Disarmed complaints: unpacking satisfaction with end-of-life care.

PubMed

Sinding, Christina

2003-10-01

Difficult health care encounters often do not translate into expressions of dissatisfaction with care. This paper focuses on the 'non-expression' of dissatisfaction with care in the accounts of 12 people in Canada who provided care to a relative or friend who died of breast cancer. The analysis foregrounded in this paper began from the observation that as difficult health care experiences were elaborated, speakers located health professionals' actions in relation to various situational factors, including the fact of a (cancer) death and conditions of constraint in the health system. Set alongside these two realities, expressions of dissatisfaction tended to be disarmed. Results of this study suggest that the cost of articulating dissatisfaction with care is high where the cared-for person has died, and the perceived value of focusing on difficult experiences is low. Further, respondents in this study took the specificity of the situation and the setting into account in formulating beliefs about the care outcomes for which health professionals could be held responsible. When conditions in the health system and the disease process of advanced cancer were positioned in talk as 'ultimate limits' on health professionals' actions, perceived lapses in care were excused.

[Epidemiology of HIV infection in 2005].

PubMed

Arvieux, Cédric

2005-06-04

Various concomitant epidemics of HIV infection currently exist and have created a worldwide pandemic. In Eastern Europe, in France and in industrialized countries, the prevalence of HIV infection is on the rise due to the increased life expectancy of seropositive patients and the persistently "high" incidence rate. In Western Europe, the proportion of new cases among women and people from endemic countries is growing. The role of drug use in HIV transmission is decreasing. The opposite situation is encountered in Eastern Europe, where intravenous drug abuse remains the major risk factor, although heterosexual contamination is also rising. In sub-Saharan Africa, the situation is alarming: decreased life expectancy, increased infant mortality, and a prevalence approaching 50% in prenatal consultations in some countries. Minor improvements have been noted (decline in the prevalence in Uganda). Major deficits in the healthcare systems thwart antiHIV campaigns. In southern and eastern Asia, the epidemic is expanding, notably in countries in which it is recent (China, Indonesia). It is difficult today to envisage a global answer to the epidemic, in view of the wide variety of situations.

Life satisfaction and social support received by women in the perinatal period.

PubMed

Gebuza, Grażyna; Kaźmierczak, Marzena; Mieczkowska, Estera; Gierszewska, Małgorzata; Kotzbach, Roman

2014-01-01

Birth of a baby has a big impact on women's lives. The presence and help of loved ones favours wellbeing, health, coping with difficult situations. The aim of this study was to determine whether women's satisfaction with life changes during pregnancy and after delivery, and to identify correlates of life satisfaction. Life satisfaction was measured using The Satisfaction with Life Scale - SWLS and received social support was assessed using the Berlin Social Support Scales - BSSS. The study was conducted in the third trimester of pregnancy and during the postpartum period, before discharge from the hospital. The research sample included a total of 199 women in the third trimester of pregnancy and 188 of initially participating women, who had physiological births or caesarean sections. The results clearly show a significant increase in life satisfaction in the postpartum period (p < 0.0001). An important correlate of life satisfaction in the third trimester of pregnancy is social support received (p < 0.0001). During pregnancy such a correlate is emotional support received, and in the postnatal period- instrumental support received. An increase in instrumental support received (p = 0.031) and informational (p = 0.013) has been observed in the postpartum period. The assessment of life satisfaction and received social support seem to be needed to gain a full picture of women's situation during birth, which will allow for planning and implementing maternity care appropriate to the needs of women.

What should a suspended doctor do when his actions could save a patient's life?

PubMed Central

Stewart, J

2003-01-01

Suspension from duty is becoming an increasing threat for medical practitioners. While under suspension a doctor may, in extreme circumstances, find themselves in a difficult legal dilemma as to their duty of care towards others. A suspended doctor may risk litigation if they are unaware of the legal ramifications of their unusual circumstances. The following article outlines the legal situation as it applies to England and Wales. PMID:12743336

Fixed Future and Uncertain Past: Theorems Explain Why It Is Often More Difficult to Reconstruct the Past Than to Predict the Future

NASA Technical Reports Server (NTRS)

Alefeld, Goetz; Koshelev, Misha; Mayer, Guenter

1997-01-01

At first glance. it may seem that reconstructing the past is, in general, easier than predicting the future, because the past has already occurred and it has already left its traces, while the future is still yet to come, and so no traces of the future are available. However, in many real life situations, including problems from geophysics and celestial mechanics, reconstructing the past is much more computationally difficult than predicting the future. In this paper, we give an explanation of this difficulty. This explanation is given both on a formal level (as a theorem) and on the informal level (as a more intuitive explanation).

Predictive testing and existential absurdity: resonances between experiences around genetic diagnosis and the philosophy of Albert Camus.

PubMed

Porz, Rouven; Widdershoven, Guy

2011-07-01

Predictive genetic testing may confront those affected with difficult life situations that they have not experienced before. These life situations may be interpreted as 'absurd'. In this paper we present a case study of a predictive test situation, showing the perspective of a woman going through the process of deciding for or against taking the test, and struggling with feelings of alienation. To interpret her experiences, we refer to the concept of absurdity, developed by the French Philosopher Albert Camus. Camus' writings on absurdity appear to resonate with patients' stories when they talk about their body and experiences of illness. In this paper we draw on Camus' philosophical essay 'The Myth of Sisyphus' (1942), and compare the absurd experiences of Sisyphus with the interviewee's story. This comparison opens up a field of ethical reflection. We demonstrate that Camus' concept of absurdity offers a new and promising approach to understanding the fragility of patients' situations, especially in the field of predictive testing. We show that people affected might find new meaning through narratives that help them to reconstruct the absurd without totally overcoming it. In conclusion, we will draw out some normative consequences of our narrative approach. © 2009 Blackwell Publishing Ltd.

Treatment of palliative care emergencies by prehospital emergency physicians in Germany: an interview based investigation.

PubMed

Wiese, C H R; Bartels, U E; Ruppert, D; Marung, H; Luiz, T; Graf, B M; Hanekop, G G

2009-06-01

Palliative care medical emergencies as a consequence of advanced cancer account for approximately 3% of all prehospital emergency cases. Therefore, prehospital emergency physicians (EP) are confronted with 'end of life decisions'. No educational content exists concerning palliative medicine in emergency medicine curricula. Over the course of 6 months, we interviewed 150 EPs about their experiences in 'end of life decisions' using a specific questionnaire. The total response rate was 69% (n = 104). Most of the interviewed EPs (89%, n = 93) had been confronted with palliative care medical emergencies and expressed uncertainties in dealing with these difficult situations, especially in the area of psychosocial care of the patients (50%). The emergency treatment of palliative care patients can become a particular challenge for any EP. A large percentage of interviewed EPs felt uncertain about aspects of social care and in the assessment of decisions at the end of life. Further information and training are necessary to amenable EPs to provide adequate patient-oriented care to palliative care patients and their relatives in emergency situations.

Managing the emotional aspects of end of life care for children and young people.

PubMed

Pearson, Helen

2010-09-01

Caring for a child at the end of life stage is one of the greatest challenges a nurse can encounter in practice. The way professionals help support, maintain and give comfort to the child and his or her family helps shape the experience the young patient is about to face. Whatever the stage of your nursing career it is likely you will provide end of life care to a child or young person and their family. This article is designed to help enable professionals to cope emotionally and provide the best quality of care in an emotionally charged situation. The information contained may be used as a guidance tool through is challenging and difficult time.

[Clinical interview in psychiatric difficult situations].

PubMed

Lorettu, Liliana; Nivoli, Gian Carlo; Milia, Paolo; Depalmas, Cristiano; Clerici, Massimo; Nivoli, Alessandra M A

2017-01-01

There are here described a number of basic principles underlying an effective clinical interview in psychiatric difficult situations (violent or suicidal patients, victims of serious physical and psychological damages, authors of inadequate or anti-social requests to the therapist). The aim of the present study is to provide the psychiatric operator with useful skills for the optimal management of the interview in difficult situations both at diagnostically and therapeutically level. The methodology was based on examination of the literature and personal experience of the authors. The authors highlighted 18 working hypothesis that may represent beneficial instruments in situations of difficult psychiatric interview. Further studies will deepen under the clinical, actuarial and statistical validity the principles covered in various clinical and crisis situations with difficulty to the interview, in relation also to specific types of patients for a more updated training of the operators in the field of mental health.

Cervical and facial infections - a real life threat

NASA Astrophysics Data System (ADS)

Rosu, S.; Fratila, M.

2014-03-01

Cervicofacial infections of dental origin are a difficult and complex issue of oral and maxillofacial surgery. Recognizing in due time the situations which are likely to develop a life-threatening condition and medical surgical prompt interventions significantly reduce the rate of the complications. Between January 2009 and March 2013, at the Clinic of Oral and Maxillofacial Surgery of the University of Medicine and Pharmacy "Victor Babes" Timisoara, 17 patients with severe cervicofacial infections were admitted in the emergency department as they needed a complex medical surgical treatment in accordance with protocol established together with the intensive-care department. Assessing the situations, we noticed a difficult, prolonged time of the recovery process which needed a hospitalization period of around 20 days. It recorded two deceased because of cervical necrotizing fasciitis and oral floor phlegmon, the most severe forms of the cervicofacial infections. The severity of the condition of the patients with cervicofacial infections must be figured and as quickly as possible an energetic therapeutic attitude must be adopted. The experience shows a frequent resistance to antibiotics like ampicillin, penicillin and oxacillin. The patients must be guided in due time to a clinic which has an intensive care department, where the surgical treatment must be administrated together with an intensive treatment for supporting the general condition. The reduction of the vital risk of the cervicofacial infections of dental origin will be done through an attentive assessment of the general and local condition (status) of the outpatients, before the dental extraction. The absence of a treatment adapted to the situation and to the clinic development, meaningfully increases the rate of the complications and the length of the hospitalization, the lethal evolution being not excluded.

Improving the Quality of Home Visitation: An Exploratory Study of Difficult Situations

ERIC Educational Resources Information Center

LeCroy, Craig Winston; Whitaker, Kate

2005-01-01

Objective: The primary purpose of this study was to use an ecological assessment model to obtain a better understanding of difficult situations that home visitors confront when implementing home visitation services. Method: A mixed method study was used which included conducting focus groups to identify specific situations faced by home visitors…

[Assessment of daily quality of life in children surviving cancer].

PubMed

Lemétayer, F; Lanfranchi, J-B; Chastagner, P

2016-05-01

The purpose of this study was to identify the daily problems experienced by school-age children in remission from cancer. It also sought to assess the predictive value of these problems on the mental health of these children 1 year after the first assessment. Against this background, 50 children in remission from cancer and in mainstream education, aged 8-12 years, completed two questionnaires: the Quality of Life Systemic Inventory for Children (QLSI-C) (Missotten et al., 2007) and the Child Depression Inventory (CDI). THE QLSI-C consists of 20 life areas: Sleep, Diet, Physical pain, Health, Clothing, Physical appearance, Bedroom, Grandparents, Mother, Father, Siblings, Friends, How my friends talk about me, School, School results, Sport, Non-sporting activities, Autonomy, Obedience to authority, and Tolerance of frustration. Each of these 20 life areas was evaluated by the child by reference on each occasion to an ideal situation, first in relation to their current situation and then in relation to their personal goals, in order to measure the gap between these two evaluations. This difference was then weighted by the importance given to each life area and the dynamic situation of approximation to or distance from the goals. All the children in this study were seen in person for two interviews 1 year apart (T1 and T2). The analyses conducted following the PLS-PM approach enabled eight of the 20 life areas evaluated to be identified as difficult to access by the children in this study. These analyses also showed that the difficulties perceived by children in remission from cancer have mainly proximal effects (i.e., short-term) on the discomfort experienced (direct effect of difficulties expressed in T1 on discomfort felt at T1; idem for T2). However, the areas perceived as difficult at T1 did not enable distal effects (i.e., effect over a year) on the discomfort expressed in T2 to be updated. Nonetheless, the conflicts at T1 fed the conflicts at T2 and, as a consequence, indirectly affected the experience of depression at T2. The discussion examines the nature of the daily difficulties perceived by school-age children in remission from cancer and the short-term psychological distress experienced by these children. It concludes that the difficulties encountered by children in remission from cancer are not necessarily cumulative over time and that they do not inevitably result in permanent psychological suffering. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Analysis of factors affecting the quality of life of those suffering from Crohn's disease.

