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1.  The journey with dementia from the perspective of bereaved family caregivers: a qualitative descriptive study 
BMC Nursing  2014;13(1):42.
Background
With increasing rates of dementia among older adults, many people will be affected by this disease; either by having the disease or by caring for a relative with dementia. Due to a shift toward home and community-based care there will be an increase in the number of family caregivers caring for persons with dementia. The caregiving experience in the dementia journey is influenced by many factors. Currently there is a paucity of research that examines the dementia caregiving experience from the perspective of bereaved caregivers or that presents the complete caregiving journey. The purpose of this study was to describe the dementia caregiving journey as revealed by bereaved family caregivers.
Methods
This study utilized qualitative description to describe the overall dementia caregiving journey as told by 11 bereaved caregivers. Open-ended interviews resulted in rich detailed descriptions of the caregiving journey from before a dementia diagnosis and into bereavement.
Results
Findings are discussed based on the following caregiving themes: (a) getting a diagnosis; (b) managing at home; (c) transition to long-term care; (d) end of life; and (e) grief in bereavement. Subthemes reflect the dementia caregiving journey using the words of the participants. Participants spoke of grieving throughout the caregiving experience.
Conclusions
Bereaved caregivers have similar experiences to active caregivers over comparable points in the journey with dementia. Findings from this work contribute new understanding to the literature around the unique perspective of bereaved caregivers, while presenting the overall dementia caregiving journey.
doi:10.1186/s12912-014-0042-x
PMCID: PMC4247750  PMID: 25435810
Bereaved; Dementia; Family caregivers; Journey; Qualitative description
2.  Utility of passive photography to objectively audit built environment features of active transport journeys: an observational study 
Background
Active transport can contribute to physical activity accumulation and improved health in adults. The built environment is an established associate of active transport behaviours; however, assessment of environmental features encountered during journeys remains challenging. The purpose of this study was to examine the utility of wearable cameras to objectively audit and quantify environmental features along work-related walking and cycling routes.
Methods
A convenience sample of employed adults was recruited in New Zealand, in June 2011. Participants wore a SenseCam for all journeys over three weekdays and completed travel diaries and demographic questionnaires. SenseCam images for work-related active transport journeys were coded for presence of environmental features hypothesised to be related to active transport. Differences in presence of features by transport mode and in participant-reported and SenseCam-derived journey duration were determined using two-sample tests of proportion and an independent samples t-test, respectively.
Results
Fifteen adults participated in the study, yielding 1749 SenseCam images from 30 work-related active transport journeys for coding. Significant differences in presence of features were found between walking and cycling journeys. Almost a quarter of images were uncodeable due to being too dark to determine features. There was a non-significant tendency for respondents to under-report their journey duration.
Conclusion
This study provides proof of concept for the use of the SenseCam to capture built environment data in real time that may be related to active transportation. Further work is required to test and refine coding methodologies across a range of settings, travel behaviours, and demographic groups.
doi:10.1186/1476-072X-12-20
PMCID: PMC3627618  PMID: 23575288
Walking; Cycling; SenseCam; Measure; Physical activity
3.  P05.02. Non-cognitive Therapy to Alleviate Suffering in Pediatric Palliative Care: Shamanic Journeying 
Focus Areas: Pediatrics, Alleviating Pain
Many children receiving palliative care sufffer from physical, emotional, and spiritual issues that are not adequately relieved by pharmacologic means or cognitive therapies. Children's hospitals rely upon music, art, and childlife therapies to provide a child-friendly environment that allows them to explore and express feelings in a safe and developmentally appropriate environment. The use of complementary medicine techniques such as massage, Reiki, therapeutic touch, imagery-relaxation, and acupuncture have been used in adult and pediatric palliative care. A technique that has been used less frequently is shamanic journeying in which the patient or the shaman moves into an altered state of awareness and encounters “spirits,” “power animals,” or teachers or guides who can provide information they need to complete their life work. Shamanic journeying may be done as a guided process with the assistance of drumming, rattling, or chanting, helping to propel the person on the journey. The difference between imagery-relaxation techniques/hypnosis and shamanic journeying rests in the presumed source of the information. Conventional medicine assumes that insight comes from the patient's subconscious mind. Shamans believe that the source of information derives from the energetic-spirit world surrounding us. We have explored the use of shamanic journeying to retrieve “power animals” (guardian totems) on behalf of patients and as a way for patients to access other levels of insight and teaching about their condition. Questions to be pursued for patients include “finding the meaning of the disease” or “what do I need to do to feel better or help myself?” Children may come up with remarkable responses. We believe that shamanic journeying offers an opportunity to explore a patient's spiritual and subconscious mind through a novel and enjoyable route.
doi:10.7453/gahmj.2013.097CP.P05.02
PMCID: PMC3875083
4.  Incorporating walking or cycling into car journeys to and from work: The role of individual, workplace and environmental characteristics 
Preventive Medicine  2013;56(3-4):211-217.
Objective
Small increases in walking or cycling for transport could contribute to population health improvement. We explore the individual, workplace and environmental characteristics associated with the incorporation of walking and cycling into car journeys.
Methods
In 2009, participants from the Commuting and Health in Cambridge study (UK) reported transport modes used on the commute in the last week as well as individual, workplace and environmental characteristics. Logistic regression was used to assess the explanatory variables associated with incorporating walking or cycling into car commuting journeys.
