Parents' experiences of their children's presence in discussions with physicians about leukemia

OBJECTIVE: We aimed to examine parents' views regarding their preadolescent child's presence during discussions about serious illnesses. METHODS: In-depth qualitative interviews with parents of children receiving treatment for acute lymphoblastic leukemia were conducted. Parents were sampled from 6 UK treatment centers. Analysis was informed by the constant comparative method and content analysis. RESULTS: We report on interviews with 53 parents (33 mothers, 20 fathers). Parents acknowledged the benefits of communicating openly with children, but few thought that their child's presence in discussions was straightforwardly desirable. They described how their child's presence restricted their own communication with physicians, made concentrating difficult, and interfered with their efforts to care for their child emotionally. Children's presence was particularly difficult when significant issues were being discussed, including prognoses, adverse results, and certain medical procedures. Parents felt that such discussions posed a potential threat to their child, particularly when they had not first had an opportunity to discuss information with the physician separately from the child. In contrast, separate meetings enabled parents to absorb information and to convey it to their child at an appropriate time and in a reassuring way. Some parents experienced difficulties in accessing separate meetings with physicians. CONCLUSIONS: The difficulties parents described could potentially be addressed by extending, beyond the diagnosis period, the practice of sequencing significant information so that it is communicated to parents in separate meetings before being communicated to the child and by periodically exploring with parents what information would be in each child's interests.

Treatment non-adherence in teenage and young adult patients with cancer

Adhering to treatment can be a significant issue for many patients diagnosed with chronic health conditions and this has been reported to be greater during the adolescent years. However, little is known about treatment adherence in teenage and young adult (TYA) patients with cancer. To increase awareness of the adherence challenges faced by these patients, we have reviewed the published work. The available evidence suggests that a substantial proportion of TYA patients with cancer do have difficulties, with reports that up to 63% of patients do not adhere to their treatment regimens. However, with inconsistent findings across studies, the true extent of non-adherence for these young patients is still unclear. Furthermore, it is apparent that there are many components of the cancer treatment regimen that have yet to be assessed in relation to patient adherence. Factors that have been shown to affect treatment adherence in TYA patients include patient emotional functioning (depression and self-esteem), patient health beliefs (perceived illness severity and vulnerability), and family environment (parental support and parent–child concordance). Strategies that foster greater patient adherence are also identified. These strategies are multifactorial, targeting not only the patient, but the health professional, family, and treatment regimen. This review highlights the lack of interventional studies addressing treatment adherence in TYA patients with cancer, with only one such intervention being identified: a video game intervention focusing on behavioural issues related to cancer treatment and care. Methodological issues in measuring adherence are addressed and suggestions for improving the design of future adherence studies highlighted, of which there is a great need.

Faith and protection: the construction of hope by parents of children with leukemia and their oncologists

Background. Oncologists are criticized for fostering unrealistic hope in patients and families, but criticisms reflect a perspective that is oversimplified and “expert” guidance that is ambiguous or impractical. Our aim was to understand how pediatric oncologists manage parents' hope in practice and to evaluate how they address parents' needs. Methods. Participants were 53 parents and 12 oncologists whom they consulted across six U.K. centers. We audio recorded consultations approximately 1–2, 6, and 12 months after diagnosis. Parents were interviewed after each consultation to elicit their perspectives on the consultation and clinical relationship. Transcripts of consultations and interviews were analyzed qualitatively. Results. Parents needed hope in order to function effectively in the face of despair, and all wanted the oncologists to help them be hopeful. Most parents focused hope on the short term. They therefore needed oncologists to be authoritative in taking responsibility for the child's long-term survival while cushioning parents from information about longer-term uncertainties and being positive in providing information about short-term progress. A few parents who could not fully trust their oncologist were unable to hope. Conclusion. Oncologists' pivotal role in sustaining hope was one that parents gave them. Most parents' “faith” in the oncologist allowed them to set aside, rather than deny, their fears about survival while investing their hopes in short-term milestones. Oncologists' behavior generally matched parents' needs, contradicting common criticisms of oncologists. Nevertheless, oncologists need to identify and address the difficulty that some parents have in fully trusting the oncologist and, consequently, being hopeful.