PubMed

Chrobak-Bień, Joanna; Gawor, Anna; Paplaczyk, Małgorzata; Małecka-Panas, Ewa; Gąsiorowska, Anita

2017-08-31

Crohn's disease is an inflammatory bowel disease of unknown etiology. Its chronic nature, as well as symptoms of intestinal and overall significantly impedes the daily functioning of patients. Alternately occurring periods of exacerbation and remission are the cause of reduced quality of life of patients. Understanding the factors that caused the decrease in the quality of life, it allows us to understand the behavior and the situation of the patient and the ability to cope with stress caused by the disease. The aim of the study was to analyze the factors affecting the quality of life of people with Crohn's disease. The study group consisted of 50 people diagnosed with Crohn's disease. Respondents were treated at the Department of General Surgery and Colorectal Medical University of Lodz and Gastroenterological Clinic at the University Clinical Hospital No. 1 in Lodz. Quality of Life Survey was carried out by a diagnostic survey using a research tool SF-36v2 and surveys of its own design. Analysis of the results demonstrated that the quality of life of patients with Crohn's disease was reduced, especially during exacerbations. Evaluation of the quality of life of respondents in physical terms was slightly higher than in the mental aspect. Higher education subjects and the lack of need for surgical treatment significantly improves the quality of life. The occurrence of chronic disease reduces the quality of life of respondents. Elderly patients are better able to adapt to the difficult situation caused by the disease. The quality of life of women and men is at a similar level and patients in remission of the disease have a better quality of life of patients during exacerbations.

Self-regulation of driving and its relationship to driving ability among older adults.

PubMed

Baldock, M R J; Mathias, J L; McLean, A J; Berndt, A

2006-09-01

Although it is known that older drivers limit their driving, it is not known whether this self-regulation is related to actual driving ability. A sample of 104 older drivers, aged between 60 and 92, completed a questionnaire about driving habits and attitudes. Ninety of these drivers also completed a structured on-road driving test. A measure of self-regulation was derived from drivers' self-reported avoidance of difficult driving situations. The on-road driving test involved a standard assessment used to determine fitness to drive. Driving test scores for the study were based on the number of errors committed in the driving tests, with weightings given according to the seriousness of the errors. The most commonly avoided difficult driving situations, according to responses on the questionnaire, were parallel parking and driving at night in the rain, while the least avoided situation was driving alone. Poorer performance on the driving test was not related to overall avoidance of difficult driving situations. Stronger relationships were found between driving ability and avoidance of specific difficult driving situations. These specific driving situations were the ones in which the drivers had low confidence and that the drivers were most able to avoid if they wished to.

Surrogate inaccuracy in predicting older adults' desire for life-sustaining interventions in the event of decisional incapacity: is it due in part to erroneous quality-of-life assessments?

PubMed

Bravo, Gina; Sene, Modou; Arcand, Marcel

2017-07-01

Family members are often called upon to make decisions for an incapacitated relative. Yet they have difficulty predicting a loved one's desire to receive treatments in hypothetical situations. We tested the hypothesis that this difficulty could in part be explained by discrepant quality-of-life assessments. The data come from 235 community-dwelling adults aged 70 years and over who rated their quality of life and desire for specified interventions in four health states (current state, mild to moderate stroke, incurable brain cancer, and severe dementia). All ratings were made on Likert-type scales. Using identical rating scales, a surrogate chosen by the older adult was asked to predict the latter's responses. Linear mixed models were fitted to determine whether differences in quality-of-life ratings between the older adult and surrogate were associated with surrogates' inaccuracy in predicting desire for treatment. The difference in quality-of-life ratings was a significant predictor of prediction inaccuracy for the three hypothetical health states (p < 0.01) and nearly significant for the current health state (p = 0.077). All regression coefficients were negative, implying that the more the surrogate overestimated quality of life compared to the older adult, the more he or she overestimated the older adult's desire to be treated. Discrepant quality-of-life ratings are associated with surrogates' difficulty in predicting desire for life-sustaining interventions in hypothetical situations. This finding underscores the importance of discussing anticipated quality of life in states of cognitive decline, to better prepare family members for making difficult decisions for their loved ones. ISRCTN89993391.

Developmental changes in facial expressions of emotions in the strange situation during the second year of life.

PubMed

Izard, Carroll E; Abe, Jo Ann A

2004-09-01

Infants' expressions of discrete emotions were coded during the more stressful episodes (4 through 8) of the Strange Situation at 13 and 18 months. The data showed a significant decrease in full-face expressions (more complex configurations of movements) and a significant increase in component expressions (simpler and more constrained patterns of movements). The authors interpreted this trend as a developmental change toward more regulated and less intense emotions. Consistent with this view, the aggregate index of infants' full-face negative emotion expressions, interpreted as reflecting relatively unregulated intense emotions, correlated significantly with maternal ratings of difficult temperament. The authors discuss alternative interpretations of the findings in terms of changes in reactivity/arousability and the emerging capacity for self-regulation. (c) 2004 APA, all rights reserved

Communication about life-sustaining therapy: insights from the Adaptive Leadership Framework

PubMed Central

Neglia, Elizabeth; Anderson, Ruth A.; Brandon, Debra; Docherty, Sharron L.

2014-01-01

Objective Effective provider and caregiver communication is central to quality care during treatment for life-threatening illnesses. The study aim was to analyze communication patterns between providers and a parent of an infant with a life-threatening disease using the Adaptive Leadership Framework, which is an activity that involves mobilizing others to adapt to a difficult situation. Method A secondary analysis was conducted on one case using 23 interviews with providers and mother of an infant diagnosed with Hurler’s syndrome. The interviews focused on decision-making challenges in regard to the infant’s treatment and were conducted over a 1-year period (pre-transplant, study entry, monthly, after a life-threatening event or substantial change in treatment and at 1-year post enrollment). Content analysis was used to identify and categorize communication patterns using concepts from the Adaptive Leadership Framework. Results Infant illness events and parent-provider caregiving were chronicled across a 1-year trajectory. Despite the life-threatening nature of Hurler’s disease, the parent and providers did not discuss palliative care or end-of-life. The parent sought direction and answers from the providers. The Adaptive Leadership Framework suggested how communication approaches were often mismatched with the needs of the parent. Discussion The results of the study accentuate the need to improve communication between provider and parents about end-of-life for their child. Adaptive Leadership illuminates how providers can influence a parent’s behavior when facing a challenging situation. This study suggests that Adaptive Leadership is a useful framework to guide research about healthcare communication in dealing with challenging issues. PMID:25309745

A survey of Canadian anesthesiologists' preferences in difficult intubation and "cannot intubate, cannot ventilate" situations.

PubMed

Wong, David T; Mehta, Arpan; Tam, Amanda D; Yau, Brian; Wong, Jean

2014-08-01

The purpose of this survey was to determine the equipment that anesthesiologists prefer in difficult tracheal intubation and "cannot intubate, cannot ventilate" (CICV) situations. A questionnaire was e-mailed to members of the Canadian Anesthesiologists' Society to ascertain their preferences, experience, and comfort level with regard to their use of airway equipment in difficult intubation and CICV situations in adult patients. A Chi square test was used to analyse the data. All reported P values are two-sided. Nine hundred ninety-seven of 2,532 questionnaires (39%) were returned. In an unanticipated difficult direct laryngoscopic intubation situation, 893 of 997 (90%) respondents chose a video laryngoscope as the first-choice rescue technique, while 41 (4%) and 21 (2%) of respondents chose a flexible bronchoscope and an intubating laryngeal mask airway device, respectively. The majority of anesthesiologists had experience and were comfortable with using a flexible bronchoscope or a video laryngoscope. Regarding CICV, 294 of 955 (31%) respondents stated that they had never encountered it. Wire-guided cricothyroidotomy was chosen as the first-choice surgical airway by 375 of 955 (39%) respondents, while intravenous catheter cricothyroidotomy and "defer to tracheostomy by surgeon" were selected by 266 (28%) and 215 (23%) respondents, respectively. Seven hundred eighty-five of 997 (78%) respondents were familiar with the exact steps of the American Society of Anesthesiologists' difficult airway algorithm, while 448 (47%) had attended an airway workshop within the past five years. In a difficult intubation situation, the most frequently selected first-choice airway device was a video laryngoscope, followed by a flexible bronchoscope. In a CICV situation, the most frequently selected first-choice surgical airway technique was a wire-guided cricothyroidotomy, followed by an intravenous catheter cricothyroidotomy.

Depression and embodiment: phenomenological reflections on motility, affectivity, and transcendence.

PubMed

Aho, Kevin A

2013-11-01

This paper integrates personal narratives with the methods of phenomenology in order to draw some general conclusions about 'what it means' and 'what it feels like' to be depressed. The analysis has three parts. First, it explores the ways in which depression disrupts everyday experiences of spatial orientation and motility. This disruption makes it difficult for the person to move and perform basic functional tasks, resulting in a collapse or contraction of the life-world. Second, it illustrates how depression creates a situational atmosphere of emotional indifference that reduces the person's ability to qualitatively distinguish what matters in his or her life because nothing stands out as significant or important anymore. In this regard, depression is distinct from other feelings because it is not directed towards particular objects or situations but to the world as a whole. Finally, the paper examines how depression diminishes the possibility for 'self-creation' or 'self-making'. Restricted by the illness, depression becomes something of a destiny, preventing the person from being open and free to access a range of alternative self-interpretations, identities, and possible ways of being-in-the-world.

Dignity of older people in a nursing home: narratives of care providers.

PubMed

Jakobsen, Rita; Sørlie, Venke

2010-05-01

The purpose of this study was to illuminate the ethically difficult situations experienced by care providers working in a nursing home. Individual interviews using a narrative approach were conducted. A phenomenological-hermeneutic method developed for researching life experience was applied in the analysis. The findings showed that care providers experience ethical challenges in their everyday work. The informants in this study found the balance between the ideal, autonomy and dignity to be a daily problem. They defined the culture they work in as not supportive. They also thought they were not being seen and heard in situations where they disagree with the basic values of the organization. The results are discussed in terms of Habermas's understanding of modern society. Care settings for elderly people obviously present ethical challenges, particularly in the case of those suffering from dementia. The care provider participants in this study expressed frustration and feelings of powerlessness. It is possible to understand their experiences in terms of Habermas's theory of modern society and the concept of the system's colonization of the life world.

The dumbest mistake I ever made.

PubMed

Reichman, O Howard

2015-01-01

Life as a Neurological Surgeon is a foreboding responsibility and a gratifying opportunity. Having the confidence and trust of individuals faced with a life or death situation requires extensive training and experience. Curiosity provides the motivation to continuously seek better understanding of complex disease problems, better technology, improved diagnostic capability, and surgical skills. Solution of these challenges has been a constant process for several decades and continues to pose opportunities for progress. Early observation of results provides important information, but in many circumstances it may require long-term evaluation to fully document the benefit, or lack of benefit, for any treatment procedure. The focus of attention by the Neurological Surgeon must be on the proper immediate management of each given situation, but it is also important, and a responsibility to consider the long-term consequences or results. This presents a difficult challenge because patients move into distant places and Neurological Surgeons frequently move to accept new opportunities. It is expensive and cumbersome to retain records for many years. It is also unpredictable which patient's information will become particularly significant. It is an opportunity to describe experience with four patients to illustrate this dilemma.

Care dependence: a struggle toward moments of respite.

PubMed

Eriksson, Monika; Andershed, Birgitta

2008-08-01

The purpose of this study was to describe people's experiences of being dependent on others for care in their final stage of life, as well as what they felt made their experience of being dependent easier or more difficult. The phenomenological-hermeneutical method was chosen, where data collection consisted of open-ended interviews with nine people undergoing palliative care at a hospice unit or at home. The meaning of being care dependent is described via the following themes: changed relationship with oneself and with others, striving to adapt oneself to the situation, obstacles, and opportunities along the way while dependent. The result is described as an effort, a journey from independence to moments where it was possible to rest and recuperate while struggling with care dependency. Nursing staff require knowledge and understanding of experiences with care dependency to make life easier for people during increasing dependency in the final stage of life.

[The importance of relationship satisfaction and the questionnaire techniques of its measurement].

