Caring for an intimate stranger: parenting a child with psychosis.

WHAT IS KNOWN ON THE SUBJECT: The care of an adult son or daughter with psychosis is filled with overwhelming demands caused by the symptomatology and illness exacerbations. Parents display disenfranchised grief over multiple losses and report increased levels of emotional burden. Most studies use quantitative methods and rely on pre-existing theoretical frameworks to investigate, through psychometric measures, the effects of being a carer. Meaning attributions to the disorder, and changes in parent-child relations over time, are poorly understood. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This hermeneutic phenomenological study illuminates the subjective experience of parenting a son or daughter with psychosis, as it is lived and described by parents of young adults with psychosis. Findings suggest that the parents' perceptions of their child changes over the course of the disorder, leading to a redefinition of the parent-child relationship, causing alternations in attachment. Findings illuminate the parents' profound guilt over having contributed or not prevented the disorder, over not being 'good' parents and feeling ambivalent towards an 'intimate stranger.' Guilt is compensated by absolute dedication to the son or daughter's care, at the expense of their own well-being. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Interventions for parents must be available as soon as possible, both during hospitalization and after discharge. Professionals should provide a therapeutic space, where parents could express intimate thoughts and feelings, address guilt, fear and resentment issues, be assisted in their parenting role as well as in the reconstruction of a sense of self and self-esteem. Professionals are invited to facilitate illness acceptance, provide accurate information, assist parents to redefine their relationship to the child and facilitate the integration of the traumatic experience into their personal and family narrative. Professionals must develop in depth awareness of their biases and attitudes, have an ongoing training on how to respond to the parents' needs, facilitate therapeutic change and accompany families through the course of their adult child's illness trajectory. ABSTRACT: Introduction Children who are diagnosed with psychosis often rely on their parents for prolonged care. The impact of such care is partially understood as most studies use quantitative methods and pre-existing theoretical frameworks that limit their investigation to emotional burden, and emotional responses. Aim Explore the parents' lived experience of caring for a child with psychosis. Method A hermeneutic phenomenological design was used with a sample of 16 parents of children with psychotic disorders who were hospitalized or attended the outpatient clinic of a large psychiatric Greek hospital. Results Identified themes were as follows: (i) the psychosis experience, (ii) redefinition of the parent-child relationship over the course of the disorder and (iii) challenges of parenting a child with psychosis. Discussion 'Caring for an intimate stranger' reflects the parents' overall experience, involving changes in the parent-child relationship, ambivalence towards caretaking and profound guilt, compensated by self-sacrifice parenting practices. IMPLICATIONS FOR PRACTICE: Findings highlight the necessity to train mental health professionals to provide individualized information; facilitate family communication; address the parents' guilt, ambivalence, meaning attributions that compromise adjustment; and support them through the challenges of parenting a son or daughter with psychosis.

Copper(I) halide complexes of 5-carbethoxy-2-thiouracil: synthesis, structure and in vitro cytotoxicity.

5-Carbethoxy-2-thiouracil (eitotH2) reacts with copper(I) halides CuX (X = Cl, Br, I) to give dinuclear complexes of the formula [CuX(eitotH2)2]2 while mononuclear mixed-ligand complexes of the formula [CuX(PPh3)2(eitotH2)] result when the reactions are performed in the presence of two equivalents of triphenylphosphine (PPh3). The molecular structures of representative compounds from each of the above types of complexes, namely [CuI(eitotH2)2]2, [CuCl(PPh3)2(eitotH2)] and [CuBr(PPh3)2(eitotH2)] have been established by single-crystal X-ray diffraction. The new copper(I) complexes were evaluated for in vitro antitumor properties against two tumor cell lines, A549 (human pulmonary carcinoma cell line) and HeLa (human epithelial carcinoma cell line) and one normal immortalized cell line MRC5 (human fetal lung fibroblast). The mixed-ligand complexes possessing triphenylphosphine were found to be highly cytotoxic in contrast to the phosphine-free ones which inhibited cell proliferation only in relatively high concentrations.

Empirically based recommendations to support parents facing the dilemma of paediatric cadaver organ donation.

