Caregiving at the end of life:perspectives from spousal caregivers and care recipients.

OBJECTIVE: The purpose of this study is to examine the perspectives of both the spousal caregiver and care recipient on the caregiving experience in home-based palliative care. METHODS: A qualitative research strategy involving home-based face-to-face interviews with older palliative care patients and their spousal caregivers was used to examine the caregiving experience. RESULTS: Ten spousal caregivers and care recipient dyads participated in the study. Most informal caregivers viewed caregiving as an extension of the family relationship where caregiving responsibilities evolved over time. Spousal caregivers identified many negative reactions to caregiving, such as fatigue or weariness, depression, anger and sadness, financial stresses, and lack of time. Care recipients acknowledged the emotional and financial strain and expressed concern for their spouses. Both caregivers and care recipients were appreciative of home care services although they identified the need for additional services. They also identified difficulties in communication with formal providers and poor coordination of care among the various services. Both caregivers and care recipients disclosed some challenges with informal supports, but on the whole felt that their presence was positive. Additional positive aspects of caregiving reported by spouses included strengthened relationship with their spouse and discovering emotional strength and physical abilities in managing care. SIGNIFICANCE OF RESULTS: Health care and social service professionals need to recognize and understand both caregiver and care recipient perspectives if they are to successfully meet the needs of both members of the dyad.

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.

Known risk factors for violence predict 12-month-old infants' aggressiveness with peers

This study tested the hypothesis that 12-month-old infants' use of force against peers is associated with known risk factors for violence. We conducted a prospective longitudinal study, which included laboratory observations of firstborn British infants (N = 271) during simulated birthday parties. No gender differences in aggressiveness were observed. The infants' observed aggressiveness was significantly correlated with mothers' mood disorder during pregnancy and with mothers' history of conduct problems. Infants' observed aggressiveness was correlated with parents' ratings of infants' anger and aggression, which were also predicted by mothers' mood disorder and history of conduct problems. Our findings indicate that infants at risk for serious aggression can already be identified when the motor ability to use physical force first enters the human repertoire.

Moral emotions and the envisioning of mitigating circumstances for wrongdoing

Anger may be more responsive than disgust to mitigating circumstances in judgments of wrongdoing. We tested this hypothesis in two studies where we had participants envision circumstances that could serve to mitigate an otherwise wrongful act. In Study 1, participants provided moral judgments, and ratings of anger and disgust, to a number of transgressions involving either harm or bodily purity. They were then asked to imagine and report whether there might be any circumstances that would make it all right to perform the act. Across transgression type, and controlling for covariance between anger and disgust, levels of anger were found to negatively predict the envisioning of mitigating circumstances for wrongdoing, while disgust was unrelated. Study 2 replicated and extended these findings to less serious transgressions, using a continuous measure of mitigating circumstances, and demonstrated the impact of
anger independent of deontological commitments. These findings highlight the differential relationship that anger and disgust have with the ability to envision mitigating factors.

Temper outbursts in Prader-Willi syndrome: causes, behavioural and emotional sequence and responses by carers

Background: Temper outbursts are common in Prader-Willi syndrome but rarely described in detail. This study investigated the phenomenology of temper outbursts in terms of antecedents, sequence of behaviours and emotions and intervention strategies used.

Method: A semi-structured interview about temper outbursts was conducted with the main carers of seven children (9.5 to 16.7 years) and seven adults (24.7 to 47.10 years) with Prader-Willi syndrome (10 male, 4 female). Reliability and validity of the interview results was established.

Results: Various setting events increased and reduced the likelihood of temper outbursts. The most common antecedent was a change to routine or expectation. There were marked similarities in the sequence of behaviours and emotions during temper outbursts, with anger rising quickly followed by expressions of remorse and distress at the end of an outburst.

Discussion: The sequence of behaviours and emotions within outbursts was similar to that described in temper tantrums in typical development. Cognitive and emotional processes are likely to be important in the understanding of temper outbursts with implications for early intervention.

The challenge to health professionals when carers resist truth telling at the end of life: a qualitative secondary analysis

Aims and objectives: To draw out the similar complexities faced by staff around
truth-telling in a children’s and adult population and to interrogate the dilemmas faced by staff when informal carers act to block truth-telling.

