors. Data were analysed thematically focusing on similarities and differences between ethnic groups. Carers were recruited from voluntary sector organisations supporting carers, stroke survivors and black and minority ethnic groups in the UK. 41 carers from 5 ethnic groups (Asian Indian, Asian Pakistani, black African, black Caribbean, white British) participated in the focus groups. Several interconnected themes were identified including: the service gap between hospital discharge and home; carers as the best person to care and cultural aspects of caring and using services. Many themes were common to all the included ethnic groups but some related to specific groups. Across ethnic groups there were many similarities in the experiences of people caring for stroke survivors with complex, long-term care needs. Accessing services demands effort and persistence on carers' part. If carers believe services are unsatisfactory or that they, rather than formal services, should be providing support for stroke survivors, they are unlikely to persist in their efforts. Cultural and language differences add to the challenges black and minority ethnic group carers face. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A new indicator of the oral hygiene habits of disabled persons: relevance of the carer's personal appearance and interest in oral health.

Science.gov (United States)

Limeres, J; Martínez, F; Feijoo, J F; Ramos, I; Liñares, A; Diz, P

2014-05-01

To investigate whether there is a relationship between the oral hygiene habits of individuals with severe disability the carer's personal appearance and interest in oral health. The study group was formed of 60 disabled persons and their respective carers who came for the first time to consultation in the Special-Needs Dentistry Unit of the University of Santiago de Compostela, Spain. All the carers answered a standardised questionnaire of 28 questions divided into four sections: disabled individual's demographic data, disabled individual's general medical details, social aspects of the carer (personal appearance of the carer and interest in oral health), and disabled individual's oral hygiene habits. The personal appearance of the carers and their interest in the disabled individual's oral health were evaluated using independent scales designed specifically for the study, with five binary items in each scale. The carer's personal appearance and interest in the disabled individual's oral health showed a statistically significant relationship with the individual's oral hygiene habits, particularly with respect to the frequency and duration of toothbrushing, need for physical restraint during toothbrushing, use of a manual toothbrush and use of toothpaste. The carer's personal appearance and interest in the disabled individual's oral health are good indicators of the oral hygiene habits of an individual with severe disability. Consideration should be given to the inclusion of these aspects as a complementary element of the dental record. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Supporting change in chronic disease risk behaviours for people with a mental illness: a qualitative study of the experiences of family carers.

Science.gov (United States)

Bailey, Jacqueline M; Hansen, Vibeke; Wye, Paula M; Wiggers, John H; Bartlem, Kate M; Bowman, Jennifer A

2018-03-27

People with a mental illness experience greater chronic disease morbidity and mortality, and associated reduced life expectancy, compared to those without such an illness. A higher prevalence of chronic disease risk behaviours (inadequate nutrition, inadequate physical activity, tobacco smoking, and harmful alcohol consumption) is experienced by this population. Family carers have the potential to support change in such behaviours among those they care for with a mental illness. This study aimed to explore family carers': 1) experiences in addressing the chronic disease risk behaviours of their family members; 2) existing barriers to addressing such behaviours; and 3) perceptions of potential strategies to assist them to provide risk behaviour change support. A qualitative study of four focus groups (n = 31), using a semi-structured interview schedule, was conducted with carers of people with a mental illness in New South Wales, Australia from January 2015 to February 2016. An inductive thematic analysis was employed to explore the experience of carers in addressing the chronic disease risk behaviours. Two main themes were identified in family carers' report of their experiences: firstly, that health behaviours were salient concerns for carers and that they were engaged in providing support, and secondly that they perceived a bidirectional relationship between health behaviours and mental well-being. Key barriers to addressing behaviours were: a need to attend to carers' own well-being; defensiveness on behalf of the family member; and not residing with their family member; with other behaviour-specific barriers also identified. Discussion around strategies which would assist carers in providing support for health risk behaviours identified a need for improved communication and collaboration between carers and health services accessed by their family members. Additional support from general and mental health services accessed by family members is desired to

Study protocol: pragmatic randomized control trial of an internet-based intervention (My tools 4 care) for family carers.

Science.gov (United States)

Duggleby, Wendy; Ploeg, Jenny; McAiney, Carrie; Fisher, Kathryn; Swindle, Jenny; Chambers, Tracey; Ghosh, Sunita; Peacock, Shelley; Markle-Reid, Maureen; Triscott, Jean; Williams, Allison; Forbes, Dorothy; Pollard, Lori

2017-08-14

Family carers of older persons with Alzheimer's' disease and related dementia (ADRD) and multiple chronic conditions (MCC) experience significant, complex, and distressing transitions such as changes to their environment, roles and relationships, physical health, and mental health. An online intervention (My Tools 4 Care) was developed for family carers of persons with ADRD and MCC living at home, with the aim of supporting these carers through transitions and increasing their self-efficacy, hope, and health related quality of life (HRQoL). This study will evaluate My Tools 4 Care (MT4C) by asking the following research questions: 1. Does use of MT4C result in a 3 month (immediately post intervention) and 6-month (3 months after intervention) increase in HRQoL, self-efficacy, and hope, in carers of persons with ADRD and MCC compared to an educational control group? 2. Does use of MT4C help carers of community-dwelling older adults with ADRD and MCC deal with significant changes they experience as carers? and 3. Are the effects/benefits of the MT4C intervention achieved at no additional cost compared to an educational control group? Using a pragmatic mixed methods randomized controlled trial design, 180 family carers of community dwelling older persons (65 years of age and older) with ADRD and MCC will participate in the study. Data will be collected from the intervention and an educational control group at four time points: baseline, 1 month, 3 and 6 months. We expect to find that family carers using MT4C will show greater improvement in hope, self-efficacy and HRQoL, at no additional cost from a societal perspective, compared to those in the educational control group. General estimating equations will be used to determine differences between groups and over time. Data collection began in Ontario and Alberta Canada in June 2015 and is expected to be completed in June 2017. The results will inform policy and practice as MT4C can be easily revised for local

Mental Health Interventions for Parent Carers of Children with Autistic Spectrum Disorder: Practice Guidelines from a Critical Interpretive Synthesis (CIS) Systematic Review.

Science.gov (United States)

Catalano, Denise; Holloway, Linda; Mpofu, Elias

2018-02-14

Parent carers of children with Autism Spectrum Disorder (ASD) often report increased levels of stress, depression, and anxiety. Unmet parent carer mental health needs pose a significant risk to the psychological, physical, and social well-being of the parents of the child affected by ASD and jeopardize the adaptive functioning of the family as well as the potential of the child affected by ASD. This systematic review identifies key qualities of interventions supporting the mental health of parent carers and proposes practitioner-parent carer support guidelines. A search of four databases (Medline, PubMed, PsycINFO, and Social Science Data) was conducted to identify studies that met the following criteria: (1) an intervention was delivered to parent carers of a child with ASD under the age of 18 years; (2) the research design allowed for a comparison on outcomes across groups; and (3) outcome measures of the parent carers' mental health were used. A total of 23 studies met the inclusion criteria. A critical interpretive synthesis approach was used to produce an integrated conceptualization of the evidence. Findings suggest practitioner guidelines to support the mental health and wellbeing of parent carers should include addressing the parent's self-perspective taking and skill for real time problem-solving.

[Psychosocial strategies to strengthen the coping with Parkinson's disease: Perspectives from patients, family carers and healthcare professionals].

Science.gov (United States)

Navarta-Sánchez, María Victoria; Caparrós, Neus; Ursúa Sesma, María Eugenia; Díaz de Cerio Ayesa, Sara; Riverol, Mario; Portillo, Mari Carmen

2017-04-01

To explore the main psychosocial aspects which have influence on the coping with the disease in patients with Parkinson's disease (PD) and their family carers. An exploratory qualitative study which constitutes the second phase of a mixed-methods project. Multicenter study carried out in Navarre in 2014 in collaboration with Primary Care of Navarre Service of Health-Osasunbidea, Clínica Universidad de Navarra and Navarre Association of Parkinson's patients. A total of 21 participants: 9 people with PD, 7 family carers and 5 healthcare professionals. Participants were selected through purposive sampling. Focus groups were conducted until a suitable saturation data was achieved. Transcriptions were analysed by 2 researchers through a content analysis. Three aspects that affected how patients and family carers coped with PD were identified: features of the clinical practice; family environment, and disease's acceptance. Taking account of these findings, some strategies which could foster these aspects from primary healthcare are suggested in order to improve the adjustment to the disease in patients and family carers. The healthcare in people with PD should have an integral approach that tackle the symptoms control in patients and also deal with psychosocial aspects that influence on the coping with the disease, in patients and family carers. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

The place for emotions in professional carers' thinking: reflections on two cases.

Science.gov (United States)

Koren, E

2010-12-01

How do carers know what is right for their patient? What can they do further to relying on the two pillars of knowledge and ethics? Knowledge foregrounds rational decision-making based on scientific evidence. It allows cost-benefit rationalization and the choice of the best feasible objective. The steady advance of medical science drives responsible carers to keep their knowledge and skills up-to-date. Bioethics grants primary attention to the prevention of causing harm in general, to pursuant of patients' subjective wellbeing and to allow the latter enjoy their autonomy and to guarantee them the sense of justice. There are, however, cases where these values collide and any care decision violates one principle or another. How are carers expected to act then? This article concerns the choices made by carers, as presented and discussed in two cases. These cases deal with a clash between two principles: parenthood vs. fertility, religious rite vs. social affiliation. This class has generated an ethical dilemma. In each case carers try to justify their choices by expert knowledge and other ethical values, but later reflection reveals that the predominant element in 'solving' these dilemmas was "emotions." Professional training submits that: 'Set aside feelings in order to keep your thinking 'straight.' However, reality proves this simply infeasible. The more complex the medical-ethical situation, it is more likely that "emotions" take over. We have no choice as responsible carers but to allow our emotions the status of a factor of influence in their own right. Nowadays, a basic medical training for doctors and nurses offers an integrated body of knowledge and therapeutic skills. In addition, trainees are introduced to bioethics, supposedly sufficient to guide their future steps in their chosen profession. But how does this training in fact shape their future ethical conduct, if at all? How does it affect their ability to maintain ethical responsibility throughout

'I'm not an outsider, I'm his mother!' A phenomenological enquiry into carer experiences of exclusion from acute psychiatric settings.

Science.gov (United States)

Wilkinson, Claire; McAndrew, Sue

2008-12-01

Contemporary standards and policies advocate carer involvement in planning, implementing, and evaluating mental health services. Critics have questioned why such standards and policies fail to move from rhetoric to reality, this particularly being applicable to carer involvement within acute psychiatric settings. As there is only limited UK research on this topic, this interpretive phenomenological study was undertaken to explore the perceived level of involvement from the perspective of carers of service users who were admitted to acute inpatient settings within the previous 2 years. Interviews were conducted with four individuals who cared for a loved one with a mental illness. The interview analysis was influenced by Van Manen, whose interpretive approach seeks to generate a deeper understanding of the phenomenon under study. Four main themes emerged: powerlessness, feeling isolated, needing to be recognized and valued, and a desire for partnership. The findings reflect the views expressed by carers in other studies, identifying that while carers seek to work in partnership with health-care professionals, at a clinical level they often feel excluded. The study concludes by discussing ways of improving and promoting carer involvement and advocating a partnership in care approach within acute psychiatry.

What do people with dementia and their carers want to know about neuroimaging for dementia?

Science.gov (United States)

Featherstone, Hannah; Butler, Marie-Louise; Ciblis, Aurelia; Bokde, Arun L; Mullins, Paul G; McNulty, Jonathan P

2017-05-01

Neuroimaging forms an important part of dementia diagnosis. Provision of information on neuroimaging to people with dementia and their carers may aid understanding of the pathological, physiological and psychosocial changes of the disease, and increase understanding of symptoms. This qualitative study aimed to investigate participants' knowledge of the dementia diagnosis pathway, their understanding of neuroimaging and its use in diagnosis, and to determine content requirements for a website providing neuroimaging information. Structured interviews and a focus group were conducted with carers and people with dementia. The findings demonstrate an unmet need for information on neuroimaging both before and after the examination. Carers were keen to know about neuroimaging at a practical and technical level to help avoid diagnosis denial. People with dementia requested greater information, but with a caveat to avoid overwhelming detail, and were less likely to favour an Internet resource.

Helioscope bounds on hidden sector photons

International Nuclear Information System (INIS)

Redondo, J.

2008-01-01

The flux of hypothetical ''hidden photons'' from the Sun is computed under the assumption that they interact with normal matter only through kinetic mixing with the ordinary standard model photon. Requiring that the exotic luminosity is smaller than the standard photon luminosity provides limits for the mixing parameter down to χ -14 , depending on the hidden photon mass. Furthermore, it is pointed point out that helioscopes looking for solar axions are also sensitive to hidden photons. The recent results of the CAST collaboration are used to further constrain the mixing parameter χ at low masses (m γ' <1 eV) where the luminosity bound is weaker. In this regime the solar hidden photon ux has a sizable contribution of longitudinally polarized hidden photons of low energy which are invisible for current helioscopes. (orig.)

Modern technology to support carers of care recipients with dementia or functional mental illness: promising progress, but a long road ahead.

Science.gov (United States)

Lautenschlager, Nicola T; Diehl-Schmid, Janine; Loi, Samantha M; Mayer, Johannes; Tensil, Maria; Kurz, Alexander F

2017-12-01

There is no doubt that family carers who look after a family member with dementia or with a functional mental illness fulfill an important role, not only for their loved one, but also for the health and aged care systems of the countries they live in. Due to increasing life expectancy, but also improved healthcare the number of family carers supporting older care recipients with functional mental illness or dementia is on the rise. While the carer role often can offer rewarding experiences caregivers are at increased risk of stress, depression, sleep problems, and often experience poor health outcomes with increased morbidity and mortality (Oyebode, 2003). Next to the stressors directly associated with the carer role, they often do not have the time to engage in healthy behavior to protect their physical, mental, and cognitive health (Loi et al., 2014). There is a wealth of literature providing evidence about effective strategies to support carers and the recent Lancet Commission on Dementia prevention, intervention, and care highlighted the importance of exploring how the use of technological innovations could support carers better (Livingston et al., 2017). The use of modern technology in this context can mean a variety of approaches, such as internet-based programs to provide education and skill-building, virtual support to assist with monitoring and managing challenging behavior, online support groups, and the use of assistive or therapeutic technology to improve safety, enable positive activities, and support communication between carer and care recipient, to name just a few (D'Onofrio et al., 2017; Ienca et al., 2017; Livingston et al., 2017). More specifically, telehealth approaches via videoconferences have the potential to better support carers who live in rural or remote regions (O'Connell et al., 2014) or who cannot attend face-to-face support programs for other reasons such as inability to leave the care recipient alone at home, being a multiple carer

Evaluating and Quantifying User and Carer Involvement in Mental Health Care Planning (EQUIP: Co-Development of a New Patient-Reported Outcome Measure.

Directory of Open Access Journals (Sweden)

Penny Bee

Full Text Available International and national health policy seeks to increase service user and carer involvement in mental health care planning, but suitable user-centred tools to assess the success of these initiatives are not yet available. The current study describes the development of a new reliable and valid, interval-scaled service-user and carer reported outcome measure for quantifying user/carer involvement in mental health care planning. Psychometric development reduced a 70-item item bank to a short form questionnaire using a combination of Classical Test, Mokken and Rasch Analyses. Test-retest reliability was calculated using t-tests of interval level scores between baseline and 2-4 week follow-up. Items were worded to be relevant to both service users and carers. Nine items were removed following cognitive debriefing with a service user and carer advisory group. An iterative process of item removal reduced the remaining 61 items to a final 14-item scale. The final scale has acceptable scalability (Ho = .69, reliability (alpha = .92, fit to the Rasch model (χ2(70 = 97.25, p = .02, and no differential item functioning or locally dependent items. Scores remained stable over the 4 week follow-up period, indicating good test-retest reliability. The 'Evaluating the Quality of User and Carer Involvement in Care Planning (EQUIP' scale displays excellent psychometric properties and is capable of unidimensional linear measurement. The scale is short, user and carer-centred and will be of direct benefit to clinicians, services, auditors and researchers wishing to quantify levels of user and carer involvement in care planning.

Managing Hidden Costs of Offshoring

DEFF Research Database (Denmark)

Larsen, Marcus M.; Pedersen, Torben

2014-01-01

This chapter investigates the concept of the ‘hidden costs’ of offshoring, i.e. unexpected offshoring costs exceeding the initially expected costs. Due to the highly undefined nature of these costs, we position our analysis towards the strategic responses of firms’ realisation of hidden costs....... In this regard, we argue that a major response to the hidden costs of offshoring is the identification and utilisation of strategic mechanisms in the organisational design to eventually achieving system integration in a globally dispersed and disaggregated organisation. This is heavily moderated by a learning......-by-doing process, where hidden costs motivate firms and their employees to search for new and better knowledge on how to successfully manage the organisation. We illustrate this thesis based on the case of the LEGO Group....

The Hidden Costs of Offshoring

DEFF Research Database (Denmark)

Møller Larsen, Marcus; Manning, Stephan; Pedersen, Torben

2011-01-01

of offshoring. Specifically, we propose that hidden costs can be explained by the combination of increasing structural, operational and social complexity of offshoring activities. In addition, we suggest that firm orientation towards organizational design as part of an offshoring strategy and offshoring......This study seeks to explain hidden costs of offshoring, i.e. unexpected costs resulting from the relocation of business tasks and activities outside the home country. We develop a model that highlights the role of complexity, design orientation and experience in explaining hidden costs...... experience moderate the relationship between complexity and hidden costs negatively i.e. reduces the cost generating impact of complexity. We develop three hypotheses and test them on comprehensive data from the Offshoring Research Network (ORN). In general, we find support for our hypotheses. A key result...

The effectiveness of an Internet support forum for carers of people with dementia: a pre-post cohort study.

Science.gov (United States)

McKechnie, Vicky; Barker, Chris; Stott, Josh

2014-02-28

The well-being of informal carers of people with dementia is an important public health issue. Caring for an elderly relative with dementia may be burdensome and stressful, and can negatively affect the carer's social, family, and professional life. The combination of loss, the physical demands of caregiving, prolonged distress, and biological vulnerabilities of older carers may compromise their physical health, increase social isolation, and increase the risk of anxiety and depressive disorders. Caregiver stress is also linked to negative outcomes for the recipient of care and costs to society, including increased nursing home and hospital admissions. Consequently, carer support interventions are an important component of dementia care. Computer-mediated carer support offers a range of potential advantages compared to traditional face-to-face support groups, including accessibility and the possibility of tailoring to meet individual needs, but there has been little research on its effectiveness so far. This mixed-methods study examined the impact of a well-respected UK-based online support forum for carers of people with dementia. A total of 61 new forum users completed measures of anxiety (7-item Generalized Anxiety Disorder scale, GAD-7), depression (9-item Patient Health Questionnaire, PHQ-9), and quality of relationship with the person with dementia (Scale for the Quality of the Current Relationship in Caregiving, SQCRC), at baseline and again after 12 weeks of forum usage, within a pre-post design. In addition, 8 participants were interviewed about their experiences with using the forum. There was an improvement in the quality of the relationship with the person with dementia (SQCRC: P=.003). There was no change in users' depression (PHQ-9) or anxiety (GAD-7) over the 12-week study period. Interview participants reported a range of positive experiences and benefits from using the forum. Limited negative experiences were also reported. Many of the reported

'Sustaining Place' - a grounded theory of how informal carers of people with dementia manage alterations to relationships within their social worlds.

Science.gov (United States)

Daly, Louise; McCarron, Mary; Higgins, Agnes; McCallion, Philip

2013-02-01

This paper presents a theory explaining the processes used by informal carers of people with dementia to mange alterations to their, and people with dementias' relationships with and places within their social worlds. Informal carers provide the majority of care to people with dementia. A great deal of international informal dementia care research is available, much of which elucidates the content, impacts and consequences of the informal caring role and the coping mechanisms that carers use. However, the socially situated experiences and processes integral to informal caring in dementia have not yet been robustly accounted for. A classic grounded theory approach was used as it is designed for research enquiries that aim to generate theory illustrating social patterns of action used to address an identified problem. Thirty interviews were conducted with 31 participants between 2006-2008. The theory was conceptualised from the data using the concurrent methods of theoretical sampling, constant comparative analysis, memo writing and theoretical sensitivity. Informal carers' main concern was identified as 'Living on the fringes', which was stimulated by dementia-related stigma and living a different life. The theory of 'Sustaining Place' explains the social pattern of actions employed by informal carers to manage this problem on behalf of themselves and the person with dementia. The theory of 'Sustaining Place' identifies an imperative for nurses, other formal carers and society to engage in actions to support and enable social connectedness, social inclusion and citizenship for informal carers and people with dementia. 'Sustaining Place' facilitates enhanced understanding of the complex and socially situated nature of informal dementia care through its portrayal of informal carers as social agents and can be used to guide nurses to better support those who live with dementia. © 2012 Blackwell Publishing Ltd.

Preferences for support services among adolescents and young adults with cancer or a blood disorder: a discrete choice experiment.

Science.gov (United States)

Goodall, Stephen; King, Madeleine; Ewing, Jane; Smith, Narelle; Kenny, Patricia

2012-10-01

Life-threatening illnesses in young people are traumatic for patients and their families. Support services can help patients and families deal with various non-medical impacts of diagnosis, disease and treatment. The aim of this study was to determine which types of support are most valued by adolescents and young adults (AYA) with cancer or blood disorders and their families. A discrete choice experiment (DCE). Separate experiments were conducted with AYA and their carers. Completed surveys were returned by 83 patients and 78 carers. AYA preferred emotional support for themselves (either by counsellors and/or peers), emotional support for their family, financial support and assistance returning to school/work over services relating to cultural and spiritual needs. Covariate analysis indicated female AYA were more likely than males to prefer emotional support, while males were more likely to prefer assistance returning to work/school. Carers preferred emotional support for their AYA and assistance returning to school/work. Like AYA, they were indifferent about services relating to cultural and spiritual needs. Providing the types of support services that people prefer should maximise effectiveness. This study suggests that AYA patients require support services that included financial aid, assistance returning to work/study, emotional support for themselves and for their family. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Care home design for people with dementia: What do people with dementia and their family carers value?

Science.gov (United States)

Innes, Anthea; Kelly, Fiona; Dincarslan, Ozlem

2011-07-01

To report on the views of people with dementia who live in care homes and their family carers on aspects of design that are important to them, and discuss these in relation to developing physical care environments that respond to the wishes of people with dementia and their family carers. Six focus groups were held: two in Northern Ireland and four in Scotland. A total of 40 people participated in the focus groups. Twenty nine people were with dementia (24 female and five male), and 11 were family carers (10 female and one male). Carers discussed the features of a building they took into account when selecting a care home, and discussed this in relation to 'bricks and mortar versus people'. Key themes reported by people with dementia and their family carers included how the space in the environment is used, for example, what happens in the building and the presence or absence of certain design features. Outside space and wayfinding aids were identified as positive features of the home, along with a general lack of concern about ensuite provision. The results demonstrate the complexity of building design as it must provide living space acceptable to people with dementia living there and family members who visit, as well as provide a workable environment for staff. The findings highlight areas that should be considered by care home teams involved in the build of a new home or the redevelopment of an existing care home.

Factors influencing practitioner adoption of carer-led assessment in palliative homecare: A qualitative study of the use of the Carer Support Needs Assessment Tool (CSNAT.

Directory of Open Access Journals (Sweden)

Lynn Austin

Full Text Available Informal caregivers play a pivotal role in supporting patients approaching the end of life. The Carer Support Needs Assessment Tool (CSNAT is designed to facilitate person-centred assessment and support through a process that is practitioner-facilitated, but carer-led. This study explored practitioners' experiences of implementing the CSNAT in palliative homecare.We conducted qualitative interviews/focus groups with 20 practitioners in one UK hospice homecare service (18 nurses, two healthcare assistants before and after the implementation of the CSNAT. Thematic analysis of the data was underpinned by framework analysis.Not all practitioners appreciated that using the CSNAT required a shift towards a more person-centred approach to assessment; consequently they tagged the tool onto their existing practitioner-led practice. Practitioners who did use the CSNAT as intended were able to act as role models and support their colleagues in making this transition. Practitioners' comments revealed a number of contradictions: 1 Most felt that they 'already do' identify carer support needs, but feared using the CSNAT could increase their workload; 2 some worried about introducing the CSNAT 'too soon', but recognised that it was 'too late' once patients were close to the end of life; 3 whilst practitioners stated 'they were there for the family as well as the patient', care provision was overtly centred around patients.This study provides vital insights into barriers and facilitators to implementing the CSNAT as part of a person-centred approach to assessment. The findings identified the training and support required to help practitioners make this transition to this new way of working.

Experiences from a communication training programme of paid carers in a residential rehabilitation centre for people with traumatic brain injury.

Science.gov (United States)

Behn, Nicholas; Togher, Leanne; Power, Emma

2015-01-01

To determine the impact of a communication training programme by exploring the experiences of paid carers who attended the programme in a residential rehabilitation centre for people with traumatic brain injury (TBI). Five paid carers attended a communication training programme which comprised 17 hours (across 8 weeks). Semi-structured interviews were conducted pre- and post-training. Analysis used a generic procedure with constant comparative analysis to identify categories across and within interview transcripts. Paid carers described improved knowledge and use of strategies, improved communication, positive emotional experiences and barriers and facilitators to consider for future communication training programmes. Training communication skills of paid carers in a residential rehabilitation centre had a positive impact on their conversations with people with TBI. These positive changes support quantitative findings for the effectiveness of communication training.

Is the qualitative research interview an acceptable medium for research with palliative care patients and carers?

OpenAIRE

Shipman Cathy; Gysels Marjolein; Higginson Irene J

2008-01-01

Abstract Background Contradictory evidence exists about the emotional burden of participating in qualitative research for palliative care patients and carers and this raises questions about whether this type of research is ethically justified in a vulnerable population. This study aimed to investigate palliative care patients' and carers' perceptions of the benefits and problems associated with open interviews and to understand what causes distress and what is helpful about participation in a...

Barriers to access and minority ethnic carers' satisfaction with social care services in the community: a systematic review of qualitative and quantitative literature

Science.gov (United States)

Greenwood, Nan; Habibi, Ruth; Smith, Raymond; Manthorpe, Jill

2015-01-01

As populations age, the numbers of carers overall and numbers of carers from minority ethnic groups in particular are rising. Evidence suggests that carers from all sections of the community and particularly carers from minority groups often fail to access care services. This may relate to barriers in accessing services and service dissatisfaction. The aim of this systematic review was to identify and summarise minority ethnic carers' perceptions of barriers to accessing community social care services and their satisfaction with these services if accessed. The following databases were searched from their start until July 2013: Social Care Online, Social Policy and Research, Scopus, PsychINFO, HMIC, ASSIA, MEDLINE, Embase, CINAHL Plus and AMED. Thirteen studies met the inclusion criteria. Most investigated either barriers to access or satisfaction levels, although three explored both. Only 4 studies investigated minority ethnic carers' satisfaction with social care, although 12 studies reported perceived barriers to accessing services. Few studies compared minority ethnic carers' perceptions with majority ethnic groups, making it difficult to identify issues specific to minority groups. Most barriers described were potentially relevant to all carers, irrespective of ethnic group. They included attitudinal barriers such as not wanting to involve outsiders or not seeing the need for services and practical barriers such as low awareness of services and service availability. Issues specific to minority ethnic groups included language barriers and concerns about services' cultural or religious appropriateness. Studies investigating satisfaction with services reported a mixture of satisfaction and dissatisfaction. Barriers common to all groups should not be underestimated and a better understanding of the relationship between perceived barriers to accessing services and dissatisfaction with services is needed before the experiences of all carers can be improved. PMID

Results and implications of the EU-project CARERS ‘Content materials to raise employability and reinforce skills of carers’

Science.gov (United States)

Weber, Germain; Zeilinger, Elisabeth; Oppenauer, Claudia; Brehmer, Barbara

2009-01-01

Purpose The population, and needs, of informal carers is changing, reflecting not only the changing demographics across Europe, but also the unequal challenges and opportunities for education and training—and official approval of competences—across Europe for people involved in the care sector, formal as well as informal carers. Theory The objective of this European project (Austria, France, Lithuania Luxembourg, Poland and Spain) was to create, offer and evaluate an education and training programme specifically aimed at informal carers (e.g. family members), providing answers to meet their real needs in their support work as well as for their own emotional well-being. Therefore, project partners produced six innovative, online supported training modules (total 60 hours) for face-to-face delivery. Methods The presentation will highlight the development and the content of one training Module for older people with ‘intellectual disabilities’ more detailed. Results and conclusions All trainings were evaluated by the participants through pre/post questionnaires. The results of the trainings will be presented. Discussion The importance of trainings and support for informal carers will be discussed with special emphasis given on the fact that informal carers represent a most substantial economic resource for every country and its care system.

Parent-Related Stress of Male and Female Carers of Adolescents with Intellectual Disabilities and Carers of Children within the General Population: A Cross-Sectional Comparison

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Patton, Kiri A.; Ware, Robert; McPherson, Lyn; Emerson, Eric; Lennox, Nicholas

2018-01-01

Background: Carers of children with intellectual disability show high rates of parent-related stress and are at an increased risk for deleterious physical and mental health. Materials and Methods: This study investigated the relationship between demographic and social characteristics and parenting stress, within two different cross-sectional…

A review of patient and carer participation and the use of qualitative research in the development of core outcome sets.

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Jones, Janet E; Jones, Laura L; Keeley, Thomas J H; Calvert, Melanie J; Mathers, Jonathan

2017-01-01

To be meaningful, a core outcome set (COS) should be relevant to all stakeholders including patients and carers. This review aimed to explore the methods by which patients and carers have been included as participants in COS development exercises and, in particular, the use and reporting of qualitative methods. In August 2015, a search of the Core Outcomes Measures in Effectiveness Trials (COMET) database was undertaken to identify papers involving patients and carers in COS development. Data were extracted to identify the data collection methods used in COS development, the number of health professionals, patients and carers participating in these, and the reported details of qualitative research undertaken. Fifty-nine papers reporting patient and carer participation were included in the review, ten of which reported using qualitative methods. Although patients and carers participated in outcome elicitation for inclusion in COS processes, health professionals tended to dominate the prioritisation exercises. Of the ten qualitative papers, only three were reported as a clear pre-designed part of a COS process. Qualitative data were collected using interviews, focus groups or a combination of these. None of the qualitative papers reported an underpinning methodological framework and details regarding data saturation, reflexivity and resource use associated with data collection were often poorly reported. Five papers reported difficulty in achieving a diverse sample of participants and two reported that a large and varied range of outcomes were often identified by participants making subsequent rating and ranking difficult. Consideration of the best way to include patients and carers throughout the COS development process is needed. Additionally, further work is required to assess the potential role of qualitative methods in COS, to explore the knowledge produced by different qualitative data collection methods, and to evaluate the time and resources required to

Hidden Risk Factors for Women

Science.gov (United States)

... A.S.T. Quiz Hidden Stroke Risk Factors for Women Updated:Nov 22,2016 Excerpted from "What Women Need To Know About The Hidden Risk Factors ... 2012) This year, more than 100,000 U.S. women under 65 will have a stroke. Stroke is ...

Hidden-Sector Dynamics and the Supersymmetric Seesaw

CERN Document Server

Campbell, Bruce A; Maybury, David W

2008-01-01

In light of recent analyses that have shown that nontrivial hidden-sector dynamics in models of supersymmetry breaking can lead to a significant impact on the predicted low-energy supersymmetric spectrum, we extend these studies to consider hidden-sector effects in extensions of the MSSM to include a seesaw model for neutrino masses. A dynamical hidden sector in an interval of mass scales below the seesaw scale would yield renormalization-group running involving both the anomalous dimension from the hidden sector and the seesaw-extended MSSM renormalization group equations (RGEs). These effects interfere in general, altering the generational mixing of the sleptons, and allowing for a substantial change to the expected level of charged-lepton flavour violation in seesaw-extended MSSM models. These results provide further support for recent theoretical observations that knowledge of the hidden sector is required in order to make concrete low-energy predictions, if the hidden sector is strongly coupled. In parti...

Unmet needs of people with severe multiple sclerosis and their carers: qualitative findings for a home-based intervention.

