Illness perception clusters at diagnosis predict psychological distress among women with breast cancer at 6 months post-diagnosis.

OBJECTIVE:

This study aimed to examine the extent to which illness perceptions and coping strategies among women diagnosed with breast cancer explain psychological distress at diagnosis and at 6?months post diagnosis relative to demographic and illness-related variables.

METHODS:

Women were recruited to the study shortly after diagnosis. A total of 90 women completed study materials (Illness Perception Questionnaire-Revised, the Cancer Coping Questionnaire and the Hospital Anxiety and Depression Scale) at time 1. The same questionnaires were sent approximately 6?months later to those who had consented at time 1, and completed questionnaires were returned by 72 women.

RESULTS:

Cluster analysis was used to identify groups of respondents who reported a similar profile of illness perception scores. Regression analysis demonstrated that one of these clusters was more likely to experience psychological distress than the other both at diagnosis and at 6?months post diagnosis. Illness perception cluster membership and positive focus type coping were the most important and consistent predictors of lower psychological distress at diagnosis and at 6?months post diagnosis.

CONCLUSIONS:

Illness perceptions remained relatively stable over the study period, and therefore we are unable to clarify whether changes in illness cognitions are associated with a corresponding change in psychological symptoms. Future research should evaluate the impact on psychological distress of interventions specifically designed to modify illness cognitions among women with breast cancer.

Content validity of the Illness Perception Questionnaire-Revised for people with Type 2 Diabetes: A Think-Aloud study

Objectives: To access the cognitions of adults with type 2 diabetes whilst completing items on the Illness Perceptions Questionnaire – Revised (IPQ-R). To determine whether these cognitions are congruent with the meaning of items and subscales as interpreted by researchers and clinicians using the IPQ-R and to identify the nature and extent of problems that individuals experience when completing the IPQ-R.
Design: Participants (n=36) were recruited from a primary care diabetes clinic and a hospital diabetes clinic. They were asked to complete the IPQ-R using a ‘think-aloud’ methodology.
Main Outcome Measures: Transcripts were analysed to identify instances where participants expressed problems with item completion, or where there was inconsistency between verbal and written responses.
Results: The most problematic subscales were those of ‘personal control’ and ‘consequences’.
Conclusion: Generally, participants found the IPQ-R unproblematic. However, participants had problems with the concept of ‘cure’ and ‘symptoms’ in the context of type 2 diabetes, and with the negative phrasing used in some items. These findings have important implications for the interpretation of IPQ-R scores, particularly when the IPQ-R is used as the basis for individualised interventions among people with type 2 diabetes.

Behavior, pain perception, and the extremely low-birth weight survivor

This article explores the literature concerning responses to pain of both premature and term-born newborn infants, the evidence for short-term and long-term effects of pain, and behavioral sequelae in individuals who have experienced repeated early pain in neonatal life as they mature. There is no doubt that pain causes stress in babies and this in turn may adversely affect long-term neurodevelopmental outcome. Although there are methods for assessing dimensions of acute reactivity to pain in an experimental setting, there are no very good measures available at the present time that can be used clinically. In the clinical setting repeated or chronic pain is more likely the norm rather than infrequent discrete noxious stimuli of the sort that can be readily studied. The wind-up phenomenon suggests that, exposed to a cascade of procedures as happens with clustering of care in the clinical setting in an attempt to provide periods of rest for stressed babies, an infant may in fact perceive procedures that are not normally viewed as noxious, as pain. Pain exposure during lifesaving intensive medical care of ELBW neonates may also affect subsequent reactivity to pain in the neonatal period, but behavioral differences are probably not likely to be clinically significant in the long term. Prolonged and repeated untreated pain in the newborn period, however, may produce a relatively permanent shift in basal autonomic arousal related to prior NICU pain experience, which may have long-term sequelae. In the long run, the most significant clinical effects of early pain exposure may be on neurodevelopment, contributing to later attention, learning, and behavior problems in these vulnerable children. Although there is considerable evidence to support a variety of adverse effects of early pain, there is less information about the long-term effects of opiates and benzodiazepines on the developing central nervous system. Current evidence reviewed suggests that judicious use of morphine for adjustment to mechanical ventilation may ameliorate the altered autonomic response. It may be very important, however, to distinguish stress from pain. Animal evidence suggests that the neonatal brain is affected differently when exposed to morphine administered in the absence of pain than in the presence of pain. Pain control may be important for many reasons but overuse of morphine or benzodiazepines may have undesirable long-term effects. This is a rapidly evolving area of knowledge of clear relevance to clinical management likely to affect long-term outcomes of high-risk children.