PubMed

Vajda, Dóra; Sz Makó, Hajnalka

2014-01-01

The quality of marriage or partnership has an impact on many areas of life. Consequently, a good working relationship can be a significant resource to cope with difficult life situations and stress, and may contribute to partners' well-being and healthy lifestyle. Therefore, its investigation has particular relevance. Relationship satisfaction is a complex concept which is confirmed by both diversity and multidimensionality of its definition. The aim of this study is to provide an overview of the importance of relationship satisfaction, inter- and intrapersonal factors influencing its development, its changes over family life cycles and the gender differences that may manifest in relationship satisfaction. In addition, this review summarizes the questionnaire techniques of measuring relationship satisfaction which are also reflected within the complexity and the diversity of the concept. Given the fact that the degree of relationship satisfaction plays a salient role in many aspects of life, the empirical research findings which emphasize the importance of this conception can serve as an alternative to aim the mobilization of its practical work.

[The professional and family characteristics, difficulties, contentment and resources of physicians working at level 3 neonatal intensive care centres. General overview in Hungary].

PubMed

Soósné Kiss, Zsuzsanna; Feith, Helga Judit; Szabó, Miklós; Gradvohl, Edina

2018-04-01

A survey that investigates the situation of physicians working at neonatal intensive care (NIC) centres has not been made since 1997. To give an overview of the sociodemographic characteristics; personal and professional problems; the satisfaction with their job and family roles; their levels of healthy lifestyle; resources in the families of physicians working at NIC. We have made an examination in Hungary at NIC among physicians from April 2015 till January 2016, with an anonym self-fill-in questionnaire. The physicians involved in the research (n = 111) are representatively middle-aged people. They are well-qualified and hold a subordinate post. Most of them have second jobs. The manager and deputy-manager positions are characteristic for the men. Most of them live in family. The main problems for them are financial and professional difficulties, not the family or personal problems. They have conflicts in families because of finding partners and having children as well as job problems. They are satisfied with their parenting, partnership and professional roles but they are not contented with their family role as a financial safety provider person and as a person living a healthy life. In difficult situations in their life, they can count on friends and family members, furthermore they can rely on their workmates and superiors. It is the first research that focuses on the general situation of physicians working at level 3 NIC centres. This is the first time when a survey investigates their professional-personal-family life. Orv Hetil. 2018; 159(16): 628-635.

Only Behavioral But Not Self-Report Measures of Speech Perception Correlate with Cognitive Abilities.

PubMed

Heinrich, Antje; Henshaw, Helen; Ferguson, Melanie A

2016-01-01

Good speech perception and communication skills in everyday life are crucial for participation and well-being, and are therefore an overarching aim of auditory rehabilitation. Both behavioral and self-report measures can be used to assess these skills. However, correlations between behavioral and self-report speech perception measures are often low. One possible explanation is that there is a mismatch between the specific situations used in the assessment of these skills in each method, and a more careful matching across situations might improve consistency of results. The role that cognition plays in specific speech situations may also be important for understanding communication, as speech perception tests vary in their cognitive demands. In this study, the role of executive function, working memory (WM) and attention in behavioral and self-report measures of speech perception was investigated. Thirty existing hearing aid users with mild-to-moderate hearing loss aged between 50 and 74 years completed a behavioral test battery with speech perception tests ranging from phoneme discrimination in modulated noise (easy) to words in multi-talker babble (medium) and keyword perception in a carrier sentence against a distractor voice (difficult). In addition, a self-report measure of aided communication, residual disability from the Glasgow Hearing Aid Benefit Profile, was obtained. Correlations between speech perception tests and self-report measures were higher when specific speech situations across both were matched. Cognition correlated with behavioral speech perception test results but not with self-report. Only the most difficult speech perception test, keyword perception in a carrier sentence with a competing distractor voice, engaged executive functions in addition to WM. In conclusion, any relationship between behavioral and self-report speech perception is not mediated by a shared correlation with cognition.

Only Behavioral But Not Self-Report Measures of Speech Perception Correlate with Cognitive Abilities

PubMed Central

Heinrich, Antje; Henshaw, Helen; Ferguson, Melanie A.

2016-01-01

Good speech perception and communication skills in everyday life are crucial for participation and well-being, and are therefore an overarching aim of auditory rehabilitation. Both behavioral and self-report measures can be used to assess these skills. However, correlations between behavioral and self-report speech perception measures are often low. One possible explanation is that there is a mismatch between the specific situations used in the assessment of these skills in each method, and a more careful matching across situations might improve consistency of results. The role that cognition plays in specific speech situations may also be important for understanding communication, as speech perception tests vary in their cognitive demands. In this study, the role of executive function, working memory (WM) and attention in behavioral and self-report measures of speech perception was investigated. Thirty existing hearing aid users with mild-to-moderate hearing loss aged between 50 and 74 years completed a behavioral test battery with speech perception tests ranging from phoneme discrimination in modulated noise (easy) to words in multi-talker babble (medium) and keyword perception in a carrier sentence against a distractor voice (difficult). In addition, a self-report measure of aided communication, residual disability from the Glasgow Hearing Aid Benefit Profile, was obtained. Correlations between speech perception tests and self-report measures were higher when specific speech situations across both were matched. Cognition correlated with behavioral speech perception test results but not with self-report. Only the most difficult speech perception test, keyword perception in a carrier sentence with a competing distractor voice, engaged executive functions in addition to WM. In conclusion, any relationship between behavioral and self-report speech perception is not mediated by a shared correlation with cognition. PMID:27242564

How anaesthesiologists understand difficult airway guidelines-an interview study.

PubMed

Knudsen, Kati; Pöder, Ulrika; Nilsson, Ulrica; Högman, Marieann; Larsson, Anders; Larsson, Jan

2017-11-01

In the practice of anaesthesia, clinical guidelines that aim to improve the safety of airway procedures have been developed. The aim of this study was to explore how anaesthesiologists understand or conceive of difficult airway management algorithms. A qualitative phenomenographic design was chosen to explore anaesthesiologists' views on airway algorithms. Anaesthesiologists working in three hospitals were included. Individual face-to-face interviews were conducted. Four different ways of understanding were identified, describing airway algorithms as: (A) a law-like rule for how to act in difficult airway situations; (B) a cognitive aid, an action plan for difficult airway situations; (C) a basis for developing flexible, personal action plans for the difficult airway; and (D) the experts' consensus, a set of scientifically based guidelines for handling the difficult airway. The interviewed anaesthesiologists understood difficult airway management guidelines/algorithms very differently.

Prerequisites and driving forces behind an extended working life among older workers.

PubMed

Hovbrandt, Pia; Håkansson, Carita; Albin, Maria; Carlsson, Gunilla; Nilsson, Kerstin

2017-11-28

Reforms are changing pension systems in many European countries, in order to both restrict early retirement and force people to extend their working life. From occupational therapy and occupational science perspectives, studies focusing on aspects of working life that motivate the older worker is urgent. The aim was to describe incentives behind an extended working life among people over age 65. Focus group methodology was used, with participants ages 66-71, from varying work fields: construction and technical companies and the municipal elderly care sector. Work was considered important and valuable to the degree of how challenging work was, the possibilities for inclusion in a team of colleagues and the chances for better personal finances. Amongst all, the participants expressed a feeling of a strengthened identity by being challenged and having the opportunity to manage working tasks. The finding showed the actual reasons behind an extended working life among older workers. However, a risk of rising social inequity may appear with increased working life if older people are forced to extend their working life due to a difficult financial situation as a pensioner. A variety of retirement options and initiatives in order to support older workers are justified.

The cardiac tumors - some exceptional heart conditions.

PubMed

Cristian, Ana Maria; Moraru, Oriana Elena; Goleanu, Viorel Constantin; Butuşină, Marian; Pinte, Florina; Cotoi, Bogdan Virgil; Cristian, Gabriel

2018-01-01

Cardiac tumors are exceptional cardiac conditions, since they have a minimal occurrence, according to statistics. The cardiac myxoma cases are the most dominant for the representative examples for these clinical situations. Those tumors being benign, the patients enjoy a reasonable life expectancy provided they receive an early diagnosis. In the absence of potential complications, the symptoms can vary very much and they may often be non-specific, a fact which makes it more difficult to establish a proper diagnosis and to quickly tailor the optimal therapeutic solutions. Surgery is, in the most cases, a comfortable solution, allowing the cases to be permanently healed. Nowadays, cardiac surgery provides all the needed facilities to diagnose cases at an early stage, when diagnosis is quick and accurate. This paper illustrates, by the means of two suggestive cases, how difficult it is to establish a quick positive diagnosis, which is vital for healing this condition with an evolutionary risk frequently worsen by major complications.

Municipalities' Priority Problems and Prospect of Establishing Ordinance to Measures for Marginal Hamlets

NASA Astrophysics Data System (ADS)

Nakanishi, Mayumi; Hoshino, Satoshi; Hashimoto, Shizuka; Kuki, Yasuaki

The problems of Marginal Hamlets are getting worse, in which more than half of the population is over 65 and community-based life is difficult. To contribute to effective policy making, we conducted a questionnaire survey to members of the National Liaison Council of ‘Suigen no Sato’ constituted to share information about problems and effective counter measures for marginal hamlets. Our study clarified that first, most of respondents had common problems such as lack of job-opportunities and animal damage on farm, and second, though most of respondents recognized the effectiveness of selecting target communities in policy implementations, it is difficult for municipal governments to establish such ordinance provided that councilors and those who were not living in areas of policy target wouldn't agree with it. Finally, we pointed out the roles of national and prefectural governments to help municipal governments effectively cope with such entangled situations.

How anaesthesiologists understand difficult airway guidelines—an interview study

PubMed Central

Knudsen, Kati; Nilsson, Ulrica; Larsson, Anders; Larsson, Jan

2017-01-01

Background In the practice of anaesthesia, clinical guidelines that aim to improve the safety of airway procedures have been developed. The aim of this study was to explore how anaesthesiologists understand or conceive of difficult airway management algorithms. Methods A qualitative phenomenographic design was chosen to explore anaesthesiologists’ views on airway algorithms. Anaesthesiologists working in three hospitals were included. Individual face-to-face interviews were conducted. Results Four different ways of understanding were identified, describing airway algorithms as: (A) a law-like rule for how to act in difficult airway situations; (B) a cognitive aid, an action plan for difficult airway situations; (C) a basis for developing flexible, personal action plans for the difficult airway; and (D) the experts’ consensus, a set of scientifically based guidelines for handling the difficult airway. Conclusions The interviewed anaesthesiologists understood difficult airway management guidelines/algorithms very differently. PMID:29299973

The Impact of Self-Narratives of Motherhood for Mothers of Children with Autism

PubMed Central

Trzebiński, Jerzy; Wołowicz-Ruszkowska, Agnieszka; Wójcik, Adrian Dominik

2016-01-01

The main goal of this study was to identify the impact of a narrative construction of a life challenge - discovering to have a child with autism - on the meaning of life and on resources for coping depending on the challenge’s novelty, i.e., the number of years from the diagnosis. Three hundred and sixty four mothers of children with autism participated in a long-term 3 × 2 experiment. Half of the mothers had children with autism at the age of 9–12 years. For the remaining half, having children with autism was a new and stressful life situation. Their children were 2–3 years old and just diagnosed by a medical center as having autism spectrum disorder. The mothers were assigned to one of three study conditions: they were either asked to write stories of their motherhood or to describe their children’s behavior on a questionnaire or they did not participate in any tasks. One month and then 4 months after this task the participants completed measures of meaning of life and several well-being scales. The results indicated that following the narrative writing the participants had the highest scores on the meaning of life and well-being scales. This affect was sustained over 4 months and was significant only for mothers with older children. The mediation analysis showed that the effects of the experimental conditions on different well-being scales were mediated by the changes in perceived meaning of life. The results suggest that construction of self-narratives of difficult ongoing challenges facilitates meaning making and subsequently strengthens resources for coping. However, it seems that a meaning-making construction of such self-story may be blocked by the uncertainty and stress caused by novelty of the challenging situation. PMID:27994568

It is not just a Minor Thing - A Phenomenological-Hermeneutic Study of Patients' Experiences when afflicted by a Minor Heart Attack and Participating in Cardiac Rehabilitation.