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Claudia Borreani

Full Text Available Few data on services for people with severe multiple sclerosis (MS are available. The Palliative Network for Severely Affected Adults with MS in Italy (PeNSAMI developed a home palliative care program for MS patients and carers, preceded by a literature review and qualitative study (here reported.To identify unmet needs of people with severe MS living at home by qualitative research involving key stakeholders, and theorize broad areas of intervention to meet those needs.Data were collected from: at least 10 personal interviews with adults with severe MS (primary/secondary progressive, EDSS≥8.0; three focus group meetings (FGs of carers of people with severe MS; and two FGs of health professionals (HPs. Grounded theory guided the analysis of interview and FG transcripts, from which the areas of intervention were theorized.Between October 2012 and May 2013, 22 MS patients, 30 carers and 18 HPs participated. Forty-eight needs themes were identified, grouped into 14 categories and four domains. Seven, highly interdependent intervention areas were theorized. Patients had difficulties expressing needs; experiences of burden and loneliness were prominent, chiefly in dysfunctional, less affluent families, and among parent carers. Needs differed across Italy with requirements for information and access to services highest in the South. All participants voiced a strong need for qualified personnel and care coordination in day-to-day home care. Personal hygiene emerged as crucial, as did the need for a supportive network and preservation of patient/carer roles within family and community.Unmet needs transcended medical issues and embraced organizational and psychosocial themes, as well as health policies. The high interdependence of the seven intervention areas theorized is in line with the multifaceted approach of palliative care. At variance with typical palliative contexts, coping with disability rather than end-of-life was a major concern of patients

Consumers and Carers Versus Pharmacy Staff: Do Their Priorities for Australian Pharmacy Services Align?

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McMillan, Sara S; Kelly, Fiona; Sav, Adem; Kendall, Elizabeth; King, Michelle A; Whitty, Jennifer A; Wheeler, Amanda J

2015-10-01

Health professionals, including pharmacists, are encouraged to meet the needs of their consumers in an efficient and patient-centred manner. Yet, there is limited information as to what consumers with chronic conditions need from pharmacy as a healthcare destination or how well pharmacy staff understand these needs. The aim of this study was to identify service user priorities for ideal community pharmacy services for consumers with chronic conditions and their carers, and compare these priorities with what pharmacy staff think these groups want. The nominal group technique was undertaken with pharmacist, pharmacy support staff, consumer and carer groups in four Australian regions between December 2012 and April 2013. Participant ideas and priorities for ideal services or care were identified, and contextual insight was obtained by thematic analysis. Twenty-one nominal group sessions are accepted, including 15 consumer and carer, four pharmacist and two pharmacy support staff groups. Pharmacy staff views generally aligned with consumer priorities, such as access, affordability, patient-centred care and continuity and coordinated care, yet diverged with respect to consumer information or education on medication and services. Fundamentally, consumers and carers sought streamlined access to information and medication, in a coordinated, patient-centred approach. Alleviating financial burden was a key consumer priority, with a call for the continuation and extension of medication subsidies. Overall, pharmacy staff had a reasonable understanding of what consumers would prioritise, but further emphasis on the importance, delivery, or both, of consumer information is needed. Greater consideration is needed from policy makers regarding the financial barriers to accessing medication for consumers with chronic conditions.

Accessibility and equity of health and social care services: exploring the views and experiences of Bangladeshi carers in South Wales, UK.

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Merrell, Joy; Kinsella, Faye; Murphy, Fiona; Philpin, Sue; Ali, Amina

2006-05-01

There is a paucity of information regarding the extent and nature of caring provided by minority ethnic communities. The proportion of older people from these communities will dramatically increase in the next 20 years, which will be accompanied by increasing health and social care needs and an increased demand for carers. A qualitative, exploratory study was conducted to identify the health and social care needs of informal carers, who were caring for a dependent adult from a Bangladeshi community in South Wales, UK. This paper focuses on Bangladeshi carers' access to formal support services provided by the statutory, private and voluntary sectors to assist them with their caring responsibilities. The findings are based on data collected using face-to-face, focused interviews with 20 Bangladeshi carers. Purposive and snowball sampling were used to recruit the sample. The data were analysed using thematic content analysis. The dimensions of accessibility and equity of quality of care were drawn upon to aid understanding of the findings. Bangladeshi carers faced a number of barriers in accessing health and social service provision, which impeded uptake of these services. Additionally, there was evidence of inequity in service provision. Recommendations for improving the accessibility of health and social care services are proposed, which may assist in promoting more equitable services for carers from the Bangladeshi community.

Global Update and Trends of Hidden Hunger, 1995-2011: The Hidden Hunger Index.

Directory of Open Access Journals (Sweden)

Julie C Ruel-Bergeron

Full Text Available Deficiencies in essential vitamins and minerals-also termed hidden hunger-are pervasive and hold negative consequences for the cognitive and physical development of children.This analysis evaluates the change in hidden hunger over time in the form of one composite indicator-the Hidden Hunger Index (HHI-using an unweighted average of prevalence estimates from the Nutrition Impact Model Study for anemia due to iron deficiency, vitamin A deficiency, and stunting (used as a proxy indicator for zinc deficiency. Net changes from 1995-2011 and population weighted regional means for various time periods are measured.Globally, hidden hunger improved (-6.7 net change in HHI from 1995-2011. Africa was the only region to see a deterioration in hidden hunger (+1.9 over the studied time period; East Asia and the Pacific performed exceptionally well (-13.0, while other regions improved only slightly. Improvements in HHI were mostly due to reductions in zinc and vitamin A deficiencies, while anemia due to iron deficiency persisted and even increased.This analysis is critical for informing and tracking the impact of policy and programmatic efforts to reduce micronutrient deficiencies, to advance the global nutrition agenda, and to achieve the Millennium Development Goals (MDGs. However, there remains an unmet need to invest in gathering frequent, nationally representative, high-quality micronutrient data as we renew our efforts to scale up nutrition, and as we enter the post-2015 development agenda.Preparation of this manuscript was funded by Sight and Life. There was no funding involved in the study design, data collection, analysis, or decision to publish.

Inconsistencies in the Roles of Family- and Paid- Carers in Monitoring Health Issues in People with Learning Disabilities: Some Implications for the Integration of Health and Social Care

Science.gov (United States)

Willis, Diane S.

2015-01-01

Changes in the living circumstances of people with learning disabilities have seen responsibility for their health become the provenance of paid-and family-carers. Thirteen semi-structured interviews were conducted with three family-carers and ten paid-carers. Findings revealed that the role of these carers was undefined, leading to difficulty in…

Caring for patients on home enteral nutrition: Reported complications by home carers and perspectives of community nurses.

Science.gov (United States)

Lim, Mei Ling; Yong, Bei Yi Paulynn; Mar, Mei Qi Maggie; Ang, Shin Yuh; Chan, Mei Mei; Lam, Madeleine; Chong, Ngian Choo Janet; Lopez, Violeta

2018-07-01

To explore the experiences of community nurses and home carers, in caring for patients on home enteral nutrition. The number of patients on home enteral nutrition is on the increase due to advancement in technology and shift in focus of providing care from acute to community care settings. A mixed-method approach was adopted. (i) A face-to-face survey design was used to elicit experience of carers of patients on home enteral nutrition. (ii) Focus group interviews were conducted with community nurses. Ninety-nine carers (n = 99) were recruited. Patient's mean age that they cared for was aged 77.7 years (SD = 11.2), and they had been on enteral feeding for a mean of 29 months (SD = 23.0). Most were bed-bound (90%) and required full assistance with their feeding (99%). Most were not on follow-up with dietitians (91%) and dentists (96%). The three most common reported gastrointestinal complications were constipation (31%), abdominal distension (28%) and vomiting (22%). Twenty community nurses (n = 20) were recruited for the focus group interviews. Four main themes emerged from the analysis: (i) challenge of accessing allied health services in the community; (ii) shorter length of stay in the acute care setting led to challenges in carers' learning and adaptation; (iii) transition gaps between hospital and home care services; and (iv) managing expectations of family. To facilitate a better transition of care for patients, adequate training for carers, standardising clinical practice in managing patients with home enteral nutrition and improving communication between home care services and the acute care hospitals are needed. This study highlighted the challenges faced by community home care nurses and carers. Results of this study would help to inform future policies and practice changes that would improve the quality of care received by patients on home enteral nutrition. © 2018 John Wiley & Sons Ltd.

Speech, communication and use of augmentative communication in young people with cerebral palsy: the SH&PE population study.

Science.gov (United States)

Cockerill, H; Elbourne, D; Allen, E; Scrutton, D; Will, E; McNee, A; Fairhurst, C; Baird, G

2014-03-01

Communication is frequently impaired in young people (YP) with bilateral cerebral palsy (CP). Important factors include motoric speech problems (dysarthria) and intellectual disability. Augmentative and Alternative Communication (AAC) techniques are often employed. The aim was to describe the speech problems in bilateral CP, factors associated with speech problems, current AAC provision and use, and to explore the views of both the parent/carer and young person about communication. A total population of children with bilateral CP (n = 346) from four consecutive years of births (1989-1992 inclusive) with onset of CP before 15 months were reassessed at age 16-18 years. Motor skills and speech were directly assessed and both parent/carer and the young person asked about communication and satisfaction with it. Sixty had died, eight had other conditions, 243 consented and speech was assessed in 224 of whom 141 (63%) had impaired speech. Fifty-two (23% of total YP) were mainly intelligible to unfamiliar people, 22 (10%) were mostly unintelligible to unfamiliar people, 67 (30%) were mostly or wholly unintelligible even to familiar adults. However, 89% of parent/carers said that they could communicate 1:1 with their young person. Of the 128 YP who could independently complete the questions, 107 (83.6%) were happy with their communication, nine (7%) neither happy nor unhappy and 12 (9.4%) unhappy. A total of 72 of 224 (32%) were provided with one or more types of AAC but in a significant number (75% of 52 recorded) AAC was not used at home, only in school. Factors associated with speech impairment were severity of physical impairment, as measured by Gross Motor Function Scale level and manipulation in the best hand, intellectual disability and current epilepsy. In a population representative group of YP, aged 16-18 years, with bilateral CP, 63% had impaired speech of varying severity, most had been provided with AAC but few used it at home for communication. © 2013 John

Hidden variables and locality in quantum theory

International Nuclear Information System (INIS)

Shiva, Vandana.

1978-12-01

The status of hidden variables in quantum theory has been debated since the 1920s. The author examines the no-hidden-variable theories of von Neumann, Kochen, Specker and Bell, and finds that they all share one basic assumption: averaging over the hidden variables should reproduce the quantum mechanical probabilities. Von Neumann also makes a linearity assumption, Kochen and Specker require the preservation of certain functional relations between magnitudes, and Bell proposes a locality condition. It has been assumed that the extrastatistical requirements are needed to serve as criteria of success for the introduction of hidden variables because the statistical condition is trivially satisfied, and that Bell's result is based on a locality condition that is physically motivated. The author shows that the requirement of weak locality, which is not physically motivated, is enough to give Bell's result. The proof of Bell's inequality works equally well for any pair of commuting magnitudes satisfying a condition called the degeneracy principle. None of the no-hidden-variable proofs apply to a class of hidden variable theories that are not phase-space reconstructions of quantum mechanics. The author discusses one of these theories, the Bohm-Bub theory, and finds that hidden variable theories that re all the quantum statistics, for single and sequential measurements, must introduce a randomization process for the hidden variables after each measurement. The philosophical significance of this theory lies in the role it can play in solving the conceptual puzzles posed by quantum theory

Mental Health Interventions for Parent Carers of Children with Autistic Spectrum Disorder: Practice Guidelines from a Critical Interpretive Synthesis (CIS Systematic Review

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Denise Catalano

2018-02-01

Full Text Available Parent carers of children with Autism Spectrum Disorder (ASD often report increased levels of stress, depression, and anxiety. Unmet parent carer mental health needs pose a significant risk to the psychological, physical, and social well-being of the parents of the child affected by ASD and jeopardize the adaptive functioning of the family as well as the potential of the child affected by ASD. This systematic review identifies key qualities of interventions supporting the mental health of parent carers and proposes practitioner-parent carer support guidelines. A search of four databases (Medline, PubMed, PsycINFO, and Social Science Data was conducted to identify studies that met the following criteria: (1 an intervention was delivered to parent carers of a child with ASD under the age of 18 years; (2 the research design allowed for a comparison on outcomes across groups; and (3 outcome measures of the parent carers’ mental health were used. A total of 23 studies met the inclusion criteria. A critical interpretive synthesis approach was used to produce an integrated conceptualization of the evidence. Findings suggest practitioner guidelines to support the mental health and wellbeing of parent carers should include addressing the parent’s self-perspective taking and skill for real time problem-solving.

Coming out to care: gay and lesbian carers' experiences of dementia services.

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Price, Elizabeth

2010-03-01

This article reports on findings from a qualitative study, undertaken in England that explored the experiences of 21 gay men and lesbian women who care, or cared, for a person with dementia. The aim of the study was to explore how a person's gay or lesbian sexuality might impact upon their experience of providing care in this context. This paper reports on one theme that emerged from the wider study--carers' experiences of 'coming out' to service providers. Respondents were recruited using 'snowballing' methods and the study employed semi-structured interviewing techniques. Data collection occurred over a protracted period (2003-2007), the time scale being determined by (the well documented) difficulties in recruiting respondents from this group of people. Data analysis was undertaken with the intent of developing common and contrary themes using a constant thematic comparative method. The results reported here demonstrate the ways in which carers mediated disclosures of their sexualities to health and social care service providers and, for some, their wider support network. For many carers, responses to these disclosures proved to be a critical issue and one that coloured their experience of providing care. Service providers' reactions are demonstrated as being characterised by, at best, a broad acceptance of gay and lesbian people's circumstances, through to a pervasive disregard of their needs.

Interventions for adult family carers of people who have had a stroke: a systematic review.

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Brereton, Louise; Carroll, Christopher; Barnston, Sue

2007-10-01

A systematic review of the effectiveness of interventions for adult family carers of people with stroke, and an exploratory examination of the relationship between the conceptual basis of these interventions and their effectiveness. Seventeen electronic databases and grey literature sources were searched, including ASSIA, BNI, Cochrane Library, CINAHL, EMBASE, MEDLINE, PsycINFO, Social Science Citation Index and the Science Citation Index, HMIC and the National Research Register. Authors of unpublished material were contacted for data and additional publications. Reference and citation tracking was performed on included publications. randomized controlled trials of interventions aimed primarily at adult family carers of people post stroke; carers were the primary sample; primary outcomes reported were for carers. Two independent reviewers screened titles and abstracts to identify publications and extract data. Quality assessment was performed to weight study findings. Eight papers were found reporting on six complex, generally heterogeneous, interventions: caregiver training; education and counselling; social problem-solving partnerships, delivered principally by telephone; a psycho-educational telephone support group; a nurse-led support and education programme; and a support programme, delivered either to groups in hospital or individuals during home visits. Half of the interventions were based on stress-coping theories; the remainder did not identify a conceptual basis for the intervention. Some benefits were reported for all interventions, although trials were generally of low quality, preventing firm conclusions being drawn. The presence of a conceptual basis for interventions does not appear to influence effectiveness.

Information provision to clients with stroke and their carers: self-reported practices of occupational therapists.

Science.gov (United States)

Gustafsson, Louise; Hodge, Anna; Robinson, Mia; McKenna, Kryss; Bower, Kylie

2010-06-01

The literature promotes the use of a wide range of educational materials for teaching and training clients with chronic conditions such as stroke. Client education is a valuable tool used by occupational therapists to facilitate client and carer ability to manage the stroke-affected upper limb. The aim of this study was to identify what information was provided to clients and carers, how this information was delivered, when the information was delivered and the client factors that influenced the method of information provision. Convenience and snowball sampling was used to recruit occupational therapists working in stroke. Twenty-eight participants completed the study questionnaire anonymously and their responses were summarised descriptively. There was a clinically important trend for carers to receive less information than clients. Written and/or verbal information was the favoured method for delivering information related to handling (57%), soft-tissue injury minimisation (46.4%) and oedema management (50%). Information was delivered with decreasing frequency from admission (86%) to discharge (64%). More than 90% of participants indicated that the client's cognitive ability, visual ability, level of communication, primary language and perceptual ability were considered prior to the delivery of information. Participants regularly conveyed information to clients and carers with respect to management of the stroke-affected upper limb. However, an increased emphasis on the development of practical self-management skills, awareness of the impact of personal factors and a timeline for information provision may prove useful.

Six key topics informal carers of patients with breathlessness in advanced disease want to learn about and why: MRC phase I study to inform an educational intervention.

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Morag Farquhar

Full Text Available Breathlessness is a common symptom of advanced disease placing a huge burden on patients, health systems and informal carers (families and friends providing daily help and support. It causes distress and isolation. Carers provide complex personal, practical and emotional support yet often feel ill-prepared to care. They lack knowledge and confidence in their caring role. The need to educate carers and families about breathlessness is established, yet we lack robustly developed carer-targeted educational interventions to meet their needs.We conducted a qualitative interview study with twenty five purposively-sampled patient-carer dyads living with breathlessness in advanced disease (half living with advanced cancer and half with advanced chronic obstructive pulmonary disease (COPD. We sought to identify carers' educational needs (including what they wanted to learn about and explore differences by diagnostic group in order to inform an educational intervention for carers of patients with breathlessness in advanced disease.There was a strong desire among carers for an educational intervention on breathlessness. Six key topics emerged as salient for them: 1 understanding breathlessness, 2 managing anxiety, panic and breathlessness, 3 managing infections, 4 keeping active, 5 living positively and 6 knowing what to expect in the future. A cross-cutting theme was relationship management: there were tensions within dyads resulting from mismatched expectations related to most topics. Carers felt that knowledge-gains would not only help them to support the patient better, but also help them to manage their own frustrations, anxieties, and quality of life. Different drivers for education need were identified by diagnostic group, possibly related to differences in caring role duration and resulting impacts.Meeting the educational needs of carers requires robustly developed and evaluated interventions. This study provides the evidence-base for the content

Self-efficacy and health-related quality of life in family carers of people with dementia

DEFF Research Database (Denmark)

Crellin, Nadia E.; Orrell, Martin; McDermott, Orii

2014-01-01

Objectives: This review aims to explore the role of self-efficacy (SE) in the health-related quality of life (QoL) of family carers of people with dementia. Methods: A systematic review of literature identified a range of qualitative and quantitative studies. Search terms related to caring, SE......, and dementia. Narrative synthesis was adopted to synthesise the findings. Results: Twenty-two studies met the full inclusion criteria, these included 17 quantitative, four qualitative, and one mixed-method study. A model describing the role of task/domain-specific SE beliefs in family carer health-related Qo...

Hidden love: sexual ideologies and relationship ideals among rural South African adolescents in the context of HIV/AIDS.

Science.gov (United States)

Harrison, Abigail

2008-02-01

In KwaZulu/Natal, South Africa, the social construction of young people's sexuality reflects both a complex historical process of cultural and religious integration, as well as the contemporary resurgence of 'traditionalism'. How do young people interpret these factors to construct and give meaning to their own sexualities? This multi-method qualitative study examined sexuality and relationship formation among sexually experienced young people aged 14-19 in a rural sub-district. In this setting, sexual activity is highly stigmatised, particularly for young teenage women. Dominant sexual ideologies centre on 'good behaviour', the idea that 'sex is wrong', and abstinence as a preferred prevention strategy. Young women's relationships are often hidden but sexual relationships are also an important part of the transition to adulthood. These dichotomies of love and romance versus stigma and secrecy frame young people's discourse about sexuality. A discourse about healthy sexuality is largely absent, impeding the prevention of HIV in this setting.

Using Google Adwords to recruit family carers of people with dementia.

Science.gov (United States)

O'Dwyer, Siobhan T; Moyle, Wendy

2014-06-01

Online advertising is a new frontier in research recruitment and Google Adwords (GA) is one method of online advertising. Only a handful of studies, however, have described its cost and effectiveness and none have focused on older adults. The aim of this paper is to describe a GA campaign used to recruit family carers of people with dementia and provide insight for researchers planning to use GA to recruit other older adults. A GA campaign was used to recruit family carers of people with dementia to a cross-sectional study of wellbeing. The ads were viewed more than 450,000 times in a six-week period, but only 49 surveys were completed, at a cost of $122 per survey. GA has promise, but much remains to be understood about how to maximize its potential in ageing research. Recommendations for the design of future GA campaigns are provided. © 2013 ACOTA.

… To be hidden does not mean to be merely revealed – Part 1 Artistic research on hidden curriculum

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Annette Krause

2015-09-01

Full Text Available This text revisits the long-term project Hidden Curriculum, initiated by Annette Krauss. The project addresses unquestioned routines, hierarchies of knowledge (part 1, and the role of the body in learning processes (part 2 from the perspective of secondary/high school education (in the research on a hidden curriculum. A deeper analysis of educational studies on the phenomenon of ‘hidden curriculum’ in relation to the feminist and critical pedagogies of bell hooks, Paulo Freire, and Jacques Rancière brings forward important insights generated through the artistic research within hidden curriculum. The aim of this text is to address academic canons, corporeality, and investigate everyday norms through revisiting the framework, results, and processes of the collaborative research into hidden curriculum with secondary high school students.

Global Update and Trends of Hidden Hunger, 1995-2011: The Hidden Hunger Index

Science.gov (United States)

Stevens, Gretchen A.; Ezzati, Majid; Black, Robert E.; Kraemer, Klaus

2015-01-01

Background Deficiencies in essential vitamins and minerals–also termed hidden hunger–are pervasive and hold negative consequences for the cognitive and physical development of children. Methods This analysis evaluates the change in hidden hunger over time in the form of one composite indicator–the Hidden Hunger Index (HHI)–using an unweighted average of prevalence estimates from the Nutrition Impact Model Study for anemia due to iron deficiency, vitamin A deficiency, and stunting (used as a proxy indicator for zinc deficiency). Net changes from 1995–2011 and population weighted regional means for various time periods are measured. Findings Globally, hidden hunger improved (-6.7 net change in HHI) from 1995–2011. Africa was the only region to see a deterioration in hidden hunger (+1.9) over the studied time period; East Asia and the Pacific performed exceptionally well (-13.0), while other regions improved only slightly. Improvements in HHI were mostly due to reductions in zinc and vitamin A deficiencies, while anemia due to iron deficiency persisted and even increased. Interpretation This analysis is critical for informing and tracking the impact of policy and programmatic efforts to reduce micronutrient deficiencies, to advance the global nutrition agenda, and to achieve the Millennium Development Goals (MDGs). However, there remains an unmet need to invest in gathering frequent, nationally representative, high-quality micronutrient data as we renew our efforts to scale up nutrition, and as we enter the post-2015 development agenda. Funding Preparation of this manuscript was funded by Sight and Life. There was no funding involved in the study design, data collection, analysis, or decision to publish. PMID:26673631

Is it objectionable to create a child as a carer for a disabled parent?

Science.gov (United States)

Pojer, Benjamin

2016-12-01

In his recent paper, Adam Cureton presents a compelling case in support of the right of parents with disabilities to conceive and raise children. Cureton argues that (a) caring for a parent with a disability may be beneficial for a child and (b) the creation of a child with the intention of him/her being a carer for his/her disabled parent is objectionable. This response to Cureton's paper will focus on the creation of children with the purpose of them being carers for their disabled parents. I will respond to Cureton on three counts. First, I propose that claims (a) and (b) are incompatible. Second, I will argue that even from a Kantian perspective it is not clear that creating a child as a carer is objectionable. Third, I will argue more broadly that the intentions with which parents bring children into the world are not predictive of the concern parents should show their children once they come into existence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Supporting wellbeing in motor neurone disease for patients, carers, social networks, and health professionals: A scoping review and synthesis.

Science.gov (United States)

Harris, Melanie; Thomas, Geoff; Thomas, Mary; Cafarella, Paul; Stocks, Allegra; Greig, Julia; McEvoy, R Doug

2018-04-01

ABSTRACTObjective:Disease management in motor neurone disease (MND) is focused on preserving quality of life. However, the emphasis has so far been on physical symptoms and functioning and not psychosocial wellbeing. MND affects the wellbeing of carers, of family and social network members, and of healthcare providers, as well as of the patients. We therefore aimed to assess and synthesize the knowledge about maximizing MND-related psychosocial wellbeing across all these groups. We used a systematic search and selection process to assess the scope of the literature along with a narrative synthesis of recent high-quality reviews. The original studies were mainly observational studies of patients and, to a lesser extent, of carers. There were few interventional studies, mainly of patients. There were very few studies of any type on wellbeing in their wider social network or in healthcare professionals. All the review literature looked at MND patient or carer wellbeing, with some covering both. No reviews were found of wellbeing in other family members, patients' social networks, or their healthcare professionals. The reviews demonstrated wellbeing problems for patients linked to psychosocial issues. Carer wellbeing is also compromised. Psychotherapies, social supports, improved decision supports, and changes to healthcare delivery are among the suggested strategies for improved patient and carer wellbeing, but no proven interventions were identified for either. Early access to palliative care, also not well-tested but recommended, is poorly implemented. Work on interventions to deal with well-established wellbeing problems for patients and carers is now a research priority. Explicit use of current methods for patient and public involvement and for design and testing of interventions provide a toolkit for this research. Observational research is needed in other groups. There is a potential in considering needs across patients' social networks rather than looking

Compressing the hidden variable space of a qubit

OpenAIRE

Montina, Alberto

2010-01-01

In previously exhibited hidden variable models of quantum state preparation and measurement, the number of continuous hidden variables describing the actual state of a single realization is never smaller than the quantum state manifold dimension. We introduce a simple model for a qubit whose hidden variable space is one-dimensional, i.e., smaller than the two-dimensional Bloch sphere. The hidden variable probability distributions associated with the quantum states satisfy reasonable criteria ...

Search for Hidden Particles

CERN Multimedia

Solovev, V

The SHiP Experiment is a new general-purpose fixed target facility at the SPS to search for hidden particles as predicted by a very large number of recently elaborated models of Hidden Sectors which are capable of accommodating dark matter, neutrino oscillations, and the origin of the full baryon asymmetry in the Universe. Specifically, the experiment is aimed at searching for very weakly interacting long lived particles including Heavy Neutral Leptons - right-handed partners of the active neutrinos; light supersymmetric particles - sgoldstinos, etc.; scalar, axion and vector portals to the hidden sector. The high intensity of the SPS and in particular the large production of charm mesons with the 400 GeV beam allow accessing a wide variety of light long-lived exotic particles of such models and of SUSY. Moreover, the facility is ideally suited to study the interactions of tau neutrinos.

Caring for the carer in the era of HIV diagnosis

Directory of Open Access Journals (Sweden)

Lempye J. Sempane

2013-05-01

Full Text Available The care of terminally ill patients can be physically, emotionally as well as psychologically exhausting. In the era where everyone is busy with his or her hectic daily schedule, caring for someone diagnosed with HIV on her or his deathbed can be a daunting challenge. Caring for someone dying of AIDS does not only challenge the physical being but rather leaves the carer emotionally drained. What was of concern to the author was to see the struggle that the caregiver goes through whilst caring for the sufferer. More often than not, pastoral care and counselling concentrate mainly on the pain and the suffering of the sick person. In the process, pastoral care loses sight of the agony, the emotional strain and, above all, the trauma of the caregivers in their search for answers as they care for the infected. This scenario has prompted the author to look into the theology of caring with an emphasis on pastoral care of the carers with a view of alleviating their emotional burden in caring for the HIV patients.

Supporting South Asian carers and those they care for: the role of the primary health care team.

OpenAIRE

Katbamna, Savita; Bhakta, Padma; Ahmad, Waqar; Baker, Richard; Parker, Gillian

2002-01-01

BACKGROUND: Demographic and socioeconomic changes have increased policy interest in informal carers. However, despite the multicultural nature of British society, most research in this field has been in majority communities. AIM: To explore the role of the primary health care team (PHCT) in supporting carers from British South Asian communities. DESIGN OF STUDY: Qualitative study. SETTING: Four South Asian communities in Leicestershire and West Yorkshire. METHODS: Focus groups and in-depth in...

Higgs Portal into Hidden Sectors

CERN Multimedia

CERN. Geneva

2007-01-01

Several attractive theoretical ideas suggest the existence of one or more 'hidden sectors' consisting of standard model singlet fields, some of which may not be too heavy. There is a profound reason to think that the Higgs sector might provide the first access to these hidden sectors. This scenario could affect Higgs phenomenology in drastic ways.

Hidden in plain sight: the formal, informal, and hidden curricula of a psychiatry clerkship.

Science.gov (United States)

Wear, Delese; Skillicorn, Jodie

2009-04-01

To examine perceptions of the formal, informal, and hidden curricula in psychiatry as they are observed and experienced by (1) attending physicians who have teaching responsibilities for residents and medical students, (2) residents who are taught by those same physicians and who have teaching responsibilities for medical students, and (3) medical students who are taught by attendings and residents during their psychiatry rotation. From June to November 2007, the authors conducted focus groups with attendings, residents, and students in one midwestern academic setting. The sessions were audiotaped, transcribed, and analyzed for themes surrounding the formal, informal, and hidden curricula. All three groups offered a similar belief that the knowledge, skills, and values of the formal curriculum focused on building relationships. Similarly, all three suggested that elements of the informal and hidden curricula were expressed primarily as the values arising from attendings' role modeling, as the nature and amount of time attendings spend with patients, and as attendings' advice arising from experience and intuition versus "textbook learning." Whereas students and residents offered negative values arising from the informal and hidden curricula, attendings did not, offering instead the more positive values they intended to encourage through the informal and hidden curricula. The process described here has great potential in local settings across all disciplines. Asking teachers and learners in any setting to think about how they experience the educational environment and what sense they make of all curricular efforts can provide a reality check for educators and a values check for learners as they critically reflect on the meanings of what they are learning.

A Novel Method for Decoding Any High-Order Hidden Markov Model

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Fei Ye

2014-01-01

Full Text Available This paper proposes a novel method for decoding any high-order hidden Markov model. First, the high-order hidden Markov model is transformed into an equivalent first-order hidden Markov model by Hadar’s transformation. Next, the optimal state sequence of the equivalent first-order hidden Markov model is recognized by the existing Viterbi algorithm of the first-order hidden Markov model. Finally, the optimal state sequence of the high-order hidden Markov model is inferred from the optimal state sequence of the equivalent first-order hidden Markov model. This method provides a unified algorithm framework for decoding hidden Markov models including the first-order hidden Markov model and any high-order hidden Markov model.

Abelian hidden sectors at a GeV

International Nuclear Information System (INIS)

Morrissey, David E.; Poland, David; Zurek, Kathryn M.

2009-01-01

We discuss mechanisms for naturally generating GeV-scale hidden sectors in the context of weak-scale supersymmetry. Such low mass scales can arise when hidden sectors are more weakly coupled to supersymmetry breaking than the visible sector, as happens when supersymmetry breaking is communicated to the visible sector by gauge interactions under which the hidden sector is uncharged, or if the hidden sector is sequestered from gravity-mediated supersymmetry breaking. We study these mechanisms in detail in the context of gauge and gaugino mediation, and present specific models of Abelian GeV-scale hidden sectors. In particular, we discuss kinetic mixing of a U(1) x gauge force with hypercharge, singlets or bi-fundamentals which couple to both sectors, and additional loop effects. Finally, we investigate the possible relevance of such sectors for dark matter phenomenology, as well as for low- and high-energy collider searches.

