Acceptance of relapse fears in breast cancer patients: effects of an act-based abridged intervention

Objective: Relapse fear is a common psychological scar in cancer survivors. The aim of this study is to assess the effects of an abridged version of Acceptance and Commitment Therapy (ACT) in breast cancer patients.Method: An open trial was developed with 12 non-metastatic breast cancer patients assigned to 2 conditions, ACT and waiting list. Interventions were applied in just one session and focused on the acceptance of relapse fears through a ‘defusion’ exercise. Interference and intensity of fear measured through subjective scales were collected after each intervention and again 3 months later. Distress, hypochondria and ‘anxious preocupation’ were also evaluated through standardized questionnaires.Results: The analysis revealed that ‘defusion’ contributed to decrease the interference of the fear of recurrence, and these changes were maintained three months after intervention in most subjects. 87% of participants showed clinically significant decreases in interference at follow-up sessions whereas no patient in the waiting list showed such changes. Statistical analysis revealed that the changes in interference were significant when comparing pre, post and follow-up treatment, and also when comparing ACT and waiting list groups. Changes in intensity of fear, distress, anxious preoccupation and hypochondria were also observed.Conclusions: Exposure through ‘defusion’ techniques might be considered a useful option for treatment of persistent fears in cancer patients. This study provides evidence for therapies focusing on psychological acceptance in cancer patients through short, simple and feasible therapeutic methods.

Duelo, ansiedad y depresión en familiares de pacientes en una unidad de cuidados paliativos a los dos meses de la pérdida

Aim: This study is going to assess the prevalance of prolonged grief diagnoses and it will evaluate the severity of the symptoms of depression, anxiety and complicated grief two months after a loved one is lost. We also intend to study which variables associated with the risk of grief could be more decisive when diagnosing it, its symptoms and the consequent emotional distress.Method: A total of 66 families of patients in the Palliative Care Unit (PCU) at Hospital San Cecilio in Granada have been evaluated. Measurements were taken two months after the death. This investigation has explored the existing emotional distress using the following questionnaires: Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Inventory of Complicated Grief (ICG) and Prolongued Grief Disorder (PG-12).Results: The results show that 33.3% and 21.21% of the sufferers had high levels of depression and clinical anxiety two months after the death. The prevalence of prolongued grief diagnoses, according to the PG-12, is 10.6% and 53.03% of the participants showed symptoms of complicated grief according to the ICG. Additionally, statistically significant differences are found in the sufferers with and without a prolongued grief diagnosis and scores in the ICG and BDI-II. The family’s financial situation is linked to the presence of symptoms of anxiety and depression and complicated grief, with the most determining variable being the risk of grief. Finally, the greater the age of the deceased and the longer the time spent in the PCU is linked to fewer symptoms of grief. However, important links have been found between the sufferers who have experienced stressful critical events prior to losing their loved one, with symptoms of depression, anxiety and complicated grief.Conclusions: The high numbers of cases of symptoms of complicated grief and levels of anxiety and clinical depression two months after a death suggests that early interventions should be carried out in those individuals with greater vulnerability.

Terapia de aceptación y compromiso en un caso de tras¬torno mixto de ansiedad y depresión en una paciente con cáncer

This paper introduces the case of a woman with breast cancer who had developed a mixed depressive-anxiety disorder with avoidance behaviors. The patient presented depressive symptoms like listlessness, insomnia, weeping, food disorders and hopelessness though. Also, she exhibited physiological arousal and restlessness feelings. Additionally, the patient had an avoidance patron behavior in relation with all stimulus she believed could hurt her. Based on the Acceptance and Commitment Therapy (ACT) the intervention planted the following objectives: the patient will learn to accept her illness and the emotional distress that she was experiencing, also, the patient will recover the other areas of her life that she had abandoned. The treatment was developed in 14 sessions. The therapist used these techniques: creative hopelessness, disabling verbal functions, values clarification and loss of control over private events. In the results, it was observed a positive change in the behavior of the patient as well as a decrease in emotional distress that was his reason for initial consultation

Effects of a positive emotion-based adjuvant psychological therapy in colorectal cancer patients: a pilot study

