One of the major issues of mental health provision in Indonesia is related to services for carers of people with serious mental illnesses. Very basic and limited services have been offered to the carers. Understanding the needs of Indonesian carers is of key importance before developing appropriate interventions for them. The aim of this study was to explore the needs of carers from mental health hospital services in Indonesia from the perspectives of carers, service users and professionals. It consisted of three separate, but, interrelated studies: (1) a review of international literature about carer needs from mental health services and Indonesian policies relating to carers contribution in the services, (2) focus groups with carers and service users, and (3) individual interviews with professionals. In the first stage, 40 studies eliciting the needs of carers from mental health services were reviewed systematically. The results could not provide adequate information of carer needs which were suitable to an Indonesian context. Therefore, reviewing additional literature of 15 policy documents relating to the contribution of carers in mental health services in Indonesia was conducted. The policy review showed that the need of involving carers in the services was acknowledged, but there has not been clear and strong political endorsement ensuring the carers to receive adequate supports based on their own needs and for their own wellbeing. In the second stage, focus groups with carers and service users were undertaken to explore the needs of Indonesian carers and how mental health hospital services could help to meet those needs. In total, 9 focus groups were conducted, seven with carers (n=33) and two with service users (n=13). All carer and service user participants were recruited from two government mental health hospitals in the capital city of Indonesia. The data were analysed by using framework analysis (Ritchie and Spencer 1994), and resulted in four themes: experiences in caregiving, carer needs from mental health hospital services, current support for carers, and recommendations for service improvement. In the third stage, individual qualitative interviews with health professionals were conducted to explore their views of what Indonesian carers need from the mental hospital services, the extent to which the current services have met the needs, and ideas for service improvements. The interviews involved 24 practitioners from a wide range of health professions, recruited from the hospitals where the earlier focus groups were completed. Framework data analysis (Ritchie and Spencer 1994) was adopted and produced five major themes: Professional views of why services should involve carers, professional views of what carers need for ill relatives, professional views of what carers need for own wellbeing, focus of current contact, and perspectives of support provision. The synthesis of the findings sourced from the focus groups and interviews was completed by adopting a thematic approach (Harden and Thomas 2008). This resulted in overall identifications of the needs of carers for own wellbeing as well as for ill persons, current support provision the carers and recommendations for service improvement within an Indonesian context. The synthesis could also identify similarities and differences between the groups of carer, service user and professional participants in viewing the needs of carers. The findings were valuable resources to aid in the design of a need-based and culturally sensitive intervention for carers in the country.

Thesis advisor: Jonathan Krones / The manifold effects of the COVID-19 pandemic include many changes to humanity's impact on the natural environment, including reduced greenhouse gas emissions from air travel and increased personal protective equipment (PPE) waste generation. The pandemic has served as a global natural experiment, revealing interactions between human health and the environment that were not clearly observable before. This research aims to develop a framework for systematically assessing the impacts of human health on the environment. This framework has been structured and populated from a review of the emerging literature on the documented environmental effects of the pandemic in addition to existing literature on environmental impacts of the health care sector in general. The framework tool catalogs observed and expected environmental effects in five stages of a public health crisis (the health issue, the medical response, the public health response, adaptation and rebound, and long-term effects) and five environmental impact categories (water pollution, solid waste, air pollution, global warming, and environmental degradation). The applicability of this framework is examined using two case studies: the 2003 SARS outbreak and the localized experience of COVID-19 in New York City. The application revealed that the framework is both transferable and scalable for use in assessing other human health crises. Overall, many of the beneficial environmental impacts that occurred as a result of the COVID-19 pandemic only came at the expense of widespread human suffering, and over time, many of these benefits were reversed. The goal is that this tool will be useful to understanding both the ways COVID-19 will continue to affect the environment as well as the effects of potential public health campaigns and crises in the future. / Thesis (BA) — Boston College, 2021. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Environmental Studies.