Development and validation of an Eating Disorders Symptom Impact Scale (EDSIS for carers of people with eating disorders

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Hankins Matthew

2008-04-01

Full Text Available Abstract Background Family members of relatives with eating disorders experience high levels of distress due to the difficulties in their care giving role. However no measures have been developed to measure the specific impact that an individual with an eating disorder has on family life. The aim of this study was to develop a measure to assess the specific caregiving burden of both anorexia nervosa and bulimia nervosa. A secondary aim was to examine whether this measure was sensitive to change. Methods A new scale, the Eating Disorders Symptom Impact Scale (EDSIS, was generated by a panel of clinicians and researchers based upon quantitative and qualitative work with carers and reviewed by a panel of "expert carers". A cross-sectional study was conducted among carers of relatives with an eating disorder to examine the properties of the new scale. In addition, participants from an ongoing pre-and-post design study completed several self-report questionnaires to assess the sensitivity of the EDSIS to change. Results A sample of 196 carers of relatives with an eating disorder aged 25–68 compted the scale. A 24-item EDSIS scale was derived with four factors: nutrition, guilt, dysregulated behaviour and social isolation. These explained 58.4% of the variance in carer distress. Reliability was acceptable (Cronbach's alpha ranged from 0.84 to 0.90. The convergent validity of the EDSIS subscales was moderately supported by correlations with a general caregiving measure (Experience of Caregiving Inventory (ECI, r = 0.42 to 0.60, psychological distress (General Health Questionnaire (GHQ-12, r = 0.33 and perceived functioning of the relative (Children Global Assessment Scale (CGAS, r = -30. A sample of 57 primary caregivers completed pre-post intervention assessments and the overall scale (t = 2.3, p Conclusion The EDSIS instrument has good psychometric properties and may be of value to assess the impact of eating disorder symptoms on family members. It

Stargate of the Hidden Multiverse

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Alexander Antonov

2016-02-01

Full Text Available Concept of Monoverse, which corresponds to the existing broad interpretation of the second postulate of the special theory of relativity, is not consistent with the modern astrophysical reality — existence of the dark matter and the dark energy, the total mass-energy of which is ten times greater than the mass-energy of the visible universe (which has been considered as the entire universe until very recent . This concept does not allow to explain their rather unusual properties — invisibility and lack of baryon content — which would seem to even destroy the very modern understanding of the term ‘matter’. However, all numerous alternative concepts of Multiverses, which have been proposed until today, are unable to explain these properties of the dark matter and dark energy. This article describes a new concept: the concept of the hidden Multiverse and hidden Supermultiverse, which mutual invisibility of parallel universes is explained by the physical reality of imaginary numbers. This concept completely explains the phenomenon of the dark matter and the dark energy. Moreover, it is shown that the dark matter and the dark energy are the experimental evidence for the existence of the hidden Multiverse. Described structure of the hidden Multiverse is fully consistent with the data obtained by the space stations WMAP and Planck. An extremely important property of the hidden Multiverse is an actual possibility of its permeation through stargate located on the Earth.

Service user and carer experiences of seeking help for a first episode of psychosis: a UK qualitative study

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Raine Rosalind

2011-09-01

Full Text Available Abstract Background Long duration of untreated psychosis (DUP is associated with poor outcomes and low quality of life at first contact with mental health services. However, long DUP is common. In order to inform initiatives to reduce DUP, we investigated service users' and carers' experiences of the onset of psychosis and help-seeking in two multicultural, inner London boroughs and the roles of participants' social networks in their pathways to care. Method In-depth interviews were conducted with service users and carers from an early intervention service in North London, purposively sampled to achieve diversity in sociodemographic characteristics and DUP and to include service users in contact with community organisations during illness onset. Interviews covered respondents' understanding of and reaction to the onset of psychosis, their help-seeking attempts and the reactions of social networks and health services. Thematic analysis of interview transcripts was conducted. Results Multiple barriers to prompt treatment included not attributing problems to psychosis, worries about the stigma of mental illness and service contact, not knowing where to get help and unhelpful service responses. Help was often not sought until crisis point, despite considerable prior distress. The person experiencing symptoms was often the last to recognise them as mental illness. In an urban UK setting, where involved, workers in non-health community organisations were frequently willing to assist help-seeking but often lacked skills, time or knowledge to do so. Conclusion Even modest periods of untreated psychosis cause distress and disruption to individuals and their families. Early intervention services should prioritise early detection. Initiatives aimed at reducing DUP may succeed not by promoting swift service response alone, but also by targeting delays in initial help-seeking. Our study suggests that strategies for doing this may include addressing the

Self-management support at the end of life: Patients', carers' and professionals' perspectives on managing medicines.

Science.gov (United States)

Campling, N; Richardson, A; Mulvey, M; Bennett, M; Johnston, B; Latter, S

2017-11-01

Pain is a frequently reported symptom by patients approaching the end of life and well-established that patients and carers hold fears relating to opioids, and experience side effects related to their use. The management of medicines is intrinsic to achieving effective pain relief. The concept of self-management support whilst well characterised in the context of chronic illness has not been elaborated with respect to end of life care. To identify patient, carer and professional views on the concept of self-management support at end of life, specifically in relation to analgesia and related medicines (for side-effect management) in order to describe, characterise and explain self-management support in this context. Qualitative design, data collection methods involved focus groups and interviews. Topics included the meaning of self-management support in this context, roles and behaviours adopted to manage pain-related medicines, and factors that influence these. A largely deductive approach was used, involving verification and validation of key frameworks from the literature, but with capacity for new findings to emerge. Participants were drawn from two different localities in England, one North, the other South. Interviews with patients and carers took place in their own homes and focus groups with healthcare professionals were held at local hospices. 38 individuals participated. 15 patients, in the last year of life, and 4 carers under the care of community-based specialist palliative care services and 19 specialist palliative care health professionals (predominantly community palliative care nurses). The concept of self-management support had salience for patients, carers and specialist nurses alongside some unique features, specific to the end of life context. Specifically self-management was identified as an ever-changing process enacted along a continuum of behaviours fluctuating from full to no engagement. Disease progression, frequent changes in symptoms and

Development of Measures to Assess Personal Recovery in Young People Treated in Specialist Mental Health Services.

Science.gov (United States)

John, Mary; Jeffries, Fiona W; Acuna-Rivera, Marcela; Warren, Fiona; Simonds, Laura M

2015-01-01

Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist. Aim The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services. On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10-18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem. All three measures had high internal consistency (alpha ≥ 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r = -0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75). The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. No tools exist to evaluate recovery-relevant processes in young people treated in specialist mental health services. This study reports on the development and psychometric evaluation of three self-report recovery-relevant assessments for young

Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis.

Science.gov (United States)

Sadath, Anvar; Muralidhar, D; Varambally, Shivarama; Gangadhar, B N; Jose, Justin P

2017-02-01

Caring for a person with first episode psychosis (FEP) is a challenging and distressing task for the carers. The carers' stress in the early stage of psychosis can increase their expressed emotion (EE) while social support is hypothesized to decrease EE. However, the influence of stress and social support on carers' EE is not well understood in FEP. To examine how the stress and social support shape expressed emotion in the carers of FEP. Seventy one carers of the patients with non-affective FEP were recruited from the inpatient psychiatry ward of a tertiary mental health care center in South India. The family questionnaire, perceived stress scale and multidimensional scale of perceived social support were used to measure their EE, stress and social support respectively. Carers experienced high level of perceived stress, EE and poor social support. Perceived stress significantly increased EE (β=0.834; psocial support did not significantly influence EE (β=-0.065; p>0.05). Perceived stress predicted 76 percent of the variance on EE (Adjusted R 2 =0.761). The results emphasize high level of stress and EE in carers of patients with FEP that implies the need for appropriate psychosocial interventions to manage their stress. Copyright © 2016 Elsevier B.V. All rights reserved.

EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user-involved care planning.

Science.gov (United States)

Fraser, C; Grundy, A; Meade, O; Callaghan, P; Lovell, K

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: UK NHS policy highlights the importance of user and carer involvement in health professional training. We know little about service user and carer motivations and experiences of accessing training courses for delivering training to health professionals and how well such courses prepare them for delivering training to healthcare professionals. 'Involvement' in training has often been tokenistic and too narrowly focused on preregistration courses. There is limited data on how best to prepare and support potential service user and carer trainers. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study adds to the international literature by highlighting service user and carer motivations for accessing a training course for delivering training to health professionals. Service users and carers wanted to gain new skills and confidence in presentation/facilitation as well as to make a difference to healthcare practice. We also learned that service users desired different levels of involvement in training facilitation - some wanted to take a more active role than others. A one-size-fits-all approach is not always appropriate. Encountering resistance from staff in training was a previously unidentified challenge to service user and carers' experience of delivering training in practice and is a key challenge for trainers to address in future. Professional training involvement can be enhanced via specialist training such as the EQUIP training the trainers programme evaluated here. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When training service users and carers to deliver training to mental health professionals, it is important that service users are equipped to deal with resistance from staff. It is important that service user and carer roles are negotiated and agreed prior to delivering training to healthcare professionals to accommodate individual preferences and allay anxieties. Training for service users and carers must be offered

Methodology of Young Minds Matter: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

Science.gov (United States)

Hafekost, Jennifer; Lawrence, David; Boterhoven de Haan, Katrina; Johnson, Sarah E; Saw, Suzy; Buckingham, William J; Sawyer, Michael G; Ainley, John; Zubrick, Stephen R

2016-09-01

To describe the study design of Young Minds Matter: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing. The aims of the study, sample design, development of survey content, field procedures and final questionnaires are detailed. During 2013-2014, a national household survey of the mental health and wellbeing of young people was conducted involving a sample of 6310 families selected at random from across Australia. The survey included a face-to-face diagnostic interview with parents/carers of 4- to 17-year-olds and a self-report questionnaire completed by young people aged 11-17 years. The overall response rate to the survey was 55% with 6310 parents/carers of eligible households participating in the survey. In addition, 2967 or 89% of young people aged 11-17 years in these participating households completed a questionnaire. The survey sample was found to be broadly representative of the Australian population on major demographic characteristics when compared with data from the Census of Population and Housing. However, adjustments were made for an over-representation of younger children aged 4 to 7 years and also families with more than one eligible child in the household. Young Minds Matter provides updated national prevalence estimates of common child and adolescent mental disorders, describes patterns of service use and will help to guide future decisions in the development of policy and provision of mental health services for children and adolescents. Advancements in interviewing methodology, addition of a data linkage component and informed content development contributed to improved breadth and quality of the data collected. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Coding with partially hidden Markov models

DEFF Research Database (Denmark)

Forchhammer, Søren; Rissanen, J.

1995-01-01

Partially hidden Markov models (PHMM) are introduced. They are a variation of the hidden Markov models (HMM) combining the power of explicit conditioning on past observations and the power of using hidden states. (P)HMM may be combined with arithmetic coding for lossless data compression. A general...... 2-part coding scheme for given model order but unknown parameters based on PHMM is presented. A forward-backward reestimation of parameters with a redefined backward variable is given for these models and used for estimating the unknown parameters. Proof of convergence of this reestimation is given....... The PHMM structure and the conditions of the convergence proof allows for application of the PHMM to image coding. Relations between the PHMM and hidden Markov models (HMM) are treated. Results of coding bi-level images with the PHMM coding scheme is given. The results indicate that the PHMM can adapt...

Compressing the hidden variable space of a qubit

International Nuclear Information System (INIS)

Montina, Alberto

2011-01-01

In previously exhibited hidden variable models of quantum state preparation and measurement, the number of continuous hidden variables describing the actual state of single realizations is never smaller than the quantum state manifold dimension. We introduce a simple model for a qubit whose hidden variable space is one-dimensional, i.e., smaller than the two-dimensional Bloch sphere. The hidden variable probability distributions associated with quantum states satisfy reasonable criteria of regularity. Possible generalizations of this shrinking to an N-dimensional Hilbert space are discussed.

A survey of hidden-variables theories

CERN Document Server

Belinfante, F J

1973-01-01

A Survey of Hidden-Variables Theories is a three-part book on the hidden-variable theories, referred in this book as """"theories of the first kind"""". Part I reviews the motives in developing different types of hidden-variables theories. The quest for determinism led to theories of the first kind; the quest for theories that look like causal theories when applied to spatially separated systems that interacted in the past led to theories of the second kind. Parts II and III further describe the theories of the first kind and second kind, respectively. This book is written to make the literat

A classification of hidden-variable properties

International Nuclear Information System (INIS)

Brandenburger, Adam; Yanofsky, Noson

2008-01-01

Hidden variables are extra components added to try to banish counterintuitive features of quantum mechanics. We start with a quantum-mechanical model and describe various properties that can be asked of a hidden-variable model. We present six such properties and a Venn diagram of how they are related. With two existence theorems and three no-go theorems (EPR, Bell and Kochen-Specker), we show which properties of empirically equivalent hidden-variable models are possible and which are not. Formally, our treatment relies only on classical probability models, and physical phenomena are used only to motivate which models to choose

A qualitative analysis of changes in relationship dynamics and roles between people with cancer and their primary informal carer.

Science.gov (United States)

Ussher, Jane M; Tim Wong, W K; Perz, Janette

2011-11-01

It is widely accepted that cancer is an intersubjective experience that impacts upon the psychological well-being of people with cancer and informal carers, as well as on couple relationships. This qualitative study examined the nature and consequences of cancer on the relationship between informal carers and the person with cancer, from the perspective of Australian cancer carers. Sixty-two carers (42 women and 20 men), across a range of cancer types, stages and relationship dyads took part in semi-structured interviews. Participants reported that cancer had precipitated a change in roles and in the dynamics of the relationship, including having to take on quasi-medical tasks and decisions, neglecting self and other relationships, changes to the emotions or personality of the person with cancer, changed patterns of communication, and changes to sexuality and intimacy. The impact of the changed relationship included sadness, anger and frustration, as well as feelings of love and being closer together, resulting in relationship enhancement. Women were more likely to report changes in the person with cancer and to mourn the previous relationship, while more men reported relationship enhancement.

Children as carers: an integrative review Niños como cuidadores: revisión integrativa Crianças como cuidadoras: revisão integrativa

Directory of Open Access Journals (Sweden)

Ana Sofia Filipe Marote

2012-12-01

Full Text Available OBJECTIVE: to undertake an integrative literature review on the issue of "Children as carers". This is an emerging topic in the provision of health care, but nevertheless has a low profile in the literature. METHODOLOGY: this study was based in a survey of nine databases of scientific articles, using as descriptor: child, young, caregivers, lay carer and nursing role, as well as the corresponding terms in Portuguese. 21 articles were analyzed. RESULTS: these were organized into six categories - factors which motivate the child to take on the role of caregiver; these children's characteristics; tasks performed; time spent in caring; consequences of providing care and the role of the nurse in partnership with these children and their families. CONCLUSION: the children as carers are a focus of attention relevant to nursing practice, this issue representing an opportunity for investigation in Portuguese-speaking countries, as no article was found on the subject in Portuguese. In addition, with this first study in Portuguese, a work of the creation of a bibliography is begun, allowing an awareness of the issue and the identification of ways to respond to the families involved, in line with their needs.OBJETIVO: realizar una revisión bibliográfica integrativa del tema "Niños como Cuidadores". Se Trata de un tema emergente en la prestación de atenciones de salud, que sin embargo se mantiene poco visible en la literatura. METODOLOGÍA: se basó en una investigación sobre nueve bases de datos de artículos científicos, utilizándose como descriptores: child, young, caregivers, lay carer y nursing role, así como los correspondientes en portugués. Fueron analizados 21 artículos. RESULTADOS: fueron organizados en seis categorías - factores que motivan el niño a asumir el papel de cuidador; características de esos niños; tareas desempeñadas; tiempo pasado a cuidar; consecuencias de la prestación de atenciones y papel del enfermero junto de

Anxiety and depression symptoms in young people with perinatally acquired HIV and HIV affected young people in England.

Science.gov (United States)

Le Prevost, Marthe; Arenas-Pinto, Alejandro; Melvin, Diane; Parrott, Francesca; Foster, Caroline; Ford, Deborah; Evangeli, Michael; Winston, Alan; Sturgeon, Kate; Rowson, Katie; Gibb, Diana M; Judd, Ali

2018-03-04

Adolescents with perinatal HIV (PHIV) may be at higher risk of anxiety and depression than HIV negative young people. We investigated prevalence of anxiety and depression symptoms in 283 PHIV and 96 HIV-affected (HIV-negative) young people in England recruited into the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. We used Hospital Anxiety and Depression Scale (HADS) scores and linear regression investigated predictors of higher (worse) scores.115 (41%) and 29 (30%) PHIV and HIV-affected young people were male, median age was 16 [interquartile range 15,18] and 16 [14,18] years and 241 (85%) and 71 (74%) were black African, respectively. There were no differences in anxiety and depression scores between PHIV and HIV-affected participants. Predictors of higher anxiety scores were a higher number of carers in childhood, speaking a language other than English at home, lower self-esteem, ever thinking life was not worth living and lower social functioning. Predictors of higher depression scores were male sex, death of one/both parents, school exclusion, lower self-esteem and lower social functioning. In conclusion, HIV status was not associated with anxiety or depression scores, but findings highlight the need to identify and support young people at higher risk of anxiety and depression..

Preferences of Informal Carers on Technology Packages to Support Meal Production by People Living with Dementia, Elicited from Personalised AT and ICT Product Brochures

Directory of Open Access Journals (Sweden)

Maria Laura De Filippis

2017-01-01

Full Text Available Assistive technology (AT can help support the continued independence of people living with dementia, supported by informal carers. Opinions and preferences of informal carers towards a range of assistive and digital information and communication technologies (ICT to support food purchase and menu selection, including navigation and online shopping, and safe meal-making by individuals living with dementia were investigated. General attitudes and experiences with assistive technologies were first probed by means of a focus group with carers (n = 6, organised through the Alzheimer’s Society in Nottingham, England. A series of AT/ICT product brochures were then produced, describing packages of technologies to enable meal production. Task-specific questions were asked of carers (n = 10 at local Memory Cafés as to the perceived capabilities of each individual for shopping and meal-making. Carers were asked to make pair-wise choices in order to select a personalised brochure and to complete a questionnaire to elicit the practicality, desirability and affordability of specific products and to probe for preferences amongst key features. Opinions on ease-of-use, aesthetics, expected safety-in-use, independence of use and stigma related to the technology packages were also collected. Results showed that carers are able to make detailed choices and express preferences about assistive and digital technologies for the individuals in their care, and customise their enabler package. Most believed that having an enabler package would improve safety. Greater exposure of carers to newer digital products would be beneficial. The brochure method could be employed on consumer websites and by AT assessors.

Perspective: Disclosing hidden sources of funding.

Science.gov (United States)

Resnik, David B

2009-09-01

In this article, the author discusses ethical and policy issues related to the disclosure of hidden sources of funding in research. The author argues that authors have an ethical obligation to disclose hidden sources of funding and that journals should adopt policies to enforce this obligation. Journal policies should require disclosure of hidden sources of funding that authors know about and that have a direct relation to their research. To stimulate this discussion, the author describes a recent case: investigators who conducted a lung cancer screening study had received funding from a private foundation that was supported by a tobacco company, but they did not disclose this relationship to the journal. Investigators and journal editors must be prepared to deal with these issues in a manner that promotes honesty, transparency, fairness, and accountability in research. The development of well-defined, reasonable policies pertaining to hidden sources of funding can be a step in this direction.

Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis.

Science.gov (United States)

Ellis, Graham; Mant, Jonathan; Langhorne, Peter; Dennis, Martin; Winner, Simon

2010-05-12

Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing. To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'. We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators. Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care. We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain. We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P

Efficacy and experiences of telephone counselling for informal carers of people with dementia.

Science.gov (United States)

Lins, Sabine; Hayder-Beichel, Daniela; Rücker, Gerta; Motschall, Edith; Antes, Gerd; Meyer, Gabriele; Langer, Gero

2014-09-01

Informal carers of people with dementia can suffer from depressive symptoms, emotional distress and other physiological, social and financial consequences. This review focuses on three main objectives:To:1) produce a quantitative review of the efficacy of telephone counselling for informal carers of people with dementia;2) synthesize qualitative studies to explore carers' experiences of receiving telephone counselling and counsellors' experiences of conducting telephone counselling; and3) integrate 1) and 2) to identify aspects of the intervention that are valued and work well, and those interventional components that should be improved or redesigned. The Cochrane Dementia and Cognitive Improvement Group's Specialized Register, The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, PSYNDEX, PsycINFO, Web of Science, DIMDI databases, Springer database, Science direct and trial registers were searched on 3 May 2011 and updated on 25 February 2013. A Forward Citation search was conducted for included studies in Web of Science and Google Scholar. We used the Related Articles service of PubMed for included studies, contacted experts and hand-searched abstracts of five congresses. Randomised controlled trials (RCTs) or cross-over trials that compared telephone counselling for informal carers of people with dementia against no treatment, usual care or friendly calls for chatting were included evaluation of efficacy. Qualitative studies with qualitative methods of data collection and analysis were also included to address experiences with telephone counselling. Two authors independently screened articles for inclusion criteria, extracted data and assessed the quantitative trials with the Cochrane 'Risk of bias' tool and the qualitative studies with the Critical Appraisal Skills Program (CASP) tool. The authors conducted meta-analyses, but reported some results in narrative form due to clinical heterogeneity. The authors synthesised the qualitative data and

'It was like he was in the room with us': patients' and carers' perspectives of telemedicine in acute stroke.

Science.gov (United States)

Gibson, Josephine; Lightbody, Elizabeth; McLoughlin, Alison; McAdam, Joanna; Gibson, Alison; Day, Elaine; Fitzgerald, Jane; May, Carl; Price, Chris; Emsley, Hedley; Ford, Gary A; Watkins, Caroline

2016-02-01

Telemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients' and carers' views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health-care staff. We recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semi-structured interviews were conducted using an interview guide based on normalization process theory (NPT). Thematic analysis was undertaken. We conducted 24 interviews with 29 participants (16 patients; 13 carers). Eleven interviews pertained to 'live' telemedicine assessments (at the time of admission); nine had mock-up telemedicine assessments (within 48 h of admission); four had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sense making) included people's knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. Although telemedicine was well accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The 'remote' nature of the consultation posed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking. © 2015 John Wiley & Sons Ltd.

Hidden Statistics of Schroedinger Equation

Science.gov (United States)

Zak, Michail

2011-01-01

Work was carried out in determination of the mathematical origin of randomness in quantum mechanics and creating a hidden statistics of Schr dinger equation; i.e., to expose the transitional stochastic process as a "bridge" to the quantum world. The governing equations of hidden statistics would preserve such properties of quantum physics as superposition, entanglement, and direct-product decomposability while allowing one to measure its state variables using classical methods.

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning.

Science.gov (United States)

Grundy, A C; Walker, L; Meade, O; Fraser, C; Cree, L; Bee, P; Lovell, K; Callaghan, P

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers. Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the

The Association of Health Literacy and Electronic Health Literacy With Self-Efficacy, Coping, and Caregiving Perceptions Among Carers of People With Dementia: Research Protocol for a Descriptive Correlational Study.

Science.gov (United States)

Efthymiou, Areti; Middleton, Nicos; Charalambous, Andreas; Papastavrou, Evridiki

2017-11-13

In the last decade, electronic health (eHealth) literacy has attracted the attention of the scientific community, as it is associated with the self-management of patients with chronic diseases and the quality and cost of care. It is estimated that 80% of people with chronic diseases are cared for at home by a family member, friend, or relative. Informal carers are susceptible to physical and mental health problems, as well as social and financial hardships. Nevertheless, there seems to be a research gap in terms of carers' needs, skills, and available resources in the age of new technologies, with the vital role of eHealth literacy of the carers remaining unexplored. The aim of this study was to investigate the level of eHealth literacy and health literacy of primary and secondary carers of people with dementia, to explore the association between health and eHealth literacy, as well as their association with the caregiving variables: self-efficacy, coping, and caring perceptions. A sample of 200 primary carers (the carer who supports the people with dementia in everyday living) and 200 secondary carers (family member, friend, or other person in the social network assisting the primary carer in their role) will be recruited from dementia day care centers and Alzheimer's associations in Greece and Cyprus. The study will be a cross-sectional correlational descriptive study. Tools to be used include the eHealth Literacy Scale adapted for carers to measure eHealth literacy, European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16), Single Item Literacy Screener, Revised Scale for Caregiving Self-Efficacy, Carers of Older People in Europe (COPE) index for caregiving perceptions, and COPE brief to measure selected coping strategies. Descriptive statistics will be reported, and correlations between different variables will be explored with parametric and nonparametric measures. As a preliminary study, the HLS-EU-Q16 has been validated in 107 older people. The internal

Hidden supersymmetry and Fermion number fractionalization

International Nuclear Information System (INIS)

Akhoury, R.

1985-01-01

This paper discusses how a hidden supersymmetry of the underlying field theories can be used to interpret and to calculate fermion number fractionalization in different dimensions. This is made possible by relating it to a corresponding Witten index of the hidden supersymmetry. The closely related anomalies in odd dimensions are also discussed

Effectiveness of weekly cognitive stimulation therapy for people with dementia and the additional impact of enhancing cognitive stimulation therapy with a carer training program

Directory of Open Access Journals (Sweden)

Cove J

2014-12-01

Full Text Available Jennifer Cove,1 Nicola Jacobi,2 Helen Donovan,3 Martin Orrell,4 Josh Stott,5 Aimee Spector5 1Department of Clinical, Educational and Health Psychology, University College London, London, 2Department of Psychology, City University, London, 3Clinical Psychology Service, South Essex Partnership NHS Foundation Trust, Bedford, 4Department of Psychiatry, 5Department of Clinical, Educational and Health Psychology, University College London, London, UKPurpose of the study: Cognitive stimulation therapy (CST is a widely used, evidence-based intervention for people with dementia (PwD. Although designed as a 14 session, twice weekly intervention, many services in the UK deliver CST once a week for 14 weeks. However, this method of delivery has yet to be evaluated. In addition, CST does not include any formal carer training. This study aimed to evaluate the effectiveness of once weekly CST and determine any additional impact when enhanced with a carer training program.Design and methods: A single blind, randomized controlled trial was conducted. Sixty eight PwD and their carers were recruited through three community Memory Assessment Services. PwD and their carers were randomized to one of three conditions: CST plus carer training, CST only, or a wait list control. PwD were administered standardized measures of cognition, quality of life, and quality of relationship with carer at baseline and the 15 week follow-up.Results: There were no baseline differences across the three groups. At follow-up, there were no significant differences between PwD in the three groups on any outcomes. Implications: Weekly CST with or without carer training may not be an effective form of delivery. Several possible explanations for the outcomes are proposed. Weekly CST may not offer the necessary “dose” required to combat decline, and equally the carer training may have been too brief to have made a difference. Services currently offering weekly CST should collect routine

Professional carers' experiences of providing a pediatric palliative care service in Ireland.

Science.gov (United States)

Clarke, Jean; Quin, Suzanne

2007-11-01

In this article the authors present findings on professional carers' experience of providing pediatric palliative care to children with life-limiting conditions. For this qualitative study, part of a national pediatric palliative care needs analysis, the authors engaged in 15 focus group interviews and drew on the responses of open-ended questions to give voice to the experiences of professional carers and to situate the humanity of their caring reality. This humanity is articulated through three themes: clarity of definition and complexity of engagement, seeking to deliver a palliative care service, and the emotional cost of providing palliative care. Further analysis of these themes points to a work-life experience of skilled and emotional engagement with children, and their parents, in complex processes of caregiving and decision making. Pediatric palliative care occurs in an environment where parents shoulder a large burden of the care and professionals find themselves working in underresourced services.

The Hidden Reason Behind Children's Misbehavior.

Science.gov (United States)

Nystul, Michael S.

1986-01-01

Discusses hidden reason theory based on the assumptions that: (1) the nature of people is positive; (2) a child's most basic psychological need is involvement; and (3) a child has four possible choices in life (good somebody, good nobody, bad somebody, or severely mentally ill.) A three step approach for implementing hidden reason theory is…

Hidden worlds in quantum physics

CERN Document Server

Gouesbet, Gérard

2014-01-01

The past decade has witnessed a resurgence in research and interest in the areas of quantum computation and entanglement. This new book addresses the hidden worlds or variables of quantum physics. Author Gérard Gouesbet studied and worked with a former student of Louis de Broglie, a pioneer of quantum physics. His presentation emphasizes the history and philosophical foundations of physics, areas that will interest lay readers as well as professionals and advanced undergraduate and graduate students of quantum physics. The introduction is succeeded by chapters offering background on relevant concepts in classical and quantum mechanics, a brief history of causal theories, and examinations of the double solution, pilot wave, and other hidden-variables theories. Additional topics include proofs of possibility and impossibility, contextuality, non-locality, classification of hidden-variables theories, and stochastic quantum mechanics. The final section discusses how to gain a genuine understanding of quantum mec...

Acquiring a Pet Dog Significantly Reduces Stress of Primary Carers for Children with Autism Spectrum Disorder: A Prospective Case Control Study

Science.gov (United States)

Wright, H. F.; Hall, S.; Hames, A.; Hardiman, J.; Mills, R.; Mills, D. S.

2015-01-01

This study describes the impact of pet dogs on stress of primary carers of children with Autism Spectrum Disorder (ASD). Stress levels of 38 primary carers acquiring a dog and 24 controls not acquiring a dog were sampled at: Pre-intervention (17 weeks before acquiring a dog), post-intervention (3-10 weeks after acquisition) and follow-up…

Hidden charged dark matter and chiral dark radiation

Science.gov (United States)

Ko, P.; Nagata, Natsumi; Tang, Yong

2017-10-01

In the light of recent possible tensions in the Hubble constant H0 and the structure growth rate σ8 between the Planck and other measurements, we investigate a hidden-charged dark matter (DM) model where DM interacts with hidden chiral fermions, which are charged under the hidden SU(N) and U(1) gauge interactions. The symmetries in this model assure these fermions to be massless. The DM in this model, which is a Dirac fermion and singlet under the hidden SU(N), is also assumed to be charged under the U(1) gauge symmetry, through which it can interact with the chiral fermions. Below the confinement scale of SU(N), the hidden quark condensate spontaneously breaks the U(1) gauge symmetry such that there remains a discrete symmetry, which accounts for the stability of DM. This condensate also breaks a flavor symmetry in this model and Nambu-Goldstone bosons associated with this flavor symmetry appear below the confinement scale. The hidden U(1) gauge boson and hidden quarks/Nambu-Goldstone bosons are components of dark radiation (DR) above/below the confinement scale. These light fields increase the effective number of neutrinos by δNeff ≃ 0.59 above the confinement scale for N = 2, resolving the tension in the measurements of the Hubble constant by Planck and Hubble Space Telescope if the confinement scale is ≲1 eV. DM and DR continuously scatter with each other via the hidden U(1) gauge interaction, which suppresses the matter power spectrum and results in a smaller structure growth rate. The DM sector couples to the Standard Model sector through the exchange of a real singlet scalar mixing with the Higgs boson, which makes it possible to probe our model in DM direct detection experiments. Variants of this model are also discussed, which may offer alternative ways to investigate this scenario.

Adaptive filtering for hidden node detection and tracking in networks.

Science.gov (United States)

Hamilton, Franz; Setzer, Beverly; Chavez, Sergio; Tran, Hien; Lloyd, Alun L

2017-07-01

The identification of network connectivity from noisy time series is of great interest in the study of network dynamics. This connectivity estimation problem becomes more complicated when we consider the possibility of hidden nodes within the network. These hidden nodes act as unknown drivers on our network and their presence can lead to the identification of false connections, resulting in incorrect network inference. Detecting the parts of the network they are acting on is thus critical. Here, we propose a novel method for hidden node detection based on an adaptive filtering framework with specific application to neuronal networks. We consider the hidden node as a problem of missing variables when model fitting and show that the estimated system noise covariance provided by the adaptive filter can be used to localize the influence of the hidden nodes and distinguish the effects of different hidden nodes. Additionally, we show that the sequential nature of our algorithm allows for tracking changes in the hidden node influence over time.

Coping strategies and styles of family carers of persons with enduring mental illness: a mixed methods analysis.

LENUS (Irish Health Repository)

Kartalova-O'Doherty, Yulia

2008-03-01

A qualitative exploratory study investigated the experiences and needs of family carers of persons with enduring mental illness in Ireland. The current mixed-methods secondary study used content analysis and statistical procedures to identify and explore the coping strategies emerging from the original interviews. The majority of family carers reported use of active behavioural coping strategies, sometimes combined with active cognitive or avoidance strategies. The percentage of cares reporting use of active cognitive strategies was the lowest among those whose ill relative lived in their home, and the highest among those whose relative lived independently. Participants with identified active cognitive strategies often reported that their relative was employed or in training. Participants who reported use of avoidance strategies were significantly younger than participants who did not report use of such strategies. The lowest percentage of avoidance strategies was among participants whose ill relative lived independently, whereas the highest was among carers whose relative lived in their home. The findings of this study highlight the importance of a contextual approach to studying coping styles and processes. Further research questions and methodological implications are discussed.