The Musical Body: Devising a choreo-musical interpretation for the work Tierkreis (1974-75) by Karlheinz Stockhausen

In this chapter the authors explore a practice-led approach to understanding the role of the body in music performance.

Many writers have discussed the body in music performance, in improvised music, as well as in electronic music. In this chapter the authors offer new modalities of reflection on the musical body in the interpretation of existing contemporary repertoire. Specifically, the authors discuss a re-interpretation of German composer Karlheinz Stockhausen's musical work 'Tierkreis'. Through the development of a specifically physical approach to the performance, the authors investigate the intrinsic relationship between the body and the music and point to an under-explored modality, which is not a musical choreography, but a choreography that is shaped through the musical body itself. It is a modality in which music itself propels forward choreographic ideas, the body becoming the driving force behind musical interpretation. The authors' thinking is influenced by Susan Kozel’s understanding of performance as an ecosystem (Kozel 2007) and framed within a subjective account of musical embodiment.

By merging theory with praxis the authors offer a deeper understanding of the role of the body in music performance and consider how such contributions might lead to new and exciting interpretive frameworks for existing musical repertoires.

Farmer perception of suitable conditions for slurry application compared with decision support system recommendations

The application of slurry nutrients to land can be associated with unintended losses to the environment depending on soil and weather conditions. Correct timing of slurry application, however, can increase plant nutrient uptake and reduce losses. A decision support system (DSS), which predicts optimum conditions for slurry spreading based on the Hybrid Soil Moisture Deficit (HSMD) model, was investigated for use as a policy tool. The DSS recommendations were compared to farmer perception of suitable conditions for slurry spreading for three soil drainage classes (well, moderate and poorly drained) to better understand on farm slurry management practices and to identify potential conflict with farmer opinion. Six farmers participated in a survey over two and a half years, during which they completed a daily diary, and their responses were compared to Soil Moisture Deficit (SMD) calculations and weather data recorded by on farm meteorological stations. The perception of land drainage quality differed between farmers and was related to their local knowledge and experience. It was found that the allocation of grass fields to HSMD drainage classes using a visual assessment method aligned farmer perception of drainage at the national scale. Farmer opinion corresponded to the theoretical understanding that slurry should not be applied when the soil is wetter than field capacity, i.e. when drainage can occur. While weather and soil conditions (especially trafficability) were the principal reasons given by farmers not to spread slurry, farm management practices (grazing and silage) and current Nitrates Directive policies (closed winter period for spreading) combined with limited storage capacities were obstacles to utilisation of slurry nutrients. Despite the slightly more restrictive advice of the DSS regarding the number of suitable spreading opportunities, the system has potential to address an information deficit that would help farmers to reduce nutrient losses and optimise plant nutrient uptake by improved slurry management. The DSS advice was in general agreement with the farmers and, therefore, they should not be resistant to adopting the tool for day to day management.

