title: Counselling Patients with a Spinal Cord Injury

authors: Sliedrecht, Susan

subjects: Spinal Injury

abstract: The aim of this study was to improve current counselling services at the Auckland
Spinal Unit. This purpose was achieved by co-researching the topic with people
who have extensive experience of living in the community with a spinal cord injury
to reveal what they believe was helpful, or believe would have been helpful, in
terms of the counselling, when they were newly injured.
Listening to the stories of the research participants, through supervision of my own
practice, doing a literature review and writing a journal became sources that
provided rich knowledges to reflect on my current counselling practice.
A qualitative study was conducted using aspects of action research, feminist
research and post-structuralist methods.
In November 2005, an information pack was mailed to the sixteen patients who had
been discharged from the Auckland Spinal Unit between June 2002 and June 2004,
who were under the age of sixty -five and lived in the Auckland area, inviting them
to participate in this research. Seven people agreed and were available to
participate.
I interviewed these seven participants, using unstructured interviews. All the
interviews were audio-taped and then transcribed verbatim. These verbatim
transcripts were then sent back to the participants for any
additions/deletions/alterations they chose to make.
To initiate the reflecting process, I then went through all the interviews and
identified common themes. I understand that if the research participants had been
involved in this process, other themes might have emerged for them.
The themes identified were loss and grief as a result of a spinal cord injury,
sexuality, family (whanau) involvement and how counselling services should be
positioned in a setting such as the Auckland Spinal Unit. These themes formed the
iii
foci of the chapters, with an additional chapter on weaving cultural threads into
counselling.
The main findings of the study centre on the very important role of counselling at
the Auckland Spinal Unit. In particular, the study highlighted the importance of
counselling as a place for conversations that make room for multiple positionings
and multiple versions of events, a space that respects a patient's hopes, beliefs and
dreams for his/her life (which often does not include wheelchairs, catheters and
caregivers) but that also supports the patient to make meaning of living life with a
spinal cord injury.
The study also identified the importance of sexuality counselling. Not including
sexuality as a topic in the rehabilitation services provided perpetuates dominant
discourses that a person with a spinal cord injury does not want sexual intimacy or
cannot be sexually intimate and cannot have children.
Family (whanau) involvement in and family's becoming part of the rehabilitation
team was very important to most participants. This study looks at how this
involvement can be achieved and explores some of the structures currently in place
at the Auckland Spinal Unit to facilitate this involvement. Participants in this study
expressed a desire for counselling to be highly accessible to both themselves and
their families (whanau). They would prefer the counsellors to get to know the
patients in their own environment first (in their rooms), so that the patients are
positioned to have agency to make choices about how they would like to use the
available counselling services.
The study concludes with my personal journey of working as a counsellor at the
Auckland Spinal Unit and how this research has shaped and fine-tuned my practice.