Objective: To examine the effectiveness of an “Enhancing Positive Emotions Procedure” (EPEP) based on positive psychology and cognitive behavioral therapy in relieving distress at the time of adjuvant chemotherapy treatment in colorectal cancer patients (CRC). It is expected that EPEP will increase quality of life and positive affect in CRC patients during chemotherapy treatment intervention and at 1 month follow-up.Method: A group of 24 CRC patients received the EPEP procedure (intervention group), whereas another group of 20 CRC patients did not receive the EPEP (control group). Quality of life (EORTC-QLQC30), and mood (PANAS) were assessed in three moments: prior to enter the study (T1), at the end of the time required to apply the EPEP (T2, 6 weeks after T1), and, at follow-up (T3, one-month after T2). Patient’s assessments of the EPEP (improving in mood states, and significance of the attention received) were assessed with Lickert scales.Results: Insomnia was reduced in the intervention group. Treatment group had better scores on positive affect although there were no significantly differences between groups and over time. There was a trend to better scores at T2 and T3 for the intervention group on global health status, physical, role, and social functioning scales. Patients stated that positive mood was enhanced and that EPEP was an important resource.Conclusions: CRC patients receiving EPEP during chemotherapy believed that this intervention was important. Furthermore, EPEP seems to improve positive affect and quality of life. EPEP has potential benefits, and its implementation to CRC patients should be considered.

Bienestar psicológico, optimismo y resiliencia en mujeres con cáncer de mama

Objective: To evaluate the relationship between Perceived Psychological well-being, Optimism and Resilience in women survivors of breast cancer.Method: The sample was composed of 30 women diagnosed with breast cancer who were undergoing adjuvant treatment in Oncology Units General Hospital of Jerez de la Frontera and the University Hospital Puerta del Mar (Cadiz). The average age was 47.47 years (SD = 6,356) and the average of months from diagnosis of the disease was 9.93 (SD = 8,541). Scale of Psychological Well-being administered Perceived Ryff (1989), the Life Orientation Test Revised (LOT-R) Scheier, Carver and Bridges (1994) and the Scale of Resilience Wagnild and Young (1993) to assess psychological well-being the dispositional optimism and resilience respectivelyResults: Descriptive analyzes show that women diagnosed with breast cancer have levels of psychological well-being, dispositional optimism and higher than the average values provided by Resilience scales. On the other hand, regression analyses revealed that only some of the dimensions of resilience allowed to explain and predict some dimensions of psychological wellbeing, not dispositional optimism.Conclusions: The results seem to confirm the idea that if the capacity of women with breast moderate negative affect generated by the diagnosis itself and the consequences of their cancer treatment works and to promote their adaptation to the new situation we can contribute to increasing psychological well-being.

Chemotherapy patient perception regarding communication with the healthcare staff

Purpose: To qualitatively explore the communication between healthcare professionals and oncology patients based on the perception of patients undergoing chemotherapy.Method: Qualitative and exploratory design. Participants were 14 adult patients undergoing chemotherapy at different stages of the disease. A socio-demographic and clinical data form was utilized along with semi-structured interviews. The interviews were audio-recorded, transcribed and content analysis was performed. Two independent judges evaluated the interview content in regards to emerging categories and obtained a Kappa index of 0.834.Results: Three categories emerged from the data: 1) Technical communication without emotional support, in which the information provided is composed of strictly technical information regarding the diagnosis, treatment and/or prognosis; 2) Technical communication, in which the information provided is oriented towards the technical aspects of the patient’s physical condition, while also providing psychological support for the patients’ subjective needs; and 3) Insufficient technical communication, win which there are gaps in the information provided causing confusion and suffering to the patient.Conclusions: Communication with emotional support contributes to greater satisfaction of chemotherapy patients. Practical implications: the results provide elements for the training of healthcare professionals regarding the importance of the emotional support that can be offered to cancer patients during their treatment.