Results
31% of car commuters (n = 419, mean age 43.3 years, SD 0.3) regularly incorporated walking or cycling into their commute. Those without access to car parking at work (OR: 26.0, 95% CI:11.8 to 57.2) and who reported most supportive environments for walking and cycling en route to work (highest versus lowest tertile, OR: 2.7, 95% CI 1.4 to 5.5) were more likely to incorporate walking or cycling into their car journeys.
Conclusions
Interventions that provide pleasant and convenient routes, limit or charge for workplace car parking and provide free off-site car parking may encourage car commuters to incorporate walking and cycling into car journeys. The effects of such interventions remain to be evaluated.
Highlights
► Walking or cycling for transport could contribute to population health improvement. ► We explore why commuters incorporate walking and cycling into car journeys. ► Supportive environments and lack of workplace car parking were important contributors.
doi:10.1016/j.ypmed.2013.01.014
PMCID: PMC3712186  PMID: 23375993
Walking; Health promotion; Health behaviour; Physical activity
5.  Aligning Heart Intelligence for Strategic Impact 
Global Advances in Health and Medicine  2014;3(Suppl 1):BPA14.
Background:
Memorial Hospital & Health System is a midwestern, level 2 trauma center and health system with more than 4000 employees. We are a community-owned, not-for-profit hospital/health system with a more than 100-year history of serving with innovative excellence. Memorial began its partnership with HeartMath in 2002 as part of our Wellness initiative, reconnecting in 2008 to invigorate our “Great Place to Work” journey.
Introduction:
We highlighted the fertile ground we prepared over 20 years to ensure a healthy, well-integrated reception for the concept/practice of coherence. The evolution of the organization included a strategic focus on leadership development and intentional people-related tactics.
Method:
We believe that “stand alone” programs have strength by themselves but can be even stronger and more sustainable when linked or integrated with other like concepts or ideas. We summarized our 20-year journey of striving to become the “best place to work.” In 1992, we partnered with Stephen Covey and introduced The 7 Habits of Highly Effective People to all of our senior and mid-level leaders. We emphasized emotional and spiritual intelligence, building on the concept of the whole-person paradigm.
We built the Memorial brand around the flame of individual passion ignited by the four intelligences: spiritual, emotional, intellectual, and physical. We enlisted the executive leaders as our “fire starters,” charging them with being the “Keepers of the Flame.” Building on the primary principle of effectiveness—Be Proactive—we added the concept of coherence as the basis for decision-making and action in the organization.
Adding Covey's notion of Holistic Renewal, we held leaders accountable for self-renewal and work regeneration. In 2000, we introduced the Hartman Value Profile. This tool assesses one's value system, measuring critical-thinking skills, morale, and amount of stress. It also measures self-care and self-criticism. We believe you can't improve what you can't measure. We now had a tool that could measure progress in managing personal and work-related stress. This opened the door in 2002 to a formal partnership with HeartMath as the experts on “The Power to Change Performance.” We offered workshops on a twice-monthly basis; participants volunteered to attend. Pleased with the number of registrants, we realized we were only touching the tip of the iceberg. Soon after, HeartMath created the POQA, which gave us another measure of the workshops' impact. We finally had the combination of assessment tools to guarantee progress and scientific rigor for our journey.
Results:
Two events ignited our Coherence Journey: (1) implementation of the Baron EQ-I assessment for leaders (2005); among the strong predictors of success are stress management and general mood and (2) HeartMath introduced Transforming Stress (2008) to our executive leadership team. As our champions, these team members enlisted their teams in learning the skills.
Conclusion:
We reached more than 900 individuals and continue to offer a variety of learning formats. We adapt to the pressures our healthcare associates experience in these changing times. Coherence is the heart of our healing environment.
doi:10.7453/gahmj.2014.BPA14
PMCID: PMC3923291
Personal and Organizational Quality Assessment; biofeedback; stress reduction; HeartMath
6.  Walking and cycling to work despite reporting an unsupportive environment: insights from a mixed-method exploration of counterintuitive findings 
BMC Public Health  2013;13:497.
Background
Perceptions of the environment appear to be associated with walking and cycling. We investigated the reasons for walking and cycling to or from work despite reporting an unsupportive route environment in a sample of commuters.
Methods
This mixed-method analysis used data collected as part of the Commuting and Health in Cambridge study. 1164 participants completed questionnaires which assessed the travel modes used and time spent on the commute and the perceived environmental conditions on the route to work. A subset of 50 also completed qualitative interviews in which they discussed their experiences of commuting. Participants were included in this analysis if they reported unsupportive conditions for walking or cycling on their route (e.g. heavy traffic) in questionnaires, walked or cycled all or part of the journey to work, and completed qualitative interviews. Using content analysis of these interviews, we investigated their reasons for walking or cycling.
Results
340 participants reported walking or cycling on the journey to work despite unsupportive conditions, of whom 15 also completed qualitative interviews. From these, three potential explanations emerged. First, some commuters found strategies for coping with unsupportive conditions. Participants described knowledge of the locality and opportunities for alternative routes more conducive to active commuting, as well as their cycling experience and acquired confidence to cycle in heavy traffic. Second, some commuters had other reasons for being reliant on or preferring active commuting despite adverse environments, such as childcare arrangements, enjoyment, having more control over their journey time, employers’ restrictions on car parking, or the cost of petrol or parking. Finally, some survey respondents appeared to have reported not their own environmental perceptions but those of others such as family members or ‘the public’, partly to make a political statement regarding the adversity of active commuting in their setting.
