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“Share the Fear”: Communication Concerns of Parents with Cancer with Dependents and Coparents: A Qualitative Needs Assessment Study
Get PDFBackground: The estimated 1.6 million adults in the United States with cancer who also have dependents face unique challenges given the profound impact of cancer on their families, such as increased psychological distress, decreased quality of life, and altered family functioning. Unfortunately, little is known about the mutual cancer-related communication concerns for the perspectives of the parents with cancer or the coparents. Coparents care for the patient and dependents until they reach adulthood (e.g., unmarried, divorced, stepparent, and/or same-sex partnerships).
Objective: To understand the mutual cancer-related communication concerns from the perspectives of parents with cancer and the coparents and intervention delivery preferences.
Methods: Fifteen parents with cancer and 15 coparents were recruited to participate in semi-structured interviews between October 2022 to September 2023 within an academic medical center in Midwestern states. Interviews were conducted via Zoom. The data were analyzed though Charmaz’s inductive grounded theory approach.
Results: Parents with cancer and the coparents desire communication assistance with each other about discussing the cancer diagnosis with dependents, end-of-life planning, managing finances, and addressing mental health concerns and emotions. The majority of participants reported interest in a virtually delivered intervention.
Conclusions: Findings from this study provide a mutual understanding of cancer-related communication concerns from the parents with cancer and the coparents perspectives. Implications for Practice: These findings provide awareness for providers and the foundation to inform a web-based communication intervention about cancer-related concerns to promote family resiliency in this population which provides a resource for providers to utilize
Clinical Applications Of Quantitative Susceptibility Mapping
No full textThe presence and location of brain iron is implicated in a myriad of diseases and conditions, as well as normal aging. In the last decade, quantitative susceptibility mapping (QSM), an MRI post-processing technique, has gained traction in the research realm to locate and quantify iron through susceptibility measurements. This holds promise clinically to identify abnormal susceptibility as a marker for oxidative stress and inflammation, demyelination and neuronal loss, as well as blood brain barrier and vessel damage, hemorrhaging and blood product. This thesis demonstrates the clinical potential of QSM and is divided into three major sections.Hereditary hemochromatosis (HH) is a genetic disorder caused by the mutation in the HFE gene which causes the body to absorb an abnormal amount of iron in multiple systems and organs. Research on brain iron in HH is lacking, thus, the first work used QSM to show higher susceptibility in the gray matter in a clinical cohort of HH compared to a group of healthy controls. The QSM findings were corroborated by R2* relaxation mapping data, another means of measuring in vivo iron. Though QSM has been validated in phantoms and postmortem histological measurements, some questions remain about its consistency across vendors and imaging parameters. The second work evaluates the robustness of QSM over scans collected with multiple systems and varying MRI collection parameters. Normative data over the adult age range have been generated to provide a prediction of susceptibility as a function of age using both whole structure and thresholded structure approaches. MRI is commonly used as pre-surgical structural mapping tool. The third work relates to demarcating the lateral habenula as a surgical target to treat intractable psychiatric disorders. A scanning protocol using QSM was optimized to locate and quantify the lateral habenula which has not previously been done. This may have great potential for therapeutic and deep brain stimulation treatments. QSM is a robust method for measuring iron and demarcating iron-rich structures in the brain. It is consistent across myriad variables and validated by R2* mapping. It has the potential to be used in clinical cohorts, and the normative data in this work can be used to compare to new individual subject data. Lastly, the habenula and its subnuclei can be located and identified using QSM and true susceptibility weighted imaging for pre-surgical planning and therapeutic interventions
Transitioning From Morphine To Buprenorphine During Pregnancy: Effects On Maternal Care And Offspring Neurodevelopment In A Translational Rodent Model
No full textOpioid use during pregnancy has increased drastically in the last two decades. Pregnant women who use opioids are often prescribed Medications for Opioid Use Disorder (MOUDs), including buprenorphine (BUP) to mitigate negative effects on the fetus. However, BUP exposure during pregnancy may still negatively impact on maternal care behavior and offspring neurodevelopment. Further, it is not known how the transition from an opioid of abuse (i.e., morphine) to a MOUD (i.e., BUP) during gestation affects maternal and offspring outcomes. In the current study, we used a translational rodent model to investigate acute offspring neurodevelopmental outcomes following either the transition from morphine to BUP or continued use of morphine or BUP from preconception (7 days prior to mating) to the early postpartum period. Dams were assigned to one of 5 experimental groups: BUP continued (BC, 1 mg/kg, s.c.), morphine continued (MC, 3 – 10 