Many of the 23 million individuals with heart failure (HF) worldwide receive daily, unpaid support from a family member or friend. Although HF and palliative care practice guidelines stipulate that support be provided to family caregivers, the evidence-base to guide care for this population has not been comprehensively assessed. In order to appraise the state-of-the-science of HF family caregiving and recommend areas for future research, the aims of this review were to summarize: 1) how caregivers influence patients, 2) the consequences of HF for caregivers, and 3) interventions directed at HF caregivers. We reviewed all literature to December 2015 in PubMed and CINAHL using the search terms “heart failure” AND “caregiver.” Inclusion criteria dictated that studies report original research of HF family caregiving. Articles focused on children or instrument development or aggregated HF with other illnesses were excluded. We identified 120 studies, representing 5,700 caregivers. Research on this population indicates that: 1) caregiving situations vary widely with equally wide-ranging tasks for patients to help facilitate their health behaviors, psychological health and relationships, and quality of life (QoL); 2) caregivers have numerous unmet needs that fluctuate with patients’ unpredictable medical status, are felt to be ignored by the formal healthcare system, and can lead to distress, burden, and reduced QoL; and 3) relatively few interventions have been developed and tested that effectively support HF family caregivers. We provide recommendations to move the science forward in each of these areas that moves beyond descriptive work to intervention development and clinical trials testing.

Previous research has shown that purpose in life, the belief that one's life is meaningful and goal-directed, is associated with greater engagement in self-reported physical activity. The purpose of this study was to examine the relationship between purpose in life and accelerometer-measured physical activity. Community volunteers (N = 104) completed measures of purpose in life and potential confounds and wore accelerometers for three consecutive days. Purpose in life was positively associated with objectively measured movement, moderate to vigorous physical activity, and with self-reported activity. These relationships were largely unchanged after controlling for potential confounds. These results suggest that purpose in life is a reliable correlate of physical activity.

Accumulating evidence suggests that a global sense of meaning in life is related to physical health, including increased longevity and reduced morbidity. However, the mechanisms responsible for these relationships remain largely unknown and uninvestigated. Moreover, there is no unifying conceptual framework linking meaning in life to physical health. Our aims are to (a) review the literature linking meaning in life to potential mechanisms associated with better physical health; (b) offer a comprehensive conceptual framework associating meaning in life with physical health; and (c) introduce a new construct, meaning salience, as a potentially important intermediary mechanism. Specifically, we review the evidence suggesting that meaning in life is associated with reduced stress, more adaptive coping, and greater engagement in health-promoting behaviors. Our model proposes that effects of global sense of meaning are potentiated through increased meaning salience, or daily awareness of meaning in the moment, which enhances self-regulation. Suggestions are proposed for empirically examining this new model.

Mutuality in patient-caregiver dyads is associated with patient self-care and caregiver burden and may be an important intervention target to improve self-care and reduce hospitalizations.

Carbon nanotubes exhibit a range of chemistries, including mixtures of different nanotube diameters, lengths, and chiralities coupled with various concentrations of metallic and non-nanotube-carbon impurities. The performance of a given material for a specific application depends on the chemistry, which is dictated in large part by the manufacturing process. Here, thermogravimetric analysis is utilized as a bulk characterization method for determining nanotube quality after manufacturing. The application of thermogravimetric analysis for quantifying basic nanotube chemistry is described (e.g., carbon-to-metal content, homogeneity). In addition, extension of the method to analyze specific nanotube properties (i.e., length and diameter) is reported. Results indicate that thermogravimetric analysis is sufficiently sensitive to enable quality control at both the macro-scale (carbon-to-metal ratio) and nano-scale (single-walled to multi-walled) and can detect subtle modifications in manufacturing processes.

In this exploratory study, relationship quality was positively associated with caregiver benefit and negatively associated with burden. Future studies are needed to further understand these key caregiving factors, which may lead to opportunities to help caregivers see benefits and reduce burden.

Relationship quality and communication seem to matter in the health and well-being of both HF patients and their informal family caregivers. More research is needed to elucidate mechanisms and to design effective relationship-focused interventions.

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