The hidden universe

International Nuclear Information System (INIS)

Disney, M.

1985-01-01

Astronomer Disney has followed a somewhat different tack than that of most popular books on cosmology by concentrating on the notion of hidden (as in not directly observable by its own radiation) matter in the universe

Incremental discovery of hidden structure: Applications in theory of elementary particles

International Nuclear Information System (INIS)

Zytkow, J.M.; Fischer, P.J.

1996-01-01

Discovering hidden structure is a challenging, universal research task in Physics, Chemistry, Biology, and other disciplines. Not only must the elements of hidden structure be postulated by the discoverer, but they can only be verified by indirect evidence, at the level of observable objects. In this paper we describe a framework for hidden structure discovery, built on a constructive definition of hidden structure. This definition leads to operators that build models of hidden structure step by step, postulating hidden objects, their combinations and properties, reactions described in terms of hidden objects, and mapping between the hidden and the observed structure. We introduce the operator dependency diagram, which shows the order of operator application and model evaluation. Different observational knowledge supports different evaluation criteria, which lead to different search systems with verifiable sequences of operator applications. Isomorph-free structure generation is another issue critical for efficiency of search. We apply our framework in the system GELL-MANN, that hypothesizes hidden structure for elementary particles and we present the results of a large scale search for quark models

Gender Differences in Self-Silencing and Psychological Distress in Informal Cancer Carers

Science.gov (United States)

Ussher, Jane M.; Perz, Janette

2010-01-01

This study examined gender differences in self-silencing, the relationship between self-silencing and psychological distress, and reasons for self-silencing in informal cancer carers (329 women, 155 men), using a mixed-method design. Men reported greater self-silencing than women on the Silencing the Self Scale; however, women reported higher…

Assessment of foster carers : their willingness to raise children with special needs

NARCIS (Netherlands)

Strijker, Johan; Knorth, Erik J.

2018-01-01

A substantial part of children placed out of home in family foster care suffers severe emotional and behavioural problems. These problems can enlarge the risk of a placement breakdown: the stay of a child in a foster family comes prematurely to an end because, for instance, the foster carers are not

Religious Tolerance in the Hidden Curriculum

Directory of Open Access Journals (Sweden)

Kevin Nobel Kurniawan

2018-03-01

Full Text Available Religious intolerance is spreading within the Indonesian institution of education. Previous studies have shown that the growth of intolerance is due to the state’s regulation and pedagogical apparatus. In contrast to the previous studies, I argue that the intolerance is related to hidden curriculum applied by the institution of education.  Normatively, the hidden curriculum contains the value of religious tolerance. However, factually, the author found that there are practices of intolerance, through the formal and informal spheres in the school’s structure, within the hidden curriculum. This article applies a qualitative approach with a mixed method research strategy to analyze data collected from students, teachers, and alumnis through field observation, in-depth interview, and survey.

Hidden gauge structure of supersymmetric free differential algebras

Energy Technology Data Exchange (ETDEWEB)

Andrianopoli, Laura [DISAT, Politecnico di Torino,Corso Duca degli Abruzzi 24, I-10129 Turin (Italy); INFN - Sezione di Torino,Torino (Italy); D’Auria, Riccardo [DISAT, Politecnico di Torino,Corso Duca degli Abruzzi 24, I-10129 Turin (Italy); Ravera, Lucrezia [DISAT, Politecnico di Torino,Corso Duca degli Abruzzi 24, I-10129 Turin (Italy); INFN - Sezione di Torino,Torino (Italy)

2016-08-16

The aim of this paper is to clarify the role of the nilpotent fermionic generator Q{sup ′} introduced in http://dx.doi.org/10.1016/0550-3213(82)90376-5 and appearing in the hidden supergroup underlying the free differential algebra (FDA) of D=11 supergravity. We give a physical explanation of its role by looking at the gauge properties of the theory. We find that its presence is necessary, in order that the extra 1-forms of the hidden supergroup give rise to the correct gauge transformations of the p-forms of the FDA. This interpretation is actually valid for any supergravity containing antisymmetric tensor fields, and any supersymmetric FDA can always be traded for a hidden Lie superalgebra containing extra fermionic nilpotent generators. As an interesting example we construct the hidden superalgebra associated with the FDA of N=2, D=7 supergravity. In this case we are able to parametrize the mutually non local 2- and 3-form B{sup (2)} and B{sup (3)} in terms of hidden 1-forms and find that supersymmetry and gauge invariance require in general the presence of two nilpotent fermionic generators in the hidden algebra. We propose that our approach, where all the invariances of the FDA are expressed as Lie derivatives of the p-forms in the hidden supergroup manifold, could be an appropriate framework to discuss theories defined in enlarged versions of superspace recently considered in the literature, such us double field theory and its generalizations.

Fitting Hidden Markov Models to Psychological Data

Directory of Open Access Journals (Sweden)

Ingmar Visser

2002-01-01

Full Text Available Markov models have been used extensively in psychology of learning. Applications of hidden Markov models are rare however. This is partially due to the fact that comprehensive statistics for model selection and model assessment are lacking in the psychological literature. We present model selection and model assessment statistics that are particularly useful in applying hidden Markov models in psychology. These statistics are presented and evaluated by simulation studies for a toy example. We compare AIC, BIC and related criteria and introduce a prediction error measure for assessing goodness-of-fit. In a simulation study, two methods of fitting equality constraints are compared. In two illustrative examples with experimental data we apply selection criteria, fit models with constraints and assess goodness-of-fit. First, data from a concept identification task is analyzed. Hidden Markov models provide a flexible approach to analyzing such data when compared to other modeling methods. Second, a novel application of hidden Markov models in implicit learning is presented. Hidden Markov models are used in this context to quantify knowledge that subjects express in an implicit learning task. This method of analyzing implicit learning data provides a comprehensive approach for addressing important theoretical issues in the field.

Geometric phases and hidden local gauge symmetry

International Nuclear Information System (INIS)

Fujikawa, Kazuo

2005-01-01

The analysis of geometric phases associated with level crossing is reduced to the familiar diagonalization of the Hamiltonian in the second quantized formulation. A hidden local gauge symmetry, which is associated with the arbitrariness of the phase choice of a complete orthonormal basis set, becomes explicit in this formulation (in particular, in the adiabatic approximation) and specifies physical observables. The choice of a basis set which specifies the coordinate in the functional space is arbitrary in the second quantization, and a subclass of coordinate transformations, which keeps the form of the action invariant, is recognized as the gauge symmetry. We discuss the implications of this hidden local gauge symmetry in detail by analyzing geometric phases for cyclic and noncyclic evolutions. It is shown that the hidden local symmetry provides a basic concept alternative to the notion of holonomy to analyze geometric phases and that the analysis based on the hidden local gauge symmetry leads to results consistent with the general prescription of Pancharatnam. We however note an important difference between the geometric phases for cyclic and noncyclic evolutions. We also explain a basic difference between our hidden local gauge symmetry and a gauge symmetry (or equivalence class) used by Aharonov and Anandan in their definition of generalized geometric phases

Caring for the carer: a systematic review of pure technology-based cognitive behavioral therapy (TB-CBT) interventions for dementia carers.

Science.gov (United States)

Scott, Jennifer L; Dawkins, Sarah; Quinn, Michael G; Sanderson, Kristy; Elliott, Kate-Ellen J; Stirling, Christine; Schüz, Ben; Robinson, Andrew

2016-08-01

Face-to-face delivery of CBT is not always optimal or practical for informal dementia carers (DCs). Technology-based formats of CBT delivery (TB-CBT) have been developed with the aim to improve client engagement and accessibility, and lower delivery costs, and offers potential benefits for DCs. However, research of TB-CBT for DCs has maintained heavy reliance on therapist involvement. The efficacy of pure TB-CBT interventions for DCs is not currently established Methods: A systematic review of trials of pure TB-CBT intervention for DCs from 1995 was conducted. PsycINFO, Cochrane Reviews, Scopus and MedLine databases were searched using key terms related to CBT, carers and dementia. Four hundred and forty two articles were identified, and inclusion/exclusion criteria were applied; studies were only retained if quantitative data was available, and there was no active therapist contact. Four articles were retained; two randomized and two waitlist control trials. Methodological and reporting quality was assessed. Meta-analyses were conducted for the outcome measures of caregiver depression. Meta-analysis revealed small significant post-intervention effects of pure TB-CBT interventions for depression; equivalent to face-to-face interventions. However, there is no evidence regarding long-term efficacy of pure TB-CBT for DCs. The systematic review further identified critical methodological and reporting shortcomings pertaining to these trials Conclusions: Pure TB-CBT interventions may offer a convenient, economical method for delivering psychological interventions to DCs. Future research needs to investigate their long-term efficacy, and consider potential moderating and mediating factors underpinning the mechanisms of effect of these programs. This will help to provide more targeted interventions to this underserviced population.

Locating Hidden Servers

National Research Council Canada - National Science Library

Oeverlier, Lasse; Syverson, Paul F

2006-01-01

.... Announced properties include server resistance to distributed DoS. Both the EFF and Reporters Without Borders have issued guides that describe using hidden services via Tor to protect the safety of dissidents as well as to resist censorship...

Hidden neural networks

DEFF Research Database (Denmark)

Krogh, Anders Stærmose; Riis, Søren Kamaric

1999-01-01

A general framework for hybrids of hidden Markov models (HMMs) and neural networks (NNs) called hidden neural networks (HNNs) is described. The article begins by reviewing standard HMMs and estimation by conditional maximum likelihood, which is used by the HNN. In the HNN, the usual HMM probability...... parameters are replaced by the outputs of state-specific neural networks. As opposed to many other hybrids, the HNN is normalized globally and therefore has a valid probabilistic interpretation. All parameters in the HNN are estimated simultaneously according to the discriminative conditional maximum...... likelihood criterion. The HNN can be viewed as an undirected probabilistic independence network (a graphical model), where the neural networks provide a compact representation of the clique functions. An evaluation of the HNN on the task of recognizing broad phoneme classes in the TIMIT database shows clear...

Enhancement of carer skills and patient function in the non-pharmacological management of frontotemporal dementia (FTD): A call for randomised controlled studies

Science.gov (United States)

O'Connor, Claire M.; Clemson, Lindy; da Silva, Thaís Bento Lima; Piguet, Olivier; Hodges, John R.; Mioshi, Eneida

2013-01-01

FTD is a unique condition which manifests with a range of behavioural symptoms, marked dysfunction in activities of daily living (ADL) and increased levels of carer burden as compared to carers of other dementias. No efficacious pharmacological interventions to treat FTD currently exist, and research on pharmacological symptom management is variable. The few studies on non-pharmacological interventions in FTD focus on either the carer or the patients' symptoms, and lack methodological rigour. This paper reviews and discusses current studies utilising non-pharmacological approaches, exposing the clear need for more rigorous methodologies to be applied in this field. Finally, a successful randomised controlled trial helped reduce behaviours of concern in dementia, and through implementing participation in tailored activities, the FTD-specific Tailored Activities Program (TAP) is presented. Crucially, this protocol has scope to target both the person with FTD and their carer. This paper highlights that studies in this area would help to elucidate the potential for using activities to reduce characteristic behaviours in FTD, improving quality of life and the caregiving experience in FTD. PMID:29213832

Hidden neural networks: application to speech recognition

DEFF Research Database (Denmark)

Riis, Søren Kamaric

1998-01-01

We evaluate the hidden neural network HMM/NN hybrid on two speech recognition benchmark tasks; (1) task independent isolated word recognition on the Phonebook database, and (2) recognition of broad phoneme classes in continuous speech from the TIMIT database. It is shown how hidden neural networks...

Involving a young person in the development of a digital resource in nurse education.

Science.gov (United States)

Fenton, Gaynor

2014-01-01

Health policies across western societies have embedded the need for service user and carer perspectives in service design and delivery of educational programmes. There is a growing recognition of the need to include the perspectives of children and young people as service users in the design and delivery of child focused educational programmes. Digital storytelling provides a strategy for student nurses to gain insight into the lived experiences of children and young people. Engaging with these stories enables students to develop an understanding of a young persons' experience of healthcare. This paper outlines a project that developed a digital learning object based upon a young person's experience of cancer and student evaluations of the digital learning object as a teaching and learning strategy. Over 80% of students rated the digital learning object as interesting and were motivated to explore its content. In addition, the evaluation highlighted that listening to the young person's experiences of her treatment regimes was informative and assisted understanding of a patients' perspective of care delivery. Copyright © 2013 Elsevier Ltd. All rights reserved.

Communication training for centre-based carers of children with severe or profound disabilities in the Western Cape, South Africa

Directory of Open Access Journals (Sweden)

Martha Geiger

2012-09-01

Full Text Available The purpose of this paper is to provide a preliminary, qualitative review of an approach to training centre-based carers in supporting basic communication development and providing communication opportunities for the children with severe and profound disabilities in their care. In South Africa, these children are often the most neglected in terms of planning and providing appropriate interventions. For those with severe communication disabilities, an additional lack is in the area of the basic human right to meaningful interactions and communication. Sustainable strategies to provide opportunities for basic communication development of these children are urgently sought. Several effective international and local parent training programmes have been developed, but the urgent need remains to train centre-based carers who are taking care of groups of diversely disabled children in severely under-resourced settings. Non-profit organisations (NPOs have been exploring practical centre-based approaches to skills sharing in physical rehabilitation, activities for daily living, feeding and support for basic communication development. As a freelance speech therapist contracted by four NPOs to implement hands-on training in basic communication for centre-based carers of non-verbal children, the author describes a training approach that evolved over three years, in collaboration with the carers and centre managements. Implications for training (for speech therapists and for community-based rehabilitation workers and for further research are identified.

Microwave background constraints on mixing of photons with hidden photons

International Nuclear Information System (INIS)

Mirizzi, Alessandro; Redondo, Javier; Sigl, Guenter

2008-12-01

Various extensions of the Standard Model predict the existence of hidden photons kinetically mixing with the ordinary photon. This mixing leads to oscillations between photons and hidden photons, analogous to the observed oscillations between different neutrino flavors. In this context, we derive new bounds on the photon-hidden photon mixing parameters using the high precision cosmic microwave background spectral data collected by the Far Infrared Absolute Spectrophotometer instrument on board of the Cosmic Background Explorer. Requiring the distortions of the CMB induced by the photon-hidden photon mixing to be smaller than experimental upper limits, this leads to a bound on the mixing angle χ 0 -7 - 10 -5 for hidden photon masses between 10 -14 eV and 10 -7 eV. This low-mass and low-mixing region of the hidden photon parameter space was previously unconstrained. (orig.)

Hidden Crises and Communication: An Interactional Analysis of Hidden Crises

NARCIS (Netherlands)

dr. Annette Klarenbeek

2011-01-01

In this paper I describe the ways in which the communication discipline can make a hidden crisis transparent. For this purpose I examine the concept of crisis entrepreneurship from a communication point of view. Using discourse analysis, I analyse the discursive practices of crisis entrepreneurs in

Hidden Crises and Communication : An Interactional Analysis of Hidden Crises

NARCIS (Netherlands)

dr. Annette Klarenbeek

2011-01-01

In this paper I describe the ways in which the communication discipline can make a hidden crisis transparent. For this purpose I examine the concept of crisis entrepreneurship from a communication point of view. Using discourse analysis, I analyse the discursive practices of crisis entrepreneurs in

Is dignity therapy feasible to enhance the end of life experience for people with motor neurone disease and their family carers?

Directory of Open Access Journals (Sweden)

Bentley Brenda

2012-09-01

Full Text Available Abstract Background Development of interventions that address psychosocial and existential distress in people with motor neurone disease (MND or that alleviate caregiver burden in MND family carers have often been suggested in the research literature. Dignity therapy, which was developed to reduce psychosocial and existential distress at the end of life, has been shown to benefit people dying of cancer and their families. These results may not be transferable to people with MND. The objectives of this study are to assess the feasibility, acceptability and potential effectiveness of dignity therapy to enhance the end of life experience for people with motor neurone disease and their family carers. Methods/design This is a cross-sectional study utilizing a single treatment group and a pre/post test design. The study population will comprise fifty people diagnosed with MND and their nominated family carers. Primarily quantitative outcomes will be gathered through measures assessed at baseline and at approximately one week after the intervention. Outcomes for participants include hopefulness, spirituality and dignity. Outcomes for family carers include perceived caregiver burden, hopefulness and anxiety/depression. Feedback and satisfaction with the intervention will be gathered through a questionnaire. Discussion This detailed research will explore if dignity therapy has the potential to enhance the end of life experience for people with MND and their family carers, and fill a gap for professionals who are called on to address the spiritual, existential and psychosocial needs of their MND patients and families. Trial registration ACTRN Trial Number: ACTRN12611000410954

Hidden treasures - 50 km points of interests

Science.gov (United States)

Lommi, Matias; Kortelainen, Jaana

2015-04-01

Tampere is third largest city in Finland and a regional centre. During 70's there occurred several communal mergers. Nowadays this local area has both strong and diversed identity - from wilderness and agricultural fields to high density city living. Outside the city center there are interesting geological points unknown for modern city settlers. There is even a local proverb, "Go abroad to Teisko!". That is the area the Hidden Treasures -student project is focused on. Our school Tammerkoski Upper Secondary School (or Gymnasium) has emphasis on visual arts. We are going to offer our art students scientific and artistic experiences and knowledge about the hidden treasures of Teisko area and involve the Teisko inhabitants into this project. Hidden treasures - Precambrian subduction zone and a volcanism belt with dense bed of gold (Au) and arsenic (As), operating goldmines and quarries of minerals and metamorphic slates. - North of subduction zone a homogenic precambrian magmastone area with quarries, products known as Kuru Grey. - Former ashores of post-glasial Lake Näsijärvi and it's sediments enabled the developing agriculture and sustained settlement. Nowadays these ashores have both scenery and biodiversity values. - Old cattle sheds and dairy buildings made of local granite stones related to cultural stonebuilding inheritance. - Local active community of Kapee, about 100 inhabitants. Students will discover information of these "hidden" phenomena, and rendering this information trough Enviromental Art Method. Final form of this project will be published in several artistic and informative geocaches. These caches are achieved by a GPS-based special Hidden Treasures Cycling Route and by a website guiding people to find these hidden points of interests.

Hidden Markov Model Application to Transfer The Trader Online Forex Brokers

Directory of Open Access Journals (Sweden)

Farida Suharleni

2012-05-01

Full Text Available Hidden Markov Model is elaboration of Markov chain, which is applicable to cases that can’t directly observe. In this research, Hidden Markov Model is used to know trader’s transition to broker forex online. In Hidden Markov Model, observed state is observable part and hidden state is hidden part. Hidden Markov Model allows modeling system that contains interrelated observed state and hidden state. As observed state in trader’s transition to broker forex online is category 1, category 2, category 3, category 4, category 5 by condition of every broker forex online, whereas as hidden state is broker forex online Marketiva, Masterforex, Instaforex, FBS and Others. First step on application of Hidden Markov Model in this research is making construction model by making a probability of transition matrix (A from every broker forex online. Next step is making a probability of observation matrix (B by making conditional probability of five categories, that is category 1, category 2, category 3, category 4, category 5 by condition of every broker forex online and also need to determine an initial state probability (π from every broker forex online. The last step is using Viterbi algorithm to find hidden state sequences that is broker forex online sequences which is the most possible based on model and observed state that is the five categories. Application of Hidden Markov Model is done by making program with Viterbi algorithm using Delphi 7.0 software with observed state based on simulation data. Example: By the number of observation T = 5 and observed state sequences O = (2,4,3,5,1 is found hidden state sequences which the most possible with observed state O as following : where X1 = FBS, X2 = Masterforex, X3 = Marketiva, X4 = Others, and X5 = Instaforex.

Supporting the provision of palliative care in the home environment: a proof-of-concept single-arm trial of a PalliativE Carers Education Package (PrECEPt).

Science.gov (United States)

Forbat, Liz; Haraldsdottir, Erna; Lewis, Marsha; Hepburn, Ken

2016-10-25

Practical educational interventions for palliative carers are needed. Current supports frequently rely on carers travelling to a central venue to receive education. A substantial gap therefore exists around determining how high-quality relevant information can be delivered nationally, with limited cost implications, using educational methods that are acceptable to carers in palliative care. This study seeks to design and assess feasibility and acceptability of a distance-learning approach to educating carers. This is an embedded mixed-method feasibility and acceptability study. It embeds an unblinded 1-arm pilot test, with subsequent qualitative interviews which will be used to inform the assessment of the intervention's acceptability and feasibility. The theoretical framework is self-efficacy theory, whereby we seek to impact carers' beliefs in their ability to carry out and succeed in caring tasks and situations. The educational materials focused on pain and nutrition/hydration will be developed in phase 1 with former carers (n=8) providing input into the content and style of materials. The educational package privileges adult-learning styles, recognising and responding to the learner's context including their learning needs, prior knowledge and motivations for engaging in education. The materials will be tested with up to 24 current carers. Analysis will focus on determining recruitment processes for a full-scale study, data collection procedures/completion rates, queries directed to the hospice from carers involved in the feasibility work, mode of delivery and content of the materials. The primary outcome measure is self-efficacy, with other measures focused on caregiver preparedness and caregiving tasks, consequences and needs questionnaire. Adherence to educational components will also be collected and reported. Ethical approval has been provided by the participating site, Calvary Healthcare, Canberra, reference 02-2016, and the Australian Catholic University

Microwave background constraints on mixing of photons with hidden photons

Energy Technology Data Exchange (ETDEWEB)

Mirizzi, Alessandro [Max-Planck-Institut fuer Physik, Muenchen (Germany); Redondo, Javier [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); Sigl, Guenter [Hamburg Univ. (Germany). 2. Inst. fuer Theoretische Physik

2008-12-15

Various extensions of the Standard Model predict the existence of hidden photons kinetically mixing with the ordinary photon. This mixing leads to oscillations between photons and hidden photons, analogous to the observed oscillations between different neutrino flavors. In this context, we derive new bounds on the photon-hidden photon mixing parameters using the high precision cosmic microwave background spectral data collected by the Far Infrared Absolute Spectrophotometer instrument on board of the Cosmic Background Explorer. Requiring the distortions of the CMB induced by the photon-hidden photon mixing to be smaller than experimental upper limits, this leads to a bound on the mixing angle {chi}{sub 0} hidden photon masses between 10{sup -14} eV and 10{sup -7} eV. This low-mass and low-mixing region of the hidden photon parameter space was previously unconstrained. (orig.)

Hidden symmetries in minimal five-dimensional supergravity

International Nuclear Information System (INIS)

Poessel, Markus; Silva, Sebastian

2004-01-01

We study the hidden symmetries arising in the dimensional reduction of d=5, N=2 supergravity to three dimensions. Extending previous partial results for the bosonic part, we give a derivation that includes fermionic terms, shedding light on the appearance of the local hidden symmetry SO(4) in the reduction

Association of quality of life of carers with quality of life and functional independence of stroke survivors

Directory of Open Access Journals (Sweden)

Deepak Ganjiwale

2016-01-01

Full Text Available Background: Stroke has a great impact not only on patients′ but also on their caregivers′ lives. Carers may experience high levels of burden that can result in deterioration of their health status, social life, and well-being. Association between quality of life (QOL of carers and that of stroke survivors in Indian setting is not much researched. Aims and Settings: To find out QOL and mental health of caregivers of individuals with stroke visiting Physiotherapy Department of Tertiary Care Center in Western India. Design and Methodology: A cross-sectional survey to find QOL and mental health of caregiver of stroke survivors, self-administered screening instrument WHO-QOL BREF, functional independence measurement (FIM scale, and BRIEF COPE were used for data collection on adult populations. Statistical Analysis Used: The statistical analysis was performed by descriptive analysis and correlation. Result: Fifty-four stroke patients and their caregivers (all adults were included in the study. Average FIM score was 83.75 (18.46 while median was 90 (25. FIM score of patients did not much affect QOL of caregivers. Discussion: Analysis of QOL data showed that QOL of caregivers was good in all domains, but patient′s QOL was good only in social relations. There was no correlation found in QOL of carers and stroke survivors. Nine percent of change in caregivers social relationship scores can be attributed to patients′ sphincter scores. Conclusion: QOL of carers and stroke survivors may be independent. Stroke patients in the study required a moderate assistance for their functional independence which does not seem to affect the caregivers QOL significantly.

Childhood disability in Turkana, Kenya: Understanding how carers cope in a complex humanitarian setting

Directory of Open Access Journals (Sweden)

Maria Zuurmond

2016-09-01

Conclusion: The needs of children with disabilities and their carers in Turkana are not being met by either community social support systems or humanitarian aid programmes. There is an urgent need to mainstream disability into Turkana services and programmes.

Local models and hidden nonlocality in Quantum Theory

OpenAIRE

Guerini, Leonardo

2014-01-01

This Master's thesis has two central subjects: the simulation of correlations generated by local measurements on entangled quantum states by local hidden-variables models and the revelation of hidden nonlocality. We present and detail the Werner's local model and the hidden nonlocality of some Werner states of dimension $d\\geq5$, the Gisin-Degorre's local model for a Werner state of dimension $d=2$ and the local model of Hirsch et al. for mixtures of the singlet state and noise, all of them f...

Searching for hidden-charm baryonium signals in QCD sum rules

Energy Technology Data Exchange (ETDEWEB)

Chen, Hua-Xing; Zhou, Dan [Beihang University, School of Physics, Beijing Key Laboratory of Advanced Nuclear Materials and Physics, Beijing (China); Chen, Wei [University of Saskatchewan, Department of Physics and Engineering Physics, Saskatoon, SK (Canada); Liu, Xiang [Lanzhou University, School of Physical Science and Technology, Lanzhou (China); Lanzhou University, Research Center for Hadron and CSR Physics, Institute of Modern Physics of CAS, Lanzhou (China); Zhu, Shi-Lin [Peking University, School of Physics, State Key Laboratory of Nuclear Physics and Technology, Beijing (China); Collaborative Innovation Center of Quantum Matter, Beijing (China); Peking University, Center of High Energy Physics, Beijing (China)

2016-11-15

We give an explicit QCD sum rule investigation for hidden-charm baryonium states with the quark content u anti ud anti dc anti c, spin J = 0/1/2/3, and of both positive and negative parities. We systematically construct the relevant local hidden-charm baryonium interpolating currents, which can actually couple to various structures, including hidden-charm baryonium states, charmonium states plus two pions, and hidden-charm tetraquark states plus one pion, etc. We do not know which structure these currents couple to at the beginning, but after sum rule analyses we can obtain some information. We find some of them can couple to hidden-charm baryonium states, using which we evaluate the masses of the lowest-lying hidden-charm baryonium states with quantum numbers J{sup P} = 2{sup -}/3{sup -}/0{sup +}/1{sup +}/2{sup +} to be around 5.0 GeV. We suggest to search for hidden-charm baryonium states, especially the one of J = 3{sup -}, in the D-wave J/ψππ and P-wave J/ψρ and J/ψω channels in this energy region. (orig.)

Hidden symmetries in five-dimensional supergravity

International Nuclear Information System (INIS)

Poessel, M.

2003-05-01

This thesis is concerned with the study of hidden symmetries in supergravity, which play an important role in the present picture of supergravity and string theory. Concretely, the appearance of a hidden G 2(+2) /SO(4) symmetry is studied in the dimensional reduction of d=5, N=2 supergravity to three dimensions - a parallel model to the more famous E 8(+8) /SO(16) case in eleven-dimensional supergravity. Extending previous partial results for the bosonic part, I give a derivation that includes fermionic terms. This sheds new light on the appearance of the local hidden symmetry SO(4) in the reduction, and shows up an unusual feature which follows from an analysis of the R-symmetry associated with N=4 supergravity and of the supersymmetry variations, and which has no parallel in the eleven-dimensional case: The emergence of an additional SO(3) as part of the enhanced local symmetry, invisible in the dimensional reduction of the gravitino, and corresponding to the fact that, of the SO(4) used in the coset model, only the diagonal SO(3) is visible immediately upon dimensional reduction. The uncovering of the hidden symmetries proceeds via the construction of the proper coset gravity in three dimensions, and matching it with the Lagrangian obtained from the reduction. (orig.)

Music in the family: music making and music therapy with young children and their families.

Science.gov (United States)

Wetherick, Donald

2009-01-01

Songs and singing games are a healthy part of young children's social, emotional and cognitive development. Such shared music making can facilitate and strengthen relationships between parents and children. Family health workers can encourage carers' informal uses of music with their children. In cases of developmental delay, disability, severe illness or family stress, music can continue to have a significant role in supporting children and parents. In some cases referral to specialist music therapy services may be appropriate for assessment and/or treatment.

QCD sum rule study of hidden-charm pentaquarks

Energy Technology Data Exchange (ETDEWEB)

Chen, Hua-Xing; Cui, Er-Liang [Beihang University, School of Physics and Beijing Key Laboratory of Advanced Nuclear Materials and Physics, Beijing (China); Chen, Wei; Steele, T.G. [University of Saskatchewan, Department of Physics and Engineering Physics, Saskatoon, Saskatchewan (Canada); Liu, Xiang [Lanzhou University, School of Physical Science and Technology, Lanzhou (China); Lanzhou University and Institute of Modern Physics of CAS, Research Center for Hadron and CSR Physics, Lanzhou (China); Zhu, Shi-Lin [Peking University, School of Physics and State Key Laboratory of Nuclear Physics and Technology, Beijing (China); Collaborative Innovation Center of Quantum Matter, Beijing (China); Peking University, Center of High Energy Physics, Beijing (China)

2016-10-15

We study the mass spectra of hidden-charm pentaquarks having spin J = (1)/(2)/(3)/(2)/(5)/(2) and quark contents uudc anti c. We systematically construct all the relevant local hidden-charm pentaquark currents, and we select some of them to perform QCD sum rule analyses. We find that the P{sub c}(4380) and P{sub c}(4450) can be identified as hidden-charm pentaquark states composed of an anti-charmed meson and a charmed baryon. Besides them, we also find (a) the lowest-lying hidden-charm pentaquark state of J{sup P} = 1/2{sup -} has the mass 4.33{sup +0.17}{sub -0.13} GeV, while the one of J{sup P} = 1/2{sup +} is significantly higher, that is, around 4.7-4.9 GeV; (b) the lowest-lying hidden-charm pentaquark state of J{sup P} = 3/2{sup -} has the mass 4.37{sup +0.18}{sub -0.13} GeV, consistent with the P{sub c}(4380) of J{sup P} = 3/2{sup -}, while the one of J{sup P} = 3/2{sup +} is also significantly higher, that is, above 4.6 GeV; (c) the hidden-charm pentaquark state of J{sup P} = 5/2{sup -} has a mass around 4.5-4.6 GeV, slightly larger than the P{sub c}(4450) of J{sup P} = 5/2{sup +}. (orig.)

A qualitative study protocol of ageing carers' caregiving experiences and their planning for continuation of care for their immediate family members with intellectual disability.

Science.gov (United States)

Low, Lisa Pau Le; Chien, Wai Tong; Lam, Lai Wah; Wong, Kayla Ka Yin

2017-04-07

Understanding the difficulties and needs of the family carers in taking care of a person with ID can facilitate the development of appropriate intervention programmes and services to strengthen their caring capacity and empower them to continue with their caring roles. This study aims to explore ageing family carers' caregiving experiences and the plans they have to provide care for themselves and their ageing children with mild or moderate intellectual disability (ID). A constructivist grounded theory will be used to interview around 60 carers who have a family member with mild or moderate ID and attending sheltered workshops in Hong Kong. Constant comparative analysis methods will be used for data analysis. The theory will capture family caregiving experiences and the processes of carers in addressing caregiving needs, support received and plans to continue to provide care for themselves and their relatives with ID in their later life. New insights into the emerging issues, needs and plights of family caregivers will be provided to inform the policies and practices of improving the preparation for the ageing process of the persons with ID, and to better support the ageing carers. The theoretical framework that will be generated will be highly practical and useful in generating knowledge about factors that influence the caregiving processes; and, tracking the caregiving journey at different time-points to clearly delineate areas to implement practice changes. In this way, the theoretical framework will be highly useful in guiding timely and appropriate interventions to target at the actual needs of family carers as they themselves are ageing and will need to continue to take care of their family members with ID in the community.