Conclusions
Participants report walking and cycling to work despite adverse environmental conditions. Understanding this resilience might be just as important as investigating ‘barriers’ to cycling. These findings suggest that developing knowledge of safe walking and cycling routes, improving cycling confidence and restricting workplace parking may help to encourage walking and cycling to and from work.
doi:10.1186/1471-2458-13-497
PMCID: PMC3665474  PMID: 23705951
Mixed methods; Transport; Active commuting; Environmental perceptions
7.  Mechanics, malignancy, and metastasis: The force journey of a tumor cell 
Cancer metastasis reviews  2009;28(1-2):113-127.
A cell undergoes many genetic and epigenetic changes as it transitions to malignancy. Malignant transformation is also accompanied by a progressive loss of tissue homeostasis and perturbations in tissue architecture that ultimately culminates in tumor cell invasion into the parenchyma and metastasis to distant organ sites. Increasingly, cancer biologists have begun to recognize that a critical component of this transformation journey involves marked alterations in the mechanical phenotype of the cell and its surrounding microenvironment. These mechanical differences include modifications in cell and tissue structure, adaptive force-induced changes in the environment, altered processing of micromechanical cues encoded in the extracellular matrix (ECM), and cell-directed remodeling of the extracellular stroma. Here, we review critical steps in this “force journey,” including mechanical contributions to tissue dysplasia, invasion of the ECM, and metastasis. We discuss the biophysical basis of this force journey and present recent advances in the measurement of cellular mechanical properties in vitro and in vivo. We end by describing examples of molecular mechanisms through which tumor cells sense, process and respond to mechanical forces in their environment. While our understanding of the mechanical components of tumor growth, survival and motility remains in its infancy, considerable work has already yielded valuable insight into the molecular basis of force-dependent tumor pathophysiology, which offers new directions in cancer chemotherapeutics.
doi:10.1007/s10555-008-9173-4
PMCID: PMC2658728  PMID: 19153673
Cancer; Extracellular matrix; Cell mechanics; Atomic force microscopy; Subcellular laser ablation; Rho kinase; Focal adhesion kinase
8.  Clinicians’ experiences of becoming a clinical manager: a qualitative study 
Background
There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development.
Methods
We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation.
Results
We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively.
Conclusions
Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially for early stage clinician managers.
doi:10.1186/1472-6963-12-421
PMCID: PMC3562219  PMID: 23173953
Leadership; Administration and organization; Health services administration; Nurse manager; Doctor; Qualitative research
9.  Rheotaxis facilitates upstream navigation of mammalian sperm cells 
eLife  2014;3:e02403.
A major puzzle in biology is how mammalian sperm maintain the correct swimming direction during various phases of the sexual reproduction process. Whilst chemotaxis may dominate near the ovum, it is unclear which cues guide spermatozoa on their long journey towards the egg. Hypothesized mechanisms range from peristaltic pumping to temperature sensing and response to fluid flow variations (rheotaxis), but little is known quantitatively about them. We report the first quantitative study of mammalian sperm rheotaxis, using microfluidic devices to investigate systematically swimming of human and bull sperm over a range of physiologically relevant shear rates and viscosities. Our measurements show that the interplay of fluid shear, steric surface-interactions, and chirality of the flagellar beat leads to stable upstream spiralling motion of sperm cells, thus providing a generic and robust rectification mechanism to support mammalian fertilisation. A minimal mathematical model is presented that accounts quantitatively for the experimental observations.
DOI: http://dx.doi.org/10.7554/eLife.02403.001
eLife digest
A sperm cell must complete a long and taxing journey to stand a chance of fertilising an egg cell. This quest covers a distance that is thousands of times longer than the length of a sperm cell. It also passes through the diverse environments of the cervix, the uterus and, finally, the oviduct, where there might be an egg to fertilise. How the sperm cells manage to stay on course over this distance is a mystery, although it has been suggested that many different factors, including chemical signals and fluid flow, are involved.
The fluids that the sperm cells travel through are not static. Evidence suggests that contractions of the cervix and uterus help to pump sperm cells along the first part of their journey. However, mucus flows out of the oviduct in the opposite direction to way the sperm cells need to go.
Sperm cells mostly move along the walls of the cervix, uterus, and oviduct. This means that sperm cells must contend with two properties of the fluids they travel through—the viscosity (or ‘thickness’) of the fluid, and the fact that different parts of the fluid will flow at different speeds, depending on how close it is to the wall (‘shear flow’).
Kantsler et al. have now used a technique called microfluidics—which involves forcing tiny amounts of liquid to flow through very narrow channels—to study how the movement of human and bull sperm cells along a surface is affected by the viscosity and flow rate of the fluid they are swimming through. The sperm cells were found to swim upstream, moving along the walls of the channels in a spiral movement. This is likely to help the sperm cells to find the egg, because spiralling around the oviduct will increase the chances of meeting the egg.
Kantsler et al. also built a mathematical model that describes how the sperm cells move. Although further work is needed to better understand the role played by chemical signals, understanding how fluid flow and viscosity influence sperm cells could lead to more effective artificial insemination techniques.
