Three-Dimensional Residual Neural Architecture Search for Ultrasonic Defect Detection.

This study presents a deep-learning (DL) methodology using 3-D convolutional neural networks (CNNs) to detect defects in carbon fiber-reinforced polymer (CFRP) composites through volumetric ultrasonic testing (UT) data. Acquiring large amounts of ultrasonic training data experimentally is expensive and time-consuming. To address this issue, a synthetic data generation method was extended to incorporate volumetric data. By preserving the complete volumetric data, complex preprocessing is reduced, and the model can utilize spatial and temporal information that is lost during imaging. This enables the model to utilize important features that might be overlooked otherwise. The performance of three architectures was compared. The first architecture is prevalent in the literature for the classification of volumetric datasets. The second demonstrated a hand-designed approach to architecture design, with modifications to the first architecture to address the challenges of this specific task. A key modification was the use of cuboidal kernels to account for the large aspect ratios seen in ultrasonic data. The third architecture was discovered through neural architecture search (NAS) from a modified 3-D residual neural network (ResNet) search space. In addition, domain-specific augmentation methods were incorporated during training, resulting in significant improvements in model performance, with a mean accuracy improvement of 22.4% on the discovered architecture. The discovered architecture demonstrated the best performance with a mean accuracy increase of 7.9% over the second-best model. It was able to consistently detect all defects while maintaining a model size smaller than most 2-D ResNets. Each model had an inference time of less than 0.5 s, making them efficient for the interpretation of large amounts of data.

Critical care providers' support of families in bereavement: a mixed-methods study.

PURPOSE: When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. METHODS: Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. RESULTS: Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. CONCLUSIONS: Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.

RéSUMé: OBJECTIF: Lorsque des personnes décèdent dans une unité de soins intensifs (USI), jusqu'à la moitié des membres de leur famille pourraient souffrir d'une réaction émotionnelle grave. Bien que les familles rapportent le besoin d'un soutien en cas de deuil, la plupart des USI ne font pas un suivi de routine avec les membres de la famille. Les cliniciens sont traditionnellement impliqués dans le soutien aux familles pendant la mort et le décès, mais nous ne connaissons que peu de choses concernant leur travail avec les familles en deuil. Notre objectif était d'explorer la façon dont les cliniciens viennent en soutien aux familles en deuil, d'identifier les facteurs qui facilitent ou entravent le soutien, et de comprendre leur intérêt et leurs besoins en matière de suivi. MéTHODE: Nous avons réalisé une étude par méthodes mixtes auprès du personnel infirmier et des médecins travaillant dans l'une de neuf USI médico-chirurgicales pour adultes dans des hôpitaux universitaires du Canada. Des entretiens qualitatifs suivaient des sondages quantitatifs afin de refléter, approfondir et expliquer les résultats quantitatifs. RéSULTATS: Selon leur perception, les médecins et le personnel infirmier fournissent un soutien empathique aux familles en deuil. L'implication émotionnelle a été identifiée comme étant un élément crucial du soutien, mais les cliniciens ne sont pas toujours capables de s'impliquer auprès des familles en raison de leurs rôles, de leurs responsabilités, de leurs expériences ou des ressources de l'unité. Un autre facteur important qui pourrait faciliter ou au contraire entraver leur implication est la mesure dans laquelle les familles acceptent la mort. Les cliniciens seraient intéressés à participer à un programme de suivi de deuil, mais leur participation dépend de leur temps, de leur formation et de leur capacité à gérer leurs propres émotions liées à la mort et au deuil à l'USI. CONCLUSION: De nombreuses cibles ont été identifiées pour améliorer le soutien actuel aux familles en deuil, y compris le désir des cliniciens de l'USI de disposer de programmes formels de suivi. Il faudra toutefois tenir compte de nombreux facteurs psychologiques, socioculturels et structurels dans la conception de tels programmes.

Prolonged grief and the disruption of meaning: Establishing a mediation model.

This study aimed to test the hypothesis that meaning making is a mediating process in the relationship between risk factors for prolonged grief disorder (PGD) and subsequent emergence of PGD symptomatology. A survey design was employed with prospective measurement of PGD. The following variables were assessed 2-12 months postloss among adults across North America and Europe (N = 357): (a) risk factors for PGD (insecure attachment, social support, neuroticism, violent loss, and spousal loss) and (b) meaning made. Meaning made was measured using the Grief and Meaning Reconstruction Inventory (GMRI) as well as using the Integration of Stressful Life Experiences-Short Form (ISLES-SF). At a 7-10-months follow-up (n = 171) symptoms of PGD were assessed. The mean age at the second assessment point was 44.3 years (SD = 16.1) and the majority of the sample identified as female (71.9%). Process analysis was employed to test a series of simple mediation models. When the GMRI was used as a measure of meaning, the indirect effect of each risk factor on PGD symptoms, as mediated by meaning made, was significant (95% CI). When the ISLES-SF was used to measure meaning, the indirect effect of each risk factor with the exception of violent loss was significant (95% CI). The study demonstrates that meaning making serves to mediate the adverse impact of multiple PGD risk factors on the development of PGD symptomatology. Specifically, the study suggests that PGD risk factors exacerbate symptoms of PGD by impeding the meaning-making process. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Rumination moderates the role of meaning in the development of prolonged grief symptomatology.