Yes / Objectives Dementia can affect language processing and production, making communication more difficult. This creates challenges for including the person’s perspective in research and service evaluation. This study aims to identify methods, tools and approaches that could facilitate meaningful communication with people with moderate-to-severe dementia and support the inclusion of their perspectives. Methods This qualitative study was conducted as part of the IDEAL programme and involved in-depth, semi-structured interviews with 17 dementia research and/or care professionals with expertise in communication. Transcripts were analysed using framework analysis. Findings Three main themes each with sub-themes were identified: (1) Awareness, knowledge and experience; (2) Communication approach and (3) Personalization. A person-centred orientation based on getting to know the participant and developing a bi-directional exchange formed the fundamental context for effective communication. Building on this foundation, an approach using pictures, photographs or objects that are meaningful to the person and appropriate for that person’s preferences and ability could help to facilitate conversations. The findings were integrated into a diagram illustrating how the topics covered by the themes interrelate to facilitate communication. Conclusions Useful skills and approaches were identified to help researchers engage and work with people with moderate-to-severe dementia and ensure their perspective is included. These covered getting to know the participant, using a variety of tangible tools and interactional techniques and considering the environment and context of the conversation. / ESRC, NIHR (ES/L001853/2); Alzheimer's Society (348, AS-PR2-16-001)

Patients who self-harm reported negative staff attitudes towards them on presentation to an Emergency Department (ED). The present research aims to explore staff attitudes and behaviours (own and perception of others’) and the impact of this on behaviour, barriers and facilitators of effective treatment, and team identification and norms. Ten staff members from one ED were interviewed, representing all major professional groups working non-therapeutically in the ED. A thematic framework analysis was applied and cross-referenced with another researcher and participants for validation. Analysis identified the following themes: Beliefs about self-harm, attitudes and behaviours, influences on behaviour, and identity, culture and role; related through an overarching theme of balancing difference and diversity. Evidence of PI was found, although interviewees were able to accurately recognise a mixture of beliefs and attitudes in both themselves and others. Influences on behaviour and identity were important in gaining a contextual perspective, and the concept of a ‘fluid team’, relating to patient needs, was highlighted. Results suggest that exposure of the phenomenon of PI may be useful, in conjunction with training to minimise feelings of failure/frustration. This could increase understanding and improve patient care; however, further research is required prior to this. Team stability must, however, be considered. Limitations included restricted participation across one ED and a powerful advocate for mental health patients. Although this is positive for the department, it may set it apart from others.

Introduction: Inflammatory bowel disease (IBD), Crohn’s Disease and ulcerative colitis, are long term conditions which follow a relapsing and remitting pattern. The rising incidence of IBD in adults and children has implications for the lifelong burden of disease and the provision of specialist services. Patients are predominantly managed by secondary care and follow a traditional, scheduled follow-up cycle, which is unsustainable and unsatisfactory. Patients with IBD should have access to specialist care which is delivered according to their values and needs. However few studies have examined patients’ views of follow-up care. There is also concern in the UK that services for patients with long term conditions are not orgnised to promote independence with silo working in primary and secondary care.These may be brought together formally through the development of models of care. Utilization of current out-patient spaces to regularly review stable patients is inappropriate and is challenged by commissioners. The question remains as to what models of follow-up are we able to offer patients which are acceptable and what is the role of the general practitioner (GP) and primary care within this. The aim of this study was to develop an integrated, acceptable, model of follow-up care for patients with IBD.Methods The study follows the development phase of the MRC Framework for complex interventions. A best evidence synthesis was undertaken to identify the follow-up care models in IBD. A meta-synthesis of the health and social care needs of patients with IBD was conducted to explore the impact of living with IBD. Qualitative interviews with 24 IBD patients (18 patients had CD, and 6 UC, age range 27-72 years, disease duration range 2 – 40yr) and 20 GPs purposively selected from across NW England were carried out. Patients were asked about their experience, values and preference of follow-up care. The GPs were questioned about their current and potential role in IBD. Analysis was undertaken using Framework Analysis. The best evidence synthesis, meta-synthesis and interviews were synthesised by an expert panel, Consultant Gastroenterologist, patient, GP, IBD Nurse, to develop the model of follow-up care.Results There were similarities and commonalities between the patient and general practitioner interviews. Patients did not want to be seen when well, GPs wanted more involvement in care and there is scope for an IBD outreach nurse at the interface of primary/secondary care. Discharging quiescent patients into enhanced GP care, to ensure equitable treatment, was acceptable to all, as was the concept of ‘virtual’ clinics. Patients would initiate self referral within the ‘virtual’ arm whilst patients under GP care would be referred back into secondary care as a rapid referral < 7days and not using a new patient tariff. Complex IBD patients would remain under secondary care. A stratified model of follow-up care was developed.Conclusion This study provides an acceptable integrated model of follow-up for patients with IBD. It takes into account the growing incidence of IBD and UK policy to reduce inappropriate follow-up. It emphasises role of self management, the integration of primary and secondary care, placing the patient closer to home whilst allowing secondary care to concentrate on complex patient management.