Fast recognition of musical sounds based on timbre

Human listeners seem to have an impressive ability to recognize a wide variety of natural sounds. However, there is surprisingly little quantitative evidence to characterize this fundamental ability. Here the speed and accuracy of musical-sound recognition were measured psychophysically with a rich but acoustically balanced stimulus set. The set comprised recordings of notes from musical instruments and sung vowels. In a first experiment, reaction times were collected for three target categories: voice, percussion, and strings. In a go/no-go task, listeners reacted as quickly as possible to members of a target category while withholding responses to distractors (a diverse set of musical instruments). Results showed near-perfect accuracy and fast reaction times, particularly for voices. In a second experiment, voices were recognized among strings and vice-versa. Again, reaction times to voices were faster. In a third experiment, auditory chimeras were created to retain only spectral or temporal features of the voice. Chimeras were recognized accurately, but not as quickly as natural voices. Altogether, the data suggest rapid and accurate neural mechanisms for musical-sound recognition based on selectivity to complex spectro-temporal signatures of sound sources.

Designing Digital Musical Interactions in Experimental Contexts

As NIME's focus has expanded beyond the design reports which were pervasive in the early days to include studies and experiments involving music control devices, we report on a particular area of activity that has been overlooked: designs of music devices in experimental contexts. We demonstrate this is distinct from designing for artistic performances, with a unique set of novel challenges. A survey of methodological approaches to experiments in NIME reveals a tendency to rely on existing instruments or evaluations of new devices designed for broader creative application. We present two examples from our own studies that reveal the merits of designing purpose-built devices for experimental contexts.

Ambiguous Devices

Developed and performed in collaboration with Tom Davis (Bournemouth University), the work explores notions of presence and absence, technologically mediated communication and audience perception through the staging of ambiguous but repeatable performative interactions taking place on a co-located but distributed musical instrument. Public performances and installations include: CCRMA, Stanford University (2012); NIME conference, University of Michigan (2012); SARC, Queen's University Belfast (2013); INTIME symposium, Coventry University (2013); RE-NEW digital arts festival, Copenhagen (2013).

Reflecting on Tradition: Four Ulster Musical Lives

Communicating musical knowledge through gesture: Piano teachers’ gestural behaviours across different levels of student proficiency

Teachers’ communication of musical knowledge through physical gesture represents a valuable pedagogical field in need of investigation. This exploratory case study compares the gestural behaviour of three piano teachers while giving individual lessons to students who differed according to piano proficiency levels. The data was collected by video recordings of one-to-one piano lessons and gestures were categorized using two gesture classifications: the spontaneous co-verbal gesture classification (McNeill, 1992; 2005) and spontaneous co-musical gesture classification (Simones, Schroeder & Rodger, 2013). Poisson regression analysis and qualitative observation suggest a relationship between teachers’ didactic intentions and the types of gesture they produced while teaching, as shown by differences in gestural category frequency between teaching students of higher and lower levels of proficiency. Such reported agreement between teachers’ gestural approach in relation to student proficiency levels indicates a teachers’ gestural scaffolding approach whereby teachers adapted gestural communicative channels to suit students’ specific conceptual skill levels.

Sound Synthesis for Contact-Driven Musical Instruments via Discretisation of Hamilton's Equations

Physical modelling of musical instruments involves studying nonlinear interactions between parts of the instrument. These can pose several difficulties concerning the accuracy and stability of numerical algorithms. In particular, when the underlying forces are non-analytic functions of the phase-space variables, a stability proof can only be obtained in limited cases. An approach has been recently presented by the authors, leading to unconditionally stable simulations for lumped collision models. In that study, discretisation of Hamilton’s equations instead of the usual Newton’s equation of motion yields a numerical scheme that can be proven to be energy conserving. In this paper, the above approach is extended to collisions of distributed objects. Namely, the interaction of an ideal string with a flat barrier is considered. The problem is formulated within the Hamiltonian framework and subsequently discretised. The resulting nonlinearmatrix equation can be shown to possess a unique solution, that enables the update of the algorithm. Energy conservation and thus numerical stability follows in a way similar to the lumped collision model. The existence of an analytic description of this interaction allows the validation of the model’s accuracy. The proposed methodology can be used in sound synthesis applications involving musical instruments where collisions occur either in a confined (e.g. hammer-string interaction, mallet impact) or in a distributed region (e.g. string-bridge or reed-mouthpiece interaction).