The aim of the study was to describe the challenges donor and non-donor parents encounter before, during, and after the organ donation decision, and to identify parents' needs and expectations from health care professionals. A further aim was to propose evidence-based recommendations for effectively introducing the option of donation, and supporting families through the grieving process. This study was undertaken as part of a larger research project investigating the experiences of Greek parents who consented or declined organ and tissue donation, using a qualitative methodology for data collection and analysis. The experiences of 22 Greek bereaved parents of 14 underage brain dead children were studied through semi-structured interviews. Parents' decision-making process was described as challenging and fraught with difficulties both before and after the donation period. Identified challenges were clustered into: (a) personal challenges, (b) conditions of organ request, and (c) interpersonal challenges. Parents' main concern following donation was the lack of information about transplantation outcomes. Findings led to a list of recommendations for nurses and other health professionals for approaching and supporting parents in making choices about paediatric organ donation that are appropriate to them, and for facilitating their adjustment to the sudden death of their underage child.

Master Logic Diagram: method for hazard and initiating event identification in process plants.

Master Logic Diagram (MLD), a method for identifying events initiating accidents in chemical installations, is presented. MLD is a logic diagram that resembles a fault tree but without the formal mathematical properties of the latter. MLD starts with a Top Event "Loss of Containment" and decomposes it into simpler contributing events. A generic MLD has been developed which may be applied to all chemical installations storing toxic and/or flammable substances. The method is exemplified through its application to an ammonia storage facility.

Supporting decision makers in land use planning around chemical sites. Case study: expansion of an oil refinery.

An approach for supporting decisions on land use around chemical sites - along with a software decision support system (DSS) - based on multi-criteria decision analysis (MCDA; and particularly on the establishment of the set of efficient solutions and letting the final selection depend on local procedures and value tradeoffs) is being illustrated through a case study where five alternative expansions of a refinery are considered along with the existing situation. Alternative land use plans are based on combinations of alternative uses of specific land cells coupled with alternative expansion options. Criteria for evaluating alternative land use plans are the potential loss of life (PLL), the noise levels and the economic benefit resulting for each specific land use plan.

Uncertainty quantification in the health consequences of the boiling liquid expanding vapour explosion phenomenon.

A methodology for estimating the risk owing to the phenomenon of boiling liquid expanding vapour explosion (BLEVE) in the presence of uncertainties both in the model and in the parameters of the models is presented. BLEVE takes place when a tank containing liquefied petroleum gas (LPG) is exposed to fire and fails catastrophically. Two models have been used in the estimation of the intensity of thermal radiation from the resulting fireball, namely the solid-flame model assuming an emission power independent of the combustion mass and the point-source model that estimates the emissive power as a function of the combustion mass. Three measures of the BLEVE consequences, the intensity of thermal radiation, the dose of thermal radiation and the probability of loss of life as a result of the exposure to the thermal radiation and as a function of the distance from the center of the tank have been considered. Uncertainties in the exact values of the parameters of the models have been quantified and the resulting uncertainties in the three consequence measures have been assessed. A sensitivity analysis on the relative contribution of the uncertainty in each of the input variables to the uncertainties of the consequence measures has been performed. One conclusion is that the uncertainties in the probability of loss of life are mainly due to the uncertainties in the model of the physical phenomenon rather than to the uncertainties of the dose-response model.

Risk-informed selection of a highway trajectory in the neighborhood of an oil-refinery.

A methodology for characterizing alternative trajectories of a new highway in the neighborhood of an oil-refinery with respect to the risk to public health is presented. The approach is based on a quantitative assessment of the risk that the storage facilities of flammable materials of the refinery pose to the users of the highway. Physical phenomena with a potential for detrimental consequences to public health such as BLEVE (Boiling Liquid Expanding Vapor Explosion), Unconfined Vapor Cloud Explosion, flash fire and pool fire are considered. Methodological and procedural steps for assessing the individual risk around the tank farm of the oil-refinery are presented. Based on the individual risk, group risk for each alternative highway trajectory is determined.

Establishing protective long term measures after severe nuclear accidents using multiple criteria.

This paper proposes a methodology supporting decisions on protective measures following severe nuclear accidents and demonstrates its use. A multicriteria decision analysis approach is adopted where value tradeoffs are postponed until the very last stage of the decision process. All feasible solutions are implicitly considered and evaluated in the chosen criteria. Technically inferior solutions are excluded. Only the non-dominated or efficient solutions forming the "efficient frontier" are retained and presented to the decision makers. Implementation of inefficient solutions is in this way avoided. A choice among the efficient solutions, although it implies value tradeoffs among the multiple criteria, avoids the direct and apriori assessment of preferences. An interactive computer package has been developed with which the decision maker can choose a point on the efficient frontier in the consequence space and immediately see the corresponding alternative in the decision space. The methodology is demonstrated through an application on the choice among possible protective measures in contaminated areas of the former USSR after the Chernobyl accident using as criteria the collective effective life-time dose received by the population and the cost associated with each possible decision.