Sociocultural Dimension of Hidden Content in a Professional Language Curriculum

Directory of Open Access Journals (Sweden)

Ekaterina E. Shishlova

2017-12-01

Full Text Available Introduction: studying curriculum as a pedagogical problem has traditionally been reduced to the analysis of its explicit content, set in official educational documents. However, a much less studied hidden content plays a significant role in education. So, what is the role of the hidden curriculum during professional language training? The purpose of the article is to determine the potential impact of hidden curriculum on students’ conceptual worldview. Comparing the worldview presented in textbooks with students’ one has allowed us to estimate the rate of influence of hidden curr iculum. Materials and Methods: the methodological basis of the work is the cultural concept of personalityoriented education. The methodology for studying the role of hidden curriculum includes four stages: at the first stage, the authors set the criteria for selecting textbooks for analysis and do the selection; at the second stage, the authors select sociocultural concepts for analysis; at the third stage, the scheme of analysis is designed and the analysis of textbooks is done; at the fourth stage, the authors identify the potential influence of hidden curriculum on students’ conceptual worldview. Results: the structure of hidden curriculum has been determined and the scheme for analysing its subject component has been developed. The authors have identified a significant influence of hidden curriculum on students’ worldview, which represents the scientific novelty of the article. Discussion and Conclusions: the article gives the definition of a hidden curriculum which is new for Russian pedagogy and presents a methodology for its analysis in EFL textbooks. That analysis is recommended to be conducted when selecting teaching materials both i n languages and other humanities.

Infinite hidden conditional random fields for human behavior analysis.

Science.gov (United States)

Bousmalis, Konstantinos; Zafeiriou, Stefanos; Morency, Louis-Philippe; Pantic, Maja

2013-01-01

Hidden conditional random fields (HCRFs) are discriminative latent variable models that have been shown to successfully learn the hidden structure of a given classification problem (provided an appropriate validation of the number of hidden states). In this brief, we present the infinite HCRF (iHCRF), which is a nonparametric model based on hierarchical Dirichlet processes and is capable of automatically learning the optimal number of hidden states for a classification task. We show how we learn the model hyperparameters with an effective Markov-chain Monte Carlo sampling technique, and we explain the process that underlines our iHCRF model with the Restaurant Franchise Rating Agencies analogy. We show that the iHCRF is able to converge to a correct number of represented hidden states, and outperforms the best finite HCRFs--chosen via cross-validation--for the difficult tasks of recognizing instances of agreement, disagreement, and pain. Moreover, the iHCRF manages to achieve this performance in significantly less total training, validation, and testing time.

Experiences of family carers of older people with mental health problems in the acute general hospital: a qualitative study.

Science.gov (United States)

Clissett, Philip; Porock, Davina; Harwood, Rowan H; Gladman, John R F

2013-12-01

To explore the experiences of family carers of people with cognitive impairment during admission to hospital. Providing appropriate care in acute hospitals for people with co-morbid cognitive impairment, especially dementia or delirium or both, is challenging to healthcare professionals. One key element is close working with family members. Qualitative interview study. Semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had co-morbid cognitive impairment. Interviews conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework. The findings elaborate a core problem, 'disruption from normal routine' and a core process, 'gaining or giving a sense of control to cope with disruption'. Family carers responded to disruption proactively by trying to make sense of the situation and attempting to gain control for themselves or the patient. They tried to stay informed, communicate with staff about the patient and plan for the future. The interaction of the core problem and the core process resulted in outcomes where family members either valued the support of hospital staff and services or were highly critical of the care provided. Family carers are not passive in the face of the disruption of hospitalization and respond both by trying to involve themselves in the care and support of their relative and by trying to work in partnership with members of staff. Nurses need to foster this relationship conscientiously. © 2013 John Wiley & Sons Ltd.

Supporting family carers providing end-of-life home care: a qualitative study on the impact of a hospice at home service.

Science.gov (United States)

Jack, Barbara A; O'Brien, Mary R; Scrutton, Joyce; Baldry, Catherine R; Groves, Karen E

2015-01-01

To explore bereaved family carers' perceptions and experiences of a hospice at home service. The increasing demand for the development of home-based end-of-life services is not confined to the western world; such services are also emerging in resource-poor countries where palliative care services are developing with limited inpatient facilities. Despite this growing trend, studies show a variety of interrelated factors, with an emphasis on the availability of informal carers and their ability to cope, which can influence whether terminally ill patients actually remain at home. A hospice at home service was developed to meet patients' and families' needs by providing individually tailored resources. A qualitative study. Data were collected by semi-structured, digitally recorded interviews from 20 family carers who had experienced the service. Interviews were transcribed verbatim and a thematic approach adopted for analysis. All participants reported a personal positive impact of the service. Family carers commented the service provided a valued presence, they felt in good hands and importantly it helped in supporting normal life. The impact of an individualised, targeted, hospice at home service using dedicated, palliative care trained, staff, is perceived positively by family carers and importantly, supportive of those with additional caring or employment commitments. The emergence of hospice at home services has resulted in more options for patients and their families, when the increased amount of care a family member has to provide in these circumstances needs to be adequately supported, with the provision of a flexible service tailored to individual needs and delivered by appropriately trained staff. © 2014 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Detecting hidden particles with MATHUSLA

Science.gov (United States)

Evans, Jared A.

2018-03-01

A hidden sector containing light long-lived particles provides a well-motivated place to find new physics. The recently proposed MATHUSLA experiment has the potential to be extremely sensitive to light particles originating from rare meson decays in the very long lifetime region. In this work, we illustrate this strength with the specific example of a light scalar mixed with the standard model-like Higgs boson, a model where MATHUSLA can further probe unexplored parameter space from exotic Higgs decays. Design augmentations should be considered in order to maximize the ability of MATHUSLA to discover very light hidden sector particles.

Electronic tracking for people with dementia: an exploratory study of the ethical issues experienced by carers in making decisions about usage.

Science.gov (United States)

White, Eleanor Bantry; Montgomery, Paul

2014-03-01

Electronic tracking through GPS (global positioning system) is being used to monitor and locate people with dementia who are vulnerable to becoming lost. Through a review of the literature and an original study, this article examined ethical issues associated with use in a domestic setting. The qualitative study consisted of in-depth interviews with 10 carers who were using electronic tracking. The study explored the values, beliefs and contextual factors that motivated carers to use electronic tracking. It examined the extent of involvement of the person with dementia in decision-making and it explored the various ethical dilemmas encountered by carers when introducing the tracking system. As an issue that emerged from the interviews, specific attention was paid to exploring covert usage. From the study findings, recommendations have been made for research and practice about the use of electronic tracking in dementia care.

Zipf exponent of trajectory distribution in the hidden Markov model

Science.gov (United States)

Bochkarev, V. V.; Lerner, E. Yu

2014-03-01

This paper is the first step of generalization of the previously obtained full classification of the asymptotic behavior of the probability for Markov chain trajectories for the case of hidden Markov models. The main goal is to study the power (Zipf) and nonpower asymptotics of the frequency list of trajectories of hidden Markov frequencys and to obtain explicit formulae for the exponent of the power asymptotics. We consider several simple classes of hidden Markov models. We prove that the asymptotics for a hidden Markov model and for the corresponding Markov chain can be essentially different.

Zipf exponent of trajectory distribution in the hidden Markov model

International Nuclear Information System (INIS)

Bochkarev, V V; Lerner, E Yu

2014-01-01

This paper is the first step of generalization of the previously obtained full classification of the asymptotic behavior of the probability for Markov chain trajectories for the case of hidden Markov models. The main goal is to study the power (Zipf) and nonpower asymptotics of the frequency list of trajectories of hidden Markov frequencys and to obtain explicit formulae for the exponent of the power asymptotics. We consider several simple classes of hidden Markov models. We prove that the asymptotics for a hidden Markov model and for the corresponding Markov chain can be essentially different

SHIFT: server for hidden stops analysis in frame-shifted translation.

Science.gov (United States)

Gupta, Arun; Singh, Tiratha Raj

2013-02-23

Frameshift is one of the three classes of recoding. Frame-shifts lead to waste of energy, resources and activity of the biosynthetic machinery. In addition, some peptides synthesized after frame-shifts are probably cytotoxic which serve as plausible cause for innumerable number of diseases and disorders such as muscular dystrophies, lysosomal storage disorders, and cancer. Hidden stop codons occur naturally in coding sequences among all organisms. These codons are associated with the early termination of translation for incorrect reading frame selection and help to reduce the metabolic cost related to the frameshift events. Researchers have identified several consequences of hidden stop codons and their association with myriad disorders. However the wealth of information available is speckled and not effortlessly acquiescent to data-mining. To reduce this gap, this work describes an algorithmic web based tool to study hidden stops in frameshifted translation for all the lineages through respective genetic code systems. This paper describes SHIFT, an algorithmic web application tool that provides a user-friendly interface for identifying and analyzing hidden stops in frameshifted translation of genomic sequences for all available genetic code systems. We have calculated the correlation between codon usage frequencies and the plausible contribution of codons towards hidden stops in an off-frame context. Markovian chains of various order have been used to model hidden stops in frameshifted peptides and their evolutionary association with naturally occurring hidden stops. In order to obtain reliable and persuasive estimates for the naturally occurring and predicted hidden stops statistical measures have been implemented. This paper presented SHIFT, an algorithmic tool that allows user-friendly exploration, analysis, and visualization of hidden stop codons in frameshifted translations. It is expected that this web based tool would serve as a useful complement for

Asymptotics for Estimating Equations in Hidden Markov Models

DEFF Research Database (Denmark)

Hansen, Jørgen Vinsløv; Jensen, Jens Ledet

Results on asymptotic normality for the maximum likelihood estimate in hidden Markov models are extended in two directions. The stationarity assumption is relaxed, which allows for a covariate process influencing the hidden Markov process. Furthermore a class of estimating equations is considered...

A hidden service model based on HS-HS anonymous network

Science.gov (United States)

Meng, Yitong; Zhao, Xing; Fei, Jinlong; Zhu, Yuefei

2017-10-01

The Hidden Service provided by Tor anonymous network can effectively protect the anonymity and security of the Hidden server, this article through the analysis of the data packet structure of Tor, three jump transmission mechanism and link establishment protocol and Hidden Service communication process, in view of the Hidden node number too much, link building Service for too long and too redundant link problem. An improved hidden service model HS-HS is proposed that incorporating multiple transmission link and reuse, and at the same time will be important transit point for reuse protection link anonymity, through the ExperimenTor simulation environment test, verify the improved model of HS-HS can be more effective in guarantee anonymity and security, improve the overall efficiency of data transmission, to meet the needs of today's anonymous service.

VISIBLE COSTS AND HIDDEN COSTS IN THE BAKING INDUSTRY

Directory of Open Access Journals (Sweden)

Criveanu Maria

2013-04-01

Full Text Available Hidden costs are present in the activity of any company, hardly identified in the traditional administrative accounting. The high levels of the hidden costs and their unknown presence have serious consequences on the decisions made by the managers. This paper aims at presenting some aspects related to the hidden costs that occur in the activity of the companies in the baking industry and the possibilities to reduce their level.

Perseverance time of informal carers. A new concept in dementia care. Validation and exploration

NARCIS (Netherlands)

Kraijo, H.

2015-01-01

Introduction and aim Because of the expected increase of dementia patients in the next decades and the growing demand for formal care, an important question appears: how to predict and influence the caring possibilities of informal carers. We introduce the concept perseverance time, describedas

The hidden values

DEFF Research Database (Denmark)

Rasmussen, Birgitte; Jensen, Karsten Klint

“The Hidden Values - Transparency in Decision-Making Processes Dealing with Hazardous Activities”. The report seeks to shed light on what is needed to create a transparent framework for political and administrative decisions on the use of GMOs and chemical products. It is our hope that the report...

Suppressing the QCD axion abundance by hidden monopoles

International Nuclear Information System (INIS)

Kawasaki, Masahiro

2015-11-01

We study the Witten effect of hidden monopoles on the QCD axion dynamics, and show that its abundance as well as isocurvature perturbations can be significantly suppressed if there is a sufficient amount of hidden monopoles. When the hidden monopoles make up a significant fraction of dark matter, the Witten effect suppresses the abundance of axion with the decay constant smaller than 10 12 GeV. The cosmological domain wall problem of the QCD axion can also be avoided, relaxing the upper bound on the decay constant when the Peccei-Quinn symmetry is spontaneously broken after inflation.

Unmet needs in young adults with a parent with a chronic condition: a mixed-method investigation and measure development study.

Science.gov (United States)

Nicholls, Wendy; Patterson, Pandora; McDonald, Fiona E J; Hulbert-Williams, Nicholas J

2017-03-01

Given the high number of young adults caring for a family member, and the potential for adverse psychosocial outcomes, there is a need for a screening tool, with clinical utility, to identify those most vulnerable to poor outcomes and to aid targeted interventions. (i) To determine whether current knowledge from cancer literature regarding young carers is generalisable to chronic conditions and, therefore, whether an existing screening tool could be adapted for this population. (ii) To develop a measure of unmet needs in this population and conduct initial psychometric analysis. This was mixed method; interviews in study one informed measure development in study two. Inclusion criteria were as follows: having a parent with a chronic condition and being aged 16-24 years. In study 1, an interpretative phenomenological analysis was conducted on interviews from seven young adults (age range 17-19 years). Study 2 explored factor structure, reliability and validity of the Offspring Chronic Illness Needs Inventory (OCINI). Participants were 73 females and 34 males (mean ages 18.22, SD = 1.16; 18.65, SD = 1.25). OCINI, Depression Anxiety and Stress Scale, and the Adult Carers Quality of Life Scale. Interviews communicated that the impact of their parent's condition went unacknowledged and resulted in psychosocial, support and informational needs. An exploratory principal axis analysis of the OCINI yielded five factors. Significant and positive correlations were found between unmet needs and stress, anxiety, and depression, and inversely with quality of life. The scale has applications in clinical settings where these young people, who are at risk of negative psychological outcomes, may be assessed and unmet needs targeted appropriately. © 2016 Nordic College of Caring Science.

The role of health care assistants in supporting district nurses and family carers to deliver palliative care at home: findings from an evaluation project.

Science.gov (United States)

Ingleton, Christine; Chatwin, John; Seymour, Jane; Payne, Sheila

2011-07-01

To examine the role of trained health and personal care assistants in supporting district nurses and family carers in providing palliative and end of life care in the community. In the UK, there is a policy directive to improve end of life care and to enable greater numbers of people to die at home. This places considerable demands on community nursing services and family carers. In response to this, the Complex and Palliative Continuing Care Service employing generic health and personal care assistants was developed as part of the Marie Curie Delivering Choice Programme in one city in the UK. This paper draws on findings from an independent evaluation of the scheme. The wider evaluation used a formative evaluation methodology. This paper draws on in-depth interviews with a range of stakeholders (n = 17), in-depth interviews with bereaved carers (n = 6) and an analysis of documentation. Stakeholders and bereaved carers perceived that the health and personal care assistants made a vital contribution to community palliative care. Careful recruitment, specific training, case management by district nursing with allocation of specific tasks and close ongoing communication were key features which stakeholders indentified. Family carers welcomed the way assistants developed relationships and became familiar and able to meet the care needs of patients. There were some problems reported which related to capacity, work flow and the need for extensive written care plans. Employing health care assistants under the supervision of district nurses appears to support patients and family at home during end of life care and contribute to good quality nursing care. The needs for community-based palliative and end of life care will increase rapidly over the course of the next 20 years, placing pressure on community nursing services and family carers. © 2011 Blackwell Publishing Ltd.

An Educational Intervention to Reduce Pain and Improve Pain Management for Malawian People Living With HIV/AIDS and Their Family Carers: A Randomized Controlled Trial.

Science.gov (United States)

Nkhoma, Kennedy; Seymour, Jane; Arthur, Antony

2015-07-01

Advances being made in improving access to HIV drugs in resource-poor countries mean HIV patients are living longer, and, therefore, experiencing pain over a longer period of time. There is a need to provide effective interventions for alleviating and managing pain. To assess whether a pain educational intervention compared with usual care reduces pain severity and improves pain management in patients with HIV/AIDS and their family carers. This was a randomized, parallel group, superiority trial conducted at HIV and palliative care clinics of two public hospitals in Malawi. A total of 182 adults with HIV/AIDS (Stage III or IV) and their family carers participated; carer participants were those individuals most involved in the patient's unpaid care. The educational intervention comprised a 30 minute face-to-face meeting, a leaflet, and a follow-up telephone call at two weeks. The content of the educational intervention covered definition, causes, and characteristics of pain in HIV/AIDS; beliefs and myths about pain and pain medication; assessment of pain; and pharmacological and nonpharmacological management. The primary outcome was average pain severity measured by the Brief Pain Inventory-Pain Severity subscale. Assessments were recorded at baseline before randomization and at eight weeks after randomization. Of the 182 patient/carer dyads randomly allocated, 157 patient/carer dyads completed the trial. Patients in the intervention group experienced a greater decrease in pain severity (mean difference = 21.09 points, 95% confidence interval = 16.56-25.63; P HIV/AIDS and their family carers. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

How best to assess quality of life in informal carers of people with dementia; A systematic review of existing outcome measures

Science.gov (United States)

Robinson, Jonah; Robalino, Shannon; Finch, Tracy; McColl, Elaine

2018-01-01

Background In the UK, there are currently 800 000 people living with dementia. This number is expected to double in the next 20 years. Two-thirds of people with dementia live in the community supported by informal carers. Caring for a person with dementia has adverse effects on psychological, physical, social wellbeing and quality of life. The measurement of quality of life of carers of people with dementia is increasingly of interest to health and social care practitioners and commissioners, policymakers, and carers themselves. However, there is lack of consensus on the most suitable instrument(s) for undertaking this. Methods A systematic review of the literature using COSMIN methodology. Searching of electronic databases (Medline, PsycINFO, CINAHL and Web of Science), reference list and citation searching of key papers was undertaken. COSMIN methodology was used to simultaneously extract data from and assess methodological quality of included studies, and make a recommendation for the instrument with the most high quality evidence for its measurement properties. Results Ten instruments were suitable for inclusion in this review. The Carer well-being and support questionnaire (CWS) has the best quality evidence for the greatest number of measurement of properties. The Caregiver Well-Being Scale is also worthy of consideration. There is not presently a measure which could be recommended for use in economic evaluations, however the Impact of Alzheimer’s Disease on the Caregiver questionnaire (IADCQ) could potentially be used following further investigation of its measurement properties in a representative population. Conclusion The CWS is the most appropriate instrument to recommend for the assessment of quality of life in informal carers of people with dementia at present. All instruments included in this review would benefit from more rigorous evaluation of their measurement properties. PMID:29538433

Investigating consumers' and informal carers' views and preferences for consumer directed care: A discrete choice experiment.

Science.gov (United States)

Kaambwa, Billingsley; Lancsar, Emily; McCaffrey, Nicola; Chen, Gang; Gill, Liz; Cameron, Ian D; Crotty, Maria; Ratcliffe, Julie

2015-09-01

Consumer directed care (CDC) is currently being embraced internationally as a means to promote autonomy and choice for consumers (people aged 65 and over) receiving community aged care services (CACSs). CDC involves giving CACS clients (consumers and informal carers of consumers) control over how CACSs are administered. However, CDC models have largely developed in the absence of evidence on clients' views and preferences. We explored CACS clients' preferences for a variety of CDC attributes and identified factors that may influence these preferences and potentially inform improved design of future CDC models. Study participants were clients of CACSs delivered by five Australian providers. Using a discrete choice experiment (DCE) approach undertaken in a group setting between June and December 2013, we investigated the relative importance to CACS consumers and informal (family) carers of gradations relating to six salient features of CDC (choice of service provider(s), budget management, saving unused/unspent funds, choice of support/care worker(s), support-worker flexibility and level of contact with service coordinator). The DCE data were analysed using conditional, mixed and generalised logit regression models, accounting for preference and scale heterogeneity. Mean ages for 117 study participants were 80 years (87 consumers) and 74 years (30 informal carers). All participants preferred a CDC approach that allowed them to: save unused funds from a CACS package for future use; have support workers that were flexible in terms of changing activities within their CACS care plan and; choose the support workers that provide their day-to-day CACSs. The CDC attributes found to be important to both consumers and informal carers receiving CACSs will inform the design of future CDC models of service delivery. The DCE approach used in this study has the potential for wide applicability and facilitates the assessment of preferences for elements of potential future aged care

Context Tree Estimation in Variable Length Hidden Markov Models

OpenAIRE

Dumont, Thierry

2011-01-01

We address the issue of context tree estimation in variable length hidden Markov models. We propose an estimator of the context tree of the hidden Markov process which needs no prior upper bound on the depth of the context tree. We prove that the estimator is strongly consistent. This uses information-theoretic mixture inequalities in the spirit of Finesso and Lorenzo(Consistent estimation of the order for Markov and hidden Markov chains(1990)) and E.Gassiat and S.Boucheron (Optimal error exp...

Extracting hidden-photon dark matter from an LC-circuit

International Nuclear Information System (INIS)

Arias, Paola; Arza, Ariel; Gamboa, Jorge; Mendez, Fernando

2014-11-01

We point out that a cold dark matter condensate made of gauge bosons from an extra hidden U(1) sector - dubbed hidden-photons - can create a small, oscillating electric density current. Thus, they could also be searched for in the recently proposed LC-circuit setup conceived for axion cold dark matter search by Sikivie, Sullivan and Tanner. We estimate the sensitivity of this setup for hidden-photon cold dark matter and we find it could cover a sizable, so far unexplored parameter space.

Extracting Hidden-Photon Dark Matter From an LC-Circuit

CERN Document Server

Arias, Paola; Döbrich, Babette; Gamboa, Jorge; Méndez, Fernando

2015-01-01

We point out that a cold dark matter condensate made of gauge bosons from an extra hidden U(1) sector - dubbed hidden- photons - can create a small, oscillating electric density current. Thus, they could also be searched for in the recently proposed LC-circuit setup conceived for axion cold dark matter search by Sikivie, Sullivan and Tanner. We estimate the sensitivity of this setup for hidden-photon cold dark matter and we find it could cover a sizable, so far unexplored parameter space.

Beating the blues after Cancer: randomised controlled trial of a tele-based psychological intervention for high distress patients and carers

Directory of Open Access Journals (Sweden)

Hutchison Sandy

2009-06-01

Full Text Available Abstract Background The diagnosis and treatment of cancer is a major life stress such that approximately 35% of patients experience persistent clinically significant distress and carers often experience even higher distress than patients. This paper presents the design of a two arm randomised controlled trial with patients and carers who have elevated psychological distress comparing minimal contact self management vs. an individualised tele-based cognitive behavioural intervention. Methods/design 140 patients and 140 carers per condition (560 participants in total will been recruited after being identified as high distress through caller screening at two community-based cancer helplines and randomised to 1 a single 30-minute telephone support and education session with a nurse counsellor with self management materials 2 a tele-based psychologist delivered five session individualised cognitive behavioural intervention. Session components will include stress reduction, problem-solving, cognitive challenging and enhancing relationship support and will be delivered weekly. Participants will be assessed at baseline and 3, 6 and 12 months after recruitment. Outcome measures include: anxiety and depression, cancer specific distress, unmet psychological supportive care needs, positive adjustment, overall Quality of life. Discussion The study will provide recommendations about the efficacy and potential economic value of minimal contact self management vs. tele-based psychologist delivered cognitive behavioural intervention to facilitate better psychosocial adjustment and mental health for people with cancer and their carers. Trial Registration ACTRN12609000301268.

Hidden photons in beam dump experiments and in connection with dark matter

Energy Technology Data Exchange (ETDEWEB)

Andreas, Sarah

2012-12-15

Hidden sectors with light extra U(1) gauge bosons, so-called hidden photons, recently received much interest as natural feature of beyond standard model scenarios like string theory and SUSY and because of their possible connection to dark matter. This paper presents limits on hidden photons from past electron beam dump experiments including two new limits from experiments at KEK and Orsay. Additionally, various hidden sector models containing both a hidden photon and a dark matter candidate are discussed with respect to their viability and potential signatures in direct detection.

Hidden photons in beam dump experiments and in connection with dark matter

International Nuclear Information System (INIS)

Andreas, Sarah

2012-12-01

Hidden sectors with light extra U(1) gauge bosons, so-called hidden photons, recently received much interest as natural feature of beyond standard model scenarios like string theory and SUSY and because of their possible connection to dark matter. This paper presents limits on hidden photons from past electron beam dump experiments including two new limits from experiments at KEK and Orsay. Additionally, various hidden sector models containing both a hidden photon and a dark matter candidate are discussed with respect to their viability and potential signatures in direct detection.

Search for hidden particles with the SHiP experiment

Energy Technology Data Exchange (ETDEWEB)

Hagner, Caren; Bick, Daniel; Bieschke, Stefan; Ebert, Joachim; Schmidt-Parzefall, Walter [Universitaet Hamburg, Institut fuer Experimentalphysik, Luruper Chaussee 149, 22761 Hamburg (Germany)

2016-07-01

Many theories beyond the standard model predict long lived neutral (hidden) particles. There might be a whole Hidden Sector (HS) of weakly interacting particles, which cannot be detected in existing high energy experiments. The SHiP experiment (Search for Hidden Particles) requires a high intensity beam dump, which could be realized by a new facility at the CERN SPS accelerator. New superweakly interacting particles with masses below O(10) GeV could be produced in the beam dump and detected in a general purpose Hidden Sector (HS) detector. In addition there will be a dedicated tau neutrino subdetector. I present the major requirements and technical challenges for the HS detector and discuss how the HS can be accessed through several portals: neutrino portal, scalar portal, vector portal and many more.

The Developmental Trajectory of Borderline Personality Disorder and Peer Victimisation: Australian Family Carers' Perspectives

Science.gov (United States)

Wlodarczyk, Julian; Lawn, Sharon

2017-01-01

Victimisation is a traumatic experience linked to development of Borderline personality disorder (BPD). However, there is limited research investigating the developmental journey prior to BPD diagnosis. School environments offer an opportunity for BPD prevention and early intervention. A survey with 19 Australian family carers of people with BPD…

An exploratory study of barriers to promoting oral hygiene through carers of elderly people

DEFF Research Database (Denmark)

Eadie, D R; Schou, L

1992-01-01

Scotland. A range of barriers to improving levels of care was identified. The paper concluded that to make positive progress, a comprehensive oral hygiene programme is required to break down these barriers. It is believed that a strong educational policy based upon carers' needs should form the main...

Benefits and burdens: family caregivers' experiences of assistive technology (AT) in everyday life with persons with young-onset dementia (YOD).

Science.gov (United States)

Holthe, Torhild; Jentoft, Rita; Arntzen, Cathrine; Thorsen, Kirsten

2017-09-11

People with dementia and their family caregivers may benefit from assistive technology (AT), but knowledge is scarce about family carers' (FC) experiences and involvement in the use of AT in everyday life. To examine the FC roles and experiences with AT as means of supporting people with young onset-dementia (YOD). Qualitative interview study with follow-up design. Repeated semi-structured interviews were conducted with 13 FC of people with YOD, participating in an ongoing intervention study investigating the families' use and experiences of AT in everyday life. Six main themes emerged: (1) timely information about AT; (2) waiting times; (3) AT incorporated into everyday living; (4) AT experienced as a relief and burden; (5) appraisal of AT qualities and (6) the committed caregiver. The study found benefits for the FC, especially with simply designed AT, but also several barriers for successful use. A committed caregiver is vital throughout the process. Users will need professional advice and support, and occupational therapists may have a significant role in the process. Interventions implementing AT must be based on analysis of the needs of the person with YOD and the carers: their capabilities, preferences, embodied habits, and coping strategies. Implications for Rehabilitation Committed family carers (FC) play an important, often decisive, role in providing support for the person with young-onset dementia (YOD, onset <65 years) to use and benefit from the AT. The simpler the AT, the better. The AT should be introduced at "the right time", before the cognitive and adaptive reduction is too great. The "window" for implementation may be short. AT has potential to ease caregiving and give relief for FC. However, many barriers, difficulties and problems must be attended to. A system for individualized support over time is necessary for implementing AT for this group.

Multilayer Neural Networks with Extensively Many Hidden Units

International Nuclear Information System (INIS)

Rosen-Zvi, Michal; Engel, Andreas; Kanter, Ido

2001-01-01

The information processing abilities of a multilayer neural network with a number of hidden units scaling as the input dimension are studied using statistical mechanics methods. The mapping from the input layer to the hidden units is performed by general symmetric Boolean functions, whereas the hidden layer is connected to the output by either discrete or continuous couplings. Introducing an overlap in the space of Boolean functions as order parameter, the storage capacity is found to scale with the logarithm of the number of implementable Boolean functions. The generalization behavior is smooth for continuous couplings and shows a discontinuous transition to perfect generalization for discrete ones

Hidden Area and Mechanical Nonlinearities in Freestanding Graphene

Science.gov (United States)

Nicholl, Ryan J. T.; Lavrik, Nickolay V.; Vlassiouk, Ivan; Srijanto, Bernadeta R.; Bolotin, Kirill I.

2017-06-01

We investigated the effect of out-of-plane crumpling on the mechanical response of graphene membranes. In our experiments, stress was applied to graphene membranes using pressurized gas while the strain state was monitored through two complementary techniques: interferometric profilometry and Raman spectroscopy. By comparing the data obtained through these two techniques, we determined the geometric hidden area which quantifies the crumpling strength. While the devices with hidden area ˜0 % obeyed linear mechanics with biaxial stiffness 428 ±10 N /m , specimens with hidden area in the range 0.5%-1.0% were found to obey an anomalous nonlinear Hooke's law with an exponent ˜0.1 .

Parents of young people with self-harm or suicidal behaviour who seek help - a psychosocial profile.

LENUS (Irish Health Repository)

Morgan, Sophia

2013-04-23

Deliberate Self-Harm (DSH) is a common problem among children and adolescents in clinical and community populations, and there is a considerable amount of literature investigating factors associated with DSH risk and the effects of DSH on the child. However, there is a dearth of research examining the impact of DSH on parents, and there are few support programmes targeted at this population. This cross-sectional study examines the profile of a sample of parents of young people with DSH who participated in a support programme (Supporting Parents and Carers of young people with self-harm: the SPACE programme), with the goal of investigating pre-test parental well-being, family communication, parental satisfaction, perceived parental social support, and child strengths and difficulties.

Extracting hidden-photon dark matter from an LC-circuit

International Nuclear Information System (INIS)

Arias, Paola; Arza, Ariel; Gamboa, Jorge; Mendez, Fernando; Doebrich, Babette

2015-01-01

We point out that a cold dark matter condensate made of gauge bosons from an extra hidden U(1) sector - dubbed hidden photons - can create a small, oscillating electric density current. Thus, they could also be searched for in the recently proposed LC-circuit setup conceived for axion cold dark matter search by Sikivie, Sullivan and Tanner. We estimate the sensitivity of this setup for hidden-photon cold dark matter and we find it could cover a sizable, so far unexplored parameter space. (orig.)

Petro Rents, Political Institutions, and Hidden Wealth

DEFF Research Database (Denmark)

Andersen, Jørgen Juel; Johannesen, Niels; Lassen, David Dreyer

2017-01-01

Do political institutions limit rent seeking by politicians? We study the transformation of petroleum rents, almost universally under direct government control, into hidden wealth using unique data on bank deposits in offshore financial centers that specialize in secrecy and asset protection. Our...... rulers is diverted to secret accounts. We find very limited evidence that shocks to other types of income not directly controlled by governments affect hidden wealth....

Hidden charm molecules in a finite volume

International Nuclear Information System (INIS)

Albaladejo, M.; Hidalgo-Duque, C.; Nieves, J.; Oset, E.

2014-01-01

In the present paper we address the interaction of charmed mesons in hidden charm channels in a finite box. We use the interaction from a recent model based on heavy quark spin symmetry that predicts molecules of hidden charm in the infinite volume. The energy levels in the box are generated within this model, and several methods for the analysis of these levels ("inverse problem") are investigated. (author)

B-graph sampling to estimate the size of a hidden population

NARCIS (Netherlands)

Spreen, M.; Bogaerts, S.

2015-01-01

Link-tracing designs are often used to estimate the size of hidden populations by utilizing the relational links between their members. A major problem in studies of hidden populations is the lack of a convenient sampling frame. The most frequently applied design in studies of hidden populations is

Hidden Agendas in Marriage: Affective and Longitudinal Dimensions.