mg/kg, s.c.), morphine to BUP (MB; 3-5 mg/kg morphine until Gestational Day (GD) 5, then 1.0 mg/kg BUP; s.c.), morphine to vehicle (MV; 3-5 mg/kg morphine until GD5, then 1.0 mL/kg saline; s.c.), or saline continued (VEH, 1.0 mL/kg, s.c.). MB and MV groups switched to BUP or saline (respectively) on GD5 to roughly mimic the time in humans when a woman would discover she is pregnant (i.e. ~ 6-8 weeks of pregnancy). All dams and their litters were sacrificed on postnatal day (PN) 2. Continuous exposure to BUP or morphine and the transition from morphine to BUP resulted in higher pup mortality, lower pup body weight, smaller pup body length, fewer milk bands, and more NOWS symptoms as compared to controls. Additionally, MB damns partook in significantly less pup-directed maternal care behaviors than drug-naïve dams, potentially contributing to the high pup mortality rate. Importantly, maternal care behavior was significantly correlated with offspring mortality, physical maturation and NOWS scores. Pup brains collected on PN2 showed lower norepinephrine (NE) in the prefrontal cortex and higher NE in the striatum of opioid-exposed pups. These results suggest that (1) the transition from morphine to BUP in early pregnancy and continued use of BUP or morphine negatively impacts offspring outcomes and alters early neurochemistry and (2) opioid-induced maternal care deficits appear to contribute to offspring neurodevelopmental outcomes following opioid exposure in utero
Hippocampal Subfield Volumes And Memory Development From Middle Childhood To Late Adulthood: 2-Year Longitudinal Change And Modifiers Of Age Effects
No full textIntroduction: The hippocampus (Hc) is crucial for memory function across all ages and is comprised of distinct subfields: dentate gyrus (DG), cornu ammonis sectors (CA1-3), and subiculum. Hc subfields support different aspects of memory function across the lifespan and are differentially vulnerable to late-life pathology. Increased knowledge of normative lifespan developmental trajectories of Hc subfield volumes will illuminate their cognitive and health correlates across different ages. Yet, the evidence on change and variability of Hc subfield volumes across the lifespan is sparse. Methods: Here, I conducted a meta-analysis of cross-sectional findings of subfield volumes across ages (n = 48,278 participants, ages = 4–94 years). Using a large longitudinal sample (ages 5-73 years, n=474 at baseline, n=189 at follow-up, mean delay=2.5 years), I further examined lifespan trends in subfield volume changes and age-group differences in change (children, ages 5-18.9 years; middle adults, ages 19-49.9 years; older adults, ages 50-73.9 years). Lastly, I assessed the associations between DG-CA3 volume changes and associative memory within the lifespan sample to gain insight into the nature of associations between volume and memory. Results: The findings of the meta-analysis suggested a nonlinear age trajectory across the lifespan for all the subfields, with a positive between age and DG and CA3-4 volumes across development, followed by a negative age-volume association for all subfields across adulthood. The longitudinal assessment of Hc subfield volumes supported a nonlinear age trajectory CA1-2 and subiculum but a fairly monotonic change pattern for DG-CA3 volumes. The assessment of DG-CA3 in relation to memory further supported a linear relation between the two across the entire lifespan: larger volumes proved advantageous to memory ability across all ages. Notably, there was evidence of individual differences in volume and memory changes with respect to their baseline measures, consistent with the lifespan hypothesis of developmental catch-up. Conclusion: The findings are novel and carry multiple implications for a better understanding of cognitive and health correlates of subfield volumes across the human lifespan
Psychometric Properties Of An Arabic Translated Version Of The Adult Inventory Of Procrastination Scale
No full textThe aim of the present study is to translate the AIP to Arabic and assess its psychometric properties in order to fill the gap on available psychometric instruments for Arabic speaking individuals. The goal is to develop and assess the reliability and validity of an Arabic version of the AIP. In addition, the use of the Arabic version of the AIP as an efficient instrument to measure procrastination among Arabic-speaking students that will be evaluated by examining scale scores across demographic characteristics (i.e., sex)
Numerical Simulation Of Bag-Mode Breakup Of Droplets: Insight Into Hole Formation And Droplet Size Distribution
No full textIn this study, we conduct three-dimensional Direct Numerical Simulations (DNS) to explore the breakup of the bag film formed by a droplet in uniform air flows. A comprehensive mesh convergence study is carried out, emphasizing the consistency of the interface shape. We analyze the time evolution of bag dimensions and compare our results with existing experimental and numerical data. Morphological transformations of the deforming droplet are scrutinized, providing insights into the intricate breakup process. Furthermore, we examine the influence of the gas Reynolds number on the droplet breakup, using comparisons between simulation results, experimental data, and outcomes obtained using the Manifold Death (MD) algorithm, a numerical technique for artificially perforating thin liquid films. The impact of the gas dynamics on the liquid film breakup is explored. A crater formation and a localized pressure jump is systematically observed inside the liquid film at the location where perforations will subsequently occur
