The experience of individuals with renal failure participating in home haemodialysis: An interpretative phenomenological analysis.

This study explored the experience of individuals with renal failure undertaking home haemodialysis (HHD). Semi-structured interviews were conducted with six participants who were active HHD users in a UK region. Participants’ accounts were transcribed verbatim and analysed using an interpretative phenomenological approach. Three main themes were identified: (1) embracing treatment and lifestyle freedom and flexibility; (2) re-establishing a sense of self and preferred self-identity; and (3) integrating aspects of active engagement and aspects of supported, life-sustaining dependence. A ‘good fit’ between the HHD user (an independent, self-determined health participant) and the healthcare provision (personalized, enabling) is proposed.

‘I don’t think I’d be frightened if the statins went’: a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals

Background

Ethical reasoning through simulation: a phenomenological analysis of student experience

Background
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students’ lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.

Methods
This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.

Results
Four main themes emerged from the analysis: (1) ‘Authentic on all levels?’, (2)‘Letting the emotions flow’, (3) ‘Ethical alarm bells’ and (4) ‘Voices of children and ghosts’. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.

Conclusions
This study provided deep insights into medical students’ immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

How well do elderly people complete individualised quality of life measures: an exploratory study.

This research note describes and discusses a study which investigated the feasibility of using an individualised approach to measure the quality of life (QoL) of a sample of older people who were in receipt of an early hospital discharge service. Most participants (86%) were able to identify areas of their lives which were important to them, rate their level of functioning on each of these areas and rank their life areas in order of importance. However, 39% were unable to quantify the relative importance of each area of life. Indeed, the majority (57%) of participants who were over 75 years old could not complete this “weighting” or evaluative stage. The results suggest that the phenomenological approach to measuring QoL may be employed successfully with older people but that the “weighting” system used by existing individualised QoL measures needs to be refined, especially when assessing people over 75.

Specific and unspecific interactions in polar fluids in view of wideband dielectric far-infrared spectra

A simple molecular analytical theory of dielectric relaxation in strongly polar fluids is considered in terms of a semi- phenomenological approach. Theoretical spectra epsilon(v), a(v) of complex permittivity and absorption coefficient are fully determined by a form of intermolecular potential well, in which a dipole reorients. In a recent publication by VI. Gaiduk, O.F. Nielsen, and T.S. Perova [J. Molliq 95 (1002) 1-25] the wideband spectra of liquid H2O and D2O were described in terms of a composite model comprising the rectangular and the cosine squared potential wells. Much better results are achieved in this work, where the rectangular well is replaced by a well with a rounded bottom termed the hat-curved well. The spectrum of the auto-correlation function (ACF) is calculated for such a potential. The proposed theory of a composite model, comprising hat-curved and parabolic wells, is applied for liquid water. This model is capable for describing the Debye relaxation region, the second relaxation region in the submillimeter wavelength range, and the far infra-red (FIR) e(v), a(v) spectra, where an intense librational band and an additional weak band are placed, respectively, near 700 cm(-1) and 200 cm(-1). The latter band reflects the features of so-called specific (viz. directly related to H-bonds) interactions and the former band reflects the features of unspecific interactions. The physical mechanisms connected with these types of interactions are discussed in terms of two relevant types of water structure (types of molecular rotation). The proposed theory is also applied to a non-associated liquid in terms of one hat-curved potential well. (C) 2004 Elsevier B.V. All rights reserved.

Experiencing Kane: an affective analysis of Sarah Kane's 'experiential' theatre in performance

The article argues for a phenomenological approach to Kane's work in performance. It notes the rise in productions of Kane's work from 2004, and focuses on productions of Crave by 11th Hour Theatre in Melbourne and Acquiesce Speck in Sydney.

The experience of cancer cachexia: A qualitative study of advanced cancer patients and their family members

Background
Cachexia in advanced malignancy is a debilitating syndrome which contributes to approximately two million deaths worldwide annually. In spite of advances in understanding the biomedical aspects of cancer cachexia, little attention has been paid to exploring its holistic impact on patients and those who care for them.

Objective
The aim of this paper is to describe the lived experience of cachexia from the perspective of patients with cancer and their family members.

Design
An interpretative phenomenological approach was employed.

Setting and participants
A purposive sampling strategy recruited 15 patients and 12 family members from the Regional Cancer Centre in Northern Ireland.

Method
Each participant was interviewed during 2004/2005 using an unstructured interview. All interviews were recorded and transcribed verbatim. Analysis combined a two stage approach using thematic and interpretative phenomenological analysis.

Results
Analysis generated six superordinate themes that reflected the complex dynamics of the cachexia experience. Themes were: physiological changes in appetite; visuality of cachexia; weight loss interpreted as a bad sign; response from health care professionals; conflict over food; and coping responses.

Conclusions
Findings confirmed that cancer cachexia has far reaching implications for patients and their families, extending beyond physical problems into psychological, social and emotional issues. This insight is a critical first step in the development of more responsive care for these clients.