Background: Policy encourages normalisation of death, but carers may act to protect or prevent the patient from being told the truth. Little is known about the impact on staff.

Design: Secondary analysis of data using a supra-analysis design to identify commonality of experiences.

Methods: Secondary ‘supra-analysis’ was used to transcend the focus of two primary studies in the UK, which examined staff perspectives in a palliative children’s and a palliative adult setting, respectively. The analysis examined new theoretical questions relating to the commonality of issues independently derived in each primary study. Both primary studies used focus groups. Existing empirical data were analysed thematically and compared across the studies.

Results: Staff reported a hiding of the truth by carers and sustained use of activities aimed at prolonging life. Carers frequently ignored the advance of end of life, and divergence between staff and carer approaches to truth-telling challenged professionals. Not being truthful with patients had a deleterious effect on staff, causing anger and feelings of incompetence.

Conclusions: Both children’s and adult specialist palliative care staff found themselves caught in a dilemma, subject to policies that promoted openness in planning for death and informal carers who often prevented them from being truthful with patients about terminal prognosis. This dilemma had adverse psychological effects upon many staff.

Relevance to clinical practice: There remains a powerful death-denying culture in
many societies, and carers of dying patients may prevent staff from being truthful with their patients. The current situation is not ideal, and open discussion of this problem is the essential first step in finding a solution.

Precursors to aggression are evident by 6 months of age

We tested the hypothesis that developmental precursors to aggression are apparent in infancy. Up to three informants rated 301 firstborn infants for early signs of anger, hitting and biting; 279 (93%) were assessed again as toddlers. Informants' ratings were validated by direct observation at both ages. The precursor behaviours were significantly associated with known risk factors for high levels of aggressiveness. Individual differences were stable from early infancy to the third year and predicted broader conduct problems. These findings suggest that some individuals set forth on the trajectory to high levels of aggression by 6 months of age. The findings have implications for developmental studies of aggression, clinical prevention and intervention strategies, and theoretical considerations regarding the detection of precursors in different domains of development.

Emotions and voting in EU referendums

There is an emerging scholarship on the emotional bases of political opinion and behaviour and, in particular, the contrasting implications of two distinct negative emotions - anger and anxiety. I apply the insights in this literature to the previously unresearched realm of the emotional bases of voting in EU referendums. I hypothesise that anxious voters rely on substantive EU issues and angry voters rely on second-order factors relating to domestic politics (partisanship and satisfaction with government). Focusing on the case of Irish voting in the Fiscal Compact referendum, and using data from a representative sample of voters, I find support for the hypotheses and discuss the implications of the findings for our understanding of the emotional conditionality of EU referendum voting. 

Human Rights Histories

This review article considers Samuel Moyn’s book The Last Utopia:Human Rights in History in the context of recent trends in the writing of human rights history. A central debate among historians of human rights, in seekingto account for the genesis and spread of human rights, is how far current humanrights practice demonstrates continuity or radical discontinuity with previousattempts to secure rights. Moyn’s discontinuity thesis and the controversysurrounding it exemplify this debate. Whether Moyn is correct is importantbeyond the confines of human rights historiography, with implications for theirmeaning in law, as well as their political legitimacy. This review argues that Moyn’s book ultimately fails to convince, for two broad reasons. First, a more balanced judgment would conclude that the history of human rights is both one of continuity and discontinuity. Second, and more importantly, Moyn fails to offer a convincing account of the normativity of human rights. Undertaking a history of human rights requires a deeper engagement with debates on the nature and validity of human rights than Moyn seems prepared to contemplate.

Does consideration of future consequences moderate the relationship between aggression and alcohol use in adolescents? Results from the United Kingdom

Background: An increasing body of literature suggests that those who give greater consideration to the future consequences (CFC) of their present behaviours are at a reduced risk of negative health outcomes. The present study examined whether CFC moderated the relationship between four domains of aggression and alcohol use in adolescents in the United Kindgom. Methods: Participants were 1058 adolescents from Northern Ireland. Participants completed questionnaires assessing: Anger; Hostility; Verbal Aggression; Physical Aggression; Consideration of Future Consequences; and alcohol use. Results: In line with extant research males scored significantly higher than females on measures of verbal and physical aggression, with no significant gender differences observed for other dependent measures. Results also revealed that CFC moderated the relationship between aggression and alcohol use, but only for females. Conclusions: These findings add to the increasing body of literature examining the temporal-health relationship. However more work is needed to help untangle the gender-specific effects.