Continuities And Transformations: The Tiwanaku Component Of The Site Of In Copacabana, Bolivia
Get PDFThe site of Cundisa in Copacabana (Copacabana Peninsula, Bolivia) was occupied almost continuously for the past 2,500 years. The oldest occupation includes a Yaya-Mama religious tradition semi-subterranean temple with some associated burials. Later, the whole site, including the interior of the Yaya-Mama temple, was used as a Tiwanaku cemetery. Subsequently, the Incas reused the site, as they incorporated Copacabana into their empire as a major pilgrimage site. After the Spanish conquest the site continued to be occupied, including an oven where glazed tiles for the Copacabana Basilica were fired. This dissertation focuses on the Tiwanaku component of this complex site. Out of the one hundred excavated Tiwanaku burials, 69 were found intact, not looted by subsequent occupations. The vast majority of the burials were typical Tiwanaku slab-lined cists, but the few outliers included larger rectangular burials and corbel-vaulted structures, both reminiscent of earlier Yaya-Mama burials on the Copacabana Peninsula. Associated grave goods included mainly pottery and unfired clay objects, with very few stone and metal artifacts. Half of pottery grave goods were broken pieces of large utilitarian vessels, some of them bearing signs of having been “upcycled,” or refashioned to be reused as bowls. Complete pottery vessels included typical Tiwanaku forms such as qeros and tazones, but also some unique shapes as well. Small unfired clay objects were also excavated in half of undisturbed graves. While recycling/upcycling of broken vessels, as well as presence of unfired clay objects, are not unique to Cundisa, the high proportions of both broken and unfired vessels are very high comparing to other Tiwanaku sites. Attribute analysis of pottery shapes, decorations, and paste/temper, revealed that Tiwanaku-style pottery at Cundisa was made using local clays and tempers, by local potters, who displayed a lower degree of specialization than Tiwanaku potters at other sites. Vessel forms emulated typical Tiwanaku-style forms, while iconography included designs showing different layers of regional and local identities. Some of the represented motifs were very widespread throughout the Tiwanaku sphere of influence, others were more common within the southern Lake Titicaca basin, and others seem to have been limited to the area of Copacabana, Island of the Sun, and Yunguyo. Based on this analysis, the people who buried their dead at Cundisa were a local community, who decided to abandon the Yaya-Mama religious tradition in favor of a new religion, which was emanating from the Tiahuanaco center. Potters of this local community began to emulate Tiwanaku forms and designs to underscore their new pan-regional Tiwanaku identity, while other designs signaled other identities, such as a local Copacabana identity, and a regional southern Lake Titicaca basin identity
Functional Evaluation Of Chek2 Single Nucleotide Variants In Hereditary Cancer Predisposition
No full textGenes associated with the DNA repair pathway and cell cycle control have been the focus of many studies for their individual roles in hereditary cancer syndromes. Comprehensive genetic risk assessment provides the opportunity for early detection of hereditary cancer and improved survival. Multigene panels for hereditary cancer syndromes sequence genes to identify the presence of pathogenic (increased risk of cancer) mutations. Multigene sequencing panels result in large quantities of genetic data, much of which cannot be interpreted and are classified as variants of uncertain significance (VUS). VUSs provide no information regarding pathogenicity and hinder the ability of clinicians to classify these variants accurately and confidently. The inability to interpret variants leads to ambiguity in genetic counseling and has the potential to lead to inaccurate medical management. In the absence of variant segregation data, in vitro functional analyses can be used to clarify variant annotations, aiding in accurate clinical management of patient risk and treatment plan.The cell cycle checkpoint kinase 2 (CHEK2) is a tumor suppressor gene coding for a protein kinase with a role in the cell cycle and DNA repair pathways. Mutations within CHEK2 are associated with an increased risk of developing breast, colorectal, prostate and several other types of cancer. Databases of patient sequencing have identified over 1000 VUSs in CHEK2, and those that are pathogenic could be revealed through functional screens. We have established methods to evaluate the functional consequences of single nucleotide variants (SNVs) individually and comprehensively throughout the open reading frame (ORF) of CHEK2. In addition to the functional studies, we performed whole exome sequencing (WES) to investigate the prevalence of germline variants in 210 breast cancer patients and identified 16 individuals with CHEK2 variants and multiple variants within breast cancer susceptibility genes. Using these data, we evaluated the prevalence of these CHEK2 variants in African American (AA) and Caucasian (CA) populations, described their current clinical classifications, assembled available functional data, and computational functional prediction, as well as explored the role these variants may play in polygenic risk assessment. Functional analyses can expand the diagnostic impact of genetic testing and provide data that can be used to support and clarify variant annotation of CHEK2. With a more comprehensive analysis of VUSs in CHEK2, genetic counselors can identify more at-risk patients and improve patient care and surveillance