Psoriasis is a chronic skin condition that can impair physical, psychological and social functioning. A sub-population of people living with psoriasis believe that psychological stress exacerbates their physical symptoms. Stress may exacerbate psoriasis via a psychoneuroimmunological pathway. The cortisol awakening response can be used to indicate whether this pathway is functional or dysfunctional. People with psoriasis have an elevated risk of emotional distress (anxiety and depression) and an impaired quality of life. Mindfulness based cognitive therapy has been effective in reducing stress, emotional distress, quality of life impairment as well as improving physical health. The aim of this thesis is to examine the efficacy and acceptability of mindfulness-based intervention for people living with psoriasis and whether the cortisol awakening response mediates the relationship between perceived stress and physical severity of psoriasis. This thesis adopted a mixed-methods design. A pilot, randomised control trial examined the effects of mindfulness based cognitive therapy upon the physical severity, perceived stress, emotional distress, quality of life and cortisol awakening response of people living with psoriasis. These variables were entered into a correlation analysis to examine whether the cortisol awakening response was associated with any of the reported study outcomes (physical severity, perceived stress, emotional distress and quality of life). Completers of the mindfulness intervention were invited to a semi-structured interview to explore the characteristics of the participants who adhered to the intervention and their experiences of participating. The mindfulness intervention significantly improved physical (z=1.96, p=0.05) and quality of life (z=2.30, p=0.02) measurements without changing perceived stress (z=0.07, p=0.94), emotional distress (z=1.60, p=0.12) or cortisol awakening responses (z=-0.33, p=0.74). The overall cortisol awakening response was not associated with physical severity (r=-0.30, p=0.07) or perceived stress (r=-0.20, p=0.25) but was significantly correlated with emotional distress (r=-0.35, p=0.04). The intervention was perceived as an acceptable adjunct treatment option. Participants reported some process barriers that inhibited their learning of mindfulness skills. A profile emerged that described a sub-population of people with psoriasis. This sub-population may be more likely to accept and adhere to mindfulness based cognitive therapy.This thesis provides preliminary support to the concept that increasing mindfulness skill can reduce the physical severity and quality of life impairment in people with psoriasis. It recommends that a fully powered trial be conducted to examine the effectiveness of mindfulness in improving physical and overall functioning for people with psoriasis. This thesis suggests clinicians screen their patients and offer a psychological intervention best suited to their needs and characteristics.

The purpose of this master’s thesis is to design and to realize the universal analyzer of serial buses. At the beginning there are described in detail specifications and properties of buses IC, SMBus, PMBus and of the UART interface. The second part is targeted especially to design and to realize the control unit, which is the main part of the whole analyzer. It provides connecting to the unknown bus, to buses IC, SMBus, PMBus and SPI and to the UART interface. The main part of the control unit is the microcontroller PIC24HJ128GP204, which partially analyses connected bus. In the next part there is created the user application for PC, which controls and sets the control unit and receives from it partially analyzed data through the USB port. These data are used for the rest of the analysis that is done by the user application. Results may be presented to user in graphical or text form. The user application provides export of results into some of image formats. Supported formats are PS, SVG, PDF, PNG and BMP. In case of the control unit is not available, the user may choose the simulator to simulate some functions that the application provides. It supports simulation of the analysis of the unknown bus and the IC bus. The user application also contains the function of the generating own signals. Signals can be created interactively by using the mouse in the graphical representation of this signal. They can be sent to the control unit and after that it applies them to output. This function is not supported in current version of the control unit software. The user application includes some items, which do not have implemented any methods and they are prepared for the future upgrading of the analyzer. It means especially user controls and components for signal conversions between any buses.