PubMed

Simonÿ, Charlotte P; Dreyer, Pia; Pedersen, Birthe D; Birkelund, Regner

2017-06-01

To improve cardiac care, especially cardiac rehabilitation, patients' perspectives should be better addressed. In Denmark, patients afflicted by a minor heart attack in terms of unstable angina pectoris or non-ST-elevation myocardial infarction are treated in fast-track programmes with subacute treatment in hospital, early discharge and follow-up specialised outpatient cardiac rehabilitation. Knowledge of these patients' experiences of their life situation is essential to develop sufficient care protocols. To gain in-depth understanding of how patients afflicted by a minor heart attack experience their life situation when following cardiac rehabilitation. Focus group interviews and individual interviews were conducted with 11 patients enrolled in the cardiac rehabilitation programme. Data consisted of text in the form of transcribed interviews. A three-phased interpretation inspired by Paul Ricoeur's theory of interpretation was applied. As an overall concept, the patients experienced being forced into a demanding life shaking journey. Three themes emerged: Difficulty accepting the disease: facing the disease is a difficult challenge for the patients, leading to vulnerability and helplessness; Understanding that life has become frail: patients feel shaken as they realise that the disease is chronic and life-threatening; and An altered life: patients must adjust to new limitations in their everyday lives. Patients experience an overall demanding transition when they are afflicted by a minor heat attack, whereby their lives are sweepingly changed. Supporting patients' integrity, which becomes vulnerable during the various stages of transitions, is essential to ensure a healthy outcome. Being together with fellow patients during cardiac rehabilitation is a facilitating factor in the course of transition. © 2016 Nordic College of Caring Science.

Futility and the Care of Surgical Patients: Ethical Dilemmas

PubMed Central

Grant, Scott B.; Modi, Parth K.

2016-01-01

Futility has been a contentious topic in medicine for several decades. Surgery in critical or end-of-life situations often raises difficult questions about futility. In this article, we discuss the definition of futility, methods for resolving futility disputes, and some ways to reframe the futility debate to a more fruitful discussion about the goals of care, better communication between surgeon and patient/surrogate, and palliative surgical care. Many definitions of futile therapy have been discussed. The most controversial of these is “qualitative futility” which describes a situation in which the treatment provided is likely to result in an unacceptable quality of life. This is an area of continued controversy because it has been impossible to identify universally held beliefs about acceptable quality of life. Many authors have described methods for resolving futility disputes, including community standards and legalistic multi-step due process protocols. Others, however, have abandoned the concept of futility altogether as an unhelpful term. Reframing the issue of futility as one of inadequate physician–patient communication, these authors have advocated for methods of improving communication and strengthening the patient–physician relationship. Finally, we discuss the utilization of consultants who may be of use in resolving futility disputes: ethics committees, palliative care specialists, pastoral care teams, and dedicated patient advocates. Involving these specialists in a futility conflict can help improve communication and provide invaluable assistance in arriving at the appropriate treatment decision. PMID:24849199

Conversations in end-of-life care: communication tools for critical care practitioners.

PubMed

Shannon, Sarah E; Long-Sutehall, Tracy; Coombs, Maureen

2011-01-01

Communication skills are the key for quality end-of-life care including in the critical care setting. While learning general, transferable communication skills, such as therapeutic listening, has been common in nursing education, learning specific communication tools, such as breaking bad news, has been the norm for medical education. Critical care nurses may also benefit from learning communication tools that are more specific to end-of-life care. We conducted a 90-min interactive workshop at a national conference for a group of 78 experienced critical care nurses where we presented three communication tools using short didactics. We utilized theatre style and paired role play simulation. The Ask-Tell-Ask, Tell Me More and Situation-Background-Assessment-Recommendation (SBAR) tools were demonstrated or practiced using a case of a family member who feels that treatment is being withdrawn prematurely for the patient. The audience actively participated in debriefing the role play to maximize learning. The final communication tool, SBAR, was practiced using an approach of pairing with another member of the audience. At the end of the session, a brief evaluation was completed by 59 nurses (80%) of the audience. These communication tools offer nurses new strategies for approaching potentially difficult and emotionally charged conversations. A case example illustrated strategies for applying these skills to clinical situations. The three tools assist critical care nurses to move beyond compassionate listening to knowing what to say. Ask-Tell-Ask reminds nurses to carefully assess concerns before imparting information. Tell Me More provides a tool for encouraging dialogue in challenging situations. Finally, SBAR can assist nurses to distill complex and often long conversations into concise and informative reports for colleagues. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care Nurses.

Emotional reactivity to daily life stress in spousal caregivers of people with dementia: An experience sampling study.

PubMed

van Knippenberg, Rosalia J M; de Vugt, Marjolein E; Ponds, Rudolf W; Verhey, Frans R J; Myin-Germeys, Inez

2018-01-01

Caregivers differ in their emotional response when facing difficult situations during the caregiving process. Individual differences in vulnerabilities and resources could play an exacerbating or buffering role in caregivers' reactivity to daily life stress. This study examines which caregiver characteristics modify emotional stress reactivity in dementia caregivers. Thirty caregivers collected momentary data, as based on the experience sampling methodology, to assess (1) appraised subjective stress related to events and minor disturbances in daily life, and (2) emotional reactivity to these daily life stressors, conceptualized as changes in negative affect. Caregiver characteristics (i.e. vulnerabilities and resources) were administered retrospectively. Caregivers who more frequently used the coping strategies 'seeking distraction', 'seeking social support', and 'fostering reassuring thoughts' experienced less emotional reactivity towards stressful daily events. A higher educational level and a higher sense of competence and mastery lowered emotional reactivity towards minor disturbances in daily life. No effects were found for age, gender, and hours of care and contact with the person with dementia. Caregiver resources can impact emotional reactivity to daily life stress. Interventions aimed at empowerment of caregiver resources, such as sense of competence, mastery, and coping, could help to reduce stress reactivity in dementia caregivers.

An interprofessional workshop for students to improve communication and collaboration skills in end-of-life care.

PubMed

Erickson, Jeanne M; Blackhall, Leslie; Brashers, Valentina; Varhegyi, Nikole

2015-12-01

Interprofessional care is critical for patients at the end of life (EOL), but programs to teach communication skills to medical and nursing students are rare. The aims of this study were to determine whether an interprofessional workshop improves (1) student attitudes toward teamwork and (2) self-efficacy for communicating in difficult situations. Nursing and medical students attended a workshop with collaborative role play of an EOL conversation. Before the workshop, students showed different attitudes toward teamwork and collaboration and varying levels of confidence about communication skills. After the workshop, both groups reported more positive attitudes toward teamwork but a mixed picture of confidence in communication. Experiential interprofessional education workshops enhance perceptions about the benefits of teamwork, but further teaching and evaluation methods are needed to maximize the effectiveness. © The Author(s) 2014.

The influence of clarification and threats on life situation: patients’ experiences 1 year after TSCI

PubMed Central

Bjørnshave Noe, Bodil; Bjerrum, Merete; Angel, Sanne

2017-01-01

Introduction: The study was conducted at the Spinal Cord Injury Centre of Western Denmark (VCR). The aim of the study was to explore patients’ experiences following traumatic spinal cord injury and to identify characteristics of positive versus negative life situation 1 year post discharge from hospital rehabilitation. This was a qualitative study conducted using inductive content analysis. Case Presentation: In this qualitative study seven patients were interviewed one year after discharge from initial rehabilitation at the VCR. The interviews were analysed using inductive content analysis. Discussion: We found that two categories condensed the patients’ experiences of their life situation 1 year post discharge: ‘clarification in relation to overall life situation’ and ‘threat to core competences’. The transversal analysis across the derived categories identified different combinations of clarification and threats to core competences explaining the patients’ experiences: high degree of clarification combined with low degree of threat to core competences was indicative of positive life situation. Also, positive life situation was seen when a high degree of clarification compensated for high degree of threats on core competencies. In contrast, an overall stressful and negative life situation was influenced by poor clarification combined with a high degree of threat to core competences. However, when core competences can be transformed into new skills, threats were manageable. This study revealed that clarification related to overall life situation in combination with threat to core competences may explain traumatic spinal cord injury patients’ overall life situation 1 year post discharge. An appropriate balance characterises a positive life situation. There might be a need to pay attention to patients who are challenged by low degree of clarification and high degree of threats on core competencies 1 year post discharge as this may influence the life situation negatively. PMID:28435741

Space Situational Awareness: Difficult, Expensive and Necessary

DTIC Science & Technology

2014-12-01

Senior Leader Perspective November–December 2014 Air & Space Power Journal | 6 Space Situational Awareness Difficult, Expensive—and Necessary Dr...authors thank Gen William Shelton for his thoughtful and insightful comments. Disclaimer: The views and opinions expressed or implied in the Journal ...permission. If it is reproduced, the Air and Space Power Journal requests a courtesy line. Report Documentation Page Form ApprovedOMB No. 0704-0188

[The serotonin syndrome. Fatal course of intoxication with citalopram and moclobemide].

PubMed

Cassens, S; Nickel, E A; Quintel, M; Neumann, P

2006-11-01

The serotonin syndrome is caused by a drug-induced increase of the intrasynaptic serotonin concentration. Milder forms of the syndrome may be difficult to diagnose because of the variability of symptoms. Severe forms often rapidly turn into a life-threatening situation, therefore the serotonin syndrome may be a challenge for physicians. We describe the pathophysiology and therapeutic options of the serotonin syndrome and report about a 42-year-old female patient who ingested large amounts of moclobemide, a monoamine oxidase inhibitor, and citalopram, a selective serotonin reuptake inhibitor, for attempted suicide. Within a few hours the patient developed a lethal serotonin syndrome although ICU therapy was initiated immediately.

Reflections on Ethics and Humanity in Pediatric Neurology: the Value of Recognizing Ethical Issues in Common Clinical Practice.

PubMed

Ronen, Gabriel M; Rosenbaum, Peter L

2017-05-01

Our goals in this reflection are to (i) identify the ethical dimensions inherent in any clinical encounter and (ii) bring to the forefront of our pediatric neurology practice the myriad of opportunities to explore and learn from these ethical questions. We highlight specifically Beauchamp and Childress's principles of biomedical ethics. We use the terms ethics in common clinical practice and an ethical lens to remind people of the ubiquity of ethical situations and the usefulness of using existing ethical principles to analyze and resolve difficult situations in clinical practice. We start with a few common situations with which many of us tend to struggle. We describe what we understand as ethics and how and why developments in technology, novel potential interventions, policies, and societal perspectives challenge us to think about and debate ethical issues. Individual patients are not a singular population; each patient has their own unique life situations, culture, goals, and expectations that need to be considered with a good dose of humanity and humility. We believe that using an ethical lens-by which we mean making an explicit effort to identify and consider these issues openly-will help us to achieve this goal in practice, education, and research.

UnKushioned Fall: Anticipated Difficult Airway in Acutely Intoxicated Patient with Severe Facial Injuries

DTIC Science & Technology

2017-10-21

A known difficult airway is an opportunity to utilize an anesthesiologist’s full skill set and oftentimes with thorough planning and careful execution even the most difficult of situations can be handled relatively smoothly.

Effects of Healthy Aging and Mild Cognitive Impairment on a Real-Life Decision-Making Task.

PubMed

Pertl, Marie-Theres; Benke, Thomas; Zamarian, Laura; Delazer, Margarete

2017-01-01

In this study, we investigated the effects of age and of mild cognitive impairment (MCI) on decision making under risk by adopting a task representing real-life health-related situations and involving complex numerical information. Moreover, we assessed the relationship of real-life decision making to other cognitive functions such as number processing, executive functions, language, memory, and attention. For this reason, we compared the performance of 19 healthy, relatively younger adults with that of 18 healthy older adults and the performance of the 18 healthy older adults with that of 17 patients with MCI. Results indicated difficulties in real-life decision making for the healthy older adults compared with the healthy, relatively younger adults. Difficulties of patients with MCI relative to the healthy older adults arose in particular in difficult items requiring processing of frequencies and fractions. Significant effects of age and of MCI in processing frequencies were also evident in a ratio number comparison task. Decision-making performance of healthy participants and of the patient group correlated significantly with number processing. There was a further significant correlation with executive functions for the healthy participants and with reading comprehension for the patients. Our results suggest that healthy older individuals and patients with MCI make less advantageous decisions when the information is complex and high demands are put on executive functions and numerical abilities. Moreover, we show that executive functions and numerical abilities are not only essential in laboratory gambling tasks but also in more realistic and ecological decision situations within the health context.

The Difficult Gallbladder: A Safe Approach to a Dangerous Problem.