OBJECTIVE: To address the etiology of prolonged grief disorder (PGD) by examining whether rumination moderates the role of meaning-making in mediating the impact of PGD risk factors. METHOD: A survey assessing PGD risk factors (low social support, insecure attachment, violent loss, neuroticism, and loss of a spouse), meaning, and rumination was administered 2-12 months postloss among adults across North America and Europe (mean age = 44.3, 71.9% female). At a 7-10 months follow-up, symptoms of PGD were assessed (n = 171). RESULTS: When measuring meaning with the Grief and Meaning Reconstruction Inventory, the moderated mediation pathway was significant for each PGD-risk factor. However, when measuring meaning with the Integration of Stressful Life Experiences-Short Form, the pathway was significant for every risk factors except violent loss. CONCLUSIONS: Rumination appears to moderate meaning-making in the development of PGD symptomatology. These findings highlight rumination as a target for intervention with at-risk grievers.

Prolonged grief symptomatology following violent loss: the mediating role of meaning.

Background: Prolonged Grief Disorder (PGD) is over-represented among those who have lost loved ones to violent causes. To tailor PGD interventions for this vulnerable population it is critical to examine the aetiology of PGD specifically in the context of violent death bereavement. Previous studies have suggested that violent loss increases symptoms of PGD by hindering the mourner's ability to make meaning of the death or its aftermath. However, these studies have relied on cross sectional data that preclude genuine prediction and have not differentiated among specific themes of meaning. Objective: This study aimed to identify specific themes of meaning that mediate the detrimental impact of violent loss on subsequent emergence of PGD symptomatology among the violently bereft. Method: A longitudinal, prospective design (N = 171) was used to assess violent loss and themes of meaning an average of six months post-loss allowing for prediction of PGD symptoms an average of eight months later. Results: Violent loss had a significant indirect effect on PGD symptomatology when meaning themes focusing on sense of peace and continuing bonds served as mediators. Conclusions: This study demonstrates the mediating role that specific meaning themes play in the development of PGD symptomatology following violent loss. These findings highlight the potential benefits of applying a meaning-based intervention approach with the violently bereft.

Antecedentes: El Trastorno de Duelo Prolongado (PGD en su sigla en inglés) está sobrerrepresentado entre aquellos que han perdido a sus seres queridos por causas violentas. Para adaptar las intervenciones de PGD para esta población vulnerable, es fundamental examinar la etiología del PGD, específicamente en el contexto de la experiencia de pérdida (bereavement) violenta. Estudios previos han sugerido que la pérdida violenta aumenta los síntomas del PGD al obstaculizar la capacidad del doliente (mourner) de dar sentido a la muerte o sus consecuencias. Sin embargo, estos estudios se han basado en datos transversales que impiden una predicción genuina y no han diferenciado entre temas específicos de significado. Objetivo: Este estudio tuvo como objetivo identificar los temas específicos de significado que median el impacto perjudicial de la pérdida violenta en la aparición posterior de la sintomatología PGD entre los dolientes. Método: Se utilizó un diseño prospectivo longitudinal (N = 171) para evaluar la pérdida violenta y los temas de significado, aproximadamente 6 meses después de la pérdida, lo que permitió la predicción de los síntomas de PGD en un promedio de 8 meses después. Resultados: La pérdida violenta tuvo un efecto indirecto significativo en la sintomatología del PGD cuando los temas de significado que se centran en la sensación de paz y continuidad de los vínculos/lazos sirvieron como mediadores. Conclusiones: El estudio demuestra el rol mediador que desempeñan los temas de específicos de significado en el desarrollo de la sintomatología del PGD después de la pérdida violenta. Estos hallazgos resaltan los beneficios potenciales de aplicar un enfoque de intervención basado en el significado con los dolientes.

OA8†Caring for the family caregiver: working with volunteers to implement and improve a service to enable family caregivers to maintain their own wellbeing.