text: Counselling Patients with a Spinal Cord Injury The aim of this study was to improve current counselling services at the Auckland
Spinal Unit. This purpose was achieved by co-researching the topic with people
who have extensive experience of living in the community with a spinal cord injury
to reveal what they believe was helpful, or believe would have been helpful, in
terms of the counselling, when they were newly injured.
Listening to the stories of the research participants, through supervision of my own
practice, doing a literature review and writing a journal became sources that
provided rich knowledges to reflect on my current counselling practice.
A qualitative study was conducted using aspects of action research, feminist
research and post-structuralist methods.
In November 2005, an information pack was mailed to the sixteen patients who had
been discharged from the Auckland Spinal Unit between June 2002 and June 2004,
who were under the age of sixty -five and lived in the Auckland area, inviting them
to participate in this research. Seven people agreed and were available to
participate.
I interviewed these seven participants, using unstructured interviews. All the
interviews were audio-taped and then transcribed verbatim. These verbatim
transcripts were then sent back to the participants for any
additions/deletions/alterations they chose to make.
To initiate the reflecting process, I then went through all the interviews and
identified common themes. I understand that if the research participants had been
involved in this process, other themes might have emerged for them.
The themes identified were loss and grief as a result of a spinal cord injury,
sexuality, family (whanau) involvement and how counselling services should be
positioned in a setting such as the Auckland Spinal Unit. These themes formed the
iii
foci of the chapters, with an additional chapter on weaving cultural threads into
counselling.
The main findings of the study centre on the very important role of counselling at
the Auckland Spinal Unit. In particular, the study highlighted the importance of
counselling as a place for conversations that make room for multiple positionings
and multiple versions of events, a space that respects a patient's hopes, beliefs and
dreams for his/her life (which often does not include wheelchairs, catheters and
caregivers) but that also supports the patient to make meaning of living life with a
spinal cord injury.
The study also identified the importance of sexuality counselling. Not including
sexuality as a topic in the rehabilitation services provided perpetuates dominant
discourses that a person with a spinal cord injury does not want sexual intimacy or
cannot be sexually intimate and cannot have children.
Family (whanau) involvement in and family's becoming part of the rehabilitation
team was very important to most participants. This study looks at how this
involvement can be achieved and explores some of the structures currently in place
at the Auckland Spinal Unit to facilitate this involvement. Participants in this study
expressed a desire for counselling to be highly accessible to both themselves and
their families (whanau). They would prefer the counsellors to get to know the
patients in their own environment first (in their rooms), so that the patients are
positioned to have agency to make choices about how they would like to use the
available counselling services.
The study concludes with my personal journey of working as a counsellor at the
Auckland Spinal Unit and how this research has shaped and fine-tuned my practice.

year: 2007

title: How effective is Cauchy-EDA in high dimensions?

authors: Sanyang, Momodou L.

subjects: Machine learning

abstract: We consider the problem of high dimensional blackbox optimisation via Estimation of Distribution Algorithms (EDA) and the use of heavy-tailed search distributions in this setting. Some authors have suggested that employing a heavy tailed search distribution, such as a Cauchy, may make EDA better explore a high dimensional search space. However, other authors have found Cauchy search distributions are less effective than Gaussian search distributions in high dimensional problems. In this paper, we set out to resolve this controversy. To achieve this we run extensive experiments on a battery of high-dimensional test functions, and develop some theory which shows that small search steps are always more likely to move the search distribution towards the global optimum than large ones and, in particular, large search steps in high-dimensional spaces nearly always do badly in this respect. We hypothesise that, since exploration by large steps is mostly counterproductive in high dimensions, and since the fraction of good directions decays exponentially fast with increasing dimension, instead one should focus mainly on finding the right direction in which to move the search distribution. We propose a minor change to standard Gaussian EDA which implicitly achieves this aim, and our experiments on a sequence of test functions confirm the good performance of our new approach.

text: How effective is Cauchy-EDA in high dimensions? We consider the problem of high dimensional blackbox optimisation via Estimation of Distribution Algorithms (EDA) and the use of heavy-tailed search distributions in this setting. Some authors have suggested that employing a heavy tailed search distribution, such as a Cauchy, may make EDA better explore a high dimensional search space. However, other authors have found Cauchy search distributions are less effective than Gaussian search distributions in high dimensional problems. In this paper, we set out to resolve this controversy. To achieve this we run extensive experiments on a battery of high-dimensional test functions, and develop some theory which shows that small search steps are always more likely to move the search distribution towards the global optimum than large ones and, in particular, large search steps in high-dimensional spaces nearly always do badly in this respect. We hypothesise that, since exploration by large steps is mostly counterproductive in high dimensions, and since the fraction of good directions decays exponentially fast with increasing dimension, instead one should focus mainly on finding the right direction in which to move the search distribution. We propose a minor change to standard Gaussian EDA which implicitly achieves this aim, and our experiments on a sequence of test functions confirm the good performance of our new approach.

year: 2016

title: Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study

authors: Blackmore, Tania Louise

subjects: Science & Technology

abstract: Background: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. 
Methods: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). 
Results: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. 
Conclusions: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.

text: Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study Background: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. 
Methods: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). 
Results: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. 
Conclusions: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.

year: 2020-10-01