PubMed

Santos, B Fernando; Brunt, L Michael; Pucci, Michael J

2017-06-01

Laparoscopic cholecystectomy is a common surgical procedure, and remains the gold standard for the management of benign gallbladder and biliary disease. While this procedure can be technically straightforward, it can also represent one of the most challenging operations facing surgeons. This dichotomy of a routine operation performed so commonly that poses such a hidden risk of severe complications, such as bile duct injury, must keep surgeons steadfast in the pursuit of safety. The "difficult gallbladder" requires strict adherence to the Culture of Safety in Cholecystectomy, which promotes safety first and assists surgeons in managing or avoiding difficult operative situations. This review will discuss the management of the difficult gallbladder and propose the use of subtotal fenestrating cholecystectomy as a definitive option during this dangerous situation.

Bioethical aspects of end-of-life care.

PubMed

Zamperetti, N; Bellomo, R; Ronco, C

2008-01-01

Managing end-of-life care can be difficult because of the particular nature of intensive care support, which can separate the biological and the biographical aspects of life. Artificial organ support can temporarily delay death but, at the same time, may fail to restore a quality of life that the patient judges acceptable. For this reason, two concepts must be considered: that the mission of the healthcare system should be to care for patients according to their interests and wishes and that quality of care is related above all to the careful commitment of healthcare workers to the patient's best interests. Keeping these concepts in mind, the rule of the five Cs (competence, collegiality, communication, continuity of care and compassion) might be helpful in the management of end-of-life care. Unfortunately, neither the rule of the five Cs nor the careful use of moral principles in order to promote the patients' dignity can assure a universally acceptable decision. A reasonable level of 'moral certainty', however, might be achieved using a deliberative approach, which provides for the inclusion of all the different subjects involved in the decision-making process (patient, family, doctors, nurses and other carers), in order to reach the best possible decision in a specific situation.

The Role of Awareness for Complex Planning Task Performance: A Microgaming Study

ERIC Educational Resources Information Center

Lukosch, Heide; Groen, Daan; Kurapati, Shalini; Klemke, Roland; Verbraeck, Alexander

2016-01-01

This study introduces the concept of microgames to support situated learning in order to foster situational awareness (SA) of planners in seaport container terminals. In today's complex working environments, it is often difficult to develop the required level of understanding of a given situation, described as situational awareness. A container…

Ethical considerations in neonatal respiratory care.

PubMed

Orzalesi, Marcello; Cuttini, Marina

2005-01-01

Recent advances in neonatal care have greatly improved the chances for survival of very sick and/or very preterm neonates and have in fact changed the concept and the limits of viability. However, in some situations, when the infant's demise can only be postponed at the price of great suffering or when survival is associated with severe disabilities and an intolerable life for the patient and the parents, it may be unwise to employ the full armamentarium of modern neonatal intensive care. In those circumstances withholding or withdrawing mechanical ventilation and other life-saving, though invasive and painful, procedures might be a better option. This review examines the ethical principles underlying those difficult decisions, the most frequent circumstances where they should be considered, the role of parents and other parties in the decision-making process and the reported behavior of neonatologists in many American and European neonatal intensive care units. Copyright 2005 S. Karger AG, Basel

Approaches for Assessing Olfaction in Children with Autism Spectrum Disorder.

PubMed

Kumazaki, Hirokazu; Okamoto, Masako; Kanzaki, Sho; Okada, Ken-Ichi; Mimura, Masaru; Minabe, Yoshio; Kikuchi, Mitsuru

2018-01-01

Olfactory traits in individuals with autism spectrum disorder (ASD) are considered the strongest predictors of social impairment. Compared to other sensory abnormalities, olfactory abnormalities in individuals with ASD are poorly understood. In this chapter, we provide an overview of the current assessment in individuals with ASD. Several confounding factors have to be considered when conducting research on olfaction in individuals with ASD. Qualitative measures of olfaction contain only limited information about the olfactory stimuli. In addition, little systematic information is available about individual's actual uses of olfaction in daily life. Only a limited number of experimental studies have performed quantitative measurements of olfactory abnormalities in ASD. Therefore, clarifying the relationship between olfactory traits and the influence of real-life situations in a laboratory setting is very difficult. Some new methodologies for measuring olfactory traits are gradually becoming available. New methods that reveal important links between ASD and olfactory traits should be developed in the future.

Difficult end-of-life treatment decisions: do other factors trump advance directives?

PubMed

Hardin, Steven B; Yusufaly, Yasmin A

2004-07-26

Advance directives are widely promoted as a means to plan for patients' decisional incapacity, yet there is little evidence of their effectiveness. We devised a study to assess physicians' compliance with hypothetical advance directives and further examine their clinical reasoning. The study consisted of an analysis of a mailed written survey containing 6 hypothetical cases of seriously ill patients. Each case contained an explicit advance directive with potential conflict between the directive and (1) prognosis, (2) wishes of family or friends, or (3) quality of life. Data were collected on the clinical treatment decisions made by physicians and the reasons for those decisions. Study participants were all internal medicine faculty and resident physicians from a single academic institution. A total of 47% analyzable surveys (117/250) were returned. Decisions by faculty and residents were not consistent with the advance directive in 65% of cases. This inconsistency was similar for faculty and residents (68% and 61%, respectively; P>.05). When physicians made decisions inconsistent with the advance directive, they were more likely to list reasons other than the directive for their decisions (89%; P<.001). Internists frequently made treatment decisions that were not consistent with an explicit advance directive. In difficult clinical situations, internists appear to consider other factors such as prognosis, perceived quality of life, and the wishes of family or friends as more determinative than the directive. Future work needs to explore the generalizability of these findings and examine how strictly patients desire their advance directives to be followed.

The effects of sexism, psychological distress, and difficult sexual situations on U.S. women's sexual risk behaviors.

PubMed

Choi, Kyung-Hee; Bowleg, Lisa; Neilands, Torsten B

2011-10-01

Women represent almost half of the people living with HIV worldwide. Although social discrimination has been recognized as a major obstacle to HIV prevention, few empirical studies have examined the effects of sexism on women's HIV sexual risk behaviors. We analyzed data collected from an ethnically diverse sample of 754 women attending family planning clinics in the San Francisco Bay Area. A majority of respondents reported lifetime experiences of sexism (e.g., 94% reported sexual harassment). Structural equation modeling results demonstrated that experiences of sexism and reports of recent unprotected sex with a primary or a secondary sexual partner were linked through psychological distress and difficult sexual situations. Our results suggest the need to develop HIV prevention strategies for women that address two mechanisms-psychological distress and difficult sexual situations-that link social discrimination to women's sexual risk for HIV.

The Effects of Sexism, Psychological Distress, and Difficult Sexual Situations on U.S. Women’s Sexual Risk Behaviors

PubMed Central

Choi, Kyung-Hee; Bowleg, Lisa; Neilands, Torsten B.

2011-01-01

Women represent almost half of the people living with HIV worldwide. Although social discrimination has been recognized as a major obstacle to HIV prevention, few empirical studies have examined the effects of sexism on women’s HIV sexual risk behaviors. We analyzed data collected from an ethnically diverse sample of 754 women attending family planning clinics in the San Francisco Bay Area. A majority of respondents reported lifetime experiences of sexism (e.g., 94% reported sexual harassment). Structural equation modeling results demonstrated that experiences of sexism and reports of recent unprotected sex with a primary or a secondary sexual partner were linked through psychological distress and difficult sexual situations. Our results suggest the need to develop HIV prevention strategies for women that address two mechanisms ---psychological distress and difficult sexual situations --- that link social discrimination to women’s sexual risk for HIV. PMID:22010804

Psychological attachment in patients with spondylosis of cervical and lumbar spine.

PubMed

Pedziwiatr, Henryk

2013-01-01

Persons with spondylosis of the cervical spine have a low sense of security, difficulties in relationships with their mothers, difficulties in contact with their own body and in coping with dysphoric affect. The question arises: Are those problems the result of the current medical condition, or one of its causes? In order to find the answer one should look closer at the period of an individual's life when a sense of security and a pattern of emotional relationships are formed, and a sense of own body and defence attitudes are developed. The earliest period of life in which these processes occur is the initial relationship between the child and mother; the period of attachment and object relation. If the attachment style in the group studied does not deviate significantly from the control group, it ought to be assumed that the present problems are situational. The problems would then a result of a chronic difficult (stressful) situation which is spondylosis of cervical or lumbar spine. In an attempt to answer the above question, preliminary studies in a 90-person group were conducted. The group included 30 patients with spondylosis of the cervical spine, 30 patients with spondylosis of the lumbar spine, and 30 control persons without spondylosis.

Historical feature pattern extraction based network attack situation sensing algorithm.

PubMed

Zeng, Yong; Liu, Dacheng; Lei, Zhou

2014-01-01

The situation sequence contains a series of complicated and multivariate random trends, which are very sudden, uncertain, and difficult to recognize and describe its principle by traditional algorithms. To solve the above questions, estimating parameters of super long situation sequence is essential, but very difficult, so this paper proposes a situation prediction method based on historical feature pattern extraction (HFPE). First, HFPE algorithm seeks similar indications from the history situation sequence recorded and weighs the link intensity between occurred indication and subsequent effect. Then it calculates the probability that a certain effect reappears according to the current indication and makes a prediction after weighting. Meanwhile, HFPE method gives an evolution algorithm to derive the prediction deviation from the views of pattern and accuracy. This algorithm can continuously promote the adaptability of HFPE through gradual fine-tuning. The method preserves the rules in sequence at its best, does not need data preprocessing, and can track and adapt to the variation of situation sequence continuously.

Historical Feature Pattern Extraction Based Network Attack Situation Sensing Algorithm

PubMed Central

Zeng, Yong; Liu, Dacheng; Lei, Zhou

2014-01-01

The situation sequence contains a series of complicated and multivariate random trends, which are very sudden, uncertain, and difficult to recognize and describe its principle by traditional algorithms. To solve the above questions, estimating parameters of super long situation sequence is essential, but very difficult, so this paper proposes a situation prediction method based on historical feature pattern extraction (HFPE). First, HFPE algorithm seeks similar indications from the history situation sequence recorded and weighs the link intensity between occurred indication and subsequent effect. Then it calculates the probability that a certain effect reappears according to the current indication and makes a prediction after weighting. Meanwhile, HFPE method gives an evolution algorithm to derive the prediction deviation from the views of pattern and accuracy. This algorithm can continuously promote the adaptability of HFPE through gradual fine-tuning. The method preserves the rules in sequence at its best, does not need data preprocessing, and can track and adapt to the variation of situation sequence continuously. PMID:24892054

Emotional reactivity to daily life stress in spousal caregivers of people with dementia: An experience sampling study

PubMed Central

2018-01-01

Introduction Caregivers differ in their emotional response when facing difficult situations during the caregiving process. Individual differences in vulnerabilities and resources could play an exacerbating or buffering role in caregivers’ reactivity to daily life stress. This study examines which caregiver characteristics modify emotional stress reactivity in dementia caregivers. Methods Thirty caregivers collected momentary data, as based on the experience sampling methodology, to assess (1) appraised subjective stress related to events and minor disturbances in daily life, and (2) emotional reactivity to these daily life stressors, conceptualized as changes in negative affect. Caregiver characteristics (i.e. vulnerabilities and resources) were administered retrospectively. Results Caregivers who more frequently used the coping strategies ‘seeking distraction’, ‘seeking social support’, and ‘fostering reassuring thoughts’ experienced less emotional reactivity towards stressful daily events. A higher educational level and a higher sense of competence and mastery lowered emotional reactivity towards minor disturbances in daily life. No effects were found for age, gender, and hours of care and contact with the person with dementia. Discussion Caregiver resources can impact emotional reactivity to daily life stress. Interventions aimed at empowerment of caregiver resources, such as sense of competence, mastery, and coping, could help to reduce stress reactivity in dementia caregivers. PMID:29617373

Difficult Knowledge and Social Studies (Teacher) Education

ERIC Educational Resources Information Center

Garrett, H. James

2010-01-01

Social studies education is a field in which those involved--teachers and students--encounter what can be called "difficult knowledge". Difficult knowledge is a theoretical construct suggesting that when an individual encounters representations of social and historical trauma in a learning situation there exists a host of emotional and pedagogical…

Agent Based Modeling of Collaboration and Work Practices Onboard the International Space Station

NASA Technical Reports Server (NTRS)

Acquisti, Alessandro; Sierhuis, Maarten; Clancey, William J.; Bradshaw, Jeffrey M.; Shaffo, Mike (Technical Monitor)

2002-01-01

The International Space Station is one the most complex projects ever, with numerous interdependent constraints affecting productivity and crew safety. This requires planning years before crew expeditions, and the use of sophisticated scheduling tools. Human work practices, however, are difficult to study and represent within traditional planning tools. We present an agent-based model and simulation of the activities and work practices of astronauts onboard the ISS based on an agent-oriented approach. The model represents 'a day in the life' of the ISS crew and is developed in Brahms, an agent-oriented, activity-based language used to model knowledge in situated action and learning in human activities.