BACKGROUND: Family caregivers suffer physically, mentally, and spiritually. Community volunteers play an important role in supporting patients at the end of life or former caregivers in bereavement. However, there are no research reports of volunteer services focused on maintaining the wellbeing of end-of-life caregivers. AIM: To have volunteers, a hired volunteer coordinator, health care providers, and researchers implement and formatively evaluate a volunteer service to enable family caregivers to maintain their well being while providing care and subsequent bereavement. This presentation will focus on the volunteers' roles with the project as both agents of change to the service and as support for the caregivers. METHOD: A qualitative formative evaluation informed by Guba and Lincoln's Fourth Generation Evaluation (1989) participatory design was conducted. Data was collected through individual interviews, focus groups, participant observation during volunteer support meetings, and through volunteers' written reflections. RESULTS: Amongst the volunteers, volunteer coordinator, and principal investigator, there was mutual respect for and interest in learning about everyone's roles and experiences in the project. The experience was rewarding because they felt they helped the family caregiver and enjoyed developing and improving the service and working in a supportive team. Volunteers' challenges included being nervous for their first meeting with a caregiver, and frustration with some rules put in place to protect them (e.g. not helping the caregiver with direct care for the patient). CONCLUSION: Volunteers can be an effective part of the research team, while providing valuable support and encouragement for family caregivers to maintain their own wellbeing.

Reconstructing Meaning with Others in Loss: A Feasibility Pilot Randomized Controlled Trial of a Bereavement Group.

More effective psychosocial interventions that target uncomplicated bereavement are needed for those actively seeking support. The objective of this study was to assess the feasibility of evaluating a unique meaning-based group counseling (MBGC) intervention with a randomized controlled trial (RCT) design. Twenty-six bereft individuals were randomly assigned to either MBGC or a control bereavement support group. Twenty participants (11 experimental, nine control) completed all aspects of the study including self-report measures at baseline, postintervention, and 3-month follow-up of meaning in life, anxiety, depression, and grief. Results support the feasibility of an RCT with MBGC.

Meaning-based group counseling for bereavement: bridging theory with emerging trends in intervention research.

A growing body of scholarship has evaluated the usefulness of meaning-based theories in the context of bereavement counseling. Although scholars have discussed the application of meaning-based theories for individual practice, there is a lack of inquiry regarding its implications when conducting bereavement support groups. The objective of this article is to bridge meaning-based theories with bereavement group practice, leading to a novel intervention and laying the foundation for future efficacy studies. Building on recommendations specified in the literature, this article outlines the theoretical paradigms and structure of a short-term meaning-based group counseling intervention for uncomplicated bereavement.

How do researchers conceive of spousal grief after cancer? A systematic review of models used by researchers to study spousal grief in the cancer context.

BACKGROUND: Although spouses bereaved after cancer are considered vulnerable people, there have been few empirical studies to explore grief specifically in this context. METHODS: Using PsycINFO, Medline, and the PRISMA statement, we systematically searched the literature by intersecting 'cancer' and 'grie*', 'cancer' and 'bereave*', and 'cancer' and 'mourn*'. RESULTS: Gathering 76 studies (2000-2013) that met the inclusion criteria for bereavement in adulthood, bereavement of an adult loved one and evidence-based research, we found the following: Spousal relationships are not systematically examined in the current dominant models of grief. Theoretically derived determinants of spousal grief after cancer and empirically derived ones converge toward the necessity to include the caregiving experience as determining grief reactions. A growing body of literature concerning prolonged grief disorders now provides integrative reflections regarding the characteristics of spousal loss, predictors, and associated therapeutic interventions in the cancer context. CONCLUSIONS: Few empirical studies (20 of 76) target spousal bereavement specifically after cancer. The process of adaptation to loss is usually decontextualized, removing any consideration of the relationship to the deceased or the experience of caregiving and dying. Our findings suggest that this topic warrants more studies that use both prospective and mixed methodologies, as well as explore typical grief needs and experiences of bereaved spouses.

Applying feminist, multicultural, and social justice theory to diverse women who function as caregivers in end-of-life and palliative home care.

OBJECTIVE: Women are largely responsible for providing care to terminally ill family members at home. The goal of this review is to conceptualize diverse women's experiences in palliative home care from feminist, multicultural, and social justice perspectives. METHODS: Peer-reviewed manuscripts were identified using the following databases: CIMAHL, psycINFO, and pubMED. The following search terms were used: women/mothers/daughters, Caregiving, family caregivers, feminism, culture, multiculturalism, and palliative home care. Article reference lists were also reviewed. The majority of penitent articles which formed the basis for the arguments presented were drawn from nursing, medicine, and counseling psychology scholarship. RESULTS: The application of feminist, multicultural, and social justice theory brings to attention several potential issues female caregivers may experience. First, there exist diverse ways in which women's Caregiving is manifested that tend to correspond with variations in culture, relationship, and age. Second, it is important to attend to changing expectations placed on women as a result of Caregiving at the end of life. Third, the changing power dynamics women may experience in end of life Caregiving are very complex. SIGNIFICANCE OF RESULTS: The principle finding of the review was the highlighting of potential risks that culturally diverse female caregivers are likely to face at the end of life. The application of social justice theory provides a number of implications for practice and policy. Specifically, the identifying significant concerns regarding female caregivers in palliative home care, as well as suggesting ways to appropriately attend to these concerns, and oppression of women is less likely to be perpetuated, specific areas for future research in this domain are identified.