Is communication guidance mistaken? Qualitative study of parent-oncologist communication in childhood cancer

background: Guidance encourages oncologists to engage patients and relatives in discussing the emotions that accompany cancer diagnosis and treatment. We investigated the perspectives of parents of children with leukaemia on the role of paediatric oncologists in such discussion. methods: Qualitative study comprising 33 audio-recorded parent–oncologist consultations and semi-structured interviews with 67 parents during the year following diagnosis. results: Consultations soon after the diagnosis were largely devoid of overt discussion of parental emotion. Interviewed parents did not describe a need for such discussion. They spoke of being comforted by oncologists’ clinical focus, by the biomedical information they provided and by their calmness and constancy. When we explicitly asked parents 1 year later about the oncologists’ role in emotional support, they overwhelmingly told us that they did not want to discuss their feelings with oncologists. They wanted to preserve the oncologists’ focus on their child’s clinical care, deprecated anything that diverted from this and spoke of the value of boundaries in the parent–oncologist relationship. conclusion: Parents were usually comforted by oncologists, but this was not achieved in the way suggested by communication guidance. Communication guidance would benefit from an enhanced understanding of how emotional support is experienced by those who rely on it.

A global empirical system for probabilistic seasonal climate prediction

Preparing for episodes with risks of anomalous weather a month to a year ahead is an important challenge for governments, non-governmental organisations, and private companies and is dependent on the availability of reliable forecasts. The majority of operational seasonal forecasts are made using process-based dynamical models, which are complex, computationally challenging and prone to biases. Empirical forecast approaches built on statistical models to represent physical processes offer an alternative to dynamical systems and can provide either a benchmark for comparison or independent supplementary forecasts. Here, we present a simple empirical system based on multiple linear regression for producing probabilistic forecasts of seasonal surface air temperature and precipitation across the globe. The global CO2-equivalent concentration is taken as the primary predictor; subsequent predictors, including large-scale modes of variability in the climate system and local-scale information, are selected on the basis of their physical relationship with the predictand. The focus given to the climate change signal as a source of skill and the probabilistic nature of the forecasts produced constitute a novel approach to global empirical prediction. Hindcasts for the period 1961–2013 are validated against observations using deterministic (correlation of seasonal means) and probabilistic (continuous rank probability skill scores) metrics. Good skill is found in many regions, particularly for surface air temperature and most notably in much of Europe during the spring and summer seasons. For precipitation, skill is generally limited to regions with known El Niño–Southern Oscillation (ENSO) teleconnections. The system is used in a quasi-operational framework to generate empirical seasonal forecasts on a monthly basis.

A new regime of carbon counting: the practices and politics of accounting for everyday carbon through C02e

Inspired by the commercial desires of global brands and retailers to access the lucrative green consumer market, carbon is increasingly being counted and made knowable at the mundane sites of everyday production and consumption, from the carbon footprint of a plastic kitchen fork to that of an online bank account. Despite the challenges of counting and making commensurable the global warming impact of a myriad of biophysical and societal activities, this desire to communicate a product or service's carbon footprint has sparked complicated carbon calculative practices and enrolled actors at literally every node of multi-scaled and vastly complex global supply chains. Against this landscape, this paper critically analyzes the counting practices that create the ‘e’ in ‘CO2e’. It is shown that, central to these practices are a series of tools, models and databases which, in building upon previous work (Eden, 2012 and Star and Griesemer, 1989) we conceptualize here as ‘boundary objects’. By enrolling everyday actors from farmers to consumers, these objects abstract and stabilize greenhouse gas emissions from their messy material and social contexts into units of CO2e which can then be translated along a product's supply chain, thereby establishing a new currency of ‘everyday supply chain carbon’. However, in making all greenhouse gas-related practices commensurable and in enrolling and stabilizing the transfer of information between multiple actors these objects oversee a process of simplification reliant upon, and subject to, a multiplicity of approximations, assumptions, errors, discrepancies and/or omissions. Further the outcomes of these tools are subject to the politicized and commercial agendas of the worlds they attempt to link, with each boundary actor inscribing different meanings to a product's carbon footprint in accordance with their specific subjectivities, commercial desires and epistemic framings. It is therefore shown that how a boundary object transforms greenhouse gas emissions into units of CO2e, is the outcome of distinct ideologies regarding ‘what’ a product's carbon footprint is and how it should be made legible. These politicized decisions, in turn, inform specific reduction activities and ultimately advance distinct, specific and increasingly durable transition pathways to a low carbon society.