Imagens das línguas e afectividade em contexto escolar

Enquadrado numa perspectiva sócio-construtivista em Didáctica de Línguas (DL), o presente trabalho propõe-se identificar e descrever as imagens face às línguas estrangeiras, em particular à língua Alemã, e sua aprendizagem, que se manifestam numa determinada comunidade escolar. Com base nas imagens identificadas, pretende-se compreender de que forma elas se relacionam com a dimensão afectiva presente no processo de ensinoaprendizagem, nomeadamente no que diz respeito à relação afectiva que o aprendente vai construindo com o alemão, objecto de estudo. Neste quadro, foram traçadas as seguintes questões de investigação para este trabalho: (1) Que imagens face às línguas escolares (inglês, francês, espanhol, português e, em particular, alemão), se manifestam numa determinada comunidade escolar (considerando os alunos, encarregados de educação, professores, administração da escola e funcionários)?; Como se (inter-) relacionam estas imagens nos diferentes públicos considerados?; (2) De que forma se manifestam as imagens face à língua alemã e sua aprendizagem na interacção em sala de aula de Alemão (LE)? Quais as marcas discursivas que as identificam e tecem?; De que forma estão estas imagens associadas às emoções e (3) Quais as emoções associadas às imagens do Alemão e sua aprendizagem em contexto de sala de aula? A investigação recente em DL sugere que as imagens que um determinado sujeito constrói face a uma dada língua permitem compreender as suas atitudes e comportamentos face à mesma, nomeadamente no que diz respeito à relação afectiva que vai construindo com a língua em causa e sua aprendizagem (cf. ARAÚJO E SÁ & SCHMIDT 2008, DE PIETRO & MÜLLER 1997, MÜLLER 1998, PERREFORT 2001). Estas imagens, enquanto constructos sociais, elaboram-se, revitalizam-se e cristalizam-se na e pela interacção verbal em sala de aula. Nesta perspectiva, o presente trabalho discute os conceitos de imagem/representação face às línguas, relacionandoos com a dimensão afectiva (inegavelmente) presente nos processos de ensino-aprendizagem das LE e à luz de uma abordagem interaccional em DL. A investigação desenrolou-se em duas fases. Numa primeira, aplicou-se um inquérito por questionário a toda uma comunidade escolar (incluindo todos os públicos anteriormente referidos), numa escola secundária com terceiro ciclo em Albergaria-a-Velha, no distrito de Aveiro. Os dados recolhidos foram analisados segundo uma abordagem mista (quantitativa e qualitativa). Os resultados apontam para imagens fortemente escolarizadas, na medida em que os inquiridos parecem considerar as línguas estrangeiras sobretudo enquanto objectos de apropriação em contextos escolares. Identificaram-se imagens homogéneas e consistentes das línguas estrangeiras, evidenciando-se, no que à língua alemã diz respeito, a sua dificuldade. Os resultados relacionam-se com os obtidos noutras investigações realizadas em terreno nacional em DL, corroborando alguns e complementando outros (ARAÚJO E SÁ 2008, SIMÕES 2006, PINTO 2005, MELO 2006 e Projecto Imagens das Línguas na comunicação intercultural: contributos para o desenvolvimento da competência plurilingue). Numa segunda fase, acompanhou-se uma turma de alemão (LE) ao longo de um ano lectivo completo, tendo-se procedido à vídeo-gravação das aulas e, posteriormente, à identificação do que designámos por ‘episódios significativos’, para constituição do corpus de análise. A análise interaccional destes episódios permitiu a identificação de diferentes marcas discursivas (verbais, para-verbais e não-verbais) que indiciam, por um lado, a circulação e (re)construção de imagens face ao alemão e sua aprendizagem e, por outro, a presença de um conjunto de emoções associadas a estas imagens, nos discursos dos aprendentes e da professora. No que diz respeito à imagem da dificuldade do alemão e da sua aprendizagem, cristalizaram-se seis indicadores: (1) a compreensão oral e a pronúncia, (2) o léxico e as palavras compostas (3) os números, (4) a leitura, (5) o sistema de regras gramaticais e, finalmente, (6) a auto-imagem dos alunos enquanto aprendentes de alemão. Os resultados sugerem ainda a associação destas imagens a emoções tendencialmente ‘negativas’ (por exemplo a arrelia e o embaraço), isto é, que se traduzem numa atitude de distanciamento e de evitamento linguístico. Face às conclusões obtidas, propõe-se um conjunto de princípios enquadradores para uma educação em línguas ‘afectivamente consciente’ e capaz de promover imagens mais positivas das línguas e das suas aprendizagens, designadamante do alemão. Considerando-se a diminuição acentuada dos aprendentes de alemão (LE) em contexto escolar nacional nos últimos dez anos, aponta-se para a necessidade de melhor compreender a relação entre a falta de popularidade escolar desta língua e a imagem da sua dificuldade (de aprendizagem).