Techniques en appui des formats de modulation avancés pour les futurs réseaux optiques

Les systèmes de communication optique avec des formats de modulation avancés sont actuellement l’un des sujets de recherche les plus importants dans le domaine de communication optique. Cette recherche est stimulée par les exigences pour des débits de transmission de donnée plus élevés. Dans cette thèse, on examinera les techniques efficaces pour la modulation avancée avec une détection cohérente, et multiplexage par répartition en fréquence orthogonale (OFDM) et multiples tonalités discrètes (DMT) pour la détection directe et la détection cohérente afin d’améliorer la performance de réseaux optiques. Dans la première partie, nous examinons la rétropropagation avec filtre numérique (DFBP) comme une simple technique d’atténuation de nonlinéarité d’amplificateur optique semiconducteur (SOA) dans le système de détection cohérente. Pour la première fois, nous démontrons expérimentalement l’efficacité de DFBP pour compenser les nonlinéarités générées par SOA dans un système de détection cohérente porteur unique 16-QAM. Nous comparons la performance de DFBP avec la méthode de Runge-Kutta quatrième ordre. Nous examinons la sensibilité de performance de DFBP par rapport à ses paramètres. Par la suite, nous proposons une nouvelle méthode d’estimation de paramètre pour DFBP. Finalement, nous démontrons la transmission de signaux de 16-QAM aux taux de 22 Gbaud sur 80km de fibre optique avec la technique d’estimation de paramètre proposée pour DFBP. Dans la deuxième partie, nous nous concentrons sur les techniques afin d’améliorer la performance des systèmes OFDM optiques en examinent OFDM optiques cohérente (CO-OFDM) ainsi que OFDM optiques détection directe (DDO-OFDM). Premièrement, nous proposons une combinaison de coupure et prédistorsion pour compenser les distorsions nonlinéaires d’émetteur de CO-OFDM. Nous utilisons une interpolation linéaire par morceaux (PLI) pour charactériser la nonlinéarité d’émetteur. Dans l’émetteur nous utilisons l’inverse de l’estimation de PLI pour compenser les nonlinéarités induites à l’émetteur de CO-OFDM. Deuxièmement, nous concevons des constellations irrégulières optimisées pour les systèmes DDO-OFDM courte distance en considérant deux modèles de bruit de canal. Nous démontrons expérimentalement 100Gb/s+ OFDM/DMT avec la détection directe en utilisant les constellations QAM optimisées. Dans la troisième partie, nous proposons une architecture réseaux optiques passifs (PON) avec DDO-OFDM pour la liaison descendante et CO-OFDM pour la liaison montante. Nous examinons deux scénarios pour l’allocations de fréquence et le format de modulation des signaux. Nous identifions la détérioration limitante principale du PON bidirectionnelle et offrons des solutions pour minimiser ses effets.

Città Metropolitane e Smart Governance Iniziative di successo e nodi critici verso la Smart City

The volume contains the results of the research project "Governance Analysis Project (GAP) for the Smart Energy City. The actualization of Smart Cities in the Metropolitan Areas of Europe and Italy” conducted within the PON “Smart Energy Master for the energy management of the territory” at the University Federico II of Naples (TeMA Lab of the Department of Civil, Architectural and Environmental Engineering). Smart Cities have gained increasing relevance in the scientific debate and in the national and international operational practice, emerging as one of the opportunities to rethink cities and, more generally, the life of urban communities. First reflections, researches and projects on the issue seem to converge towards the idea that a “smart” urban development should not only be a result of the yet necessary and unavoidable infrastructural endowment (physical capital) and of its continuing innovation, but also of the quality of human, social and environmental capital, conceived as strategic factors for development. A “smart” city is, primarily, a city able to effectively satisfy the needs of its citizens respecting the rules imposed by the environmental context. It is in such a debate that the project GAP fits with the aim to address Smart Cities in light of the administrative reorganization of Italian large cities as a consequence of the Law 56/2014. With a scientific approach, the volume provides a comprehensive and updated framework of how Italian and European Metropolitan cities are declining the Smart City issue and this thanks to the collection of a wide-ranging screening represented by more than 1.000 initiatives including researches, projects, interventions, technologies, etc. Furthermore, one original element of this research is that after an analysis conducted through indirect sources, a phase of dialogue with “stakeholders” was carried out (and of this there is a wide picture in the volume in which, by the way, are reported long excerpts of the interviews). This has enabled to give a clearer framework of what is now experimenting in Italian and European cities, avoiding being totally naïve for interventions and projects labelled as “smart”, but often lacking of innovative methods and contents.