DOI: http://dx.doi.org/10.7554/eLife.02403.002
doi:10.7554/eLife.02403
PMCID: PMC4031982  PMID: 24867640
sperm; rheotaxis; fertilization; human; other
10.  The journey from opposition to recovery from eating disorders: multidisciplinary model integrating narrative counseling and motivational interviewing in traditional approaches 
Background
In the world of today’s of ever-briefer therapies and interventions, people often seem more interested in outcome than process. This paper focuses on the processes used by a multidisciplinary team in the journey from opposition to change to recovery from eating disorders. The approach outlined is most relevant to those with severe and enduring illness.
Methods
This paper describes a five-phase journey from eating-disorder disability and back to health as it occurs for patients in a community-based facility. This integrative model uses narrative and motivational interviewing counseling weaved into traditional approaches. It approaches illness from a transdiagnostic orientation, addressing the dynamics and needs demanded by the comorbidities and at the same time responding effectively in a way that reduces the influence of the eating disorder.
The treatment described involves a five-phase journey: Preliminary phase (choosing a shelter of understanding); Phase 1: from partial recognition to full acknowledgment; Phase 2: from acknowledgment to clear cognitive stance against the eating disorder; Phase 3: towards clear stance against the “patient” status; Phase 4: towards re-authoring life and regaining self-agency; Phase 5: towards recovery and maintenance.
Results
In a longitudinal study of patients with a severe and debilitating eating disorder treated with this approach. The drop-out rate was less than 10%. This was during the first two months of treatment for those diagnosed with bulimia nervosa, and this was higher than in those diagnosed with anorexia nervosa. At the end of treatment (15 months to 4 years later) 65% of those treated with anorexia nervosa and 81% of those treated with bulimia nervosa were either in a fully recovered state or in much improved. At the four-year follow-up, 68% of those diagnosed with anorexia nervosa and 83% of those diagnosed with bulimia nervosa were categorized as either fully recovered or much improved. All patients who completed the program were gainfully employed.
Conclusions
The collaborative work, which is the heart of the described model increases the patient’s and family’s ownership of treatment and outcome and strengthen the therapeutic bond, thus enhances recovery.
doi:10.1186/2050-2974-1-19
PMCID: PMC4081798  PMID: 24999400
Anorexia nervosa; Bulimia nervosa; Transdiagnostic model
11.  Work stress and recovery measured by urinary catecholamines and cortisol excretion in long distance coach drivers 
OBJECTIVES: To evaluate coach drivers' work stress during work and in the course of recovery from work by measurement of urinary catecholamines and cortisol. METHODS: The urinary excretion rate of adrenaline, noradrenaline, and cortisol of 10 coach drivers was studied during a long distance trip of three days and two consecutive days off. Each driver was asked to provide seven urine samples on the working days and six urine samples on the days off. The second day off was considered as the baseline. RESULTS: An occupationally induced disturbance of the circadian rhythmicity was found for adrenaline and noradrenaline but not for cortisol. The mean excretion rates of adrenaline on the first working day and most samples on all working days were higher than the baseline. For both adrenaline and noradrenaline the mean excretion rates on the first day off were lower than the baseline. For cortisol, the mean excretion rate on all working days was higher than the baseline. A trend towards accumulation of cortisol excretion from the first working day to the third working day was found. A backward shift in peak concentrations was found for adrenaline and noradrenaline on the second working day, as was a forward shift in peak concentration of cortisol on both days off. CONCLUSIONS: Long distance coach drivers showed occupationally induced reactivity in rates of urinary excretion of adrenaline, noradrenaline, and cortisol. After the outward journey the rates of excretion of catecholamines did not return to baseline values. The course of recovery in adrenaline excretion after the journey showed a new phenomenon, which has been called "fatigue debt". It is recommended that longer resting times in shuttle bus trips and fixed days off after these kind of trips should be planned. Extensive future research should be focused on the additional relations between fatigue debt and health complaints.
 
PMCID: PMC1757599  PMID: 9764101
12.  Characteristics of a population of commuter cyclists in the Netherlands: perceived barriers and facilitators in the personal, social and physical environment 
Background
Daily cycling to work has been shown to improve physical performance and health in men and women. It is very common in the Netherlands: the most recent data show that one quarter of commuting journeys are by bicycle. However, despite the effort going into campaigns to promote commuter cycling, about 30% of commuter journeys up to 5 kilometers are still by car. The question is how to stimulate commuter cycling more effectively. This article aims to contribute to a better understanding of the perceived barriers and facilitators of cyclists/non-cyclists and personal factors associated with commuter cycling.
Methods
A random sample of 799 Dutch employees (response rate 39.6%) completed an internet survey, which comprised two parts. One part of the questionnaire focused on the determinants of cycling behavior including equal numbers of personal, social factors and environmental factors. The other component focused on assessing data on physical activity (PA) behavior. Descriptive and logistic regression analyses were used to analyze factors associated with commuter cycling.
Results
Meeting the physical activity guideline was positively associated with commuter cycling. Television viewing and working full-time were negatively associated. Twenty-six percent of the participants met the PA guideline simply by cycling to work, with health as the main reason. The main barriers for non-cyclists (60%) were perspiration when arriving at work, weather and travelling time. Shorter travelling times compared with other transportation modes were an important facilitator. Environmental factors were positively related to more frequent and more convenient commuter cycling, but they were hardly mentioned by non-cyclists.