The trauma still goes on...: The multigenerational legacy of Northern Ireland's conflict

Numerous studies have been conducted internationally on the subject of multigenerational trauma; however, little is currently known about its existence in the context of the Northern Ireland conflict. The present study explored the outcomes of and mechanisms through which the trauma of one generation impacts on subsequent generations in this context. Using an Interpretative Phenomenological Approach (IPA), this study examined the subjective experiences, beliefs and perceptions of four mothers from Northern Ireland, all of whom had endured trauma during their childhoods. Three main master themes emerged: 1. "Attempting to cope" addressed how the trauma was dealt with, and how these efforts can be the very mechanisms through which multigenerational trauma occurs. Examples include hiding the truth, seeing the truth as dangerous, and knowing and not knowing about the trauma; 2. "The trauma still goes on" highlighted the negative outcomes and consequences of the traumatic experiences within the family such as delayed impact, symptoms and anger; and 3. "Strength through adversity" included the more positive outcomes of their experiences, such as finding meaning through suffering and making efforts to stop the cycle. The results are discussed in terms of the existing theories on multigenerational trauma, and implications for practice are explored.

Surviving but stigmatised:Making sense of living with Burkholderia cepacia

Infection control policies recommend segregation of people with Cystic Fibrosis (CF) according to bacterial status. This involves isolating those people with cepacia from all other CF patients in order to prevent additional infection. These policies are reliant on the understanding and adherence of those colonised with cepacia. Service user reports suggest that emotions like anxiety and anger are aroused when those with cepacia are faced with cross infection measures (UK CF Trust, 2009). No studies to date investigate this anecdotal emotional reaction. This research was conducted to ask what it is like to live with cepacia, using in depth interviews. A phenomenological approach was used. Three themes that appeared to characterise the experience of living with cepacia were identified: (1) Lost Identity: cepacia can challenge one’s self identity, and along with cross infection measures lead to feeling objectified and even alienated from the CF group identity. (2) Status: Condemned: being colonised with cepacia brings with it knowledge of a certain type of restricted future, and an imagined death. There is loss of normality and hope. (3) I Am Cepacia: making decisions about preventing cross infection is influenced by medical knowledge as well as human emotions and social information; therefore adherence to these measures is fluid and contextual. These themes have real world clinical implications for all CF services, where preventing the spread of cepacia is paramount. Responsibility for cross infection is a burden and requires knowledge and understanding from both those living with and without cepacia. We need to see beyond the bacteria to the person.

Network biology: a direct approach to study biological function

In this paper we discuss the dualism of gene networks and their role in systems biology. We argue that gene networks ( 1) can serve as a conceptual framework, forming a fundamental level of a phenomenological description, and ( 2) are a means to represent and analyze data. The latter point does not only allow a systems analysis but is even amenable for a direct approach to study biological function. Here we focus on the clarity of our main arguments and conceptual meaning of gene networks, rather than the causal inference of gene networks from data. (C) 2010 John Wiley & Sons, Inc. WIREs Syst Biol Med 2011 3 379-391 DOI: 10.1002/wsbm.134

Fatigue Damage of Composite Structures Applying a Micromechanical Approach

Fatigue damage calculations of unidirectional polymer composites is presented applying micromechanics theory. An orthotropic micromechanical damage model is integrated with an isotropic fatigue evolution model to predict the micromechanical fatigue damage of the composite structure. The orthotropic micromechanical damage model is used to predict the orthotropic damage evolution within a single cycle. The isotropic fatigue model is used to predict the magnitude of fatigue damage accumulated as a function of the number of cycles. The advantage of using this approach is the cheap determination of model parameters since the orthotropic damage model parameters can be determined using available data from quasi-static loading tests. Decomposition of the state variables down to the constituent scale is accomplished by micromechanics theory. Phenomenological damage evolution models are then postulated for each constituent and for interphase among them. Comparison between model predictions and experimental data is presented.

A micromechanics approach for damage modeling of polymer matrix composites

A new model for damage evolution in polymer matrix composites is presented. The model is based on a combination of two constituent-level models and an interphase model. This approach reduces the number of empirical parameters since the two constituent- level models are formulated for isotropic materials, namely fiber and matrix. Decomposition of the state variables down to the micro-scale is accomplished by micromechanics. Phenomenological damage evolution models are then postulated for each constituent. Determination of material parameters is made from available experimental data. The required experimental data can be obtained with standard tests. Comparison between model predictions and additional experimental data is presented.

A micro-mechanics damage approach for fatigue of composite materials

A new model for fatigue damage evolution of polymer matrix composites (PMC) is presented. The model is based on a combination of an orthotropic damage model and an isotropic fatigue evolution model. The orthotropic damage model is used to predict the orthotropic damage evolution within a single cycle. The isotropic fatigue model is used to predict the magnitude of fatigue damage accumulated as a function of the number of cycles. This approach facilitates the determination of model parameters since the orthotropic damage model parameters can be determined from available data from quasi-static-loading tests. Then, limited amount of fatigue data is needed to adjust the fatigue evolution model. The combination of these two models provides a compromise between efficiency and accuracy. Decomposition of the state variables down to the constituent scale is accomplished by micro-mechanics. Phenomenological damage evolution models are then postulated for each constituent and for the micro-structural interaction among them. Model parameters are determined from available experimental data. Comparison between model predictions and additional experimental data is presented.