ABSTRACT This study explores the post-treatment psychosocial experiences of female adult cancer patients. In particular, this study aims at identifying common themes in the nature of their experiences. This research was exploratory in nature and took place within the context of the qualitative paradigm. The focus group method was utilised in collecting data. The six participants were white Christian females between the ages of 50 and 62 who had completed treatment (either chemotherapy, radiation or both) not more than four months prior to the study. Data were analysed by means of categorical content analysis. Four out of the six participants reported relief as well as mixed emotions after discovering they had survived cancer. A major finding of this research was that all of the participants were experiencing anxiety that the cancer might recur. Five out of the six participants reported ample support from their partners and other family members. The entire group of participants admitted that their genuine friends remained supportive throughout treatment, while some friends avoided them when they had cancer, but were willing to continue the friendship after treatment. This impacted negatively on their friendship. The entire group mentioned negative social experiences due to the stigma attached to having cancer. It was also found that the participants preferred spending time with people who have insight into the meaning of life. All of the participants agreed that without their relationship with God and the social support structure including churches and acquaintances at church, they would not be able to get through their experiences during and after treatment. The entire group mentioned the experience of a greater appreciation for life after having completed treatment and survived cancer. It is evident that the experiences of cancer survivors in the South African context necessitate further research and that an understanding of these experiences plays a crucial role in the development of successful interventions for survivors, their families and the wider social community in regard to cancer.

The use of brackish water and seawater desalination for augmenting potable water supplies has focused primarily on pre-treatment, process optimization, energy efficiency, and concentrate management. Much less has been documented regarding the impact of post-treatment requirements with respect to distribution system. The goals of this study were to review current literature on post-treatment of permeate water, use survey questionnaires to gather information on post-treatment water quality characteristics, gather operation information, review general capital and maintenance cost, and identify appropriate "lessons learned" with regards to post-treatment from water purveyors participating in the Project. A workshop was organized where experts from across the United States, Europe and the Caribbean active in brackish and seawater desalination, gathered to share technical knowledge regarding post-treatment stabilization, identify solutions for utilities experiencing problems with post-treatment, note lessons learned, and develop desalination water post-treatment guidelines. In addition, based on initial workshop discussions, the iodide content of reverse osmosis and nanofiltration permeate from two seawater desalination facilities was determined. The literature review identified that stabilization and disinfection are required desalination post-treatment processes, and typically are considerations when considering 1) blending, 2) re-mineralization, 3) disinfection, and 4) materials used for storage and transport of product water. Addition of chemicals can effectively achieve post-treatment goals although considerations relating to the quality of the chemical, dosage rates, and possible chemical reactions, such as possible formation of disinfection by-products, should be monitored and studied. The survey gathered information on brackish water and seawater desalination facilities with specific regards to their post-treatment operations. The information obtained was divided into seven sections 1) general desalination facility information, 2) plant characteristics with schematics, 3) post-treatment water quality, 4) permeate, blend, and point of entry quality, 5) post-treatment operation, 6) operation and maintenance costs, 7) and lessons learned. A major consideration obtained from the survey was that facilities should conduct post-treatment pilot studies in order to identify operational problems that may impact distributions systems prior to designing the plant. Effective design and regulation considerations will limit issues with permitting for the facility. The expert workshop identified fourteen priority issues pertaining to post-treatment. Priority issues were relating to post-treatment stabilization of permeate water, corrosion control, disinfection and the challenges relating to disinfection by-product (DBP) formation, water quality goals, blending, and the importance of informing the general public. For each priority issues guidelines/recommendations were developed for how facilities can effectively manage such issues if they arise. One of the key priorities identified in the workshop was related to blending of permeate and formation of DBPs. However, it was identified in the workshop that the impact of iodide on iodinated-DBP formation was unknown. Consequently, screening evaluations using a laboratory catalytic reduction method to determine iodide concentrations in the permeate of two of the workshop participants: Tampa Bay and Long Beach seawater desalination facilities. It was found that the permeate did contain iodide, although at levels near the detection limit of the analytical method (8 [micro]g/L).