Photonic integrated circuits development: a universal transceiver for NG-PON2

In the last years there has been a clear evolution in the world of telecommunications, which goes from new services that need higher speeds and higher bandwidth, until a role of interactions between people and machines, named by Internet of Things (IoT). So, the only technology able to follow this growth is the optical communications. Currently the solution that enables to overcome the day-by-day needs, like collaborative job, audio and video communications and share of les is based on Gigabit-capable Passive Optical Network (G-PON) with the recently successor named Next Generation Passive Optical Network Phase 2 (NG-PON2). This technology is based on the multiplexing domain wavelength and due to its characteristics and performance becomes the more advantageous technology. A major focus of optical communications are Photonic Integrated Circuits (PICs). These can include various components into a single device, which simpli es the design of the optical system, reducing space and power consumption, and improves reliability. These characteristics make this type of devices useful for several applications, that justi es the investments in the development of the technology into a very high level of performance and reliability in terms of the building blocks. With the goal to develop the optical networks of future generations, this work presents the design and implementation of a PIC, which is intended to be a universal transceiver for applications for NG-PON2. The same PIC will be able to be used as an Optical Line Terminal (OLT) or an Optical Network Unit (ONU) and in both cases as transmitter and receiver. Initially a study is made of Passive Optical Network (PON) and its standards. Therefore it is done a theoretical overview that explores the materials used in the development and production of this PIC, which foundries are available, and focusing in SMART Photonics, the components used in the development of this chip. For the conceptualization of the project di erent architectures are designed and part of the laser cavity is simulated using Aspic™. Through the analysis of advantages and disadvantages of each one, it is chosen the best to be used in the implementation. Moreover, the architecture of the transceiver is simulated block by block through the VPItransmissionMaker™ and it is demonstrated its operating principle. Finally it is presented the PIC implementation.

Effects of Information and Time of Use Pricing on Irish Electricity Demand and Supply

In this dissertation I quantify residential behavior response to interventions designed to reduce electricity demand at different periods of the day. In the first chapter, I examine the effect of information provision coupled with bimonthly billing, monthly billing, and in-home displays, as well as a time-of-use (TOU) pricing scheme to measure consumption over each month of the Irish Consumer Behavior Trial. I find that time-of-use pricing with real time usage information reduces electricity usage up to 8.7 percent during peak times at the start of the trial but the effect decays over the first three months and after three months the in-home display group is indistinguishable from the monthly treatment group. Monthly and bi-monthly billing treatments are not found to be statistically different from another. These findings suggest that increasing billing reports to the monthly level may be more cost effective for electricity generators who wish to decrease expenses and consumption, rather than providing in-home displays. In the following chapter, I examine the response of residential households after exposure to time of use tariffs at different hours of the day. I find that these treatments reduce electricity consumption during peak hours by almost four percent, significantly lowering demand. Within the model, I find evidence of overall conservation in electricity used. In addition, weekday peak reductions appear to carry over to the weekend when peak pricing is not present, suggesting changes in consumer habit. The final chapter of my dissertation imposes a system wide time of use plan to analyze the potential reduction in carbon emissions from load shifting based on the Ireland and Northern Single Electricity Market. I find that CO2 emissions savings are highest during the winter months when load demand is highest and dirtier power plants are scheduled to meet peak demand. TOU pricing allows for shifting in usage from peak usage to off peak usage and this shift in load can be met with cleaner and cheaper generated electricity from imports, high efficiency gas units, and hydro units.

