Background: Almost one child a day is diagnosed with cancer in Sweden. When a child is affected with cancer a whole family, not least siblings will face a new way of life. A sibling’s relationship is unique and can only be fully understood by the ones that have experienced it themselves. There are many advantages in involving family in the caring of a child and also to see the family as a unit. Aim: The aim of the study was to illuminate siblings’ experiences of living in a family with a child with cancer. Methods: This is a literature review based on the result of ten scientific articles with qualitative approach. All articles have been examined to ensure the qualitative value of them and have been textual analyzed. Included articles have qualitative approaches to seek for depth and find siblings’ experiences. Chosen theoretical framework has been used to further lift the result. Results: Four main themes emerged from the result; altered living, need of information, anxiety and grief and support interventions. What these four have in common is that the way of life was altered. Conclusion: Siblings to a child with cancer is an exposed group both physically, mentally and emotionally. There are still gaps to fill regarding what nurses can do to identify and meet siblings needs during a cancer period and altered living. Clinical significance: This literature review can contribute to enhanced knowledge about what it is like being a sibling to a child with cancer. Key words: siblings, cancer, altered living / Bakgrund: I Sverige drabbas nästan ett barn varje dag av cancer. När ett barn drabbas avcancer ställs en hel familj, inte minst syskonen inför en ny livsvärld. En syskonrelation är unikoch kan endast förstås av de som levt i en. Det finns många fördelar med att involverafamiljen i omvårdnaden av ett barn och att se familjen som en enhet. Syfte: Syftet medstudien är att belysa syskons upplevelse av att leva i en familj med ett cancersjukt barn.Metod: Detta är en litteraturstudie baserad på resultatet av tio vetenskapliga artiklar. Samtligaartiklar har kvalitetsgranskats och analyserats. Inkluderade artiklar har varit kvalitativa, dettaför att söka efter djup och finna syskonens upplevelser. Vald teoretisk referensram haranvänts för att ytterligare lyfta resultatet. Resultat: Fyra huvudteman framkom ur resultatet;förändrad vardag, behov av information, oro och sorg samt stödinsatser. Det gemensammaför dessa teman är att livsvärlden blev förändrad. Slutsats: Syskonen till barn med cancer ären utsatt grupp så väl fysiskt, psykiskt som emotionellt. Fortfarande finns kunskapsluckor omhur sjuksköterskor ska identifiera och bemöta syskonens behov under cancerperioden och ideras förändrade livsvärld. Klinisk betydelse: Denna litteraturstudie kan bidra till ökadkunskap om hur det är att vara syskon till ett barn med cancer.

Thesis (M.F.A.)--Rochester Institute of Technology, 1996. / Typescript.

Thesis (M.A.)--Miami University, Dept. of Psychology, 2004. / Title from first page of PDF document. Document formatted into pages; contains [1], iii, 54 p. Includes bibliographical references (p. 33-37).

A generalized analysis of multiple-clad cylindrical dielectric structures with step-index profiles is presented. This analysis yields unified expressions for fields, dispersion equation and cutoff conditions for weakly guiding optical fibers with step-index but otherwise arbitrary profiles. The formulation focuses on triple-clad fibers, but can accommodate single and double-clad fibers as special limiting cases. Using the generalized solutions, transmission properties of several types of specialty fibers for broadband applications, including dispersion-shifted, dispersion-flattened, and dispersion compensating fibers, are studied. Improved designs for dispersion-shifted and dispersion compensating fibers are achieved. Fiber parameters and material compositions for the improved designs are provided. The proposed design for the dispersion-shifted fiber yields zero second-order as well as third-order dispersion at the 1.55 micrometer wavelength. The dispersion compensating fiber proposed here provides a large negative dispersion of about -400 ps/nm.km at the 1.55 micrometer wavelength for the fundamental mode. Numerical results for dispersion characteristics, cutoff wavelengths, and radial field distributions are provided. / Master of Science