Order and disorder in fiction labyrinths: the librarians` representations in some contemporary cultural productions

This paper, first result of a larger research, proposes a query about some aspects of social representation of libraries and librarians, as they appear in literary and cinematographic productions. Little by little, this query, which arose from purposes of organizing catalogues, revealed elements that established different series, in which the narrative genre (literary or cinematographic) has no relevance to either libraries or librarians` representations. The presence of these elements seems to show some expectations and utopias in relation to the common knowledge, independently from narratives being located in the past, in the present or in the future, stimulating reflection on some medieval and baroque traditions about the library universe and its main characters, the librarians. The cinematographic material selected for research was The time machine, Farenheit 451, The day after tomorrow, Star Wars - episode II and the novels Martin Eden, The man without qualities, The time machine and La sombra del viento.

The politics of memory in Harold Pinter's Ashes to Ashes

The present work proposes an investigation of the treatment given to memory in Pinter’s latest play, Ashes to Ashes, and of its function in the development of Pinter’s work. In order to do that, different aspects of the construction of meaning in the theatre are analysed, so that the specificity of its reception is determined. A survey of techniques used to present information, time and space in the theatre is made. The analytical drama, the history drama, and the theatre of the absurd are defined. After that, the evolution of the author’s work is analysed to determine what characterises Pinter’s work, while at the same time determining how his treatment of themes like menace, memory, and political oppression of the individual has evolved. Finally, a detailed survey of the apparently disconnected elements that are mentioned in Ashes to Ashes is made. The intertextual analysis allied to a study of the analytical form as used in this play enables the discovery of several layers of meaning. Through the connection established between the Holocaust and man’s fall followed by expulsion from Eden, Pinter examines the use of memory as a way of dealing with personal and collective responsibility and guilt. It is through the recovery of memory (also through writing) that the present can establish a critical and responsible relation with the past.

Mapas cognitivos SODA ampliados: prescrição de um método para articular atitudes, comportamentos e seqüências cognitivas a mapas SODA

Este trabalho de tese tem por objetivo ampliar o alcance e aplicação de mapas SODA, preservando a metodologia originalmente desenvolvida. Inicialmente é realizada uma revisão do método, abordando de forma conjunta os artigos seminais, a teoria psicológica de Kelly e a teoria dos grafos; e ao final propomos uma identidade entre construtos de mapas SODA com os conhecimentos tácitos e explícitos, da gestão do conhecimento (KM). Essa sequencia introdutória é completada com uma visão de como os mapas SODA tem sido aplicado. No estágio seguinte o trabalho passa a analisar de forma crítica alguns pontos do método que dão margens a interpretações equivocadas. Sobre elas passamos a propor a aplicação de teorias, de diversos campos, tais como a teoria de means-end (Marketing), a teoria da atribuição e os conceitos de atitude (Psicologia), permitindo inferências que conduzem à proposição da primeira tese: mapas SODA são descritores de atitudes. O próximo estágio prossegue analisando criticamente o método, e foca no paradigma estabelecido por Eden, que não permite conferir ao método o status de descritor de comportamento. Propomos aqui uma mudança de paradigma, adotando a teoria da ação comunicativa, de Habermas, e sobre ela prescrevemos a teoria da ação e da escada da inferência (Action Science) e uma teoria da emoção (neuro ciência), o que permite novas inferências, que conduzem à proposição da segunda tese: mapas SODA podem descrever comportamentos. Essas teses servem de base para o alargamento de escopos do método SODA. É proposta aqui a utilização da teoria de máquinas de estado finito determinístico, designadas por autômato. Demonstramos um mapeamento entre autômato com mapas SODA, obtendo assim o autômato SODA, e sobre ele realizamos a última contribuição, uma proposta de mapas SODA hierárquicos, o que vem a possibilitar a descrição de sequencias de raciocínio, ordenando de forma determinística atitudes e comportamentos, de forma estruturada. A visão de como ela pode ser aplicada é realizada por meio de estudo de caso.