O principal objetivo desse trabalho foi desenvolver uma nova configuração de biofiltro aerado submerso utilizado no pós-tratamento do efluente de reator UASB, capaz de realizar nitrificação e desnitrificação em um único sistema. Em busca de bases operacionais dessa nova configuração, a pesquisa foi inicialmente conduzida com três reatores seqüenciais. Esses reatores foram dispostos nas seqüências I e II, respectivamente. Os resultados obtidos com esses sistemas seqüenciais levaram a concepção do projeto da nova configuração do biofiltro proposto (BF definitivo). Os resultados da seqüência I mostraram alto potencial para conversão de nitrogênio amoniacal e total, e também alta eficiência na remoção da matéria orgânica carbonácea. Esse sistema, porém, não apresentou potencial para desnitrificação. Na seqüência II foi realizada recirculação entre dois reatores do sistema (anóxico e aeróbio) para aumento de tal potencial. O maior potencial de desnitrificação, nessa seqüência, foi observado para razão de recirculação, Rc, igual a 2,65 e com o uso de 40%, em volume, de esgoto sanitário bruto como fonte de carbono. Sob essas condições operacionais, para concentração média afluente ao sistema igual a 33,74 mg de \'N-\'NH IND.3\'/L as concentrações efluentes médias de \'N-NH IND.3\', \'N-NO IND.2\'POT.-\' e \'N-NO IND.3\'POT.-\' foram, respectivamente, iguais a 0,16, 0,0026 e 9,72 mg/L. Os resultados do BF definitivo mostraram que a nova configuração proposta é viável como unidade de pós-tratamento de efluente de reator UASB, promovendo nitrificação e desnitrificação em um único sistema, além de alta eficiência de remoção da matéria orgânica. Em todas as fases dessa pesquisa, praticamente, todos os resultados obtidos atenderam ao padrão de lançamento de nitrogênio amoniacal estabelecido pela legislação ambiental. / The main objective of this work was developing a new configuration of submerged aerated biofilter used in UASB reactor post-treatment, with nitrification and denitrification in a single system. Searching operational bases of this new configuration, this research was initially driven by three sequential reactors. These reactors were arranged in the sequences I and II, respectively. The results obtained with these sequential systems took the conception of the project of the new configuration of the proposed biofilter (definitive BF). The results of the sequence I showed high ammoniacal and total nitrogen conversion potential, and also high carbonaceous organic matter removal efficiency. This system, however, not presented potential for denitrification. In the sequence II recirculation between two reactors (anoxic and aerated) of the system was made for such potential increasing. The higher denitrification potential, in this sequence, was observed with recirculation reason, Rc, equal to 2,65 and using 40%, in volume, of raw sanitary sewage as carbon source. Under these operational conditions, for average affluent concentration of 33,74 mg of \'N-NH IND.3\'/L the average effluent concentrations of \'N-NH IND.3\', \'N-NO IND.2\'POT.-\' e \'N-NO IND.3\'POT.-\' were, respectively, equal to 0,16, 0,0026 and 9,72 mg/L. The results of the definitive BF showed that the new proposed configuration is feasible as effluent UASB post-treatment unity, with nitrification and denitrification in a single system, besides high organic matter removal efficiency. Practically in all the phases of this research, all the results obtained attended to the launch standard of ammoniacal nitrogen established by the environmental legislation.

Caring for children with cancer involves caring for the entire family. Treatment for childhood cancer is centralized in major centres. A phenomenological study was conducted to elicit the lived experience of parents caring for a child who had completed treatment for cancer who do not live near their child’s cancer treatment centre. Interviews with five parents exploring their recollections of parenting their child with cancer during and after treatment were conducted. Data analysis revealed the essence of the parents’ lived experience as a journey within a journey. Four themes characterized the essence of parents’ lived experience: (1) travelling for care, (2) learning to navigate their journey with healthcare providers, (3) coping with change, and (4) giving back. Similarities and differences between the findings from this study and other studies of families with childhood cancer are presented. Recommendations relating to nursing practice, education, research and healthcare policy are provided.

Caring for children with cancer involves caring for the entire family. Treatment for childhood cancer is centralized in major centres. A phenomenological study was conducted to elicit the lived experience of parents caring for a child who had completed treatment for cancer who do not live near their child’s cancer treatment centre. Interviews with five parents exploring their recollections of parenting their child with cancer during and after treatment were conducted. Data analysis revealed the essence of the parents’ lived experience as a journey within a journey. Four themes characterized the essence of parents’ lived experience: (1) travelling for care, (2) learning to navigate their journey with healthcare providers, (3) coping with change, and (4) giving back. Similarities and differences between the findings from this study and other studies of families with childhood cancer are presented. Recommendations relating to nursing practice, education, research and healthcare policy are provided.