Incompetent Patients, Substitute Decision Making, and Quality of Life: Some Ethical Considerations

PubMed Central

Kluge, Eike-Henner W.

2008-01-01

One of the most difficult situations facing physicians involves decision making by substitute decision makers for patients who have never been competent. This paper begins with a brief examination of the ethics of substitute decision making for previously competent patients. It then applies the results to substitute decision making for patients who have never been competent, and critically analyzes 5 models of substitute decision making for such patients, showing why each either contravenes basic ethical principles or fails to guarantee the use of ethically appropriate values. It concludes by sketching a modified objective reasonable person standard for substitute decision making that avoids valuational difficulties and allows for a protocol that satisfies ethical principles. PMID:19099031

[Developmental origins of adult health and disease: an important concept for social inequalities in health].

PubMed

Charles, M-A

2013-08-01

According to the theory of the developmental origins of adult health and disease, development in utero and in the first years of life are critical phases during which susceptibility to many chronic diseases is set. Diseases eventually occur only if the environment and lifestyle in later life is favorable. Exposure to chemicals (environmental or drug), to infectious agents, unbalanced nutrition, or psychosocial stress prenatally or in the first months/years of life are all factors which have been shown to impact long-term health of individuals. The consequences, however, are not limited to health. A demonstrative example was provided by the study of the influenza epidemic of 1918-1919 in the United States. Nationwide, it was estimated that the loss of income over a lifetime for individuals exposed during fetal life to this epidemic amounted to 14 billion dollars. This example demonstrates that an exposure during fetal life, which is not socially differentiated, may affect the social situation of individuals in adulthood. In many situations, it is much more difficult to separate the specific effect of a given exposure from the overall effect of the social environment. Indeed, it has been shown that socioeconomic status in childhood is associated with increased risk of mortality in adulthood, even after accounting for the socioeconomic status and risky behaviors in adulthood. Among the explanations, the theory of developmental origins of health credits of biological plausibility the model of critical periods early in which the individual is particularly vulnerable to certain exposures. Thus, ensuring the best conditions for the biological, physical, emotional and cognitive development of children in early life will enable them to reach their potential in terms of health and socioeconomic return to society. Investment in this period also brings the hope of reducing the perpetuation of social inequalities and health from generation to generation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

System Life Cycle Evaluation(SM) (SLiCE): harmonizing water treatment systems with implementers' needs.

PubMed

Goodman, Joseph; Caravati, Kevin; Foote, Andrew; Nelson, Molly; Woods, Emily

2013-06-01

One of the methods proposed to improve access to clean drinking water is the mobile packaged water treatment system (MPWTS). The lack of published system performance comparisons combined with the diversity of technology available and intended operating conditions make it difficult for stakeholders to choose the system best suited for their application. MPWTS are often deployed in emergency situations, making selection of the appropriate system crucial to avoiding wasted resources and loss of life. Measurable critical-to-quality characteristics (CTQs) and a system selection tool for MPWTS were developed by utilizing relevant literature, including field studies, and implementing and comparing seven different MPWTS. The proposed System Life Cycle Evaluation (SLiCE) method uses these CTQs to evaluate the diversity in system performance and harmonize relevant performance with stakeholder preference via a selection tool. Agencies and field workers can use SLiCE results to inform and drive decision-making. The evaluation and selection tool also serves as a catalyst for communicating system performance, common design flaws, and stakeholder needs to system manufacturers. The SLiCE framework can be adopted into other emerging system technologies to communicate system performance over the life cycle of use.

Developing guidelines for disclosure or non-disclosure of bad news around life-limiting illness and death to people with intellectual disabilities.

PubMed

Tuffrey-Wijne, Irene; Giatras, Nikoletta; Butler, Gary; Cresswell, Amanda; Manners, Paula; Bernal, Jane

2013-05-01

There is insufficient evidence to guide decisions around (non-)disclosure of bad news of life-limiting illness and death to people with intellectual disabilities. The aim of this study was to develop guidelines for decisions about (non-)disclosure of bad news around life-limiting illness and death to people with intellectual disabilities, by examining stakeholders' preferences (and reasons) around disclosure and non-disclosure. Focus groups and interviews were held with 109 participants: people with intellectual disabilities, family carers, intellectual disabilities professionals and medical healthcare professionals. People with intellectual disabilities had wide-ranging views about disclosure. Reasons for non-disclosure included: preventing distress; too difficult for the bearer of bad news; the bearer of bad news lacks knowledge; inability to understand; no sense of time; conflicting views among stakeholders. Reasons for disclosure included: a right to know; knowledge helps the person cope; need for involvement. Disclosure of bad news could cause harm in some situations, but this needs careful assessment. The authors present guidelines for disclosure that now need to be tested in practice. © 2013 Blackwell Publishing Ltd.

Role of the Nasogastric Tube and Lingzhi (Ganoderma lucidum) in Palliative Care.

PubMed

Wang, Xiaohui; Huang, Youyi; Radha Krishna, Lalit; Puvanendran, Rukshini

2016-04-01

Decision-making on behalf of an incapacitated patient at the end of life is a complex process, particularly in family-centric societies. The situation is more complex when attempts are made to accommodate Eastern concepts of end-of-life care with more conventional Western approaches. In this case report of an incapacitated 74-year-old Singaporean man of Malay descent with relapsed Stage 4 diffuse large B cell lymphoma who was without an established lasting power of attorney, we highlight the difficult deliberations that ensue when the patient's family, acting as his proxy, elected to administer lingzhi through his nasogastric tube (NGT). Focusing on the questions pertaining to end-of-life decision-making in Asia, we consider the issues surrounding the use of NGT and lingzhi in palliative care (PC) and the implementation of NGT for administering lingzhi in a PC setting, particularly in light of a dearth of data on such treatment measures among PC patients. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Life-span development of visual working memory: when is feature binding difficult?

PubMed

Cowan, Nelson; Naveh-Benjamin, Moshe; Kilb, Angela; Saults, J Scott

2006-11-01

We asked whether the ability to keep in working memory the binding between a visual object and its spatial location changes with development across the life span more than memory for item information. Paired arrays of colored squares were identical or differed in the color of one square, and in the latter case, the changed color was unique on that trial (item change) or was duplicated elsewhere in the array (color-location binding change). Children (8-10 and 11-12 years old) and older adults (65-85 years old) showed deficits relative to young adults. These were only partly simulated by dividing attention in young adults. The older adults had an additional deficiency, specifically in binding information, which was evident only when item- and binding-change trials were mixed together. In that situation, the older adults often overlooked the more subtle, binding-type changes. Some working memory processes related to binding undergo life-span development in an inverted-U shape, whereas other, bias- and salience-related processes that influence the use of binding information seem to develop monotonically.

The consequences of tinnitus in long-standing Ménière's disease.

PubMed

Stephens, Dafydd; Pyykkö, Ilmari; Yoshida, Tadao; Kentala, Erna; Levo, Hilla; Auramo, Yrjö; Poe, Dennis

2012-10-01

To explore the perceived consequences of tinnitus in patients with long-standing Ménière's disease (MD). A questionnaire-based cross-sectional investigation of 183 randomly selected members of the Finnish Ménière's Federation. It assessed general health related quality of life (EQ-5D), a participation restriction scale, self-listed consequences and a rating of effects of MD on life. When the effects of the other cardinal symptoms of Ménière's disease were partialled out, the main reported impacts of tinnitus related to anxiety, sleep and depression. It also contributed to some difficult listening situations and to interactions with significant others. Tinnitus explained a significant component of disease-specific quality of life (QoL), but did not relate significantly to the generic measures used. However, the measure 'mood' in the QoL scale was significantly associated with severe tinnitus. The most important specific impacts of tinnitus in chronic Ménière's disease relate to broadly psychological factors and mood. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Embedded health behaviors from adolescence to adulthood: the impact of tobacco.

PubMed

Booth-Butterfield, Melanie

2003-01-01

Prevention of cancer risk behaviors before they become embedded in an individual's life is crucial. Health-related behaviors should be viewed for their embeddedness, critical aspects of which are (a) the complexity of the behavior itself; (.b) factors, both biological and psychological, within the individual communicator; (c) and external situational or sociocultural factors. The more extensively a behavior is embedded, the more difficult it will be to alter. Relative levels of embeddedness of the risk behavior and its entanglement with other nonrisky behaviors will evolve and change throughout one's life course. Smoking across the life span provides an excellent example of a thoroughly integrated, embedded behavior. How smoking is embedded with other behaviors changes from adolescence, where biological factors may be less salient and habit strength less pronounced, through adulthood, where habit strength is greater but health concerns are a more predictive factor. Researchers can produce more focused communication interventions by examining how health-endangering behaviors are embedded among benign behaviors or among other potentially dangerous behaviors. Ideally, the pattern of health behavior embeddedness should be analyzed prior to developing intervention communication strategies.

The noncavitating performance and life of a small vane-type positive displacement pump in liquid hydrogen

NASA Technical Reports Server (NTRS)

Ulbricht, T. E.; Hemminger, J. A.

1986-01-01

The low flow rate and high head rise requirements of hydrogen/oxygen auxiliary propulsion systems make the application of centrifugal pumps difficult. Positive displacement pumps are well-suited for these flow conditions, but little is known about their performance and life characteristics in liquid hydrogen. An experimental and analytical investigation was conducted to determine the performance and life characteristics of a vane-type, positive displacement pump. In the experimental part of this effort, mass flow rate and shaft torque were determined as functions of shaft speed and pump pressure rise. Since liquid hydrogen offers little lubrication in a rubbing situation, pump life is an issue. During the life test, the pump was operated intermittently for 10 hr at the steady-state point of 0.074 lbm/sec (0.03 kg/sec) flow rate, 3000 psid (2.07 MPa) pressure rise, and 8000 rpm (838 rad/sec) shaft speed. Pump performance was monitored during the life test series and the results indicated no loss in performance. Material loss from the vanes was recorded and wear of the other components was documented. In the analytical part of this effort, a comprehensive pump performance analysis computer code, developed in-house, was used to predict pump performance. The results of the experimental investigation are presented and compared with the results of the analysis. Results of the life test are also presented.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study.

PubMed

Fromberger, Peter; Meyer, Sabrina; Jordan, Kirsten; Müller, Jürgen L

2018-01-01

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study

PubMed Central

Fromberger, Peter; Meyer, Sabrina; Jordan, Kirsten; Müller, Jürgen L.

2018-01-01

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations. PMID:29559934

A preliminary investigation of daily variability of stuttering in adults.

PubMed

Constantino, Christopher D; Leslie, Paula; Quesal, Robert W; Yaruss, J Scott

2016-01-01

Variability in frequency of stuttering has made the results of treatment outcome studies difficult to interpret. Many factors that affect variability have been investigated; yet the typical range of variability experienced by speakers remains unknown. This study examined the day-to-day variability in the percentage of syllables containing stuttered and nonstuttered disfluencies in the speech of six adult speakers in three spontaneous speaking situations and two reading tasks. The frequency of moments stuttering during the tasks were compared within and between speakers and days to document the degree of variability in stuttering frequency and explore whether there were any consistent patterns. The Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A) were also tested for day-to-day variability. Correlations between frequency, severity, and life impact were made. The primary result of this study was the large range over which frequency of stuttering varied from day to day for the same individual. This variability did not correlate with any measures of stuttering severity but did correlate with life impact as measured by the OASES-A. No global pattern was detected in variability from day to day within or between participants. However, there were significantly more nonstuttered disfluencies present during the spontaneous speaking tasks than during the reading tasks. The day-to-day variability in the life impact of the disorder (OASES-A) was less than the day-to-day variability in observable stuttering behavior (percentage of syllables stuttered and SSI-4). Frequency of stuttering varies significantly from situation to situation and day to day, with observed variability exceeding the degree of change often reported in treatment outcomes studies from before to after treatment. This variability must be accounted for in future clinical and scientific work. Copyright © 2016 Elsevier Inc. All rights reserved.