Conclusions
This study shows that a relatively large group fulfils the PA recommendations merely by cycling to work. Personal factors (i.e., perceived time and distance) are major barriers to commuter cycling and should be targeted in cycling campaigns, especially in subgroups living within cycling distance to work. Targeting environmental determinants in such campaigns seems to be less important in the Netherlands.
doi:10.1186/1479-5868-7-89
PMCID: PMC3012015  PMID: 21143948
13.  Working conditions and fatigue in professional truck drivers at Israeli ports 
Injury Prevention  2005;11(2):110-114.
Background: Trucks represent 6% of all vehicles, but truck crashes account for 20% of road deaths in Israel, even though travel distances are usually short (<200 km) and overnight travel is uncommon.
Objective: To determine occupational and individual predictors of fatigue, falling asleep at the wheel, and involvement in crashes with injuries and deaths in truck drivers.
Setting and methods: We carried out field interviews of 160 port truck drivers regarding driver characteristics, workplace and driving conditions, employer-employee relations, medical conditions, sleep quality and fatigue, falling asleep at the wheel, and involvement in road crashes.
Results: One day before interview, 38.1% of the drivers had worked more than the 12 hour legal limit. More than 30% reported falling asleep at the wheel recently, and 13% had prior involvement in a sleep related crash. Sixty seven (41.9%) drivers said that their employer forced them to work beyond the legal 12 hour daily limit. Involvement in a crash with casualties was associated with poor sleep quality (adjusted OR = 2.9; p = 0.042) and frequent difficulty finding parking when tired (OR = 3.7; p = 0.049). Self assessment of fatigue underestimated fatigue from the Pittsburgh Sleep Quality Questionnaire. However fatigue occurred in many drivers without sleep problems and many crashes occurred without fatigue.
Conclusions: Prevention requires measures to reduce work stresses, screening drivers, speed control, and modal shifts. The work risks and adverse outcomes of truck drivers in large countries with long overnight journeys occur in a small country with small distances, relatively short work journeys, and little overnight travel.
doi:10.1136/ip.2004.007682
PMCID: PMC1730197  PMID: 15805441
14.  Sleepiness, Long Distance Commuting and Night Work as Predictors of Driving Performance 
PLoS ONE  2012;7(9):e45856.
Few studies have examined the effect of working night shift and long distance commuting. We examined the association between several sleep related and demographic variables, commuting distance, night work and use of mobile phones on driving performance. We used a prospective design to recruit participants and conducted a telephone survey (n = 649). The survey collected demographic and journey details, work and sleep history and driving performance concerning the day the participant was recruited. Participants also completed the Karolinska Sleepiness Scale and the Epworth Sleepiness Scale. Night workers reported significantly more sleepiness, shorter sleep duration and commuting longer distances. Seven variables were significant predictors of lane crossing. The strongest predictor was acute sleepiness (OR = 5.25, CI, 1.42–19.49, p<0.01) followed by driving ≥150 kms (OR = 3.61, CI, 1.66–7.81, p<0.001), obtaining less than 10 hours sleep in the previous 48 hours (OR = 2.58, CI, 1.03–6.46, p<0.05), driving after night shift (OR = 2.19, CI, 1.24–3.88, p<0.001), being <43 years old (OR = 1.95, CI, 1.11–3.41, p<0.05) and using mobile phones during the journey (OR = 1.90, CI, 1.10–3.27, p<0.05). Sleep related variables, long-distance commuting and night work have a major impact on lane crossing. Several interventions should be considered to reduce the level of sleepiness in night workers.
doi:10.1371/journal.pone.0045856
PMCID: PMC3448712  PMID: 23029278
15.  What Psychology Means To Me 
Mens Sana Monographs  2006;4(1):139-153.
The author takes on the task of describing the interface between emotion and cognition by way of a narrative about psychology, and its meaning to his life. Using time as an overall metaphor, or perhaps a foundation stone underpinning a series of seemingly unconnected events, some insight is given into the author's personal life. The author invokes the works of feminist philosopher and author, Susan Faludi, to portray some aspects of his journey through fantasy, and then the reality of a disparate practice on two continents in psychology and neuropsychology. With particular reference to Faludi's portrayal of men as failed heroes without a role in modern society, the author discovers that all of his work with others has been a work with his own troubled soul, and his failed heroism. Calling on his early role models, and life with and without a sense of purpose, he learns from his clients the value of courage and patience, a spiritual as well as intellectual journey that leads him to become many things to many people in order to heal them, and himself.
doi:10.4103/0973-1229.27611
PMCID: PMC3190446  PMID: 22013338
Psychological Practice; Feminism; Existential Measning; Constructivism; Systems Theory; Heroism; Masculine Identity
16.  Motivations for active commuting: a qualitative investigation of the period of home or work relocation 
Background
Promoting walking or cycling to work (active commuting) could help to increase population physical activity levels. According to the habit discontinuity and residential self-selection hypotheses, moving home or workplace is a period when people (re)assess, and may be more likely to change, their travel behavior. Research in this area is dominated by the use of quantitative research methods, but qualitative approaches can provide in-depth insight into the experiences and processes of travel behavior change. This qualitative study aimed to explore experiences and motivations regarding travel behavior around the period of relocation, in an effort to understand how active commuting might be promoted more effectively.
Methods
Participants were recruited from the Commuting and Health in Cambridge study cohort in the UK. Commuters who had moved home, workplace or both between 2009 and 2010 were identified, and a purposive sample was invited to participate in semi-structured interviews regarding their experiences of, and travel behavior before and after, relocating. A grounded theory approach was taken to analysis.