Bipeds and quadrupeds are inherently unstable and their bodies sway during quiet stance and require complex patterns of muscle activation to produce direction-specific forces to control the body’s center of mass. The relative strength of length and force feedback within and across muscles collectively regulates the mechanical properties of the limb as a whole during standing and locomotion (Bonasera and Nichols 1994; Ross and Nichols 2009). Loss of posture control following spinal cord injury (SCI) is a major clinical challenge. While much is known about intermuscular force feedback during crossed extension reflex (XER) and locomotion in decerebrate cats, these have not been well characterized in animals with spinal cord injury. In this study, we mapped the distribution of heterogenic force feedback in hindlimb ankle extensor muscles using muscle stretch (natural stimulation) in intercollicular, non-locomoting, decerebrate cats with chronic lateral spinal hemisection (LSH). We also, determined the time of onset of redistribution of heterogenic force feedback following LSH by collecting force feedback data from cats with acute sci. In addition we revisited heterogenic force feedback between ankle extensors in decerebrate non-locomoting cats during mid-stance to ascertain whether these cats with intact spinal cord depict a certain pattern of force feedback. The goal was to ascertain whether the patterns and strength of feedback was different between the two states (cats with intact spinal cord and cats with SCI). We found that heterogenic feedback pathways remained inhibitory in non-locomoting decerebrate cats in two states. The latencies of inhibition also corresponded to those observed for force feedback from Golgi tendon organs. We observed variable patterns of force feedback between ankle extensors in decerebrate/control cats. On the other hand we observed consistent results in cats with chronic LSH exhibiting very strong distal to proximal pattern of inhibition from 2 weeks to 20 weeks following chronic LSH. The same results were obtained in acute LSH cats suggest that the change in neuromuscular system appears immediately after SCI and persists even after the animal start walking following SCI. The observed altered pattern of force feedback after spinal cord injury suggests either presence of a pattern intrinsic to the spinal cord or a unique pattern exhibited by the damaged spinal cord. The results are important clinically because even with vigorous rehabilitation attempts patients do not regain posture control after SCI even though they regain ability to walk. Therefore, to effectively administer treatment and therapy for patients with compromised posture control, a complete understanding of the circuitry is required.

This thesis is an ethnographic study of place-making in a war-altered landscape. It describes over a decade of resettlement efforts in a village in northwest Cambodia. As war drew to a close in the late 1990s, land on the former frontlines was allotted to those willing to risk occupancy on possibly mined terrain. Area resettlement was driven by need, forged by hope, and fraught with physical risk and material dangers. Food security and the prospect of acquiring land rights required settlers’ physical presence in and active engagement with the materialities of a forested landscape strewn with the remnants of war and the ruins of earlier settlements. Residents' conceptual and corporeal engagements with place were influenced by longstanding Khmer depictions of the srok, the ordered and cultivated landscape of agriculture and human dwelling, and the prai, the wild and fecund landscape of the forest, replete with powerful but often malevolent spirits. The srok was the landscape that the inhabitants of Handsome village longed to dwell within and struggled to create. The area’s pre-war reputation as a famously fertile agricultural zone had drawn many of its residents to risk the hazards of resettlement. The dream of the srok drove residents' actions in the actively dangerous, ever fluctuating terrain. In addition to being envisioned, the place was intimately known and directly experienced through the corporeal bodies of its inhabitants and their engagements with its material assemblages. Making the srok involved arduous physical effort in a constantly shifting material environment along with concentrated social and conceptual work. Resettlement did not merely entail hewing fields out of forests and removing mines and ordnance, but also encompassed attempts to transition into peacetime—to move from soldiering to farming, to come to rest after years of mobility and displacement, and to recreate social and moral order. This study analyzes successes and failures in place-making processes, illustrating how different aspects of landscape posed both affordances and constraints to these processes. Particular attention is paid to the ways in which material assemblages contributed to uncertainty in place-making efforts, illustrating that the material dimensions of landscape may resist as much as they acquiesce to human alteration. On a material level, place-making was a struggle that pitted human agency and will against an active and agentive landscape. Village residents were interacting with material environs in a constant state of change and becoming. The unsettling material traces of the past and the continuing threat some remnants posed in the present contributed to the ongoing indeterminacy residents experienced about the state and contents of the once famous ground. The landscape that residents sought to form and fix was always in danger of undoing its formation and categorization and revealing itself to be something else. Yet despite their failures at establishing and fixing the srok in the constantly shifting landscape of Handsome village, residents maintained their quest to transform the present configuration of place into the landscape and the future that they desired.