Development of high-resolution gamma cameras based on silicon photosensors

The development of a compact gamma camera with high spatial resolution is of great interest in Nuclear Medicine as a means to increase the sensitivity of scintigraphy exams and thus allow the early detection of small tumours. Following the introduction of the wavelength-shifting fibre (WSF) gamma camera by Soares et al. and evolution of photodiodes into highly sensitive silicon photomultipliers (SiPMs), this thesis explores the development of a WSF gamma camera using SiPMs to obtain the position information of scintillation events in a continuous CsI(Na) crystal. The design is highly flexible, allowing the coverage of different areas and the development of compact cameras, with very small dead areas at the edges. After initial studies which confirmed the feasibility of applying SiPMs, a prototype with 5 5 cm2 was assembled and tested at room temperature, in an active field-of-view of 10 10 mm2. Calibration and characterisation of intrinsic properties of this prototype were done using 57Co, while extrinsic measurements were performed using a high-resolution parallel-hole collimator and 99mTc. In addition, a small mouse injected with a radiopharmaceutical was imaged with the developed prototype. Results confirm the great potential of SiPMs when applied in a WSF gamma camera, achieving spatial resolution performance superior to the traditional Anger camera. Furthermore, performance can be improved by an optimisation of experimental conditions, in order to minimise and control the undesirable effects of thermal noise and non-uniformity of response of multiple SiPMs. The development and partial characterisation of a larger SiPM WSF gamma camera with 10 10 cm2 for clinical application are also presented.

A fase utópico-patriótica da poesia angolana (1965-1985)

O presente trabalho propõe-se analisar a poesia dos autores angolanos que publicaram entre 1965 e 1985, identificando este segmento temporal como uma fase literária da literatura angolana (designada como utópico-patriótica), a qual exprime os princípios anticoloniais e projeta um espaço utópico genuinamente angolano. Tendo em conta a evolução da literatura angolana, subjaz à produção poética dos autores estudados um certo sentido de continuidade, o qual, estimulado pela difusão do nacionalismo, passa pela poesia «da terra» dos mensageiros e continua com os versos encriptados e anticoloniais das décadas de 60 e 70. O espaço utópico projetado na primeira parte da fase utópico-patriótica encontra a sua possibilidade de concretização com a independência de Angola, em 1975, participando os escritores da construção do recém-nascido Estado-Nação. A produção poética da segunda parte da fase utópico-patriótica é, assim, caraterizada pela celebração dos heróis, na ótica de uma (re)perspetivação da história nacional. A partir de 1985, quando se torna evidente o falhanço da utopia, a poesia angolana ensaia um novo rumo pela mão da «geração das incertezas». Ao longo deste percurso, a poesia angolana publicada entre 1965 e 1985 representa um meio de consciencialização ético-política dos cidadãos e concorre para a construção da identidade político-literária da nação angolana, cuja legitimação decorre do processo de conquista da independência.