Adaptação do paradigma orientado a notificações para desenvolvimento de sistemas fuzzy

This work proposes to adjust the Notification Oriented Paradigm (NOP) so that it provides support to fuzzy concepts. NOP is inspired by elements of imperative and declarative paradigms, seeking to solve some of the drawbacks of both. By decomposing an application into a network of smaller computational entities that are executed only when necessary, NOP eliminates the need to perform unnecessary computations and helps to achieve better logical-causal uncoupling, facilitating code reuse and application distribution over multiple processors or machines. In addition, NOP allows to express the logical-causal knowledge at a high level of abstraction, through rules in IF-THEN format. Fuzzy systems, in turn, perform logical inferences on causal knowledge bases (IF-THEN rules) that can deal with problems involving uncertainty. Since PON uses IF-THEN rules in an alternative way, reducing redundant evaluations and providing better decoupling, this research has been carried out to identify, propose and evaluate the necessary changes to be made on NOP allowing to be used in the development of fuzzy systems. After that, two fully usable materializations were created: a C++ framework, and a complete programming language (LingPONFuzzy) that provide support to fuzzy inference systems. From there study cases have been created and several tests cases were conducted, in order to validate the proposed solution. The test results have shown a significant reduction in the number of rules evaluated in comparison to a fuzzy system developed using conventional tools (frameworks), which could represent an improvement in performance of the applications.

Cynisme et falsification du langage : à propos de Diogène cherchant un homme

La célèbre anecdote où Diogène cherche un homme (ánthrōpon zētô) avec sa lanterne en plein jour (D.L. VI 41) a été interprétée de deux manières, selon la signification attribuée au mot ánthrōpos (« homme »). Les tenants de l’interprétation nominaliste, en lui assignant le sens d’homme en tant que concept, voient dans la quête de Diogène une attaque contre les Idées platoniciennes. Les défenseurs de l’interprétation morale confèrent plutôt au mot ánthrōpos un sens concret à valeur méliorative : Diogène chercherait en vain un homme vertueux. Après avoir montré que l’une et l’autre sont tout aussi valables, notre étude vise à dégager une voie intermédiaire qui réconcilie les deux positions grâce à une analyse du rapport entre langage et vérité chez les Cyniques que nous avons nommée « falsification du langage ».

Cynisme et falsification du langage : à propos de Diogène cherchant un homme

La célèbre anecdote où Diogène cherche un homme (ánthrōpon zētô) avec sa lanterne en plein jour (D.L. VI 41) a été interprétée de deux manières, selon la signification attribuée au mot ánthrōpos (« homme »). Les tenants de l’interprétation nominaliste, en lui assignant le sens d’homme en tant que concept, voient dans la quête de Diogène une attaque contre les Idées platoniciennes. Les défenseurs de l’interprétation morale confèrent plutôt au mot ánthrōpos un sens concret à valeur méliorative : Diogène chercherait en vain un homme vertueux. Après avoir montré que l’une et l’autre sont tout aussi valables, notre étude vise à dégager une voie intermédiaire qui réconcilie les deux positions grâce à une analyse du rapport entre langage et vérité chez les Cyniques que nous avons nommée « falsification du langage ».

La precaución jurídica en el tratamiento de la información periodística

Hoy se hace imperioso que la ética periodística se complemente con el tratamiento jurídico de la libertad de expresión. La precaución jurídica es la invitación a una visión integral de la ética profesional basada en la autorregulación y en el conocimiento de la teleología del periodismo

Ideación suicida y desesperanza en pacientes con cáncer

El objetivo de la presente investigación fue identificar la relación entre ideación suicida y desesperanza en 160 pacientes con cáncer. La ideación suicida se midió a través de dos ítems de una entrevista semiestructurada, la escala de ideación suicida (ISS), el ítem 9 del inventario de depresión de Beck (BDI-IA). La desesperanza se midió con la escala de desesperanza de Beck (BHS). Los resultados obtenidos indicaron una relación significativa (p=.000) entre ideación suicida y desesperanza; una prevalencia de ideación suicida en los pacientes con cáncer entre 4.4% y 13.8% y de riesgo de suicidio entre 5.6% y 30.6%; y algún grado de desesperanza en 31.9 % de los participantes. De acuerdo con lo anterior, se confirma que existe relación entre la desesperanza y la ideación suicida en pacientes oncológicos adultos. Adicionalmente, que estas variables están presentes en los pacientes y que ameritan atención en la intervención interdisciplinaria.