O principal objetivo desse trabalho foi desenvolver uma nova configuração de biofiltro aerado submerso utilizado no pós-tratamento do efluente de reator UASB, capaz de realizar nitrificação e desnitrificação em um único sistema. Em busca de bases operacionais dessa nova configuração, a pesquisa foi inicialmente conduzida com três reatores seqüenciais. Esses reatores foram dispostos nas seqüências I e II, respectivamente. Os resultados obtidos com esses sistemas seqüenciais levaram a concepção do projeto da nova configuração do biofiltro proposto (BF definitivo). Os resultados da seqüência I mostraram alto potencial para conversão de nitrogênio amoniacal e total, e também alta eficiência na remoção da matéria orgânica carbonácea. Esse sistema, porém, não apresentou potencial para desnitrificação. Na seqüência II foi realizada recirculação entre dois reatores do sistema (anóxico e aeróbio) para aumento de tal potencial. O maior potencial de desnitrificação, nessa seqüência, foi observado para razão de recirculação, Rc, igual a 2,65 e com o uso de 40%, em volume, de esgoto sanitário bruto como fonte de carbono. Sob essas condições operacionais, para concentração média afluente ao sistema igual a 33,74 mg de \'N-\'NH IND.3\'/L as concentrações efluentes médias de \'N-NH IND.3\', \'N-NO IND.2\'POT.-\' e \'N-NO IND.3\'POT.-\' foram, respectivamente, iguais a 0,16, 0,0026 e 9,72 mg/L. Os resultados do BF definitivo mostraram que a nova configuração proposta é viável como unidade de pós-tratamento de efluente de reator UASB, promovendo nitrificação e desnitrificação em um único sistema, além de alta eficiência de remoção da matéria orgânica. Em todas as fases dessa pesquisa, praticamente, todos os resultados obtidos atenderam ao padrão de lançamento de nitrogênio amoniacal estabelecido pela legislação ambiental. / The main objective of this work was developing a new configuration of submerged aerated biofilter used in UASB reactor post-treatment, with nitrification and denitrification in a single system. Searching operational bases of this new configuration, this research was initially driven by three sequential reactors. These reactors were arranged in the sequences I and II, respectively. The results obtained with these sequential systems took the conception of the project of the new configuration of the proposed biofilter (definitive BF). The results of the sequence I showed high ammoniacal and total nitrogen conversion potential, and also high carbonaceous organic matter removal efficiency. This system, however, not presented potential for denitrification. In the sequence II recirculation between two reactors (anoxic and aerated) of the system was made for such potential increasing. The higher denitrification potential, in this sequence, was observed with recirculation reason, Rc, equal to 2,65 and using 40%, in volume, of raw sanitary sewage as carbon source. Under these operational conditions, for average affluent concentration of 33,74 mg of \'N-NH IND.3\'/L the average effluent concentrations of \'N-NH IND.3\', \'N-NO IND.2\'POT.-\' e \'N-NO IND.3\'POT.-\' were, respectively, equal to 0,16, 0,0026 and 9,72 mg/L. The results of the definitive BF showed that the new proposed configuration is feasible as effluent UASB post-treatment unity, with nitrification and denitrification in a single system, besides high organic matter removal efficiency. Practically in all the phases of this research, all the results obtained attended to the launch standard of ammoniacal nitrogen established by the environmental legislation.