Results
Twenty-six commuters participated. Participants were motivated by convenience, speed, cost and reliability when selecting modes of travel for commuting. Physical activity was not a primary motivation, but incidental increases in physical activity were described and valued in association with active commuting, the use of public transport and the use of park-and-ride facilities.
Conclusions
Emphasizing and improving the relative convenience, cost, speed and reliability of active commuting may be a more promising approach to promoting its uptake than emphasizing the health benefits, at least around the time of relocation. Providing good quality public transport and free car parking within walking or cycling distance of major employment sites may encourage the inclusion of active travel in the journey to work, particularly for people who live too far from work to walk or cycle the entire journey. Contrary to a straightforward interpretation of the self-selection hypothesis, people do not necessarily decide how they prefer to travel, relocate, and then travel in their expected way; rather, there is constant negotiation, reassessment and adjustment of travel behavior following relocation which may offer an extended window of opportunity for travel behavior change.
doi:10.1186/1479-5868-9-109
PMCID: PMC3489688  PMID: 22967090
Active commuting; Qualitative; Relocation; Habit discontinuity; Residential self-selection
17.  Measuring Workplace Travel Behaviour: Validity and Reliability of Survey Questions 
Background. The purpose of this study was to assess the (previously untested) reliability and validity of survey questions commonly used to assess travel mode and travel time. Methods. Sixty-five respondents from a staff survey of travel behaviour conducted in a south-western Sydney hospital agreed to complete a travel diary for a week, wear an accelerometer over the same period, and twice complete an online travel survey an average of 21 days apart. The agreement in travel modes between the self-reported online survey and travel diary was examined with the kappa statistic. Spearman's correlation coefficient was used to examine agreement of travel time from home to workplace measured between the self-reported online survey and four-day travel diary. Moderate-to-vigorous physical activity (MVPA) time of active and nonactive travellers was compared by t-test. Results. There was substantial agreement between travel modes (K = 0.62, P < 0.0001) and a moderate correlation for travel time (ρ = 0.75, P < 0.0001) reported in the travel diary and online survey. There was a high level of agreement for travel mode (K = 0.82, P < 0.0001) and travel time (ρ = 0.83, P < 0.0001) between the two travel surveys. Accelerometer data indicated that for active travellers, 16% of the journey-to-work time is MVPA, compared with 6% for car drivers. Active travellers were significantly more active across the whole workday. Conclusions. The survey question “How did you travel to work this week? If you used more than one transport mode specify the one you used for the longest (distance) portion of your journey” is reliable over 21 days and agrees well with a travel diary.
doi:10.1155/2013/423035
PMCID: PMC3730218  PMID: 23956757
18.  Some aspects of management and outcome of acute coronary heart disease in Oxford region. 
British Heart Journal  1977;39(1):93-98.
(1) Over 15 months, 532 consecutive admissions to the CCU at the Radcliffe Oxford were studied; of these 333 were cases of myocardial infarction, and 319 were first admissions for this condition. Information about survival and return to work was collected for 300. A further 30 had artificial pacemakers inserted; there were 141 (26%) of the 532 cases which did not require the special care offered by the CCU. (2) Of 300 patients for whom data were available, 27 were recorded as having received DC shock. In hospital, case fatality was significantly higher among those requiring DC shock than among the remainder. Overall the 3-year survival rates were 47 per cent among those receiving shock, and 62 per cent among the remainder, compared with an expected 91 per cent for a population of the same age and sex. (3) Among men aged under 65 years, 6 of 11 who received shock, compared with 117 (77%) who did not receive shock, returned to work after leaving hospital. (4) Rates of admission to the CCU of cases of myocardial infarction per 1000 standardised population among people living in the areas around Oxford City were estimated as being 58 per cent of admission rates of cases among residents of the city. (5) The case incidence of ventricular fibrillation and the case fatality rate were both higher among those living in the environs than among those living in the city, but these differences were not statistically significant. (6) It is also concluded that insufficient is known about the factors underlying the general practitioner's decision to commit a case of myocardial infarction to other than short ambulance journeys or about the effects of such journeys on prognosis.
PMCID: PMC483199  PMID: 831741
19.  The experience of international nursing students studying for a PhD in the U.K: A qualitative study 
BMC Nursing  2011;10:11.
Background
Educating nurses to doctoral level is an important means of developing nursing capacity globally. There is an international shortage of doctoral nursing programmes, hence many nurses seek their doctorates overseas. The UK is a key provider of doctoral education for international nursing students, however, very little is known about international doctoral nursing students' learning experiences during their doctoral study. This paper reports on a national study that sought to investigate the learning expectations and experiences of overseas doctoral nursing students in the UK.
Methods
Semi-structured qualitative interviews were conducted in 2008/09 with 17 international doctoral nursing students representing 9 different countries from 6 different UK universities. Data were analysed thematically. All 17 interviewees were enrolled on 'traditional' 3 year PhD programmes and the majority (15/17) planned to work in higher education institutions back in their home country upon graduation.