Relações entre teorias da história e ensino de história: a compreensão de professores

This thesis has as an objective to think over the teachers` understanding of the school History of the Fundamental Teaching regarding the existent relations between the history theories and the teaching of the school History, as well as to think over how these teachers see the influence that their teaching practice gets from the history theories. The work is based on the postulates of the qualitative research and on the characteristics of the ethnography of the school practice. The main procedures of data gathering were the documental analysis, the semi-structured interviews, the field diary and the observations of classes. The scientific perspective of the multiple references is an important source in this research. The participants of this work are two teachers of the school district of Natal who work in the field of the school History in two schools on the North Side of the city. The accomplished analysis point to significant indications that didn't occur continuous and regular teaching situations in the initial and continuing education of these teachers that clearly showed the relations between the history theories and the teaching of the school History. They also suggest that their understanding about the influence that their teaching practice gets from the history theories, is not still explicit. We understand that the relations between the history theories and the teaching of the school History are important for the initial and continuing education of these teachers who belong in this knowledge field, even when these relations are not explicitly pointed by the teachers, because they will always influence the teaching practice that the teachers of the school History build

An overview of the HIBISCUS campaign

The EU HIBISCUS project consisted of a series of field campaigns during the intense convective summers in 2001, 2003 and 2004 in the State of São Paulo in Brazil. Its objective was to investigate the impact of deep convection on the Tropical Tropopause Layer (TTL) and the lower stratosphere by providing a new set of observational data on meteorology, tracers of horizontal and vertical transport, water vapour, clouds, and chemistry in the tropical Upper Troposphere/Lower Stratosphere (UT/LS). This was achieved using short duration research balloons to study local phenomena associated with convection over land, and long-duration balloons circumnavigating the globe to study the contrast between land and oceans.Analyses of observations of short-lived tracers, ozone and ice particles show strong episodic local updraughts of cold air across the lapse rate tropopause up to 18 or 19 km (420-440 K) in the lower stratosphere by overshooting towers. The long duration balloon and satellite measurements reveal a contrast between the composition of the lower stratosphere over land and oceanic areas, suggesting significant global impact of such events. The overshoots are shown to be well captured by non-hydrostatic meso-scale Cloud Resolving Models indicating vertical velocities of 50-60 m s(-1) at the top of the Neutral Buoyancy Level (NBL) at around 14 km, but, in contrast, are poorly represented by global Chemistry-Transport Models (CTM) forced by Numerical Weather Forecast Models (NWP) underestimating the overshooting process. Finally, the data collected by the HIBISCUS balloons have allowed a thorough evaluation of temperature NWP analyses and reanalyses, as well as satellite ozone, nitrogen oxide, water vapour and bromine oxide measurements in the tropics.

Basic ingredients for mathematical modeling of tumor growth in vitro: Cooperative effects and search for space

Based on the literature data from HT-29 cell monolayers, we develop a model for its growth, analogous to an epidemic model, mixing local and global interactions. First, we propose and solve a deterministic equation for the progress of these colonies. Thus, we add a stochastic (local) interaction and simulate the evolution of an Eden-like aggregate by using dynamical Monte Carlo methods. The growth curves of both deterministic and stochastic models are in excellent agreement with the experimental observations. The waiting times distributions, generated via our stochastic model, allowed us to analyze the role of mesoscopic events. We obtain log-normal distributions in the initial stages of the growth and Gaussians at long times. We interpret these outcomes in the light of cellular division events: in the early stages, the phenomena are dependent each other in a multiplicative geometric-based process, and they are independent at long times. We conclude that the main ingredients for a good minimalist model of tumor growth, at mesoscopic level, are intrinsic cooperative mechanisms and competitive search for space. © 2013 Elsevier Ltd.