No presente trabalho foi estudada a utilização do ozônio como auxiliar no pós-tratamento de reatores anaeróbios por reatores de lodos ativados. Foi estudada a influência da ozonização no aumento da biodegradabilidade da matéria orgânica recalcitrante de efluente anaeróbio antes de ser submetido ao tratamento aeróbio. A pesquisa foi dividida em três etapas. Na primeira e segunda etapas foram utilizados quatro amostras, uma bruta e três ozonizadas com dosagens de 5, 10 e 15 mg O3/L. As amostras da primeira e segunda etapa tiveram tempos de ozonização de 30 e 50 minutos, respectivamente. Os reatores de lodos ativados tiveram tempo de retenção celular de 10 dias e tempo de detenção hidráulica de 24 horas. Na terceira etapa foram utilizadas três amostras, uma bruta e duas ozonizadas cuja dosagem de ozônio foi de 15 mg/L, valor que obteve melhores resultados nas etapas anteriores. Os tempos de ozonização de cada amostra foram de 30 e 50 minutos. Nesta fase, o reator de lodos ativados teve tempo de retenção celular de 10 dias e tempo de detenção hidráulica de 12 horas. Entretanto, amostras ozonizadas submetidas a pós-tratamento em reator de lodos ativados, apresentaram aumento da biodegradabilidade quando expostas a maiores tempos de ozonização. A alimentação do reator de lodos ativados com amostras ozonizadas trouxe benefícios ao seu desempenho. / On this research was studied the utilization of ozone as auxiliary on the post-treatment of anaerobics reactors by activated sludges reactors. It was studied the influence of ozonization of anaerobic effluent before being submitted to an aerobic treatment on the increase of the biodegradability of recalcitrant organic matter. The research was divided in three stages. In the first and second stage was used four samples, one brute and three ozonizades with doses of 5, 10 and 15 mg O3/L. The samples used on first and second stages had being ozonization times of 30 and 50 minutes, respectively. The activated sludges reactors had time of cellular retention of 10 days and hydraulic time of detention of 24 hours. On the third stage were used three samples, one brute and two ozonizades whose doses of ozone was of 15 mg/L, this value achieved the best results in the previous stages. The ozonizations times of each sample were of 30 and 50 minutes. On this stage the activated sludges reactors had time of cellular retention of 10 days and hydraulic time of detention of 12 hours. It was observed that ozonizades samples submitted to post-treatment in activated sludges reactors presented increase of the biodegradability when exposed at largest times of ozonization. The feeding of activated sludges reactors with ozonizades samples benefit its perfomance.

No presente trabalho foi estudada a utilização do ozônio como auxiliar no pós-tratamento de reatores anaeróbios por reatores de lodos ativados. Foi estudada a influência da ozonização no aumento da biodegradabilidade da matéria orgânica recalcitrante de efluente anaeróbio antes de ser submetido ao tratamento aeróbio. A pesquisa foi dividida em três etapas. Na primeira e segunda etapas foram utilizados quatro amostras, uma bruta e três ozonizadas com dosagens de 5, 10 e 15 mg O3/L. As amostras da primeira e segunda etapa tiveram tempos de ozonização de 30 e 50 minutos, respectivamente. Os reatores de lodos ativados tiveram tempo de retenção celular de 10 dias e tempo de detenção hidráulica de 24 horas. Na terceira etapa foram utilizadas três amostras, uma bruta e duas ozonizadas cuja dosagem de ozônio foi de 15 mg/L, valor que obteve melhores resultados nas etapas anteriores. Os tempos de ozonização de cada amostra foram de 30 e 50 minutos. Nesta fase, o reator de lodos ativados teve tempo de retenção celular de 10 dias e tempo de detenção hidráulica de 12 horas. Entretanto, amostras ozonizadas submetidas a pós-tratamento em reator de lodos ativados, apresentaram aumento da biodegradabilidade quando expostas a maiores tempos de ozonização. A alimentação do reator de lodos ativados com amostras ozonizadas trouxe benefícios ao seu desempenho. / On this research was studied the utilization of ozone as auxiliary on the post-treatment of anaerobics reactors by activated sludges reactors. It was studied the influence of ozonization of anaerobic effluent before being submitted to an aerobic treatment on the increase of the biodegradability of recalcitrant organic matter. The research was divided in three stages. In the first and second stage was used four samples, one brute and three ozonizades with doses of 5, 10 and 15 mg O3/L. The samples used on first and second stages had being ozonization times of 30 and 50 minutes, respectively. The activated sludges reactors had time of cellular retention of 10 days and hydraulic time of detention of 24 hours. On the third stage were used three samples, one brute and two ozonizades whose doses of ozone was of 15 mg/L, this value achieved the best results in the previous stages. The ozonizations times of each sample were of 30 and 50 minutes. On this stage the activated sludges reactors had time of cellular retention of 10 days and hydraulic time of detention of 12 hours. It was observed that ozonizades samples submitted to post-treatment in activated sludges reactors presented increase of the biodegradability when exposed at largest times of ozonization. The feeding of activated sludges reactors with ozonizades samples benefit its perfomance.