Science.gov (United States)

Krokoff, Lowell J.

1990-01-01

Examines how couples' discussions of troublesome problems reveal hidden agendas (issues not directly discussed or explored). Finds disgust and contempt are at the core of both love and respect agendas for husbands and wives. Finds that wives' more than husbands' hidden agendas are directly predictive of how negatively they argue at home. (SR)

On the LHC sensitivity for non-thermalised hidden sectors

Science.gov (United States)

Kahlhoefer, Felix

2018-04-01

We show under rather general assumptions that hidden sectors that never reach thermal equilibrium in the early Universe are also inaccessible for the LHC. In other words, any particle that can be produced at the LHC must either have been in thermal equilibrium with the Standard Model at some point or must be produced via the decays of another hidden sector particle that has been in thermal equilibrium. To reach this conclusion, we parametrise the cross section connecting the Standard Model to the hidden sector in a very general way and use methods from linear programming to calculate the largest possible number of LHC events compatible with the requirement of non-thermalisation. We find that even the HL-LHC cannot possibly produce more than a few events with energy above 10 GeV involving states from a non-thermalised hidden sector.

Technology-based tools and services for people with dementia and carers: Mapping technology onto the dementia care pathway.

Science.gov (United States)

Lorenz, Klara; Freddolino, Paul P; Comas-Herrera, Adelina; Knapp, Martin; Damant, Jacqueline

2017-01-01

The extent to which technology may be able to support people with dementia and their carers along the care pathway and in different care settings is of interest to policy makers and governments. In this paper we provide an overview of the role of technology in dementia care, treatment and support by mapping existing technologies - by function, target user and disease progression. Technologies identified are classified into seven functions: memory support, treatment, safety and security, training, care delivery, social interaction and other. Different groups of potential users are distinguished: people with mild cognitive impairment and early stages of dementia, people with moderate to severe dementia and unpaid carers and health- and social care professionals. We also identified the care settings, in which the technologies are used (or for which the technologies are developed): at home in the community and in institutional care settings. The evidence has been drawn from a rapid review of the literature, expert interviews and web and social media searches. The largest number of technologies identified aim to enhance the safety and security of people with dementia living in the community. These devices are often passive monitors, such as smoke detectors. Other safety interventions, such as panic buttons, require active intervention. The second largest number of interventions aims to enhance people's memory and includes global positioning systems devices and voice prompts. These technologies mostly target people in the early stages of dementia. A third group focusing on treatment and care delivery emerged from the literature. These interventions focus on technology-aided reminiscence or therapeutic aspects of care for people with dementia and their carers. While the review found a range of technologies available for people with dementia and carers there is very little evidence of widespread practical application. Instead, it appears that stakeholders frequently rely

Massive hidden photons as lukewarm dark matter

International Nuclear Information System (INIS)

Redondo, Javier; Postma, Marieke

2008-11-01

We study the possibility that a keV-MeV mass hidden photon (HP), i.e. a hidden sector U(1) gauge boson, accounts for the observed amount of dark matter. We focus on the case where the HP interacts with the standard model sector only through kinetic mixing with the photon. The relic abundance is computed including all relevant plasma effects into the photon's self-energy, which leads to a resonant yield almost independent of the HP mass. The HP can decay into three photons. Moreover, if light enough it can be copiously produced in stars. Including bounds from cosmic photon backgrounds and stellar evolution, we find that the hidden photon can only give a subdominant contribution to the dark matter. This negative conclusion may be avoided if another production mechanism besides kinetic mixing is operative. (orig.)

Massive hidden photons as lukewarm dark matter

Energy Technology Data Exchange (ETDEWEB)

Redondo, Javier [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); Postma, Marieke [Nationaal Inst. voor Kernfysica en Hoge-Energiefysica (NIKHEF), Amsterdam (Netherlands)

2008-11-15

We study the possibility that a keV-MeV mass hidden photon (HP), i.e. a hidden sector U(1) gauge boson, accounts for the observed amount of dark matter. We focus on the case where the HP interacts with the standard model sector only through kinetic mixing with the photon. The relic abundance is computed including all relevant plasma effects into the photon's self-energy, which leads to a resonant yield almost independent of the HP mass. The HP can decay into three photons. Moreover, if light enough it can be copiously produced in stars. Including bounds from cosmic photon backgrounds and stellar evolution, we find that the hidden photon can only give a subdominant contribution to the dark matter. This negative conclusion may be avoided if another production mechanism besides kinetic mixing is operative. (orig.)

New limits on hidden photons from past electron beam dumps

International Nuclear Information System (INIS)

Andreas, Sarah; Niebuhr, Carsten; Ringwald, Andreas

2012-09-01

Hidden sectors with light extra U(1) gauge bosons, so called hidden photons, have recently attracted some attention because they are a common feature of physics beyond the Standard Model like string theory and SUSY and additionally are phenomenologically of great interest regarding recent astrophysical observations. The hidden photon is already constrained by various laboratory experiments and presently searched for in running as well as upcoming experiments. We summarize the current status of limits on hidden photons from past electron beam dump experiments including two new limits from such experiments at KEK and Orsay that have so far not been considered. All our limits take into account the experimental acceptances obtained from Monte Carlo simulations.

New limits on hidden photons from past electron beam dumps

Energy Technology Data Exchange (ETDEWEB)

Andreas, Sarah; Niebuhr, Carsten; Ringwald, Andreas

2012-09-15

Hidden sectors with light extra U(1) gauge bosons, so called hidden photons, have recently attracted some attention because they are a common feature of physics beyond the Standard Model like string theory and SUSY and additionally are phenomenologically of great interest regarding recent astrophysical observations. The hidden photon is already constrained by various laboratory experiments and presently searched for in running as well as upcoming experiments. We summarize the current status of limits on hidden photons from past electron beam dump experiments including two new limits from such experiments at KEK and Orsay that have so far not been considered. All our limits take into account the experimental acceptances obtained from Monte Carlo simulations.

Invisible axion in the hidden sector of no-scale supergravity

International Nuclear Information System (INIS)

Sato, Hikaru

1987-01-01

We propose a new axion model which incorporates the U(1) PQ symmetry into a hidden sector, as well as an observable sector, of no-scale supergravity models. The axion is a spin-zero field in the hidden sector. The U(1) PQ symmetry is naturally embedded in the family symmetry of the no-scale models. Invisible axions live in the gravity hidden sector without conflict with the cosmological and astrophysical constraints. (orig.)

Increased taxon sampling reveals thousands of hidden orthologs in flatworms

Science.gov (United States)

2017-01-01

Gains and losses shape the gene complement of animal lineages and are a fundamental aspect of genomic evolution. Acquiring a comprehensive view of the evolution of gene repertoires is limited by the intrinsic limitations of common sequence similarity searches and available databases. Thus, a subset of the gene complement of an organism consists of hidden orthologs, i.e., those with no apparent homology to sequenced animal lineages—mistakenly considered new genes—but actually representing rapidly evolving orthologs or undetected paralogs. Here, we describe Leapfrog, a simple automated BLAST pipeline that leverages increased taxon sampling to overcome long evolutionary distances and identify putative hidden orthologs in large transcriptomic databases by transitive homology. As a case study, we used 35 transcriptomes of 29 flatworm lineages to recover 3427 putative hidden orthologs, some unidentified by OrthoFinder and HaMStR, two common orthogroup inference algorithms. Unexpectedly, we do not observe a correlation between the number of putative hidden orthologs in a lineage and its “average” evolutionary rate. Hidden orthologs do not show unusual sequence composition biases that might account for systematic errors in sequence similarity searches. Instead, gene duplication with divergence of one paralog and weak positive selection appear to underlie hidden orthology in Platyhelminthes. By using Leapfrog, we identify key centrosome-related genes and homeodomain classes previously reported as absent in free-living flatworms, e.g., planarians. Altogether, our findings demonstrate that hidden orthologs comprise a significant proportion of the gene repertoire in flatworms, qualifying the impact of gene losses and gains in gene complement evolution. PMID:28400424

Searching for hidden sector in multiparticle production at LHC

Directory of Open Access Journals (Sweden)

Miguel-Angel Sanchis-Lozano

2016-03-01

Full Text Available We study the impact of a hidden sector beyond the Standard Model, e.g. a Hidden Valley model, on factorial moments and cumulants of multiplicity distributions in multiparticle production with a special emphasis on the prospects for LHC results.

An introduction to hidden Markov models for biological sequences

DEFF Research Database (Denmark)

Krogh, Anders Stærmose

1998-01-01

A non-matematical tutorial on hidden Markov models (HMMs) plus a description of one of the applications of HMMs: gene finding.......A non-matematical tutorial on hidden Markov models (HMMs) plus a description of one of the applications of HMMs: gene finding....

Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients with Mild and Moderate Intellectual Disability and Their Carers

Science.gov (United States)

Ali, Afia; Scior, Katrina; Ratti, Victoria; Strydom, Andre; King, Michael; Hassiotis, Angela

2013-01-01

Background People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years. Method and Main Findings Twenty nine participants (14 patient and carer dyads, and one carer) took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented. Conclusion Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability. PMID:23951026

Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers.

Directory of Open Access Journals (Sweden)

Afia Ali

Full Text Available People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years.Twenty nine participants (14 patient and carer dyads, and one carer took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented.Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability.

Integrity test of lead apron and its effect on personnel and carers

Directory of Open Access Journals (Sweden)

Omojola Akintayo Daniel

2018-03-01

Full Text Available The use of lead apron is known to protect radiation workers and carers (patient relatives from the scatter radiation. The study intends to assess the integrity of lead apron by checking for defects and to estimate the mean dose rate to personnel and carers and also to compare the percentage mean absorbance of the apron with the related studies. Ten lead aprons were used involving three vendors. A fluoroscopy unit, floor mounted X-ray unit, survey meter, lead aprons and meter rule were used. Crack and tear were identified with some areas close to the critical organ site. Eighty percent of the aprons showed signs that they were defective. Correlation of the lead aprons mean age and the total number of defective lead aprons were not significant (p=0.866. The mean thickness of the aprons for the three brands affected the percentage absorbance (p<0.001. The mean dose rate was above 20 mSv recommended for radiation workers averaged over a single year. It is recommended that the defective apron close to the critical organ be replaced and those in areas distal from the critical organs be further evaluated using the rejection criteria test before they are replaced.

'It is not the State's fault that we have a person like this': relations, institutions and the meaning of 'rights' to carers of People with Psychosocial Disabilities in Chile.

Science.gov (United States)

Montenegro, C R; Cornish, F

2015-01-01

The UN Convention on the Rights of Persons with Disabilities (CRPD) has been adopted by national governments to advance the interests and wellbeing of people with psychosocial disabilities (PPSD). It is often assumed that the adoption of a 'rights' framework will advance the dignity and autonomy of PPSD. However, little is known about how families and communities understand 'rights'. The present paper, based on research conducted in Santiago, Chile, takes a contextual approach to rights, asking: How do family carers of PPSD understand and use the idea of 'rights'? How does the context of caregiving shape families' understanding of rights? Four focus groups were conducted with a total of 25 family carers (predominantly mothers) of people diagnosed with schizophrenia and other severe neuropsychiatric conditions. Thematic analysis was conducted. Carers' experience of caregiving was marked by isolation, stigmatization, a lack of support and mistreatment by public services. Their family networks did not provide sustained help and support, and the public services they had used were characterized by scarce resources and inadequate support. Carers did not refer to rights of dignity or autonomy. Given an unsupportive context, and worries about who would care for their child after the carer's death, their primary interest in 'rights' was a right to guaranteed, long-term care. While carers endorsed the idea of universal, state-supported rights, appeals to compassion and the exchange of favours were spoken of as the most effective strategies for gaining a minimum level of services and support. Carers' understandings, framed against a background of unmet needs and shaped by a history of unsatisfactory interactions with services and institutions, do not resonate with the principles of the CRPD. We suggest an expanded, relational struggle for rights that acknowledges the role of families and the tensions surrounding the distribution of rights within the family.

The origin of the hidden supersymmetry

International Nuclear Information System (INIS)

Jakubsky, Vit; Nieto, Luis-Miguel; Plyushchay, Mikhail S.

2010-01-01

The hidden supersymmetry and related tri-supersymmetric structure of the free particle system, the Dirac delta potential problem and the Aharonov-Bohm effect (planar, bound state, and tubule models) are explained by a special nonlocal unitary transformation, which for the usual N=2 supercharges has a nature of Foldy-Wouthuysen transformation. We show that in general case, the bosonized supersymmetry of nonlocal, parity even systems emerges in the same construction, and explain the origin of the unusual N=2 supersymmetry of electron in three-dimensional parity even magnetic field. The observation extends to include the hidden superconformal symmetry.

Restriction periods for carers, comforters and members of the public in the treatment of hyperthyroidism

International Nuclear Information System (INIS)

Minguez, P.; Genolla, J.; Celeiro, J.; Fombellida, J. C.

2013-01-01

People treated for hyperthyroidism are normally outpatients who pose a potential radiological risk to some members of the public. In this study, measurements of the uptake in 30 patients were used to estimate the values of the activity of 131 I in the whole body of patients, AWB, by using a model of two compartments. Restriction periods to be followed by patients for different values of the administered activity of 131 I were calculated. To perform calculations, the following were used: the curve obtained for AWB; the value of the dose rate at one metre from patients after the administration of the treatment; and the estimated time that carers, comforters and members of the public will spend at certain distances from patients. Results show that protection from radiation for carers, comforters and members of the public related to patients treated for hyperthyroidism can become a cumbersome matter as patients may have to follow very long restriction periods. (authors)

Naturally light hidden photons in LARGE volume string compactifications

International Nuclear Information System (INIS)

Goodsell, M.; Jaeckel, J.; Redondo, J.; Ringwald, A.

2009-09-01

Extra ''hidden'' U(1) gauge factors are a generic feature of string theory that is of particular phenomenological interest. They can kinetically mix with the Standard Model photon and are thereby accessible to a wide variety of astrophysical and cosmological observations and laboratory experiments. In this paper we investigate the masses and the kinetic mixing of hidden U(1)s in LARGE volume compactifications of string theory. We find that in these scenarios the hidden photons can be naturally light and that their kinetic mixing with the ordinary electromagnetic photon can be of a size interesting for near future experiments and observations. (orig.)

Hidden photon dark matter search with large metallic mirror

International Nuclear Information System (INIS)

Doebrich, Babette; Lindner, Axel; Daumiller, Kai; Engel, Ralph; Roth, Markus; Kowalski, Marek

2014-10-01

If Dark Matter is composed of hidden-sector photons that kinetically mix with photons of the visible sector, then Dark Matter has a tiny oscillating electric field component. Its presence would lead to a small amount of visible radiation being emitted from a conducting surface, with the photon frequency given approximately by the mass of the hidden photon. Here, we report on experimental efforts that have started recently to search for such hidden photon Dark Matter in the (sub-)eV regime with a prototype mirror for the Auger fluorescence detector at the Karlsruhe Institute for Technology.

Menopause Experiences and Attitudes in Women with Intellectual Disability and in Their Family Carers

Science.gov (United States)

Chou, Yueh-Ching; Lu, Zxy-Yann Jane; Pu, Cheng-Yun

2013-01-01

Background: Little is known about how middle-aged and older women with intellectual disability (ID) cope with life transitions such as perimenopause and postmenopause. Method: A mixed methods approach was employed to explore the attitudes toward and experiences of menopause among women with ID and their family carers in one city in Taiwan.…

Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial.

Science.gov (United States)

Charlesworth, G; Shepstone, L; Wilson, E; Thalanany, M; Mugford, M; Poland, F

2008-03-01

To determine whether a social support intervention (access to an employed befriending facilitator in addition to usual care) is effective compared with usual care alone. Also to document direct and indirect costs, and establish incremental cost-effectiveness. The Befriending and Costs of Caring (BECCA) trial was a cost-effectiveness randomised controlled trial. Data on well-being and resource use were collected through interviews with participants at baseline and at 6, 15 and 24 months. This research was carried out in the English counties of Norfolk and Suffolk, and the London Borough of Havering. It was a community-based study. Participants were family carers who were cohabiting with, or providing at least 20 hours' care per week for, a community-dwelling relative with a primary progressive dementia. The intervention was 'access to a befriender facilitator' (BF). BFs, based with charitable/voluntary-sector organisations, were responsible for local befriending schemes, including recruitment, screening, training and ongoing support of befriending volunteers, and for matching carers with befrienders. The role of befrienders was to provide emotional support for carers. The target duration for befriending relationships was 6 months or more. Depression was measured by the Hospital Anxiety and Depression Scale (HADS) at 15 months postrandomisation. The health-related quality of life scale EQ-5D (EuroQol 5 Dimensions) was used to derive utilities for the calculation of quality-adjusted life-years (QALYs). A total of 236 carers were randomised into the trial (116 intervention; 120 control). At final follow-up, 190 carers (93 intervention; 97 control) were still involved in the trial (19% attrition). There was no evidence of effectiveness or cost-effectiveness from the primary analyses on the intention-to-treat population. The mean incremental cost per incremental QALY gained was in excess of 100,000 pounds, with only a 42.2% probability of being below 30,000 pounds per

Supersymmetry, p-brane duality, and hidden spacetime dimensions

International Nuclear Information System (INIS)

Bars, I.

1996-01-01

A global superalgebra with 32 supercharges and all possible central extensions is studied in order to extract some general properties of duality and hidden dimensions in a theory that treats p-branes democratically. The maximal number of dimensions is 12, with signature (10,2), containing one space and one time dimension that are hidden from the point of view of perturbative ten-dimensional string theory or its compactifications. When the theory is compactified on R d-1,1 circle-times T c+1,1 with d+c+2=12, there are isometry groups that relate to the hidden dimensions as well as to duality. Their combined intersecting classification schemes provide some properties of nonperturbative states and their couplings. copyright 1996 The American Physical Society

Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals.

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Bunn, Frances; Burn, Anne-Marie; Robinson, Louise; Poole, Marie; Rait, Greta; Brayne, Carol; Schoeman, Johan; Norton, Sam; Goodman, Claire

2017-01-18

People living with dementia (PLWD) have a high prevalence of comorbidty. The aim of this study was to explore the impact of dementia on access to non-dementia services and identify ways of improving service delivery for this population. Qualitative study involving interviews and focus groups. Thematic content analysis was informed by theories of continuity of care and access to care. Primary and secondary care in the South and North East of England. PLWD who had 1 of the following comorbidities-diabetes, stroke, vision impairment, their family carers and healthcare professionals (HCPs) in the 3 conditions. We recruited 28 community-dwelling PLWD, 33 family carers and 56 HCPs. Analysis resulted in 3 overarching themes: (1) family carers facilitate access to care and continuity of care, (2) the impact of the severity and presentation of dementia on management of comorbid conditions, (3) communication and collaboration across specialities and services is not dementia aware. We found examples of good practice, but these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. This study suggests that, in order to improve access and continuity for PLWD and comorbidity, a significant change in the organisation of care is required which involves: coproduction of care where professionals, PLWD and family carers work in partnership; recognition of the way a patient's diagnosis of dementia affects the management of other long-term conditions; flexibility in services to ensure they are sensitive to the changing needs of PLWD and their family carers over time; and improved collaboration across specialities and organisations. Research is needed to develop interventions that support partnership working and tailoring of care for PLWD and comorbidity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

A single hidden layer feedforward network with only one neuron in the hidden layer can approximate any univariate function

OpenAIRE

Guliyev , Namig; Ismailov , Vugar

2016-01-01

The possibility of approximating a continuous function on a compact subset of the real line by a feedforward single hidden layer neural network with a sigmoidal activation function has been studied in many papers. Such networks can approximate an arbitrary continuous function provided that an unlimited number of neurons in a hidden layer is permitted. In this paper, we consider constructive approximation on any finite interval of $\\mathbb{R}$ by neural networks with only one neuron in the hid...

Discovering hidden sectors with monophoton Z' searches

International Nuclear Information System (INIS)

Gershtein, Yuri; Petriello, Frank; Quackenbush, Seth; Zurek, Kathryn M.

2008-01-01

In many theories of physics beyond the standard model, from extra dimensions to Hidden Valleys and models of dark matter, Z ' bosons mediate between standard model particles and hidden sector states. We study the feasibility of observing such hidden states through an invisibly decaying Z ' at the LHC. We focus on the process pp→γZ ' →γXX † , where X is any neutral, (quasi-) stable particle, whether a standard model neutrino or a new state. This complements a previous study using pp→ZZ ' →l + l - XX † . Only the Z ' mass and two effective charges are needed to describe this process. If the Z ' decays invisibly only to standard model neutrinos, then these charges are predicted by observation of the Z ' through the Drell-Yan process, allowing discrimination between Z ' decays to standard model ν's and invisible decays to new states. We carefully discuss all backgrounds and systematic errors that affect this search. We find that hidden sector decays of a 1 TeV Z ' can be observed at 5σ significance with 50 fb -1 at the LHC. Observation of a 1.5 TeV state requires super-LHC statistics of 1 ab -1 . Control of the systematic errors, in particular, the parton distribution function uncertainty of the dominant Zγ background, is crucial to maximize the LHC search reach.

REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis.

Directory of Open Access Journals (Sweden)

Robert T Woods

Full Text Available Joint reminiscence groups, involving people with dementia and family carers together, are popular, but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care.This multi-centre, pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used, with an overall allocation ratio of 1:1, restricted to ensure viable sized intervention groups. Assessments, blind to treatment allocation, were carried out at baseline, three months and ten months (primary end-point, usually in the person's home. Participants were recruited in eight centres, mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV, who had a relative or other care-giver in regular contact, to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5were randomised: 268 intervention, 220 control; 350 dyads completed the study (206 intervention, 144 control. The intervention evaluated was joint reminiscence groups (with up to 12 dyads weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD, psychological distress for the carer (General Health Questionnaire, GHQ-28. Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood, relationship quality and service use and costs for both.The intention to treat analysis (ANCOVA identified no

Adults with Learning Disabilities Experiences of Using Community Dental Services: Service User and Carer Perspectives

Science.gov (United States)

Lees, Carolyn; Poole, Helen; Brennan, Michelle; Irvine, Fiona

2017-01-01

Background: The government alongside other health and social care organisation have identified the need to improve the care provided for people with learning disabilities. Materials and Methods: This service evaluation aimed to explore the experiences of people with learning disabilities and their carers who accessed community dental services…

Child Abuse: The Hidden Bruises

Science.gov (United States)

... for Families - Vietnamese Spanish Facts for Families Guide Child Abuse - The Hidden Bruises No. 5; Updated November 2014 The statistics on physical child abuse are alarming. It is estimated hundreds of thousands ...

An Exploration of Issues around Menstruation for Women with Down Syndrome and Their Carers

Science.gov (United States)

Mason, Linda; Cunningham, Cliff

2008-01-01

Background: There is little research on issues related to menstruation for women with Down syndrome, yet they may experience menstruation in a qualitatively different way from normal women, which impacts on their quality of life and that of their families and carers. The aim of this qualitative study was to explore issues with the women and/or…

Learning and inference in a nonequilibrium Ising model with hidden nodes.

Science.gov (United States)

Dunn, Benjamin; Roudi, Yasser

2013-02-01

We study inference and reconstruction of couplings in a partially observed kinetic Ising model. With hidden spins, calculating the likelihood of a sequence of observed spin configurations requires performing a trace over the configurations of the hidden ones. This, as we show, can be represented as a path integral. Using this representation, we demonstrate that systematic approximate inference and learning rules can be derived using dynamical mean-field theory. Although naive mean-field theory leads to an unstable learning rule, taking into account Gaussian corrections allows learning the couplings involving hidden nodes. It also improves learning of the couplings between the observed nodes compared to when hidden nodes are ignored.

Communication and context are important to Indigenous children with physical disability and their carers at a community-based physiotherapy service: a qualitative study

Directory of Open Access Journals (Sweden)

Caroline Greenstein

2016-01-01

Full Text Available Question: What are the experiences of Indigenous children with physical disability and their carers of their community-based physiotherapy service? What factors influence their experiences of the physiotherapy service and how could the service be improved? Design: A qualitative study using in-depth, semi-structured open-ended interviews consistent with the researchers’ interpretivist perspectives and ethical principles of Indigenous health research. Interviews were audio recorded, transcribed and coded for themes with qualitative research software using inductive analysis. The interviews were then checked for transcription accuracy and the themes were confirmed with the participants. Participants: Nine parents and foster carers of children with physical disability aged 0 to 21 years, five children and youth with physical disability aged 8 to 21 years. Results: The data generated three themes, which informed practice recommendations: carers of children with physical disability experience increased demands and complexity in their lives; relationships involving caring, consistency and communication are important to consumers using the physiotherapy service; and being Indigenous influences consumers’ experiences in ways that may not be obvious to non-Indigenous service providers. The issue of communication underpinned the participants’ experiences throughout these themes. Conclusion: The research highlighted the importance of effective communication, developing relationships, viewing the child wholistically and recognising the influence of being Indigenous on clients’ healthcare needs and experiences. The results suggested that community-based physiotherapists adopt a family/person-centred, context-specific approach when working with Indigenous children with a physical disability and their carers. [Greenstein C, Lowell A, Thomas D (2016 Communication and context are important to Indigenous children with physical disability and their carers

Analysing the hidden curriculum: use of a cultural web.

Science.gov (United States)

Mossop, Liz; Dennick, Reg; Hammond, Richard; Robbé, Iain

2013-02-01

Major influences on learning about medical professionalism come from the hidden curriculum. These influences can contribute positively or negatively towards the professional enculturation of clinical students. The fact that there is no validated method for identifying the components of the hidden curriculum poses problems for educators considering professionalism. The aim of this study was to analyse whether a cultural web, adapted from a business context, might assist in the identification of elements of the hidden curriculum at a UK veterinary school. A qualitative approach was used. Seven focus groups consisting of three staff groups and four student groups were organised. Questioning was framed using the cultural web, which is a model used by business owners to assess their environment and consider how it affects their employees and customers. The focus group discussions were recorded, transcribed and analysed thematically using a combination of a priori and emergent themes. The cultural web identified elements of the hidden curriculum for both students and staff. These included: core assumptions; routines; rituals; control systems; organisational factors; power structures, and symbols. Discussions occurred about how and where these issues may affect students' professional identity development. The cultural web framework functioned well to help participants identify elements of the hidden curriculum. These aspects aligned broadly with previously described factors such as role models and institutional slang. The influence of these issues on a student's development of a professional identity requires discussion amongst faculty staff, and could be used to develop learning opportunities for students. The framework is promising for the analysis of the hidden curriculum and could be developed as an instrument for implementation in other clinical teaching environments. © Blackwell Publishing Ltd 2013.

Anticipating hidden text salting in emails (extended abstract)

OpenAIRE

Lioma, Christina; Moens, Marie-Francine; Gomez, Juan Carlos; De Beer, Jan; Bergholz, Andre; Paass, Gerhard; Horkan, Patrick

2008-01-01

Salting is the intentional addition or distortion of content, aimed to evade automatic filtering. Salting is usually found in spam emails. Salting can also be hidden in phishing emails, which aim to steal personal information from users. We present a novel method that detects hidden salting tricks as visual anomalies in text. We solely use these salting tricks to successfully classify emails as phishing (F-measure >90%).

Complicated basins and the phenomenon of amplitude death in coupled hidden attractors

Energy Technology Data Exchange (ETDEWEB)

Chaudhuri, Ushnish [Department of Physics, Sri Venkateswara College, University of Delhi, New Delhi 110021 (India); Department of Physics, National University of Singapore, Singapore 117551 (Singapore); Prasad, Awadhesh, E-mail: awadhesh@physics.du.ac.in [Department of Physics and Astrophysics, University of Delhi, Delhi 110007 (India)

2014-02-07

Understanding hidden attractors, whose basins of attraction do not contain the neighborhood of equilibrium of the system, are important in many physical applications. We observe riddled-like complicated basins of coexisting hidden attractors both in coupled and uncoupled systems. Amplitude death is observed in coupled hidden attractors with no fixed point using nonlinear interaction. A new route to amplitude death is observed in time-delay coupled hidden attractors. Numerical results are presented for systems with no or one stable fixed point. The applications are highlighted.

Randomized controlled trial of a book-sharing intervention in a deprived South African community: effects on carer-infant interactions, and their relation to infant cognitive and socioemotional outcome.

Science.gov (United States)

Murray, Lynne; De Pascalis, Leonardo; Tomlinson, Mark; Vally, Zahir; Dadomo, Harold; MacLachlan, Brenda; Woodward, Charlotte; Cooper, Peter J

2016-12-01

Consistent with evidence from high-income countries (HICs), we previously showed that, in an informal peri-urban settlement in a low-middle income country, training parents in book sharing with their infants benefitted infant language and attention (Vally, Murray, Tomlinson, & Cooper, ). Here, we investigated whether these benefits were explained by improvements in carer-infant interactions in both book-sharing and non-book-sharing contexts. We also explored whether infant socioemotional development benefitted from book sharing. We conducted a randomized controlled trial in Khayelitsha, South Africa. Carers of 14-16-month-old infants were randomized to 8 weeks' training in book sharing (n = 49) or a wait-list control group (n = 42). In addition to the cognitive measures reported previously, independent assessments were made at base line and follow-up of carer-infant interactions during book sharing and toy play. Assessments were also made, at follow-up only, of infant prosocial behaviour in a 'help task', and of infant imitation of doll characters' nonsocial actions and an interpersonal interaction. Eighty-two carer-infant pairs (90%) were assessed at follow-up. (Trial registration ISRCTN39953901). Carers who received the training showed significant improvements in book-sharing interactions (sensitivity, elaborations, reciprocity), and, to a smaller extent, in toy-play interactions (sensitivity). Infants in the intervention group showed a significantly higher rate of prosocial behaviour, and tended to show more frequent imitation of the interpersonal interaction. Improvements in carer behaviour during book sharing, but not during toy play, mediated intervention effects on all infant cognitive outcomes, and tended to mediate intervention effects on infant interpersonal imitation. Training in book sharing, a simple, inexpensive intervention that has been shown to benefit infant cognitive development in a low-middle income country, also shows promise for

Supporting 'Young Carers' in Kenya

DEFF Research Database (Denmark)

Skovdal, Morten; Campbell, C.; Onyango, V.

2013-01-01

, avoiding engagement with support strategies that could be seen as support of child labour. To challenge this view, and move from policy paralysis to action, we present a study from western Kenya that explores community perceptions of children's work and caregiving as well as opportunities for support....... The study draws on 17 community group conversations and 10 individual interviews, involving 283 members of a Luo community in the Bondo District of western Kenya. We provide a detailed account of how integral children's work is to household survival in the context of poverty, HIV and AIDS as well...

Gauge mediation scenario with hidden sector renormalization in MSSM

International Nuclear Information System (INIS)

Arai, Masato; Kawai, Shinsuke; Okada, Nobuchika

2010-01-01

We study the hidden sector effects on the mass renormalization of a simplest gauge-mediated supersymmetry breaking scenario. We point out that possible hidden sector contributions render the soft scalar masses smaller, resulting in drastically different sparticle mass spectrum at low energy. In particular, in the 5+5 minimal gauge-mediated supersymmetry breaking with high messenger scale (that is favored by the gravitino cold dark matter scenario), we show that a stau can be the next lightest superparticle for moderate values of hidden sector self-coupling. This provides a very simple theoretical model of long-lived charged next lightest superparticles, which imply distinctive signals in ongoing and upcoming collider experiments.

Gauge mediation scenario with hidden sector renormalization in MSSM

Science.gov (United States)

Arai, Masato; Kawai, Shinsuke; Okada, Nobuchika

2010-02-01

We study the hidden sector effects on the mass renormalization of a simplest gauge-mediated supersymmetry breaking scenario. We point out that possible hidden sector contributions render the soft scalar masses smaller, resulting in drastically different sparticle mass spectrum at low energy. In particular, in the 5+5¯ minimal gauge-mediated supersymmetry breaking with high messenger scale (that is favored by the gravitino cold dark matter scenario), we show that a stau can be the next lightest superparticle for moderate values of hidden sector self-coupling. This provides a very simple theoretical model of long-lived charged next lightest superparticles, which imply distinctive signals in ongoing and upcoming collider experiments.

From physical and functional to continuity with pre-stroke self and participation in valued activities: a qualitative exploration of stroke survivors', carers' and physiotherapists' perceptions of physical activity after stroke.