[pt] No Brasil, há uma falta de investimento em tratamentos psicossociais para demência. A Terapia de Estimulação Cognitiva (CST) é uma intervenção psicossocial baseada em evidências para pessoas que vivem com demência (PvcD) que foi adaptada e validada para vários países. Desenvolvida no Reino Unido, a CST envolve 14 sessões que acontecem ao longo de sete semanas. Seu objetivo é melhorar a função cognitiva por meio de atividades em grupo temáticas, que estimulam implicitamente as habilidades, incluindo memória, função executiva e linguagem. As sessões seguem um conjunto de princípios básicos que incluem estimulação mental, novas ideias, pensamentos e associações e opiniões em vez de fatos. Estudos sugerem que a CST pode melhorar a cognição, o humor, a qualidade de vida e as atividades de vida diária em PvcD leve a moderada. No Brasil, um ensaio controlado randomizado (RCT) buscou investigar a viabilidade da CST no país. Os resultados sugerem que aqueles que participaram dos grupos da CST apresentaram melhora significativa nas medidas relativas ao humor e às atividades de vida diária. Devido à pandemia COVID-19, foram feitas adaptações para que a CST pudesse ser oferecida virtualmente (vCST). O primeiro estudo foi realizado juntamente com o RCT para acessar a perspectiva dos participantes do grupo e explorar os efeitos da CST. Foram realizadas entrevistas individuais semiestruturadas com as PvcD que participaram dos grupos e seus cuidadores (n = 23). As transcrições das entrevistas foram analisadas por meio da Framework Analysis. A partir da análise, dois temas gerais, Benefícios pessoais de fazer parte do grupo e Mudanças na vida diária e sete subtemas, Benefícios para cuidadores, Benefícios para pessoas com demência, Memória, Sociabilidade, Linguagem, Humor, Orientação, Atividades cotidianas e Sintomas comportamentais e psicológicos. Os resultados indicam que a CST traz benefícios pessoais percebidos às PvcD e aos cuidadores, e há muitas melhorias percebidas, que são consistentes com achados qualitativos anteriores e apoiadas por achados empíricos de ensaios da CST. O segundo estudo teve como objetivo acessar a experiência e as perspectivas das PvcD que participaram de grupos da vCST e seus cuidadores (n =25), durante a pandemia do COVID-19. As informações qualitativas que surgiram da análise serão comparadas com dados quantitativos para entender a eficácia e a viabilidade do vCST. As transcrições das entrevistas foram analisadas por meio daFramework Analysis. A partir da análise, dois temas gerais, Benefícios pessoais defazer parte do grupo e Design da vCST e 12 subtemas, Prazer, Estimulação mental, Estimulação contínua, Ocupação, Cognição, Humor, Sociabilidade, On-line, Duração, Estrutura de sessões, Centrada na pessoa e Baseada em evidências. Os achados indicam que a VCST levou a melhorias percebidas para a PvcD e trouxe benefícios pessoais para aqueles que participaram dos grupos. Resultados semelhantes são encontrados em estudos da CST, que sugerem que a vCST é viável, como a intervenção presencial. / [en] In Brazil, there is a lack of investment in psychosocial treatments for dementia. Cognitive Stimulation Therapy (CST) is an evidence-based psychosocial intervention for people living with dementia (PlwD) that has been adapted and validated to several countries. Developed in the UK, it involves 14 sessions over seven weeks. It aims to improve cognitive function through themed group activities, which implicitly stimulate skills including memory, executive function and language. Sessions follow a set of guiding principles which include mental stimulation, new ideas, thoughts and associations and opinions rather than facts. Studies suggest that CST can improve cognition, mood, quality of life and activities of daily living in mild to moderate dementia. In Brazil, a randomized controlled trial (RCT) sought to investigate the feasibility of CST in the country. The results suggest that those who took part in the CST groups had a significant improvement in measures relative to mood and activities of daily living. Due to the COVID-19 pandemic, adaptations were made for virtual delivery, and virtual CST (vCST) groups are being conducted. The first study was conducted alongside the randomized RCT to explore the real-life effectiveness of CST and to access the perspective of group participants. Individual semi-structured interviews were applied to PlwD who took part in the groups and their care partners (n = 23). The transcripts of interviews were analysed using Framework Analysis. From the analysis, two general themes, Personal benefits of being part of the group and Changes to daily living and 7 subthemes, Benefits for caregivers, Benefits por people with dementia, Memory, Sociability, Language, Mood, Orientation, Everyday activities and Behavioural and psychological symptoms have emerged. Results indicate that CST brings perceived personal benefits to PlwD and caregivers, and there are many perceived improvements, which are consistent with previous qualitative findings and supported by empirical findings from CST trials. The second study aimed to access the experience and perspectives of Plwd who have participated in vCST groups and their care partners (n = 25), during the COVID-19 pandemic. Qualitative information that has emerged from the analysis will be compared with quantitative data to understand the effectiveness and feasibility of vCST. The transcripts of interviews were analysed using Framework Analysis. From the analysis, two general themes, Personal benefits of being part of the group and Design of vCST and 12 subthemes, Enjoyment, Mental stimulation, Continued stimulation, Occupation, Cognition, Mood, Sociability, Online, Duration, Structure of sessions, Person-centred and Evidence-based have emerged. The findings indicate that vCST led to perceived improvements for PlwD and personal benefits for those who took part in the groups. Similar results are found in CST studies, which suggest that vCST is viable as studies have suggested with the face-to-face intervention.