Results
Studying for a UK PhD involved a number of significant transitions, including adjusting to a new country/culture, to new pedagogical approaches and, in some cases, to learning in a second language. Many students had expected a more structured programme of study, with a stronger emphasis on professional nursing issues as well as research - akin to the professional doctorate. Students did not always feel well integrated into their department's wider research environment, and wanted more opportunities to network with their UK peers. A good supervision relationship was perceived as the most critical element of support in a doctoral programme, but good relationships were sometimes difficult to attain due to differences in student/supervisor expectations and in approaches to supervision. The PhD was perceived as a difficult and stressful journey, but those nearing the end reflected positively on it as a life changing experience in which they had developed key professional and personal skills.
Conclusions
Doctoral programmes need to ensure that structures are in place to support international students at different stages of their doctoral journey, and to support greater local-international student networking. Further research is needed to investigate good supervision practice and the suitability of the PhD vis a vis other doctoral models (e.g. the professional doctorate) for international nursing students.
doi:10.1186/1472-6955-10-11
PMCID: PMC3126772  PMID: 21668951
20.  Effectiveness of a multidisciplinary facial function clinic 
Eye  2011;25(10):1360-1364.
Objectives
To analyse the usefulness of a multidisciplinary facial function clinic (FFC).
Design
Retrospective case-note review.
Setting
The FFC was established in July 2006 at the Manchester Royal Eye Hospital with attending consultants from Ophthalmology, Skull-Base Otolaryngology, Plastic Surgery, and Physiotherapy.
Participants
We retrospectively reviewed the case notes for 59 consecutive patients seen at the FFC from July 2006 to February 2009.
Main outcome measures
We documented demographic data, including distance travelled and average journey time.
Results
The 59 patients (mean age 46 years) made a total of 106 clinical visits (mean 1.8). The mean distance travelled by a patient was 31.9 miles with an estimated journey time of 47 min, each way. At presentation the average House-Brackmann grade of facial nerve weakness was IV. Ophthalmologist's advice was needed for 58 (98.3%), otolaryngologist's for 57 (96.6%), plastic surgeon for 49 (83.0%), physiotherapist for 58 (98.3%), and 4 (6.8%) were referred for psychological counselling. In all, 47 (79.7%) of our patients needed input from all four consultants during their visit at the FFC. By combining the presence of several consultants in one clinic, we saved an average of 5.1 visits (325.4 miles; 8 h travel time) for each patient.
Conclusion
We and our patients feel our multidisciplinary facial function clinic has been an effective service and has continued to work.
doi:10.1038/eye.2011.183
PMCID: PMC3194328  PMID: 21799520
facial nerve palsy; ophthalmology; multidisciplinary team; teamwork
21.  A study of Iranian immigrants’ experiences of accessing Canadian health care services: a grounded theory 
Background
Immigration is not a new phenomenon but, rather, has deep roots in human history. Documents from every era detail individuals who left their homelands and struggled to reestablish their lives in other countries. The aim of this study was to explore and understand the experience of Iranian immigrants who accessed Canadian health care services. Research with immigrants is useful for learning about strategies that newcomers develop to access health care services.
Methods
The research question guiding this study was, “What are the processes by which Iranian immigrants learn to access health care services in Canada?” To answer the question, a constructivist grounded theory approach was applied. Initially, unstructured interviews were conducted with 17 participants (11 women and six men) who were adults (at least 18 years old) and had immigrated to Canada within the past 15 years. Eight participants took part in a second interview, and four participants took part in a third interview.
Results
Using a constructivist grounded theory approach, “tackling the stumbling blocks of access” emerged as the core category. The basic social process (BSP), becoming self-sufficient, was a transitional process and had five stages: becoming a stranger; feeling helpless; navigating/seeking information; employing strategies; and becoming integrated and self-sufficient. We found that “tackling the stumbling blocks of access” was the main struggle throughout this journey. Some of the immigrants were able to overcome these challenges and became proficient in accessing health care services, but others were unable to make the necessary changes and thus stayed in earlier stages/phases of transition, and sometimes returned to their country of origin.
Conclusion
During the course of this journey a substantive grounded theory was developed that revealed the challenges and issues confronted by this particular group of immigrants. This process explains why some Iranian immigrants are able to access Canadian health care effectively while others cannot. Many elements, including language proficiency, cultural differences, education, previous experiences, financial status, age, knowledge of the host country’s health care services, and insider and outsider resources work synergistically in helping immigrants to access health care services effectively and appropriately.
doi:10.1186/1475-9276-11-55
PMCID: PMC3519565  PMID: 23021015
Immigrants; Refugees; Health care; Access; Iranians; Canada; Constructivist grounded theory
22.  Recovery post treatment: plans, barriers and motivators 
Background
The increasing focus on achieving a sustained recovery from substance use brings with it a need to better understand the factors (recovery capital) that contribute to recovery following treatment. This work examined the factors those in recovery perceive to be barriers to (lack of capital) or facilitators of (presence of capital) sustained recovery post treatment.
Methods
A purposive sample of 45 participants was recruited from 11 drug treatment services in northern England. Semi-structured qualitative interviews lasting between 30 and 90 minutes were conducted one to three months after participants completed treatment. Interviews examined key themes identified through previous literature but focused on allowing participants to explore their unique recovery journey. Interviews were transcribed and analysed thematically using a combination of deductive and inductive approaches.
Results
Participants generally reported high levels of confidence in maintaining their recovery with most planning to remain abstinent. There were indications of high levels of recovery capital. Aftercare engagement was high, often through self referral, with non substance use related activity felt to be particularly positive. Supported housing was critical and concerns were raised about the ability to afford to live independently with financial stability and welfare availability a key concern in general. Employment, often in the substance use treatment field, was a desire. However, it was a long term goal, with substantial risks associated with pursuing this too early. Positive social support was almost exclusively from within the recovery community although the re-building of relationships with family (children in particular) was a key motivator post treatment.
