Lifeworld-led healthcare is more than patient-led care: an existential view of well-being

In this paper we offer an appreciation and critique of patient-led care as expressed in current policy and practice. We argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Our critique focuses on how the consumerist/citizenship emphasis in current patient-led care obscures attention from a more fundamental challenge to conceptualise an alternative philosophically informed framework from where care can be led. We thus present an alternative interpretation of patient-led care that we call ‘lifeworld-led care’, and argue that such lifeworld-led care is more than the general understanding of patient-led care. Although the philosophical roots of our alternative conceptualisation are not new, we believe that it is timely to re-consider some of the implications of these perspectives within current discourses of patient-centred policies and practice. The conceptualisation of lifeworld-led care that we develop includes an articulation of three dimensions: a philosophy of the person, a view of well-being and not just illness, and a philosophy of care that is consistent with this. We conclude that the existential view of well-being that we offer is pivotal to lifeworld-led care in that it provides a direction for care and practice that is intrinsically and positively health focused in its broadest and most substantial sense.     

Effects of Stimulation Mode, Level and Location on Forward-Masked Excitation Patterns in Cochlear Implant Patients

In multi-channel cochlear implants, electrical current is delivered to appropriate electrodes in the cochlea to approximate the spatial representation of speech. Theoretically, electrode configurations that restrict the current spread within the cochlea (e.g., bi- or tri-polar stimulation) may provide better spatial selectivity, and in turn, better speech recognition than configurations that produce a broader current spread (e.g., monopolar stimulation). However, the effects of electrode configuration on supra-threshold excitation patterns have not been systematically studied in cochlear implant patients. In the present study, forward-masked excitation patterns were measured in cochlear implant patients as functions of stimulation mode, level and location within the cochlea. All stimuli were 500 pulses-per-second biphasic pulse trains (200 μs/phase, 20 μs inter-phase gap). Masker stimuli were 200 ms in duration; the bi-polar configuration was varied from narrow (BP + 1) to wide (BP + 17), depending on the test condition. Probe stimuli were 20 ms in duration and the masker-probe delay was 5 ms; the probe configuration was fixed at BP + 1. The results indicated that as the distance between the active and return electrodes in a bi-polar pair was increased, the excitation pattern broadened within the cochlea. When the distance between active and return electrodes was sufficiently wide, two peaks were often observed in the excitation pattern, comparable to non-overlapping electric fields produced by widely separated dipoles. Analyses of the normalized data showed little effect of stimulation level on the shape of the excitation pattern. Portions of this work were presented at the 12th International Symposium of Hearing (2001) held at Mierlo, The Netherlands.     

Synthesis and electrochemical investigation of oligo-(arylenevinylenes) intended for the preparation of two-dimensional polymer networks

Four phenylenevinylene oligomers (1–4) have been synthesized and characterized by cyclic voltammetry, absorption spectroscopy and photoluminescence (PL). Two of the oligomers contain a tri-substituted central benzene ring, while one contains a tetra-substituted central ring. These oligomers were prepared in an effort to increase hole and electron mobility in organic materials via extension of conjugation to two dimensions. Optical and electrochemical evidence is given for significant interactions of the alkoxy-substituted styryl units of 3 that are attached to the central benzene ring in meta positions. The tetra-substituted oligomer (4) also exhibits strong interactions between the pair of para substituted arms. The photoluminescence (PL) quantum yield for the tetra-substituted oligomer is high, indicating that it is an excellent candidate for the active layer in organic light-emitting diodes.     

Sharpness overconstancy: the roles of visibility and current context.

In a previous study we found that blurred edges presented in peripheral vision look sharper than when they are looked at directly, a phenomenon we have called peripheral sharpness overconstancy (Galvin et al. (1997). Vision Research, 37, 2035-2039). In the current study we show that when visibility of the stimulus edges is compromised by very brief presentations, we can demonstrate sharpness overconstancy for static, foveal viewing. We also test whether the degree of sharpening is a function of the current visual context, but find no difference between the peripheral sharpness overconstancy (at 24 degrees eccentricity) of edges measured in a blurred context and that measured in a sharp context. We conclude that if the visual system does carry a template for sharp edges which contributes to edge appearance when visibility is poor, then that template is resistant to changes in context.     

Historical reflections on hypertension

Sixty million Americans have hypertension, a major cardiovascular risk factor. Its presence accelerates the atherosclerotic process, producing strokes, heart attacks, heart failure, renal failure, and peripheral vascular disease. This article highlights the historical landmarks in the study of this disease from the first documented measurement of blood pressure in 1733, through the most recent pharmacologic approaches to treatment. In addition, the roles of the kidney and the renin-angiotensin-aldosterone system are examined.