Orientador: Lenice do Rosário de Souza / Resumo: Introdução: A aids caracteriza-se por comprometimento do sistema nervoso central, cujas células são importantes alvos para o vírus da imunodeficiência humana (HIV). Alterações neurológicas acometem cerca de 40% a 70% das pessoas que vivem com HIV/aids, chegando a 90% ou mais em estudos de necropsia. A toxoplasmose cerebral é a infecção mais comum, acomete cerca de 3% a 40% dos pacientes com aids e é a causa mais comum de lesão expansiva focal. Alguns critérios clínicos e radiológicos são utilizados para definição de seu diagnóstico. Objetivo: avaliar os dados epidemiológicos, clínicos, terapêuticos e as alterações cerebrais tomográficas no diagnóstico presuntivo de toxoplasmose cerebral em indivíduos com aids. Casuística e métodos: foram estudados, retrospectivamente, 28 pacientes com diagnóstico presuntivo de toxoplasmose cerebral, que realizaram exames de imagem a partir da suspeita clínica, atendidos no período de junho de 2012 a dezembro de 2018 e que realizaram tratamento específico para a infecção oportunista. A coleta de dados foi realizada por meio de consulta aos prontuários médicos dos pacientes que apresentaram critérios de inclusão para o estudo. Os exames de imagem foram avaliados com auxílio de médico radiologista do Serviço. As análises foram descritivas com cálculo de médias e desvios padrão para variáveis quantitativas e frequências e percentuais para variáveis categorizadas. Os sintomas pré e pós-tratamento foram comparados pelo teste qui-quadrado. Resultado... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: AIDS is characterized by impairment of the central nervous system, whose cells are important targets for the human immunodeficiency virus (HIV). Neurological changes affect about 40% to 70% of people living with HIV / AIDS, reaching 90% or more in necropsy studies. Cerebral toxoplasmosis is the most common infection, affecting about 3% to 40% of AIDS patients and is the most common cause of focal expansive lesion. Some clinical and radiological criteria are used to define its diagnosis. Objective: to evaluate epidemiological, clinical, therapeutic and tomographic brain changes in the presumptive diagnosis of cerebral toxoplasmosis in individuals with AIDS. Patients and Methods: 28 patients with a presumptive diagnosis of cerebral toxoplasmosis, who underwent imaging from the clinical suspicion, were studied retrospectively from June 2012 to December 2018 and who underwent specific treatment for the opportunistic infection. The data collection was done by consulting the medical records of the patients who presented inclusion criteria for the study. The imaging exams were evaluated with the assistance of the radiologist of the Service. The analyzes were descriptive with calculation of means and standard deviations for quantitative variables and frequencies and percentages for categorized variables. Pre and post-treatment symptoms were compared by the chi-square test. Results: the majority of the patients were men (53.6%), with a mean age of 39.8 years. Headache wa... (Complete abstract click electronic access below) / Mestre

Thesis advisor: Callista Roy / <bold>Problem</bold>: Cancer patients lack information and support needed to make the transition to survivorship. This problem was addressed by testing a psycho-educational group intervention, the Mid-Life Directions Workshop, for its effect on hope and quality of life in midlife cancer survivors. <bold>Participants</bold>: Twenty-six midlife adults (23 women, 3 men, mean age = 54.3 years, range 40-65) with breast cancer (n = 19), colorectal cancer (n = 4), lung cancer (n = 2), and malignant melanoma (n = 1) stages I, II and III were recruited from two hospital-affiliated Cancer Centers in the Northeastern United States. Mean time since completion of active primary treatment was 11.5 months (SD = 6.67, range, 0-28 months). Most participants were non-Hispanic (96.2%) and white (100%) with some college or a college degree (88.5%). <bold>Method</bold>: A multimethod experimental design randomly assigned 17 participants to the treatment group, receiving the workshop in six 2-hour sessions, and 9 participants to the control group, receiving a nutrition program in six 1-hour sessions. Hope was measured pre- and post-intervention using the Herth Hope Index as was quality of life using the Quality of Life Instrument, Patient/Cancer Survivor Version. Written reflections were created by treatment group participants post-intervention. <bold>Findings</bold>: The quantitative measures revealed a significant increase in hope (p = .047) for the control group. The treatment group reported positive effects on hope and quality of life by means of written reflections. Six themes emerged: 1) examining what is, 2) feeling connected, 3) accepting what is, even the painful, 4) embracing one's life experiences, 5) exploring new possibilities, and 6) moving forward with enthusiasm. <bold>Implications</bold>: The Mid-Life Directions Workshop demonstrated positive effects on hope and quality of life for this group of midlife cancer survivors. The richness of the qualitative findings highlights the importance of multimethod design for future studies. The Nutrition Program also merits further study. This study provides an increased understanding of interventions that may support hope in midlife cancer survivors following active primary treatment. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.