Sustainability as a Design Principle for Composition: Situational Creativity as a Habit of Mind

ERIC Educational Resources Information Center

Newcomb, Matthew

2012-01-01

Design is a rhetorical activity that requires creative thinking in response to difficult situations. That creative work ultimately builds new relationships and new contexts. Sustainable design can become an approach to composition that alters ways of thinking about writing situations, keeping ethical and contextual factors in focus, and…

Teaching Bad Apples: A Fun Way to Tackle Difficult Teaching Situations

ERIC Educational Resources Information Center

Turcotte, Nathaniel; Betrus, Anthony

2016-01-01

"Teaching Bad Apples" is a game developed in 2014 for current and future teachers. It plays much like "Apples to Apples" or "Cards Against Humanity," with each player in turn reading a situation card, followed by the other players choosing their response cards. Each situation, however dramatic or bizarre, is…

Gavagai Is as Gavagai Does: Learning Nouns and Verbs from Cross-Situational Statistics

ERIC Educational Resources Information Center

Monaghan, Padraic; Mattock, Karen; Davies, Robert A. I.; Smith, Alastair C.

2015-01-01

Learning to map words onto their referents is difficult, because there are multiple possibilities for forming these mappings. Cross-situational learning studies have shown that word-object mappings can be learned across multiple situations, as can verbs when presented in a syntactic context. However, these previous studies have presented either…

Evolution of trophic transmission in parasites: Why add intermediate hosts?

USGS Publications Warehouse

Choisy, Marc; Brown, Sam P.; Lafferty, Kevin D.; Thomas, Frédéric

2003-01-01

Although multihost complex life cycles (CLCs) are common in several distantly related groups of parasites, their evolution remains poorly understood. In this article, we argue that under particular circumstances, adding a second host to a single-host life cycle is likely to enhance transmission (i.e., reaching the target host). For instance, in several situations, the propagules of a parasite exploiting a predator species will achieve a higher host-finding success by encysting in a prey of the target predator than by other dispersal modes. In such a case, selection should favor the transition from a singleto a two-host life cycle that includes the prey species as an intermediate host. We use an optimality model to explore this idea, and we discuss it in relation to dispersal strategies known among free-living species, especially animal dispersal. The model found that selection favored a complex life cycle only if intermediate hosts were more abundant than definitive hosts. The selective value of a complex life cycle increased with predation rates by definitive hosts on intermediate hosts. In exploring trade-offs between transmission strategies, we found that more costly trade-offs made it more difficult to evolve a CLC while less costly trade-offs between traits could favor a mixed strategy.

Transarterial endovascular treatment in the management of life-threatening carotid blowout syndrome in head and neck cancer patients: review of the literature.

PubMed

Dequanter, D; Shahla, M; Paulus, P; Aubert, C; Lothaire, P

2013-12-01

Carotid blowout syndrome is a rare but devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. Bleeding from the carotid artery or its branches is a well-recognized complication following treatment or recurrence of head and neck cancer. It is an emergency situation, and the classical approach to save the patient's life is to ligate the carotid artery. But the surgical treatment is often technically difficult. Endovascular therapies were recently reported as good alternatives to surgical ligation. Retrospective review of three cases of acute or threatened carotid hemorrhage managed by endovascular therapies. Two patients presented with acute carotid blowout, and one patient with a sentinel bleed. Two patients had previously been treated with surgery and chemo radiation. One patient was treated by chemo radiation. Two had developed pharyngocutaneous fistulas, and one had an open necrosis filled wound that surrounded the carotid artery. In two patients, stent placement resolved the acute hemorrhage. In one patient, superselective embolization was done. Mean duration follow-up was 10.2 months. No patient had residual sequelae of stenting or embolization. Management of carotid blow syndrome is very critical and difficult. A multidisciplinary approach is very important in the management of carotid blow syndrome. Correct and suitable management can be life saving. An endovascular technique is a good and effective alternative with much lower morbidity rates than surgical repair or ligation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The Use of Authentic Materials with Low-Level Learners of English

ERIC Educational Resources Information Center

Unver, Meral M.

2017-01-01

In real life, people are exposed to various listening situations ranging from songs to chatting in social occasions (Ur, 1984). The variety of topics and nature of real-life listening situations put strain on learners of English; therefore, textbooks for language teaching are aimed to reflect these real life situations. However, listening, as…

Effects of Self-Rated Health and Self-Rated Economic Situation on Depressed Mood Via Life Satisfaction Among Older Adults in Costa Rica.

PubMed

Reyes Fernández, Benjamín; Rosero-Bixby, Luis; Koivumaa-Honkanen, Heli

2016-03-01

The study examined the relationship of self-rated health and self-rated economic situation with depressed mood, and life satisfaction as mediator of this relationship among older adults in Costa Rica. A longitudinal study was conducted with a subsample (N = 1,618) from the Costa Rican Longevity and Healthy Aging Study (CRELES). Self-rated health, self-rated economic situation, depressed mood, and life satisfaction were measured at baseline, and depressed mood was reassessed 18 months later. Putative mechanisms for changes in depressed mood were examined by means of conditional process analysis. Self-rated health was negatively associated to depressed mood. This effect took place via life satisfaction. An interaction showed that better economic situation compensated the effect of a low self-rated health on life satisfaction. This study suggests that subjective variables such as self-rated health, economic situation, and life satisfaction should be considered when addressing the onset of depressed mood. © The Author(s) 2015.

Effects of Self-Rated Health and Self-Rated Economic Situation on Depressed Mood Via Life Satisfaction Among Older Adults in Costa Rica

PubMed Central

Reyes Fernández, Benjamín; Rosero-Bixby, Luis; Koivumaa-Honkanen, Heli

2016-01-01

Objective: The study examined the relationship of self-rated health and self-rated economic situation with depressed mood, and life satisfaction as mediator of this relationship among older adults in Costa Rica. Method: A longitudinal study was conducted with a subsample (N = 1,618) from the Costa Rican Longevity and Healthy Aging Study (CRELES). Self-rated health, self-rated economic situation, depressed mood, and life satisfaction were measured at baseline, and depressed mood was reassessed 18 months later. Putative mechanisms for changes in depressed mood were examined by means of conditional process analysis. Results: Self-rated health was negatively associated to depressed mood. This effect took place via life satisfaction. An interaction showed that better economic situation compensated the effect of a low self-rated health on life satisfaction. Discussion: This study suggests that subjective variables such as self-rated health, economic situation, and life satisfaction should be considered when addressing the onset of depressed mood. PMID:26092651

Conflict management: difficult conversations with difficult people.

PubMed

Overton, Amy R; Lowry, Ann C

2013-12-01

Conflict occurs frequently in any workplace; health care is not an exception. The negative consequences include dysfunctional team work, decreased patient satisfaction, and increased employee turnover. Research demonstrates that training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction. Strategies to address a disruptive physician, a particularly difficult conflict situation in healthcare, are addressed.

Effect of the Holocaust on coping with cancer.

PubMed

Baider, L; Peretz, T; Kaplan De-Nour, A

1992-01-01

The aim of the study was to investigate whether surviving stressful life threatening situations influences coping with new stressful life threatening situations. The study group, therefore, was composed of 53 cancer patients (present life threatening situation) who had survived the Holocaust (past life threatening situation). They were compared to 53 cancer patients who had not gone through the Holocaust, matched for sociodemographic and medical background. The Holocaust survivors were unable to mobilize partial denial (had significantly higher scores on the Impact of Events Scale) and their psychological distress was much higher (significantly higher scores on the Brief Symptom Inventory). Their functioning however (as reported along the Psychosocial Adjustment to Physical Illness Scale) did not significantly differ from that of the comparison group. The possible mechanisms for these long term effects of past trauma are discussed as well as the need to regard traumatized persons as 'high risk' psychologically when they have to cope with new life threatening situations.

Current role of transcatheter arterial embolization for bladder and prostate hemorrhage.

PubMed

Loffroy, R; Pottecher, P; Cherblanc, V; Favelier, S; Estivalet, L; Koutlidis, N; Moulin, M; Cercueil, J P; Cormier, L; Krausé, D

2014-11-01

Intractable hematuria from the bladder or the prostate can be life-threatening and its management remains a difficult clinical problem. Severe bleeding can arise as a result of radiation cystitis, bladder carcinoma, cyclophosphamide-induced cystitis, severe infection, transurethral resection of the prostate and prostate cancer. When irrigation of the bladder through a three-way catheter and fulguration of the bleeding lesions fail to stop the hematuria, a life-threatening situation can develop, when blood transfusion fails to keep pace with the rate of blood loss. Patients with massive uncontrollable hematuria are often elderly and unfit for cystectomy as a treatment. Many urologists have had to manage this difficult problem, and several different treatments have been attempted and described, with varying degrees of success. Transcatheter arterial embolization of the vesical or prostatic arteries is occasionally indicated in these patients when all other measures have failed. There is limited published experience with this procedure, but success in 90% of patients is reported when the vesical or prostatic arteries can be identified. The aim of this review is to describe the current place of transcatheter arterial embolization in the management of severe bladder or prostate bleeding after failed conservative therapy, and to review its efficacy and morbidity. Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Perceived ability to perform daily hand activities after stroke and associated factors: a cross-sectional study.

PubMed

Ekstrand, Elisabeth; Rylander, Lars; Lexell, Jan; Brogårdh, Christina

2016-11-02

Despite that disability of the upper extremity is common after stroke, there is limited knowledge how it influences self-perceived ability to perform daily hand activities. The aim of this study was to describe which daily hand activities that persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and to evaluate how several potential factors are associated with the self-perceived performance. Seventy-five persons (72 % male) with mild to moderate impairments of the upper extremity after stroke (4 to 116 months) participated. Self-perceived ability to perform daily hand activities was rated with the ABILHAND Questionnaire. The perceived ability to perform daily hand activities and the potentially associated factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation of the hand, manual dexterity, perceived participation and life satisfaction) were evaluated by linear regression models. The activities that were perceived difficult or impossible for a majority of the participants were bimanual tasks that required fine manual dexterity of the more affected hand. The factor that had the strongest association with perceived ability to perform daily hand activities was dexterity (p < 0.001), which together with perceived participation (p = 0.002) explained 48 % of the variance in the final multivariate model. Persons with mild to moderate impairments of the upper extremity after stroke perceive that bimanual activities requiring fine manual dexterity are the most difficult to perform. Dexterity and perceived participation are factors specifically important to consider in the rehabilitation of the upper extremity after stroke in order to improve the ability to use the hands in daily life.

Do Proxies for the Neurotransmitter Cortisol Predict Adaptation to Life with Chronic Pain?

NASA Astrophysics Data System (ADS)

Deamond, Wade

Among the numerous difficulties encountered by chronic pain patients, impulsive and dysfunctional decision-making complicate their already difficult life situations yet remains relatively understudied. This study examined a recently published neurobiological decision making model that identifies eight specific neurotransmitters and hormones (Dopamine, Testosterone, Endogenous Opioids Glutamate, Serotonin, Norepinephrine, Cortisol, and GABA) linked to unsound decision making related to cognitive, motivational and emotional dysregulation (Nussbaum et al., 2011) (see Appendix 2). The Perceived Stress Scale (PSS), a proxy for the cortisol element in the pharmacological decision making model was analyzed for the neurotransmitter's relationship to functionality and quality of life in a group of 37 chronic pain patients. Participants were comprised of males and females ranging from 23 to 52 years of age and were classified with respect to levels of adjustment to living with chronic pain based on the Quality of Life Scale (QLS), the Dartmouth WONCA COOP Charts and the Global Assessment of Functioning (GAF). The Iowa Gambling Task (IGT) and Frontal System Behavioral Scale (FSBS) measured decision making related to immediate gratification and daily living respectively. Results suggest that emotional dysregulation, as measured by the PSS is a significant predictor for adaptation to life with chronic pain and the PSS is superior to predicting adaptation to life with chronic pain than reported levels of pain as measured by the McGill Pain Questionnaire.

Learning Behavior Analysis of a Ubiquitous Situated Reflective Learning System with Application to Life Science and Technology Teaching

ERIC Educational Resources Information Center

Hwang, Wu-Yuin; Chen, Hong-Ren; Chen, Nian-Shing; Lin, Li-Kai; Chen, Jin-Wen

2018-01-01

Education research has shown that reflective study can efficiently enhance learning, and the acquisition of knowledge and skills from real-life situations has become a focus of interest for scholars. The knowledge-learning model based on verbal instruction, used in traditional classrooms, does not make use of real-life situations that encourage…

[Public health policies as regards the elderly in Colombia].