Science.gov (United States)

Morris, Jacqui H; Oliver, Tracey; Kroll, Thilo; Joice, Sara; Williams, Brian

2015-01-01

Physical activity (PA) improves fitness, functioning, health and wellbeing after stroke. However, many survivors are inactive. This study explored survivors', carers' and physiotherapists' beliefs about PA to identify how these support or hinder PA participation. Semi-structured in-depth interviews with community dwelling stroke survivors (n = 38); two focus groups involving six carers each; two focus groups, respectively, involving seven and eight stroke rehabilitation physiotherapists from clinical and community settings. Data were audio-recorded and transcribed. Analysis was structured using the Framework Approach to identify themes and a dynamic, conceptual model. Desired outcomes and control over outcome achievement were key concepts. For survivors and carers, PA supported participation in valued activities, providing continuity with pre-stroke sense of self. Carers adopted motivating strategies for PA to support recovery and participation in shared activities. In contrast, physiotherapists prioritised physical and functional outcomes and viewed survivors' control of outcomes as limited which was reflected by the support they provided. Individualised interventions that account for social and environmental influences on behaviour appear vital to enabling survivors to participate in meaningful physical activities. Such interventions should facilitate development of shared perspectives among physiotherapists, carers and survivors of PA and related outcomes and provide tailored strategies to facilitate PA participation. Implications for Rehabilitation Physical activity after stroke rehabilitation is important for fitness, health, functioning and well-being. Reasons for survivors participating or not in physical activity after stroke are complex and varied. Physiotherapists and carers influence survivors' participation in physical activity but their views about how to do this do not always match, or do they always complement the views of survivors. Integrated

Teaching Intensive Interaction to Paid Carers: Using the "Communities of Practice" Model to Inform Training

Science.gov (United States)

Rayner, Kelly; Bradley, Samantha; Johnson, Gemma; Mrozik, Jennifer H.; Appiah, Afua; Nagra, Maninder K.

2016-01-01

The engagement of people with learning disabilities in social communication is crucial to the development of relationships with others, a sense of social inclusion and self-worth. Intensive Interaction is an approach that can help carers develop their skills to engage people with severe and profound learning disabilities in personally relevant…

Quantum mechanics and hidden superconformal symmetry

Science.gov (United States)

Bonezzi, R.; Corradini, O.; Latini, E.; Waldron, A.

2017-12-01

Solvability of the ubiquitous quantum harmonic oscillator relies on a spectrum generating osp (1 |2 ) superconformal symmetry. We study the problem of constructing all quantum mechanical models with a hidden osp (1 |2 ) symmetry on a given space of states. This problem stems from interacting higher spin models coupled to gravity. In one dimension, we show that the solution to this problem is the Vasiliev-Plyushchay family of quantum mechanical models with hidden superconformal symmetry obtained by viewing the harmonic oscillator as a one dimensional Dirac system, so that Grassmann parity equals wave function parity. These models—both oscillator and particlelike—realize all possible unitary irreducible representations of osp (1 |2 ).

Hidden simplicity of gauge theory amplitudes

Energy Technology Data Exchange (ETDEWEB)

Drummond, J M, E-mail: drummond@lapp.in2p3.f [LAPTH, Universite de Savoie, CNRS, B.P. 110, F-74941 Annecy-le-Vieux, Cedex (France)

2010-11-07

These notes were given as lectures at the CERN Winter School on Supergravity, Strings and Gauge Theory 2010. We describe the structure of scattering amplitudes in gauge theories, focussing on the maximally supersymmetric theory to highlight the hidden symmetries which appear. Using the Britto, Cachzo, Feng and Witten (BCFW) recursion relations we solve the tree-level S-matrix in N=4 super Yang-Mills theory and describe how it produces a sum of invariants of a large symmetry algebra. We review amplitudes in the planar theory beyond tree level, describing the connection between amplitudes and Wilson loops, and discuss the implications of the hidden symmetries.

Guilt, shame and expressed emotion in carers of people with long-term mental health difficulties: A systematic review.

Science.gov (United States)

Cherry, Mary Gemma; Taylor, Peter James; Brown, Stephen Lloyd; Rigby, Jake Wilfred; Sellwood, William

2017-03-01

Expressed emotion (EE) is a global index of familial emotional climate, whose primary components are emotional over-involvement (EOI) and critical comments (CC)/hostility. There is a strong theoretical rationale for hypothesising that carers' guilt and shame may be differentially associated with their EOI and CC/hostility respectively. This systematic review investigates the magnitude of these theorised associations in carers of people with long-term mental health difficulties. Electronic searches (conducted in May 2016 across Medline, CINAHL, Embase, PsycINFO and ProQuest) were supplemented with iterative hand searches. Ten papers, reporting data from eight studies, were included. Risk of bias was assessed using a standardised checklist. Relevant data were extracted and synthesised narratively. EOI was positively associated with both guilt and shame, whereas CC/hostility was positively associated with shame. The strength of associations varied depending on whether or not guilt and shame were assessed within the context of the caring relationship. Based on these data, an argument can be made for the refinement, development and evaluation of systemic and individual interventions designed to target carers' guilt and shame. However, more research is needed to clarify the strength of these associations and their direction of effect before firm conclusions can be drawn. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Update on hidden sectors with dark forces and dark matter

Energy Technology Data Exchange (ETDEWEB)

Andreas, Sarah

2012-11-15

Recently there has been much interest in hidden sectors, especially in the context of dark matter and ''dark forces'', since they are a common feature of beyond standard model scenarios like string theory and SUSY and additionally exhibit interesting phenomenological aspects. Various laboratory experiments place limits on the so-called hidden photon and continuously further probe and constrain the parameter space; an updated overview is presented here. Furthermore, for several hidden sector models with light dark matter we study the viability with respect to the relic abundance and direct detection experiments.

Searching for hidden sectors in multiparticle production at the LHC

CERN Document Server

Sanchis-Lozano, Miguel-Angel; Moreno-Picot, Salvador

2016-01-01

We study the impact of a hidden sector beyond the Standard Model, e.g. a Hidden Valley model, on factorial moments and cumulants of multiplicity distributions in multiparticle production with a special emphasis on the prospects for LHC results.

Using intervention mapping for the development of a targeted secure web-based outreach strategy named SafeFriend, for Chlamydia trachomatis testing in young people at risk.

Science.gov (United States)

Theunissen, Kevin A T M; Hoebe, Christian J P A; Crutzen, Rik; Kara-Zaïtri, Chakib; de Vries, Nanne K; van Bergen, Jan E A M; van der Sande, Marianne A B; Dukers-Muijrers, Nicole H T M

2013-10-22

Many young people at high risk for Chlamydia trachomatis (Ct) are not reached by current sexual health care systems, such as general practitioners and public sexual health care centres (sexually transmitted infection clinics).Ct is the most frequently diagnosed bacterial sexually transmitted infection (STI) among sexually active people and in particular young heterosexuals. Innovative screening strategies are needed to interrupt the transmission of Ct among young people and connect the hidden cases to care. Intervention Mapping (IM), a systematic approach to develop theory- and evidence-based interventions, was used to develop a strategy to target Ct testing towards young people who are currently hidden to care in The Netherlands. Both clinical users (i.e. sexual health care nurses) and public users (i.e., young people at risk for Ct) were closely involved in the IM process. A needs assessment study was carried out using semi-structured interviews among users (N = 21), a literature search and by taking lessons learned from existing screening programmes. Theoretical methods and practical applications to reach high risk young people and influence testing were selected and translated into specific programme components. The IM approach resulted in the development of a secure and web-based outreach Ct screening strategy, named SafeFriend. It is developed to target groups of high-risk young people who are currently hidden to care. Key methods include web-based Respondent Driven Sampling, starting from young Ct positive sexual health care centre clients, to reach and motivate peers (i.e., sex partners and friends) to get tested for Ct. Testing and the motivation of peers were proposed as the desired behavioural outcomes and the Precaution Adoption Process Model was chosen as theoretical framework. End users, i.e., young people and sexual health care nurses were interviewed and included in the development process to increase the success of implementation. IM proved useful

Secret Codes: The Hidden Curriculum of Semantic Web Technologies

Science.gov (United States)

Edwards, Richard; Carmichael, Patrick

2012-01-01

There is a long tradition in education of examination of the hidden curriculum, those elements which are implicit or tacit to the formal goals of education. This article draws upon that tradition to open up for investigation the hidden curriculum and assumptions about students and knowledge that are embedded in the coding undertaken to facilitate…

More than what the eye can see: the emotional journey and experience of powerlessness of integrated care service users and their carers

Directory of Open Access Journals (Sweden)

Boudioni M

2015-03-01

Full Text Available Markella Boudioni,1 Nina Hallett,2 Cristina Lora,2 Wendy Couchman2 1Patient Experience Research Centre (PERC and NIHR Imperial Biomedical Research Centre (BRC, Imperial College London, 2Faculty of Health and Social Care, London South Bank University, London, UK Purpose: This article presents the emotional journey and experience of powerlessness of integrated care service users and carers.  Materials and methods: The experiences of seven integrated care service users and carers affected by complex conditions in a London borough were captured as video stories. The integrated care service coordinated a system of health and social care: primary care, community matrons, social workers, and the voluntary sector. The service was designed to respond to identified cases of high-risk individuals with long-term, multiple, and age-related conditions needing preventive interventions. The video stories were analyzed by researchers in collaboration with service users using a visual thematic qualitative approach. This report is part of an independent analysis of the integrated care service evaluation that used the experience-based codesign model.  Results: The findings are presented in the respective contexts of people with complex conditions and their carers. The overwhelming feelings and emotions of both were loss of control and power throughout their emotional journey, with family carers adopting a protective attitude toward the patients. Their experience of powerlessness was variable throughout their emotional journey. They were affected more strongly when in need of extra help and support and while they were undergoing the process of receiving extra services. When they were receiving help and support outside and within hospitals, some participants were empowered, gaining skills and knowledge by being provided with the mechanisms to cope with their condition at present and in the future.  Conclusion: Feelings of powerlessness were very common among

Issues in caregiving for older people with intellectual disabilities and their ageing family carers: a review and commentary.

Science.gov (United States)

Ryan, Assumpta; Taggart, Laurence; Truesdale-Kennedy, Maria; Slevin, Eamonn

2014-09-01

In keeping with worldwide demographic changes and an ageing population, people with intellectual disabilities are living longer and all the evidence suggest that this trend will continue. This 'new' population of older people and their carers will pose challenges for health and social care providers. This paper presents a review of the literature on key issues influencing caregiving for older people with intellectual disabilities and their ageing family carers. The review was undertaken using a framework adapted from the NHS Centre for Reviews and Dissemination. Papers were identified through the use of databases including CINAHL, Science Direct, PsychoInfo, Blackwell Synergy, the Cochrane Library and MEDLINE. The key themes which emerged from the literature and which consequently form the basis of this review include: ageing family carers, future planning and support services. In the context of family caregiving, older people with intellectual disabilities represent a unique group insofar as they are unlikely to be married and therefore have no spouse or dependents to care for them in later life. As a result, parents (usually mothers) have to continue caring for their son or daughter with an intellectual disability as they both grow older, often resulting in a mutually dependent relationship. The caregiving situation is further complicated by poor emergency and future planning and by a lack of appropriate services for this group of individuals. In light of the emergence of a 'new' population of older people with intellectual disabilities, there is an urgent need to develop services and support structures which will enable these individuals and their ageing carers to 'age in place' and when this is no longer possible, to have appropriate alternatives that recognise the duality of their needs as older people and as people with intellectual disabilities. Opportunities for supervision could be one way to increase individuals' awareness of their own role in the team. �

Using computers to enable self-management of aphasia therapy exercises for word finding: the patient and carer perspective.

Science.gov (United States)

Palmer, Rebecca; Enderby, Pam; Paterson, Gail

2013-01-01

Speech and language therapy (SLT) for aphasia can be difficult to access in the later stages of stroke recovery, despite evidence of continued improvement with sufficient therapeutic intensity. Computerized aphasia therapy has been reported to be useful for independent language practice, providing new opportunities for continued rehabilitation. The success of this option depends on its acceptability to patients and carers. To investigate factors that affect the acceptability of independent home computerized aphasia therapy practice. An acceptability study of computerized therapy was carried out alongside a pilot randomized controlled trial of computer aphasia therapy versus usual care for people more than 6 months post-stroke. Following language assessment and computer exercise prescription by a speech and language therapist, participants practised three times a week for 5 months at home with monthly volunteer support. Semi-structured interviews were conducted with 14 participants who received the intervention and ten carers (n = 24). Questions from a topic guide were presented and answered using picture, gesture and written support. Interviews were audio recorded, transcribed verbatim and analysed thematically. Three research SLTs identified and cross-checked themes and subthemes emerging from the data. The key themes that emerged were benefits and disadvantages of computerized aphasia therapy, need for help and support, and comparisons with face-to-face therapy. The independence, flexibility and repetition afforded by the computer was viewed as beneficial and the personalized exercises motivated participants to practise. Participants and carers perceived improvements in word-finding and confidence-talking. Computer practice could cause fatigue and interference with other commitments. Support from carers or volunteers for motivation and technical assistance was seen as important. Although some participants preferred face-to-face therapy, using a computer for

State-space dimensionality in short-memory hidden-variable theories

International Nuclear Information System (INIS)

Montina, Alberto

2011-01-01

Recently we have presented a hidden-variable model of measurements for a qubit where the hidden-variable state-space dimension is one-half the quantum-state manifold dimension. The absence of a short memory (Markov) dynamics is the price paid for this dimensional reduction. The conflict between having the Markov property and achieving the dimensional reduction was proved by Montina [A. Montina, Phys. Rev. A 77, 022104 (2008)] using an additional hypothesis of trajectory relaxation. Here we analyze in more detail this hypothesis introducing the concept of invertible process and report a proof that makes clearer the role played by the topology of the hidden-variable space. This is accomplished by requiring suitable properties of regularity of the conditional probability governing the dynamics. In the case of minimal dimension the set of continuous hidden variables is identified with an object living an N-dimensional Hilbert space whose dynamics is described by the Schroedinger equation. A method for generating the economical non-Markovian model for the qubit is also presented.

The banana [re]public: A study of trans/national popular culture consumption among young Chinese living in the Netherlands

NARCIS (Netherlands)

Chow, Y.F.

2011-01-01

Public discourses on the Dutch ‘multicultural drama’ have consistently omitted the Chinese. While other ethnic minorities, particularly the younger generations, continue to be framed and visualized in Dutch society as a problem, the young Chinese remain largely invisible, hidden by the dominant

Randomized controlled trial of a book-sharing intervention in a deprived South African community: effects on carer-infant interactions, and their relation to infant cognitive and socio-emotional outcome

Science.gov (United States)

Murray, Lynne; De Pascalis, Leonardo; Tomlinson, Mark; Vally, Zahir; Dadomo, Harold; MacLachlan, Brenda; Woodward, Charlotte; Cooper, Peter J.

2017-01-01

Background Consistent with evidence from high income countries, we previously showed that, in an informal peri-urban settlement in a low-middle income country, training parents in book-sharing with their infants benefitted infant language and attention (Vally et al., 2015). Here, we investigated whether these benefits were explained by improvements in carer-infant interactions in both book-sharing and non-book-sharing contexts. We also explored whether infant socio-emotional development benefitted from book-sharing. Methods We conducted a randomized controlled trial in Khayelitsha, South Africa. Carers of 14–16 month-old infants were randomized to 8 weeks’ training in book-sharing (n = 49) or a wait list control group (n = 42). In addition to the cognitive measures reported previously, independent assessments were made at base line and follow-up of carer-infant interactions during book-sharing and toy play. Assessments were also made, at follow-up only, of infant pro-social behaviour in a ‘help task’, and of infant imitation of doll characters’ non-social actions and an interpersonal interaction. Eighty-two carer-infant pairs (90%) were assessed at follow-up. (Trial registration ISRCTN39953901). Results Carers who received the training showed significant improvements in book-sharing interactions (sensitivity, elaborations, reciprocity), and, to a smaller extent, in toy-play interactions (sensitivity). Infants in the intervention group showed a significantly higher rate of pro-social behaviour, and tended to show more frequent imitation of the interpersonal interaction. Improvements in carer behaviour during book-sharing, but not during toy play, mediated intervention effects on all infant cognitive outcomes, and tended to mediate intervention effects on infant interpersonal imitation. Conclusions Training in book sharing, a simple, inexpensive intervention that has been shown to benefit infant cognitive development in a low-middle income country, also

Introducing an electronic Palliative Care Summary (ePCS) in Scotland: patient, carer and professional perspectives.

Science.gov (United States)

Hall, Susan; Murchie, Peter; Campbell, Christine; Murray, Scott A

2012-10-01

An electronic Palliative Care Summary (ePCS) is currently being implemented throughout Scotland to provide out-of-hours (OOH) staff with up-to-date summaries of medical history, patient understanding and wishes, medications and decisions regarding treatment of patients requiring palliative care: automatic twice daily updates of information from GP records to a central electronic repository are available to OOH services. To identify key issues related to the introduction of ePCS from primary care and OOH staff, to identify facilitators and barriers to their use, to explore the experiences of patients and carers and to make recommendations for improvements. Twenty-two semi-structured interviews were carried out with a purposive sample of health professionals [practice nurses (3 interviews), GPs (12 interviews), a practice manager (1 interview) from practices using different computing software systems] and patients and/or carers (6 interviews for whom an ePCS had been completed). Interviews were digitally recorded, transcribed and analysed thematically. Patients and carers were reassured that OOH staff were informed about their current circumstances. OOH staff considered the ePCS allowed them to be better informed in decision making and in carrying out home visits. GPs viewed the introduction of ePCSs to have benefits for in-hours structures of care including advance care planning. No interviewee expressed concern about confidentiality. Barriers raised related to the introduction of new technology including unfamiliarity with the process, limited time and information technology skills. The ePCS has clear potential to improve patient care although several implementation issues and technical problems require to be addressed first to enable this. GPs and community nurses should identify more patients with malignant and non-malignant illnesses for completion of the ePCS.

Dopamine reward prediction errors reflect hidden state inference across time

Science.gov (United States)

Starkweather, Clara Kwon; Babayan, Benedicte M.; Uchida, Naoshige; Gershman, Samuel J.

2017-01-01

Midbrain dopamine neurons signal reward prediction error (RPE), or actual minus expected reward. The temporal difference (TD) learning model has been a cornerstone in understanding how dopamine RPEs could drive associative learning. Classically, TD learning imparts value to features that serially track elapsed time relative to observable stimuli. In the real world, however, sensory stimuli provide ambiguous information about the hidden state of the environment, leading to the proposal that TD learning might instead compute a value signal based on an inferred distribution of hidden states (a ‘belief state’). In this work, we asked whether dopaminergic signaling supports a TD learning framework that operates over hidden states. We found that dopamine signaling exhibited a striking difference between two tasks that differed only with respect to whether reward was delivered deterministically. Our results favor an associative learning rule that combines cached values with hidden state inference. PMID:28263301

Higher-dimensional black holes: hidden symmetries and separation of variables

International Nuclear Information System (INIS)

Frolov, Valeri P; Kubiznak, David

2008-01-01

In this paper, we discuss hidden symmetries in rotating black hole spacetimes. We start with an extended introduction which mainly summarizes results on hidden symmetries in four dimensions and introduces Killing and Killing-Yano tensors, objects responsible for hidden symmetries. We also demonstrate how starting with a principal CKY tensor (that is a closed non-degenerate conformal Killing-Yano 2-form) in 4D flat spacetime one can 'generate' the 4D Kerr-NUT-(A)dS solution and its hidden symmetries. After this we consider higher-dimensional Kerr-NUT-(A)dS metrics and demonstrate that they possess a principal CKY tensor which allows one to generate the whole tower of Killing-Yano and Killing tensors. These symmetries imply complete integrability of geodesic equations and complete separation of variables for the Hamilton-Jacobi, Klein-Gordon and Dirac equations in the general Kerr-NUT-(A)dS metrics

Tracking an Elusive Population: Family Carers of Older Adults with Intellectual Disabilities in Romandy (Switzerland)

Science.gov (United States)

Jecker-Parvex, Maurice; Breitenbach, Nancy

2012-01-01

Despite a long-standing tradition of institutional placement in Switzerland, many older adults with intellectual disabilities continue to be supported by aging parents and siblings. For various reasons, these carers and the adults concerned have been overlooked up to now. To find out how many such families are providing housing and care of this…

Extended abstract of a hidden agenda

Energy Technology Data Exchange (ETDEWEB)

Goguen, J.; Malcolm, G. [Oxford Univ. (United Kingdom)

1996-12-31

The initial goal of our hidden research programme was both straightforward and ambitious: give a semantics for software engineering, and in particular for the object paradigm, supporting correctness proofs that are as simple and mechanical as possible. This emphasizes proofs rather than models, and thus suggests an equational approach, rather than one based on higher order logic, denotational semantics, or any kind of model, because equational proofs achieve maximal simplicity and mechanization, and yet are fully expressive. We introduce powerful coinduction techniques for proving behavioral properties of complex systems. We make the no doubt outrageous claim that our hidden approach gives simpler proofs than other formalisms; this is because we exploit algebraic structure that most other approaches discard.

How can web-based training facilitate a more carer friendly practice in community-based health and social care services in Norway? Staff experiences and implementation challenges.

Science.gov (United States)

Hanssen, Helene; Norheim, Anne; Hanson, Elizabeth

2017-03-01

It is a central feature of current Norwegian health and social care policy to see informal carers as active partners. However, research has revealed that carers often experience a lack of recognition by professionals. In 2010, the Norwegian Directorate of Health initiated a web-based competence-building programme (CBP) for health and social care practitioners aimed at facilitating collaboration with carers. The programme comprised case presentations, e-lectures, exercises and topics for discussion, and was introduced in 2012. It was flexible and free of charge. This article is based on a study (2012-2013) that followed the piloting of this CBP in four settings. The study aimed to explore factors that influenced the implementation of the programme and whether or not using it affected health and social care practitioners' attitudes and perceived capacity for collaboration with carers. The study employed a mixed-methods design. A questionnaire was distributed to all staff before and 5 months after the CBP was introduced, followed by focus group interviews with a sample of staff members and individual interviews with the leadership in the involved settings and those who introduced the programme. The quantitative data were analysed using descriptive statistics, which subsequently formed the basis for the focus group interviews. The qualitative data were analysed by means of content analysis. The programme's introduction was similar across all research settings. Nevertheless, whether or not it was adopted depended to a large extent on leadership commitment and engagement. In settings where the programme's use was monitored, supported by management and formed part of on-the-job training, there seemed to be a positive impact on staff attitudes concerning collaboration with carers. Participant staff reported that their awareness of, motivation for and confidence in collaboration with carers were all strengthened. In contrast, the programme was of minimal benefit in

The structural influence of family and parenting on young people's sexual and reproductive health in rural northern Tanzania.

Science.gov (United States)

Wamoyi, Joyce; Wight, Daniel; Remes, Pieter

2015-01-01

This paper explores the structural role of the family and parenting in young people's sexual and reproductive health. The study involved eight weeks of participant observation, 26 in-depth interviews, and 11 group discussions with young people aged 14-24 years, and 20 in-depth interviews and 6 group discussions with parents/carers of children in this age group. At an individual level, parenting and family structure were found to affect young people's sexual behaviour by influencing children's self-confidence and interactional competence, limiting discussion of sexual health and shaping economic provision for children, which in turn affected parental authority and daughters' engagement in risky sexual behaviour. Sexual norms are reproduced both through parents' explicit prohibitions and their own behaviours. Girls are socialised to accept men's superiority, which shapes their negotiation of sexual relationships. Interventions to improve young people's sexual and reproductive health should recognise the structural effects of parenting, both in terms of direct influences on children and the dynamics by which structural barriers such as gendered power relations and cultural norms around sexuality are transmitted across generations.

The impact of volunteering on the volunteer: findings from a peer support programme for family carers of people with dementia.

Science.gov (United States)

Charlesworth, Georgina; Sinclair, James B; Brooks, Alice; Sullivan, Theresa; Ahmad, Shaheen; Poland, Fiona

2017-03-01

With an ageing population, there are increasing numbers of experienced family carers (FCs) who could provide peer support to newer carers in a similar care situation. The aims of this paper are to: (i) use a cross-sectional study design to compare characteristics of volunteers and recipients of a peer support programme for FCs of people with dementia, in terms of demographic background, social networks and psychological well-being; and (ii) use a longitudinal study design to explore the overall impact of the programme on the volunteers in terms of psychological well-being. Data were collected from programmes run in Norfolk, Northamptonshire, Berkshire and four London boroughs between October 2009 and March 2013. The volunteer role entailed empathic listening and encouragement over a 10-month period. Both carer support volunteers (N = 87) and recipient FCs (N = 109) provided baseline demographic information. Data on social networks, personal growth, self-efficacy, service use and well-being (SF-12; EuroQol Visual Analogue Scale; Hospital Anxiety and Depression Scale; Control, Autonomy, Self-Realisation, Pleasure-19) were collected prior to the start of the intervention (N = 43) and at either 3- to 5 month or 10 month follow-up (N = 21). Volunteers were more likely than recipients of support to be female and to have cared for a parent/grandparent rather than spouse. Volunteers were also more psychologically well than support recipients in terms of personal growth, depression and perceived well-being. The longitudinal analysis identified small but significant declines in personal growth and autonomy and a positive correlation between the volunteers' duration of involvement and perceived well-being. These findings suggest that carers who volunteer for emotional support roles are resilient and are at little psychological risk from volunteering. © 2016 John Wiley & Sons Ltd.

Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study.

Science.gov (United States)

Hsu, Ming Hung; Flowerdew, Rosamund; Parker, Michael; Fachner, Jörg; Odell-Miller, Helen

2015-07-18

Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients' care. This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes. 17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The cluster randomised, controlled trial included baseline, 3-month, 5-month and post-intervention 7-month measures of residents' symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers' feedback through semi-structured interviews, programme evaluations and track records of the study. The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p = 0.006]) and in levels of wellbeing (-0.74, 95 % CI: [-1.15 to -0.33; p = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme. The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size. Clinicaltrials.gov, number NCT01744600.

Photoacoustic imaging of hidden dental caries by using a fiber-based probing system

Science.gov (United States)

Koyama, Takuya; Kakino, Satoko; Matsuura, Yuji

2017-04-01

Photoacoustic method to detect hidden dental caries is proposed. It was found that high frequency ultrasonic waves are generated from hidden carious part when radiating laser light to occlusal surface of model tooth. By making a map of intensity of these high frequency components, photoacoustic images of hidden caries were successfully obtained. A photoacoustic imaging system using a bundle of hollow optical fiber was fabricated for using clinical application, and clear photoacoustic image of hidden caries was also obtained by this system.

A hidden history

OpenAIRE

Peppers, Emily

2008-01-01

The Cultural Collections Audit project began at the University of Edinburgh in 2004, searching for hidden treasures in its 'distributed heritage collections' across the university. The objects and collections recorded in the Audit ranged widely from fine art and furniture to historical scientific and teaching equipment and personalia relating to key figures in the university's long tradition of academic excellence. This information was gathered in order to create a central database of informa...

Repercusión de la demencia en los cuidadores primordiales del policlínico "Ana Betancourt" Repercussion of dementia in the fundamental carers of "Ana Betancourt" Polyclinic

Directory of Open Access Journals (Sweden)

Víctor T. Pérez Martínez

2010-06-01

Full Text Available Introducción: la demencia senil es reconocida actualmente como una entidad mayor en el orden socioeconómico, geriátrico, psiquiátrico y epidemiológico. Su atención representa un elevado costo emocional y económico para el paciente, la familia y el cuidador primordial. Objetivos: describir la repercusión psicosocial del síndrome demencial en los cuidadores primordiales del policlínico "Ana Betancourt". Métodos: se realizó un estudio descriptivo de corte transversal, durante el primer cuatrimestre del año 2009, en el policlínico "Ana Betancourt" del municipio Playa. Incluyó a 36 cuidadores de igual número de pacientes diagnosticados con demencia y enfermedad de Alzheimer, escogidos mediante muestreo por criterios. Resultados: los cuidadores primordiales eran en su mayoría féminas, hijas del paciente, en la quinta década de la vida, amas de casa, divorciadas y con un nivel de escolaridad de preuniversitario. El principal motivo de consulta de los cuidadores fue solicitar ayuda profesional para controlar los síntomas no cognitivos de la enfermedad. El cuidador dedica alrededor de 13 h diarias al cuidado del paciente que sufre de demencia, la mayor parte en la supervisión y vigilancia. Se encontró marcada afectación psicológica en el 64 % de los cuidadores. El nivel de sobrecarga o estrés en la población de cuidadores estudiada resultó elevado. Conclusiones: el cuidado del paciente que sufre de demencia se asocia a una sobrecarga y estrés relevantes que se expresa en la elevada morbilidad psicológica constatada en los cuidadores primordiales. Se recomienda diseñar un plan de intervención educativa dirigido a estos cuidadores para reducir la sobrecarga o estrés crónico que sufren.Introduction: senile dementia is nowadays recognized as a major entity in socioeconomic, geriatric, psychiatric and epidemiologic order. Its care represents a high emotional and economic cost for patient, family and fundamental carer

Acceptability of the Distress Thermometer and Problem List to community-based telephone cancer helpline operators, and to cancer patients and carers

Directory of Open Access Journals (Sweden)

Sargeant Hilary

2011-01-01

Full Text Available Abstract Background Cancer can be a distressing experience for cancer patients and carers, impacting on psychological, social, physical and spiritual functioning. However, health professionals often fail to detect distress in their patients due to time constraints and a lack of experience. Also, with the focus on the patient, carer needs are often overlooked. This study investigated the acceptability of brief distress screening with the Distress Thermometer (DT and Problem List (PL to operators of a community-based telephone helpline, as well as to cancer patients and carers calling the service. Methods Operators (n = 18 monitored usage of the DT and PL with callers (cancer patients/carers, >18 years, and English-speaking from September-December 2006 (n = 666. The DT is a single item, 11-point scale to rate level of distress. The associated PL identifies the cause of distress. Results The DT and PL were used on 90% of eligible callers, most providing valid responses. Benefits included having an objective, structured and consistent means for distress screening and triage to supportive care services. Reported challenges included apparent inappropriateness of the tools due to the nature of the call or level of caller distress, the DT numeric scale, and the level of operator training. Conclusions We observed positive outcomes to using the DT and PL, although operators reported some challenges. Overcoming these challenges may improve distress screening particularly by less experienced clinicians, and further development of the PL items and DT scale may assist with administration. The DT and PL allow clinicians to direct/prioritise interventions or referrals, although ongoing training and support is critical in distress screening.

Are informal carers and community care workers effective in managing malnutrition in the older adult community? A systematic review of current evidence.

Science.gov (United States)

Marshall, S; Bauer, J; Capra, S; Isenring, E

2013-01-01

Enhancing the effectiveness of the community and aged care workforce to prevent malnutrition and functional decline is important in reducing hospital and aged care facility demand. To investigate the impact of nutrition-related interventions delivered to or by informal carers and non-clinical community care workers on malnutrition-related health outcomes of community-dwelling older adults (≥65 years). Intervention studies were searched for using six electronic databases for English-language publications from January 1980 to 30 May 2012. Nine studies were eligible for inclusion. The strength and quality of the evidence was moderate (six studies with level II intervention evidence, five with positive quality). Types of interventions used were highly varied. The majority of interventions were delivered to informal carers (6 studies), with three of these studies also involving older adult care recipients. Five interventions were targeted at identifying, preventing and/or treating malnutrition specifically (two positive quality, three neutral quality, n=2368). As a result of these interventions, nutritional status improved or stabilized (two positive quality, two neutral quality, n=2333). No study reported an improvement in functional status but two successfully prevented further decline in their participants (two neutral quality, n=1097). Interventions targeted at identifying, preventing and/or treating malnutrition were able to improve or prevent decline in nutritional and functional status, without increasing informal carer burden. The findings of this review support the involvement of non-clinical community care workers and informal carers as part of the nutritional care team for community-dwelling older adults.

Life imitating art: depictions of the hidden curriculum in medical television programs.