Conclusions
Addressing internal factors and underlying issues i.e. ‘human capital’, provided confidence for continued recovery whilst motivators focused on external factors such as family and maintaining aspects of a ‘normal’ life i.e. ‘social and physical capital’. Competing recovery goals and activities can leave people feeling under pressure and at risk of taking on or being pushed to do too much too soon. The breadth of re-integration and future plans at this stage is limited primarily to the recovery community and treatment sector. Services and commissioners should ensure that this does not become a limiting factor in individuals’ long term recovery journeys.
doi:10.1186/1747-597X-8-6
PMCID: PMC3573929  PMID: 23363550
Recovery capital; Treatment; Abstinence; Employment; Family; Motivators; Peer support; Accommodation; Drugs; Alcohol
23.  The Patient Journey to Gastric Band Surgery: A Qualitative Exploration 
Aims
This study explored the views and experiences of obese people preparing to undergo laparoscopic gastric banding (LAGB) leading up to the time of surgery.
Background
Weight loss surgery (WLS) is the most successful intervention available for the treatment of morbid obesity, and LAGB is among the most commonly used procedures in bariatric surgery. So far, the patient experience of deciding to undergo LAGB has been explored rarely and predominantly retrospectively.
Design
Semi-structured interviews took place with 23 patients about to undergo LAGB between June 2011 and March 2012. Data were analyzed using thematic analysis. Demographic and quality of life data situated the sample within the LAGB patient population.
Results
Three overarching themes were described. Participants were “living with obesity,” including the physical, social, and psychological challenges and consequences of being obese. These created in them a “desire to change,” expressed in multiple unsuccessful attempts to lose weight, and a quest for information, finally focusing on WLS. Eventually, “expectations toward LAGB” were formed, mainly to hand back a measure of control that enabled them to achieve, as well as ultimately to maintain, weight loss. This active process resulted in the patients' decision to undergo LAGB. When combined, these themes outline a distinct patient journey toward gastric banding.
Conclusion
Knowledge of the patient journey can inform both selection and care of patients awaiting gastric band surgery and is required by all health professionals working with this patient group.
doi:10.1089/bari.2013.9985
PMCID: PMC3859175  PMID: 24761368
24.  Turtle Finding Fact Sheet: The Role of the Treatment Provider in Aboriginal Women’s Healing from Illicit Drug Abuse 
CES4Health.info  2010;http://www.ces4health.info/find-products/view-product.aspx?code=Z3KNXKHD.
Our research identifies key skills and traits for service providers working with Aboriginal women that assists them with re-claiming their cultural identity. The “Turtle Finding Fact Sheet: The Role of the Treatment Provider in Aboriginal Women’s Healing from Illicit Drug Abuse” was created to disseminate and commence discussion on this initial finding from our community-based research project in Canada. The study overall focussed on the role of identity and stigma in the healing journeys of criminalized Aboriginal women from illicit drug abuse. Our team is committed to sharing its finding with the community from which the information was collected–workers in the National Native Alcohol and Drug Abuse Program (NNADAP). The Fact Sheet is based on a sample of interviews with substance abuse treatment providers, and was verified with women in treatment and who have completed treatment. In recent years, the addictions literature has increased its attention toward the importance of the therapeutic alliance between treatment providers and clients(1), although understanding specific to Aboriginal women remains limited. Identity reclamation is central to women’s healing journeys and treatment providers have an influential role. This finding is framed in the fact sheet within the cultural understanding of the Seven Teachings of the Grandfathers(2). The fact sheet (8.5x11) has been distributed to the over 700 NNADAP workers, and is also available at no cost in two poster size formats. It is appropriate for anyone providing services to Aboriginal women requiring addictions treatment.
PMCID: PMC4085083  PMID: 25010607 CAMSID: cams3855
25.  Case Report from the Field: Integrating Hawaiian and Western Healing Arts in Papakolea 
Hawai'i Journal of Medicine & Public Health  2014;73(12 Suppl 3):26-28.
Papakolea, the only Native Hawaiian (NH) homestead community located in urban Honolulu, has one of the highest proportions of NHs living in a single geographic area. Despite prior attempts dating back to the 1920s to improve the health of the community, many health disparities remain within the Papakolea community. This is the story of how the Papakolea community decided to confront the health of its community by integrating Hawaiian and Western healing arts. The purpose of this “Case Report from the Field” is to share the journey the Papakolea community started back in 1992 to build capacity within their own community by forming its first 501c3 community based non-profit organization entitled Kula no na Po‘e Hawai‘i (referred to as Kula). Through Kula, a unique traditional healing training program was started called Na Lomilomi O Papakolea (NLOP). NLOP became the first self-sustaining health program for training lomilomi practitioners (traditional NH therapeutic massage) in the Papakolea community. This case report describes how lomilomi practitioners and medical practitioners began sharing their skills and expertise to heal their clients and in the process began to heal the community itself. The purpose of this paper is to describe their journey with the intent of sharing how one dedicated group of people has been successful in healing their community and is now on the road to better health and sustained well being by working together.
PMCID: PMC4271349  PMID: 25535598

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