With new VR devices entering the consumer space, the interest in the industry is growing immensely. There is currently limited information regarding controls and cybersickness in VR and the available recommendations are narrow in their nature. The goal of the thesis was to find new control and interaction guidelines that limit the onset of cybersickness, to be used by those who wish to create games in Virtual Reality. A literature review in the area of cybersickness was followed by a qualitative study. 22 participants played 4 selected VR games of different nature and were interviewed after each gaming session. The data was used in a qualitative framework designed to create policies. The resulting guidelines covered areas of cybersickness, presence and ergonomics. They validated several existing guidelines, extended some and created new ones. The new guidelines state that it is preferred to strive for controls that mirror real life, that presence has implications on interaction design and that new inputs should be implemented in a pedagogical manner. In addition some ergonomic aspects of head mounted displays were uncovered. / I takt med att VR-marknaden växer ökar konsumentintresset för teknologin mer och mer. Det är i dagsläget svårt att få tag på information angående kontroller och cybersjuka i Virtual Reality och de rekommendationer som finns är begränsade. Målet med uppsatsen var att hitta nya riktlinjer för interaktion och kontroller inom VR med fokus på att underlätta för designers att skapa spel som begränsar cybersjukans påverkan. En litteraturstudie inom området cybersjuka genomfördes och följdes upp av en kvalitativ studie. 22 deltagare spelade 4 särskilt utvalda spel vardera. Efter varje spelsession intervjuades de och den sammanlagda data bearbetades i ett kvalitativt ramverk designat för att skapa riktlinjer. Riktlinjer skapades inom områden som cybersjuka, närvaro och ergonomi. Dessa riktlinjer validerade redan existerade riktlinjer, utökade några samt skapade ett par helt nya. De nya riktlinjerna som skapades var t.ex. att det är att föredra att sträva efter interaktion som speglar det verkliga livet, att närvaron har konsekvenser på interaktionsdesign och att nya sätt att få indata bör implementeras på ett pedagogiskt vis. Dessutom har några ergonomiska aspekter av huvudmonterade skärmar upptäckts.

The emergence of energy communities entails the development of alternative energy systems, where consumers become active participants in the complex networks of material and semiotic actors. This paper looks at how local sociotechnical imaginaries are performed on island of Gotland, in Sweden. Grounded in Science, technology and society studies and co-production theory, this study provides a framework analysis of a set of documents and an interview, through the identification of conflicting visions, or sociotechnical imaginaries, of energy transition locally. The Swedish energy system is adapting slowly to the changing environment, and conflicts have emerged between national and local imaginaries. Here, the literature fails to provide satisfying arguments around political processes leading to the creation of alternative visions of energy futures. This study shows how normative orientations shape and are shaped by each other, and how alternative visions of progress often fail to be actualized and performed as long as they exist in combination with dominant visions. The two imaginaries, on one side the dominant, on the other the radical, fail to come to terms with each other because of the structural inadequacy of a system dominated by a political rationality which is unaware of itself.