Science.gov (United States)

Stanek, Agatha; Clarkin, Chantalle; Bould, M Dylan; Writer, Hilary; Doja, Asif

2015-09-26

The hidden curriculum represents influences occurring within the culture of medicine that indirectly alter medical professionals' interactions, beliefs and clinical practices throughout their training. One approach to increase medical student awareness of the hidden curriculum is to provide them with readily available examples of how it is enacted in medicine; as such the purpose of this study was to examine depictions of the hidden curriculum in popular medical television programs. One full season of ER, Grey's Anatomy and Scrubs were selected for review. A summative content analysis was performed to ascertain the presence of depictions of the hidden curriculum, as well as to record the type, frequency and quality of examples. A second reviewer also viewed a random selection of episodes from each series to establish coding reliability. The most prevalent themes across all television programs were: the hierarchical nature of medicine; challenges during transitional stages in medicine; the importance of role modeling; patient dehumanization; faking or overstating one's capabilities; unprofessionalism; the loss of idealism; and difficulties with work-life balance. The hidden curriculum is frequently depicted in popular medical television shows. These examples of the hidden curriculum could serve as a valuable teaching resource in undergraduate medical programs.

Rare Z boson decays to a hidden sector

Science.gov (United States)

Blinov, Nikita; Izaguirre, Eder; Shuve, Brian

2018-01-01

We demonstrate that rare decays of the Standard Model Z boson can be used to discover and characterize the nature of new hidden-sector particles. We propose new searches for these particles in soft, high-multiplicity leptonic final states at the Large Hadron Collider. The proposed searches are sensitive to low-mass particles produced in Z decays, and we argue that these striking signatures can shed light on the hidden-sector couplings and mechanism for mass generation.

The Consensus String Problem and the Complexity of Comparing Hidden Markov Models

DEFF Research Database (Denmark)

Lyngsø, Rune Bang; Pedersen, Christian Nørgaard Storm

2002-01-01

The basic theory of hidden Markov models was developed and applied to problems in speech recognition in the late 1960s, and has since then been applied to numerous problems, e.g. biological sequence analysis. Most applications of hidden Markov models are based on efficient algorithms for computing...... the probability of generating a given string, or computing the most likely path generating a given string. In this paper we consider the problem of computing the most likely string, or consensus string, generated by a given model, and its implications on the complexity of comparing hidden Markov models. We show...... that computing the consensus string, and approximating its probability within any constant factor, is NP-hard, and that the same holds for the closely related labeling problem for class hidden Markov models. Furthermore, we establish the NP-hardness of comparing two hidden Markov models under the L∞- and L1...

Cosmological abundance of the QCD axion coupled to hidden photons

Science.gov (United States)

Kitajima, Naoya; Sekiguchi, Toyokazu; Takahashi, Fuminobu

2018-06-01

We study the cosmological evolution of the QCD axion coupled to hidden photons. For a moderately strong coupling, the motion of the axion field leads to an explosive production of hidden photons by tachyonic instability. We use lattice simulations to evaluate the cosmological abundance of the QCD axion. In doing so, we incorporate the backreaction of the produced hidden photons on the axion dynamics, which becomes significant in the non-linear regime. We find that the axion abundance is suppressed by at most O (102) for the decay constant fa =1016GeV, compared to the case without the coupling. For a sufficiently large coupling, the motion of the QCD axion becomes strongly damped, and as a result, the axion abundance is enhanced. Our results show that the cosmological upper bound on the axion decay constant can be relaxed by a few hundred for a certain range of the coupling to hidden photons.

Development of Young Children's Understanding that the Recent Past Is Causally Bound to the Present.

Science.gov (United States)

Povinelli, Daniel J.; Landry, Anita M.; Theall, Laura A.; Clark, Britten R.; Castille, Conni M.

1999-01-01

Six experiments examined young children's understanding that very recent past events determine the present. Found that 4-year-olds, but not 3-year-olds, could locate a puppet they had observed being hidden either through a videotape or using a verbal analog of the task. When children observed 2 events in which they participated, only 5-year-olds…

From symptom onset to a diagnosis of amyotrophic lateral sclerosis/motor neuron disease (ALS/MND): experiences of people with ALS/MND and family carers - a qualitative study.

Science.gov (United States)

O'Brien, Mary R; Whitehead, Bridget; Jack, Barbara A; Mitchell, John Douglas

2011-03-01

Our objectives were to explore the personal perspectives of the diagnostic experience for people with ALS/MND and their family carers identifying issues that could impact positively or negatively on these experiences. We conducted a qualitative study with face-to-face interviews to capture experiences from 24 people with ALS/MND and 18 current family carers. Ten former family carers were also interviewed. The diagnostic experience was fraught with difficulties. There was failure to recognize the significance of some symptoms by patients, carers and primary and secondary care health professionals, which ultimately delayed diagnosis. Delivery of the diagnosis was frequently unsatisfactory despite international guidelines on the subject. Immediate post-diagnosis support often compared negatively to that provided for people with cancer. In conclusion, this study has identified a need for a more streamlined and empathetic diagnostic pathway for people with ALS/MND. Improvements to medical curricula are required to increase awareness of the condition and reduce the likelihood of diagnostic delays resulting from a failure to recognize the need for a neurological referral. Greater public awareness of the illness is also needed. Furthermore, delivery of the diagnosis should more closely adhere to established guidelines.

Oral health assessment and mouth care for children and young people receiving palliative care. Part two.

Science.gov (United States)

Sargeant, S; Chamley, C

2013-04-01

This is the second part of a two-part article on oral health assessment and mouth care for children and young people receiving palliative care. This article covers basic oral hygiene and management of oral health problems: oral candidiasis, coated tongue/dirty mouth, dry mouth, hypersalivation, ulceration, painful mouth, stomatitis and mucositis. The article also covers treating patients who are immunocompromised and the need to educate families and carers in the basic principles of oral care, including the importance of preventing cross-infection. Part one outlined oral assessment and discussed the adaptation of the Nottingham Oral Health Assessment Tool (Freer 2000).

Caring for independent lives: geographies of caring for young adults with intellectual disabilities.

Science.gov (United States)

Power, Andrew

2008-09-01

This paper engages with the emerging disciplinary clash between 'care' and 'independence' within disability studies by examining the geography of home care for young adults with intellectual disabilities. The care system as a whole is viewed as central to disablist structures within disability studies (see Thomas, C. (2007). Sociologies of disability and illness: Contested ideas in disability studies and medical sociology. Hampshire: Palgrave Macmillan.). However, despite the theorisation of dependency as being in antipathy to the goals of the disability movement, caregiving at home still continues to dominate community care. The paper attempts to address how family carers are 'caught-in-the-middle' between their 'duty' to care and at the same time, perpetuating dependency; the reality being that parents have to deal with issues of being overprotective and confronting various social assumptions about disability. It examines the narratives from 25 family caregivers in Ireland who provide personal assistance to young adults with intellectual disabilities.

Low-scale gravity mediation in warped extra dimension and collider phenomenology on hidden sector

International Nuclear Information System (INIS)

Itoh, H.; Okada, N.; Yamashita, T.

2007-01-01

We propose a new scenario of gravity-mediated supersymmetry breaking (gravity mediation) in a supersymmetric Randall-Sundrum model, where the gravity mediation takes place at a low scale due to the warped metric. We investigate collider phenomenology involving the hidden sector field, and find a possibility that the hidden sector field can be produced at the LHC and the ILC. The hidden sector may no longer be hidden. (author)

Coping strategies as mediators of the effect of the START (strategies for RelaTives) intervention on psychological morbidity for family carers of people with dementia in a randomised controlled trial.

Science.gov (United States)

Li, Ryan; Cooper, Claudia; Barber, Julie; Rapaport, Penny; Griffin, Mark; Livingston, Gill

2014-10-01

Family carers of people with dementia frequently become depressed or anxious. In observational studies, more emotion-focused and less dysfunctional coping predict fewer psychological symptoms, but no randomised controlled trial (RCT) has directly investigated emotion-focused coping as mediator of effectiveness of a successful psychological intervention. We hypothesised that emotion-focused coping would mediate the START psychological intervention׳s effects in an RCT. We tested whether mediated effects were moderated by severity of baseline symptoms. 260 family carers from NHS dementia services were randomised to START (manualised coping skills intervention), or treatment-as-usual (TAU). Blinded raters administered the Hospital Anxiety and Depression Scale (HADS-T) and Brief COPE inventory at baseline, 4 and 8 months. HADS-T improved in the intervention group when compared to TAU at all levels of psychological distress. We tested whether coping was a mediator and for moderated mediation, and (post-hoc) subgroup treatment effects on coping. Data were available for 187 carers (71.9%) for the mediation analysis. The reduced HADS-T score in the intervention group was mediated by increased emotion-focused coping only among carers with higher (16+) baseline HADS-T scores (mediated effect=-0.63 [-1.11, -0.15]; proportion of overall effect=33% [3%, 64%]). We did not measure plausible psychosocial treatment mechanisms other than coping. START benefited family carers both in preventing and treating psychological morbidity, through different mechanisms of action. The most psychologically distressed carers increased their emotion-focused coping and did not decrease their dysfunctional coping, while others benefited but not through this mechanism. Copyright © 2014 Elsevier B.V. All rights reserved.

An impossibility theorem for parameter independent hidden variable theories

Science.gov (United States)

Leegwater, Gijs

2016-05-01

Recently, Roger Colbeck and Renato Renner (C&R) have claimed that '[n]o extension of quantum theory can have improved predictive power' (Colbeck & Renner, 2011, 2012b). If correct, this is a spectacular impossibility theorem for hidden variable theories, which is more general than the theorems of Bell (1964) and Leggett (2003). Also, C&R have used their claim in attempt to prove that a system's quantum-mechanical wave function is in a one-to-one correspondence with its 'ontic' state (Colbeck & Renner, 2012a). C&R's claim essentially means that in any hidden variable theory that is compatible with quantum-mechanical predictions, probabilities of measurement outcomes are independent of these hidden variables. This makes such variables otiose. On closer inspection, however, the generality and validity of the claim can be contested. First, it is based on an assumption called 'Freedom of Choice'. As the name suggests, this assumption involves the independence of an experimenter's choice of measurement settings. But in the way C&R define this assumption, a no-signalling condition is surreptitiously presupposed, making the assumption less innocent than it sounds. When using this definition, any hidden variable theory violating parameter independence, such as Bohmian Mechanics, is immediately shown to be incompatible with quantum-mechanical predictions. Also, the argument of C&R is hard to follow and their mathematical derivation contains several gaps, some of which cannot be closed in the way they suggest. We shall show that these gaps can be filled. The issue with the 'Freedom of Choice' assumption can be circumvented by explicitly assuming parameter independence. This makes the result less general, but better founded. We then obtain an impossibility theorem for hidden variable theories satisfying parameter independence only. As stated above, such hidden variable theories are impossible in the sense that any supplemental variables have no bearing on outcome probabilities

Entry deterrence and hidden competition

NARCIS (Netherlands)

Lavrutich, Maria; Huisman, Kuno; Kort, Peter

This paper studies strategic investment behavior of firms facing an uncertain demand in a duopoly setting. Firms choose both investment timing and the capacity level while facing additional uncertainty about market participants, which is introduced via the concept of hidden competition. We focus on

Adaptive Partially Hidden Markov Models

DEFF Research Database (Denmark)

Forchhammer, Søren Otto; Rasmussen, Tage

1996-01-01

Partially Hidden Markov Models (PHMM) have recently been introduced. The transition and emission probabilities are conditioned on the past. In this report, the PHMM is extended with a multiple token version. The different versions of the PHMM are applied to bi-level image coding....

Applications of hidden symmetries to black hole physics

International Nuclear Information System (INIS)

Frolov, Valeri

2011-01-01

This work is a brief review of applications of hidden symmetries to black hole physics. Symmetry is one of the most important concepts of the science. In physics and mathematics the symmetry allows one to simplify a problem, and often to make it solvable. According to the Noether theorem symmetries are responsible for conservation laws. Besides evident (explicit) spacetime symmetries, responsible for conservation of energy, momentum, and angular momentum of a system, there also exist what is called hidden symmetries, which are connected with higher order in momentum integrals of motion. A remarkable fact is that black holes in four and higher dimensions always possess a set ('tower') of explicit and hidden symmetries which make the equations of motion of particles and light completely integrable. The paper gives a general review of the recently obtained results. The main focus is on understanding why at all black holes have something (symmetry) to hide.

Peer support for family carers of people with dementia, alone or in combination with group reminiscence in a factorial design: study protocol for a randomised controlled trial

Directory of Open Access Journals (Sweden)

Wenborn Jennifer

2011-09-01

Full Text Available Abstract Background Peer support interventions can improve carer wellbeing and interventions that engage both the carer and person with dementia can have significant mutual benefits. Existing research has been criticised for inadequate rigour of design or reporting. This paper describes the protocol for a complex trial that evaluates one-to-one peer support and a group reminiscence programme, both separately and together, in a factorial design. Design A 2 × 2 factorial multi-site randomised controlled trial of individual peer support and group reminiscence interventions for family carers and people with dementia in community settings in England, addressing both effectiveness and cost-effectiveness. Discussion The methods described in this protocol have implications for research into psychosocial interventions, particularly complex interventions seeking to test both individual and group approaches. Trial Registration ISRCTN37956201

Physical and Psychological Health of Family Carers Co-Residing with an Adult Relative with an Intellectual Disability

Science.gov (United States)

Grey, Jillian M.; Totsika, Vasiliki; Hastings, Richard P.

2018-01-01

Background: Providing long-term care to an adult relative with intellectual disability can impact negatively on caregivers' health and well-being. Methods: Data were collected via online and postal questionnaires on 110 family carers' physical and psychological health, family stress and perceived positive gains from caring. Psychological…

Euthanasia and physician-assisted suicide in dementia: A qualitative study of the views of former dementia carers.

Science.gov (United States)

Tomlinson, Emily; Spector, Aimee; Nurock, Shirley; Stott, Joshua

2015-09-01

Despite media and academic interest on assisted dying in dementia, little is known of the views of those directly affected. This study explored the views of former carers on assisted dying in dementia. This was a qualitative study using thematic analysis. A total of 16 former carers of people with dementia were recruited through national dementia charities and participated in semi-structured interviews. While many supported the individual's right to die, the complexity of assisted dying in dementia was emphasized. Existential, physical, psychological and psychosocial aspects of suffering were identified as potential reasons to desire an assisted death. Most believed it would help to talk with a trained health professional if contemplating an assisted death. Health workers should be mindful of the holistic experience of dementia at the end of life. The psychological and existential aspects of suffering should be addressed, as well as relief of physical pain. Further research is required. © The Author(s) 2015.

Detecting Hidden Hierarchy of Non Hierarchical Terrorist Networks

DEFF Research Database (Denmark)

Memon, Nasrullah

measures (and combinations of them) to identify key players (important nodes) in terrorist networks. Our recently introduced techniques and algorithms (which are also implemented in the investigative data mining toolkit known as iMiner) will be particularly useful for law enforcement agencies that need...... to analyze terrorist networks and prioritize their targets. Applying recently introduced mathematical methods for constructing the hidden hierarchy of "nonhierarchical" terrorist networks; we present case studies of the terrorist attacks occurred / planned in the past, in order to identify hidden hierarchy...

A Web-Based Psychoeducational Intervention for Adolescent Depression: Design and Development of MoodHwb.

Science.gov (United States)

Bevan Jones, Rhys; Thapar, Anita; Rice, Frances; Beeching, Harriet; Cichosz, Rachel; Mars, Becky; Smith, Daniel J; Merry, Sally; Stallard, Paul; Jones, Ian; Thapar, Ajay K; Simpson, Sharon A

2018-02-15

Depression is common in adolescence and leads to distress and impairment in individuals, families and carers. Treatment and prevention guidelines highlight the key role of information and evidence-based psychosocial interventions not only for individuals but also for their families and carers. Engaging young people in prevention and early intervention programs is a challenge, and early treatment and prevention of adolescent depression is a major public health concern. There has been growing interest in psychoeducational interventions to provide accurate information about health issues and to enhance and develop self-management skills. However, for adolescents with, or at high risk of depression, there is a lack of engaging Web-based psychoeducation programs that have been developed with user input and in line with research guidelines and targeted at both the individual and their family or carer. There are also few studies published on the process of development of Web-based psychoeducational interventions. The aim of this study was to describe the process underlying the design and development of MoodHwb (HwbHwyliau in Welsh): a Web-based psychoeducation multimedia program for young people with, or at high risk of, depression and their families, carers, friends, and professionals. The initial prototype was informed by (1) a systematic review of psychoeducational interventions for adolescent depression; (2) findings from semistructured interviews and focus groups conducted with adolescents (with depressive symptoms or at high risk), parents or carers, and professionals working with young people; and (3) workshops and discussions with a multimedia company and experts (in clinical, research, and multimedia work). Twelve interviews were completed (four each with young people, parents or carers, and professionals) and six focus groups (three with young people, one with parents and carers, one with professionals, and one with academics). Key themes from the interviews and

Communication and context are important to Indigenous children with physical disability and their carers at a community-based physiotherapy service: a qualitative study.

Science.gov (United States)

Greenstein, Caroline; Lowell, Anne; Thomas, David

2016-01-01

What are the experiences of Indigenous children with physical disability and their carers of their community-based physiotherapy service? What factors influence their experiences of the physiotherapy service and how could the service be improved? A qualitative study using in-depth, semi-structured open-ended interviews consistent with the researchers' interpretivist perspectives and ethical principles of Indigenous health research. Interviews were audio recorded, transcribed and coded for themes with qualitative research software using inductive analysis. The interviews were then checked for transcription accuracy and the themes were confirmed with the participants. Nine parents and foster carers of children with physical disability aged 0 to 21 years, five children and youth with physical disability aged 8 to 21 years. The data generated three themes, which informed practice recommendations: carers of children with physical disability experience increased demands and complexity in their lives; relationships involving caring, consistency and communication are important to consumers using the physiotherapy service; and being Indigenous influences consumers' experiences in ways that may not be obvious to non-Indigenous service providers. The issue of communication underpinned the participants' experiences throughout these themes. The research highlighted the importance of effective communication, developing relationships, viewing the child wholistically and recognising the influence of being Indigenous on clients' healthcare needs and experiences. The results suggested that community-based physiotherapists adopt a family/person-centred, context-specific approach when working with Indigenous children with a physical disability and their carers. Copyright © 2015 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Signatures of a hidden cosmic microwave background.

Science.gov (United States)

Jaeckel, Joerg; Redondo, Javier; Ringwald, Andreas

2008-09-26

If there is a light Abelian gauge boson gamma' in the hidden sector its kinetic mixing with the photon can produce a hidden cosmic microwave background (HCMB). For meV masses, resonant oscillations gammagamma' happen after big bang nucleosynthesis (BBN) but before CMB decoupling, increasing the effective number of neutrinos Nnu(eff) and the baryon to photon ratio, and distorting the CMB blackbody spectrum. The agreement between BBN and CMB data provides new constraints. However, including Lyman-alpha data, Nnu(eff) > 3 is preferred. It is tempting to attribute this effect to the HCMB. The interesting parameter range will be tested in upcoming laboratory experiments.

Hidden inventory and safety considerations

International Nuclear Information System (INIS)

Anderson, A.R.; James, R.H.; Morgan, F.

1976-01-01

Preliminary results are described of the evaluation of residual plutonium in a process line used for the production of experimental fast reactor fuel. Initial attention has been focussed on a selection of work boxes used for processing powders and solutions. Amounts of material measured as ''hidden inventory'' are generally less than 0.1 percent of throughput but in one box containing very complex equipment the amount was exceptionally about 0.5 percent. The total surface area of the box and the installed equipment appears to be the most significant factor in determining the amount of plutonium held-up as ''hidden inventory,'' representing an average of about 4 x 10 -4 g cm -2 . Present results are based on gamma spectrometer measurements but neutron techniques are being developed to overcome some of the inherent uncertainties in the gamma method. It is suggested that the routine use of sample plates of known surface area would be valuable in monitoring the deposition of plutonium in work boxes

Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure.

Directory of Open Access Journals (Sweden)

Susan Browne

Full Text Available Those with advanced heart failure (HF experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care.Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30, carers (n = 20, and professionals (n = 65. Data analysed using Normalisation Process Theory (NPT as the underpinning conceptual framework.Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom.Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences could be improved to a large extent by

Hidden School Dropout among Immigrant Students: A Cross-Sectional Study

Science.gov (United States)

Makarova, Elena; Herzog, Walter

2013-01-01

Actual school dropout among immigrant youth has been addressed in a number of studies, but research on hidden school dropout among immigrant students is rare. Thus, the objective of this paper is to analyze hidden school dropout among primary school students with an immigrant background. The analyses were performed using survey data of 1186…

Self Stigma in People with Intellectual Disabilities and Courtesy Stigma in Family Carers: A Systematic Review

Science.gov (United States)

Ali, Afia; Hassiotis, Angela; Strydom, Andre; King, Michael

2012-01-01

People with intellectual disability are one of the most stigmatised groups in society. Despite this, research in this area has been limited. This paper provides a review of studies examining self stigma in people with intellectual disability, and courtesy and affiliate stigma in family carers. An electronic search of studies published between 1990…

WIMPless dark matter from non-Abelian hidden sectors with anomaly-mediated supersymmetry breaking

International Nuclear Information System (INIS)

Feng, Jonathan L.; Shadmi, Yael

2011-01-01

In anomaly-mediated supersymmetry breaking models, superpartner masses are proportional to couplings squared. Their hidden sectors therefore naturally contain WIMPless dark matter, particles whose thermal relic abundance is guaranteed to be of the correct size, even though they are not weakly interacting massive particles. We study viable dark matter candidates in WIMPless anomaly-mediated supersymmetry breaking models with non-Abelian hidden sectors and highlight unusual possibilities that emerge in even the simplest models. In one example with a pure SU(N) hidden sector, stable hidden gluinos freeze out with the correct relic density, but have an extremely low, but natural, confinement scale, providing a framework for self-interacting dark matter. In another simple scenario, hidden gluinos freeze out and decay to visible Winos with the correct relic density, and hidden glueballs may either be stable, providing a natural framework for mixed cold-hot dark matter, or may decay, yielding astrophysical signals. Last, we present a model with light hidden pions that may be tested with improved constraints on the number of nonrelativistic degrees of freedom. All of these scenarios are defined by a small number of parameters, are consistent with gauge coupling unification, preserve the beautiful connection between the weak scale and the observed dark matter relic density, and are natural, with relatively light visible superpartners. We conclude with comments on interesting future directions.

Caring for a Child with Autism Spectrum Disorder and Parents' Quality of Life: Application of the CarerQol

NARCIS (Netherlands)

R.J. Hoefman (Renske); N. Payakachat (Nalin); N.J.A. van Exel (Job); K.A. Kuhlthau (Karen); E.M. Kovacs (Erica); J.M. Pyne (Jeffrey); J.M. Tilford (John Mick)

2014-01-01

textabstractThis study describes the impact of caregiving on parents of children with autism spectrum disorders (ASDs). Secondly, we investigate construct validation of the care-related quality of life instrument (CarerQol) measuring impact of caregiving. Primary caregivers of children with ASDs

On the hidden maxwell superalgebra underlying D = 4 supergravity

Energy Technology Data Exchange (ETDEWEB)

Penafiel, D.M. [Departamento de Fisica, Universidad de Concepcion (Chile); DISAT, Politecnico di Torino (Italy); Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Torino (Italy); Ravera, L. [DISAT, Politecnico di Torino (Italy); Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Torino (Italy)

2017-09-15

In this work, we expand the hidden AdS-Lorentz superalgebra underlying D = 4 supergravity, reaching a (hidden) Maxwell superalgebra. The latter can be viewed as an extension involving cosmological constant of the superalgebra underlying D = 4 supergravity in flat spacetime. We write the Maurer-Cartan equations in this context and we find some interesting extensions of the antisymmetric 3-form A{sup (3)} appearing in the Free Differential Algebra in Minkowski space. The structure of Free Differential Algebras is obtained by considering the zero curvature equations. We write the parametrization of A{sup (3)} in terms of 1-forms and we rend the topological features of its extensions manifest. We interestingly find out that the structure of these extensions, and consequently the structure of the corresponding boundary contribution dA{sup (3)}, strongly depends on the form of the extra fermionic generator appearing in the hidden Maxwell superalgebra. The model we develop in this work is defined in an enlarged superspace with respect to the ordinary one, and the extra bosonic and fermionic 1-forms required for the closure of the hidden Maxwell superalgebra must be considered as physical fields in this enlarged superspace. (copyright 2017 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

Nurses' Perceptions of Their Relationships with Informal Carers in Institutional Respite Care for Older People

Directory of Open Access Journals (Sweden)

Sirpa Salin

2013-01-01

Full Text Available The purpose of this study was to describe nurses' experiences of their collaboration and relationships with family members in institutional respite care for the elderly. The family has a particularly important role in respite care, which is an extension of care provided at home. However no published studies were found on this subject. The data were collected through qualitative interviews (N=22. Content analysis of the nurses’ descriptions of their collaboration with family members yielded four main categories as follows: (1 conscious ignoring, (2 attempting to understand the family’s situation, (3 hinting at private family matters, and (4 being a friend. The results lend support to earlier findings which emphasize the complexity of relationships between nurses and family carers. A novel finding here is that these relationships may also develop into friendships. Greater emphasis must be placed on primary nursing so that the nurse and informal carer can build up a genuine relationship of trust. If periods of respite care are to help older people and their families to manage independently, it is imperative that nurses have the opportunity to visit their patients at home.

The Hidden Dimensions of Databases.

Science.gov (United States)

Jacso, Peter

1994-01-01

Discusses methods of evaluating commercial online databases and provides examples that illustrate their hidden dimensions. Topics addressed include size, including the number of records or the number of titles; the number of years covered; and the frequency of updates. Comparisons of Readers' Guide Abstracts and Magazine Article Summaries are…

Low-intensity interference effects and hidden-variable theories

Energy Technology Data Exchange (ETDEWEB)

Buonomano, V [Universidade Estadual de Campinas (Brazil). Inst. de Matematica

1978-05-11

The double-slit interference experiment and other similar experiments in the low-intensity limit (that is, one photon in the apparatus at a time) are examined in the spirit of Bell's work from the point of view of hidden-variable theories. It is found that there exists a class of hidden-variable theories which disagrees with quantum mechanics for a certain type of interference experiment. A manufactured conceptualization of this class, which is a particle view of interference, is described. An experiment, which appears to be feasible, is proposed to examine this disagreement.

Application of Hidden Markov Models in Biomolecular Simulations.

Science.gov (United States)

Shukla, Saurabh; Shamsi, Zahra; Moffett, Alexander S; Selvam, Balaji; Shukla, Diwakar

2017-01-01

Hidden Markov models (HMMs) provide a framework to analyze large trajectories of biomolecular simulation datasets. HMMs decompose the conformational space of a biological molecule into finite number of states that interconvert among each other with certain rates. HMMs simplify long timescale trajectories for human comprehension, and allow comparison of simulations with experimental data. In this chapter, we provide an overview of building HMMs for analyzing bimolecular simulation datasets. We demonstrate the procedure for building a Hidden Markov model for Met-enkephalin peptide simulation dataset and compare the timescales of the process.

Detecting Faults By Use Of Hidden Markov Models

Science.gov (United States)

Smyth, Padhraic J.

1995-01-01

Frequency of false alarms reduced. Faults in complicated dynamic system (e.g., antenna-aiming system, telecommunication network, or human heart) detected automatically by method of automated, continuous monitoring. Obtains time-series data by sampling multiple sensor outputs at discrete intervals of t and processes data via algorithm determining whether system in normal or faulty state. Algorithm implements, among other things, hidden first-order temporal Markov model of states of system. Mathematical model of dynamics of system not needed. Present method is "prior" method mentioned in "Improved Hidden-Markov-Model Method of Detecting Faults" (NPO-18982).

From the solar system fo hidden cosmic structures

Energy Technology Data Exchange (ETDEWEB)

Benes, K

1987-01-01

The development of experimental astrophysics showed that in the evolution of planets, natural processes of a common nature take place. They include, e.g., radiogenic heat, the production of magmas, volcanic activity, degassing, etc. The solar system is a cosmic formation in an advanced stage of development and it is a realistic assumption that in the Galaxy other hidden planetary systems in various stages of development exist. The views on the possibility of the origination of life in other systems differ; life, however, is seen as a hidden property of cosmic matter. (M.D.).

Search for hidden Higgs decay in ATLAS detector

International Nuclear Information System (INIS)

Gabrielli, A.

2013-01-01

In this paper, a brief overview of the search for the Higgs boson in Hidden Valley models is given. Hidden Valley models predict Higgs decays to neutral particles, which can be also long lived with decay paths comparable to the LHC detectors dimensions. Decay final states consist of collimated leptons (Lepton Jets). Results are presented of a search for Higgs decays to long lived particles in the ATLAS detector at the LHC, based on 1.92 fb −1 data collected during 2011 at a 7TeV center-of-mass energy.

Dissipative hidden sector dark matter

Science.gov (United States)

Foot, R.; Vagnozzi, S.

2015-01-01

A simple way of explaining dark matter without modifying known Standard Model physics is to require the existence of a hidden (dark) sector, which interacts with the visible one predominantly via gravity. We consider a hidden sector containing two stable particles charged under an unbroken U (1 )' gauge symmetry, hence featuring dissipative interactions. The massless gauge field associated with this symmetry, the dark photon, can interact via kinetic mixing with the ordinary photon. In fact, such an interaction of strength ε ˜10-9 appears to be necessary in order to explain galactic structure. We calculate the effect of this new physics on big bang nucleosynthesis and its contribution to the relativistic energy density at hydrogen recombination. We then examine the process of dark recombination, during which neutral dark states are formed, which is important for large-scale structure formation. Galactic structure is considered next, focusing on spiral and irregular galaxies. For these galaxies we modeled the dark matter halo (at the current epoch) as a dissipative plasma of dark matter particles, where the energy lost due to dissipation is compensated by the energy produced from ordinary supernovae (the core-collapse energy is transferred to the hidden sector via kinetic mixing induced processes in the supernova core). We find that such a dynamical halo model can reproduce several observed features of disk galaxies, including the cored density profile and the Tully-Fisher relation. We also discuss how elliptical and dwarf spheroidal galaxies could fit into this picture. Finally, these analyses are combined to set bounds on the parameter space of our model, which can serve as a guideline for future experimental searches.

Hidden twelve-dimensional super Poincare symmetry in eleven dimensions

International Nuclear Information System (INIS)

Bars, Itzhak; Deliduman, Cemsinan; Pasqua, Andrea; Zumino, Bruno

2004-01-01

First, we review a result in our previous paper, of how a ten-dimensional superparticle, taken off-shell, has a hidden eleven-dimensional super Poincare symmetry. Then, we show that the physical sector is defined by three first-class constraints which preserve the full eleven-dimensional symmetry. Applying the same concepts to the eleven-dimensional superparticle, taken off-shell, we discover a hidden twelve-dimensional super Poincare symmetry that governs the theory

Electroweak-charged bound states as LHC probes of hidden forces

Science.gov (United States)

Li, Lingfeng; Salvioni, Ennio; Tsai, Yuhsin; Zheng, Rui

2018-01-01

We explore the LHC reach on beyond-the-standard model (BSM) particles X associated with a new strong force in a hidden sector. We focus on the motivated scenario where the SM and hidden sectors are connected by fermionic mediators ψ+,0 that carry SM electroweak charges. The most promising signal is the Drell-Yan production of a ψ±ψ¯ 0 pair, which forms an electrically charged vector bound state ϒ± due to the hidden force and later undergoes resonant annihilation into W±X . We analyze this final state in detail in the cases where X is a real scalar ϕ that decays to b b ¯, or a dark photon γd that decays to dileptons. For prompt X decays, we show that the corresponding signatures can be efficiently probed by extending the existing ATLAS and CMS diboson searches to include heavy resonance decays into BSM particles. For long-lived X , we propose new searches where the requirement of a prompt hard lepton originating from the W boson ensures triggering and essentially removes any SM backgrounds. To illustrate the potential of our results, we interpret them within two explicit models that contain strong hidden forces and electroweak-charged mediators, namely λ -supersymmetry (SUSY) and non-SUSY ultraviolet extensions of the twin Higgs model. The resonant nature of the signals allows for the reconstruction of the mass of both ϒ± and X , thus providing a wealth of information about the hidden sector.