Cytotoxic T lymphocytes (CTL) are major effector cells in the adaptive immune response against intracellular pathogens and cancers, killing targets with high precision. Precision is achieved through the specificity of the clonally expressed T cell receptor (TCR). TCRs recognise a specific peptide chain loaded into a major-histocompatability complex, triggering signalling, inducing the CTL to attach and kill target cells. Key stages in this attack are the initial conjugation followed by polarisation and docking of the centrosome to the junction of the two cells, the immune synapse (IS). This focuses secretion of the cytolytic components, perforin and granzyme, from modified lysosomes to kill the target cell. My PhD has utilised amino acid substitutions in the target peptide to alter its signal strength and shown this alters the subsequent killing efficiency of a target population. I developed new imaging and analysis techniques to investigate the effect of TCR signal strength at each step of the killing process. I show the first step, conjugation, is reduced for a percentage of cells with dwell times decreasing as TCR signal strength decreased. The next key step of centrosome polarisation and docking at the IS was also impaired for an increasing proportion of cells as TCR signalling reduced. Impaired centrosome docking reduced efficient granule recruitment to the IS, necessary for target killing. Centrosome docking was linked with the TCR-induced intracellular calcium flux, the duration of which increases with the strength of TCR signalling. This demonstrates how the process of CTL killing can be fine-tuned by the quality of antigen.

Altered mental status (AMS), a common and serious entity in elderly Emergency Department patients, is not well recognized by physicians. Our prospective cohort study evaluated the implementation, by nurses and physicians, of the Ottawa 3DY Scale, a cognitive screening tool. We enrolled 260 patients (60.0% female, mean age 83.7). Screening rates were: overall - 78.3%; physician - 51.8%; and nurse - 64.2%. Interrater reliability was 0.65. Physician and nurse sensitivity was 78.9, 84.6% and specificity was 39.4, 54.2%, respectively, compared with the Mini-Mental State Exam. Patient living situation, educational level, triage location, hospitalization, admission location and 30 day mortality were associated with AMS. Implementation of the Ottawa 3DY Scale increased screening for AMS in elderly Emergency Department patients. It was feasible, sensitive, specific and had good interrater reliability. Use will lead to increased identification of cognitive impairment and ultimately result in improved care and outcomes in this vulnerable patient population.

Purpose: To refute the alleged practice of "pseudoscience" by P. Finn, A. K. Bothe, and R. E. Bramlett (2005) and to illustrate their experimental and systematic bias when evaluating the SpeechEasy, an altered auditory feedback device used in the management of stuttering. Method: We challenged the experimental design that led to the seemingly predetermined outcome of pseudoscience rather than science: Limited preselected literature was submitted to a purposely sampled panel of judges (i.e., their own students). Each criterion deemed pseudoscientific was contested with published peer-reviewed data illustrating the importance of good rhetoric, testability, and logical outcomes from decades of scientific research. Conclusions: Stuttering is an involuntary disorder that is highly resistant to therapy. Altered auditory feedback is a derivation of choral speech (nature's most powerful stuttering "inhibitor") that can be synergistically combined with other methods for optimal stuttering inhibition. This approach is logical considering that in stuttering no single treatment is universally helpful. Also, caution is suggested when attempting to differentiate science from pseudoscience in stuttering treatments using the criteria employed by Finn et al. For example, evaluating behavioral therapy outcomes implements a post hoc or untestable system. Speech outcome (i.e., stuttered or fluent speech) determines success or failure of technique use, placing responsibility for failure on those who stutter.

Introduction: Space is an extreme environment exposing astronauts to microgravity and cosmic radiation resulting in immune dysfunction. To overcome the complex challenges of studying astronauts in space, bed rest studies represent an alternative model simulating microgravity exposure on Earth. We sought to characterize the steady state transcriptome changes in leukocytes isolated from two microgravity models: (1) participants to 60 days of bed rest and (2) astronauts to ~6 months of spaceflight. Methods: The bed rest study recruited twenty healthy men receiving a nutritional supplement or not; the spaceflight study had fourteen male and female astronauts participate. For both studies, ten blood samples were collected over three study phases, leukocytes were isolated, and transcriptomes were quantified using high throughput RNA-sequencing. My pipeline of data analysis applied differential expression (DE) methods and functional enrichment to identify gene expression changes and pathways responding to the altered gravity environments of both bed rest and spaceflight models. Results: Temporal differential expression identified transcriptome modulation reflecting multisystem shifts and immune dysregulation in response to the transitions to and from bed rest (2,415 DE genes) and spaceflight (247 DE genes). Interestingly, later bed rest and in-flight timepoints trended towards stable RNA levels with no differential expression. The bed rest study found the nutritional intervention had no mitigating effects on transcriptome changes (0 DE genes), and the spaceflight study revealed down-regulation in response to spaceflight followed by an opposite up-regulation upon return to Earth. Conclusion: The altered gravity environments of bed rest and spaceflight significantly modulated leukocyte transcriptome compositions revealing immune dysfunction at the molecular level. Future analyses utilizing the higher quality bed rest dataset is required to isolate the effect of microgravity from other space stressors and apply validation experiments to develop gene biomarkers indicative of immune deconditioning.