PubMed

Cardona Arango, Doris; Segura Cardona, Angela María

2011-01-01

A literature review was performed on the laws passed, and adopted in accordance with international regulations, in Colombia and which currently benefit or affect the quality of life of the elderly. Public policies in Colombia are inclined towards the well-being of the elderly, but this documental analysis concludes that the elderly Colombian is unprotected and defenseless against the obstacles and difficult situations due to the biological, political, social, economic and environmental conditions. This makes them vulnerable as it is a scheme that only benefits in cases of poverty and by being a member of the General Social Security in Health system, with transfer of obligations to the family, society and likewise the elderly. Copyright © 2010 SEGG. Published by Elsevier Espana. All rights reserved.

[Psychophysiological aspects of naval aviation pilots of the Navy in the operation of highly carrier-based aircraft].

PubMed

Mel'nik, S G; Chulaevskiĭ, A O

2011-08-01

The authors have shown that the most difficult elements of the flight deck of the ship are springboard takeoff and aerofinishing landing. An important task is to study the aerodynamic characteristics of the behavior of the aircraft during takeoff different characteristics, forming crews ready to act in particular situations. Adverse factors are the operating conditions of habitability of aircraft (noise, vibration, fumes in the air at work, and aircraft engines, etc.) that have a significant impact on the life of air crew and engineering staff. It is concluded that the development and use of effective means of protecting the organism from the effect of these factors is a priority for specialists in aviation medicine.

Selecting and starting an orthopaedic surgery practice.

PubMed

Mishra, Allan; Urquhart, Andrew G; Anders, Geoffrey T

2008-01-01

Every new surgeon is faced with the same question as their residency or fellowship draws to a close: What is next? Few residents or fellows are as well prepared to answer that question as they could be. Most programs do not teach residents how to choose a practice type and location. After formal orthopaedic training, new surgeons must make decisions about their careers that can be nearly as complex and difficult as the decisions they make in the operating room. Career choices have both significant and long-term effects on the physician's financial situation, career satisfaction, and personal life. The physician should be aware of key non academic issues that arise when completing a residency program or just beginning the practice of orthopaedic surgery.

The importance of providing scaffolding to support patient narratives when brain damage impairs storytelling ability.

PubMed

Hydén, Lars C

2011-01-01

Boundaries connected to illness are defined and redefined through new ways of interacting with other people and especially by storytelling and listening to the stories of others. Diseases or traumas that affect the brain can result in memory loss, impaired cognition, and difficulties in expressing oneself clearly, hence making it difficult to present and negotiate identities. In such situations, others often try to remedy the communicative problems by taking over those narrative functions that are lost or impaired and thereby scaffolding the injured person's storytelling capacity. This narrative scaffolding is directed at keeping interpersonal relationships functional and makes it possible for persons with communicative disabilities to continue to be participants in a shared life.

"Suspended animation," my mother's wife and cultural discernment: considerations for genetic research among immigrants.

PubMed

Kissell, Judith Lee

2005-01-01

One of the most difficult contemporary issues facing the bioethics of clinical research is balancing the maintaining of a universality of ethics standards with a sensitivity to cultural issues and differences. The concept of "vulnerability" for research subjects is especially apt for investigating the ethical and cultural issues surrounding the conduct of genetic research among new immigrants to the United States, using the Sudanese Nuer and Dinka tribes, recently settled in the Midwest, as an example. Issues of cultural vulnerability arise for some immigrants, related to relationship to the earth and to kinship issues, that threaten the narrative richness of a subject's life as well as the way she situates herself in the world.

Long-term food-exposure of zebrafish to PCB mixtures mimicking some environmental situations induces ovary pathology and impairs reproduction ability.

PubMed

Daouk, Tarek; Larcher, Thibaut; Roupsard, François; Lyphout, Laura; Rigaud, Cyril; Ledevin, Mireille; Loizeau, Véronique; Cousin, Xavier

2011-10-01

Although the use of polychlorinated biphenyls (PCBs) has been banned for several decades, they are still present in the environment and are occasionally mechanically released from sediment or transferred through the trophic chain. Field analyses have established correlations between exposure to PCBs and alterations in fish physiology including reproductive function. Experimental exposures have been mainly performed using dioxin-like PCBs or other congeners at very high concentrations. However, these studies are often difficult to relate to real-life conditions. In the present study, we performed a life-cycle exposure using zebrafish model and mixtures representative of some environmental situations in terms of doses, composition and containing mainly non dioxin-like congeners. Exposure was performed through diet which is the main contamination route in the field. We demonstrated a bioaccumulation of PCBs in males and females as well as a maternal transfer to the eggs. Survival, growth and organ size were similar for all conditions. Several reproductive traits were altered after exposure to a PCB-contaminated diet, including a reduction in the number of fertilized eggs per spawn as well as an increase of the number of poorly fertilized spawns. This latter observation was found irrespective of the sex of contaminated fish. This is related to modifications of ovary histology revealing a decrease of maturing follicles and an increase of atretic follicles in the ovaries of females exposed to PCBs. These results indicate that exposure to PCBs mixtures mimicking some environmental situations, including mainly non dioxin-like congeners, can lead to a dramatic reduction in the number of offspring produced by a female over a lifetime. This is of great concern for wild species living under natural conditions. Copyright © 2011 Elsevier B.V. All rights reserved.

A Study on Re-entry Predictions of Uncontrolled Space Objects for Space Situational Awareness

NASA Astrophysics Data System (ADS)

Choi, Eun-Jung; Cho, Sungki; Lee, Deok-Jin; Kim, Siwoo; Jo, Jung Hyun

2017-12-01

The key risk analysis technologies for the re-entry of space objects into Earth’s atmosphere are divided into four categories: cataloguing and databases of the re-entry of space objects, lifetime and re-entry trajectory predictions, break-up models after re-entry and multiple debris distribution predictions, and ground impact probability models. In this study, we focused on re- entry prediction, including orbital lifetime assessments, for space situational awareness systems. Re-entry predictions are very difficult and are affected by various sources of uncertainty. In particular, during uncontrolled re-entry, large spacecraft may break into several pieces of debris, and the surviving fragments can be a significant hazard for persons and properties on the ground. In recent years, specific methods and procedures have been developed to provide clear information for predicting and analyzing the re-entry of space objects and for ground-risk assessments. Representative tools include object reentry survival analysis tool (ORSAT) and debris assessment software (DAS) developed by National Aeronautics and Space Administration (NASA), spacecraft atmospheric re-entry and aerothermal break-up (SCARAB) and debris risk assessment and mitigation analysis (DRAMA) developed by European Space Agency (ESA), and semi-analytic tool for end of life analysis (STELA) developed by Centre National d’Etudes Spatiales (CNES). In this study, various surveys of existing re-entry space objects are reviewed, and an efficient re-entry prediction technique is suggested based on STELA, the life-cycle analysis tool for satellites, and DRAMA, a re-entry analysis tool. To verify the proposed method, the re-entry of the Tiangong-1 Space Lab, which is expected to re-enter Earth’s atmosphere shortly, was simulated. Eventually, these results will provide a basis for space situational awareness risk analyses of the re-entry of space objects.

Planning and response to the influenza A (H1N1) pandemic: ethics, equity and justice.

PubMed

Devnani, Mahesh; Gupta, Anil Kumar; Devnani, Bharti

2011-01-01

This paper aims to highlight three ethical considerations related to influenza pandemic planning and response: ethical allocation of scarce resources; obligations and duties of healthcare workers to treat patients, and the balance between conflicting individual and community interests. Among these, perhaps the most challenging question facing bioethics is how to allocate scarce, life-saving resources given the devastating social and economic ramifications of a pandemic. In such situations, the identification of clear overall goals for pandemic planning is essential in making difficult choices. The dilemma between the duty to save patients and the right to protect the healthcare personnel's own life and health is a key issue. During the course of a pandemic, civil liberties may also be threatened, requiring limits on individual freedom to protect individuals as well as entire communities. Yet, individual liberty should be restricted with great care, and only when alternative approaches are not effective. Pandemic influenza planning and response should be a cooperative and shared responsibility that balances community and individual interests.

Do children with reading delay benefit from the use of personal FM systems in the classroom?

PubMed

Purdy, Suzanne C; Smart, Jennifer L; Baily, Melissa; Sharma, Mridula

2009-12-01

FM systems have been used to compensate for poor signal-to-noise ratios in classrooms. This study evaluates benefits of a 6-week trial of personal FM systems used during the school day for children with reading delay aged 6-11 years, using a randomized control design. Teachers and children completed the LIFE-UK questionnaire. Test-retest reliability of the LIFE-UK children's version was confirmed in a separate group of 18 children from the same school. The 23 children in the FM group had significantly improved teacher ratings, and the children's ratings of classroom listening for difficult situations were significantly better after the trial. These changes did not occur for the 23 control-group children. Most children (92%) commented positively about the FM after the trial. It is likely that a longer FM trial or a specific reading intervention combined with FM will be required for the benefits of enhanced listening to affect performance on standardized reading tests.

Conflict Management: Difficult Conversations with Difficult People

PubMed Central

Overton, Amy R.; Lowry, Ann C.

2013-01-01

Conflict occurs frequently in any workplace; health care is not an exception. The negative consequences include dysfunctional team work, decreased patient satisfaction, and increased employee turnover. Research demonstrates that training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction. Strategies to address a disruptive physician, a particularly difficult conflict situation in healthcare, are addressed. PMID:24436688

Study on Early-Warning System of Cotton Production in Hebei Province

NASA Astrophysics Data System (ADS)

Zhang, Runqing; Ma, Teng

Cotton production plays an important role in Hebei. It straightly influences cotton farmers’ life, agricultural production and national economic development as well. In recent years, due to cotton production frequently fluctuating, two situations, “difficult selling cotton” and “difficult buying cotton” have alternately occurred, and brought disadvantages to producers, businesses and national finance. Therefore, it is very crucial to research the early warning of cotton production for solving the problem of cotton production’s frequent fluctuation and ensuring the cotton industry’s sustainable development. This paper founds a signal lamp model of early warning through employing time-difference correlation analysis method to select early-warning indicators and statistical analysis method associated with empirical analysis to determine early-warning limits. Finally, it not only obtained warning conditions of cotton production from 1993 to 2006 and forecast 2007’s condition, but also put forward corresponding countermeasures to prevent cotton production from fluctuating. Furthermore, an early-warning software of cotton production is completed through computer programming on the basis of the early warning model above.

Sex: a sensitive issue.

PubMed

1997-01-01

Health care workers and educators may need to improve their skills in discussing sensitive issues in order to elicit and understand what influences people's attitudes toward sex. While the health worker may be bent upon preventing HIV infection, advising on family planning, or teaching youth about sexual relationships, his or her audience may have other priorities. A good counselor/teacher must learn what people's concerns are and discuss sexual health within that context. It can be difficult talking about sex because sex is a private concern and many people are embarrassed discussing it. Even sex partners often find it difficult to talk to each other about sex. Appropriate communication techniques vary depending upon the situation. It depends upon whether one is addressing people on an individual basis or in groups, which people are being addressed, which organization one is representing, and what one's role is. Good communication is a two-way sharing of information. The different stages of life, common beliefs and myths, culture and religion, relationships between men and women, reasons for having sex, and sex practices are discussed.

Pedagogy, power and practice ethics: clinical teaching in psychiatric/mental health settings.

PubMed

Ewashen, Carol; Lane, Annette

2007-09-01

Often, baccalaureate nursing students initially approach a psychiatric mental health practicum with uncertainty, and even fear. They may feel unprepared for the myriad complex practice situations encountered. In addition, memories of personal painful life events may be vicariously evoked through learning about and listening to the experiences of those diagnosed with mental disorders. When faced with such challenging situations, nursing students often seek counsel from the clinical and/or classroom faculty. Pedagogic boundaries may begin to blur in the face of student distress. For the nurse educator, several questions arise: Should a nurse educator provide counseling to students? How does one best negotiate the boundaries between 'counselor', and 'caring educator'? What are the limits of a caring and professional pedagogic relation? What different knowledges provide guidance and to what differential consequences for ethical pedagogic relationships? This paper offers a comparative analysis of three philosophical stances to examine differences in key assumptions, pedagogic positioning, relationships of power/knowledge, and consequences for professional ethical pedagogic practices. While definitive answers are difficult, the authors pose several questions for consideration in discerning how best to proceed and under what particular conditions.

Into the Wild: Neuroergonomic Differentiation of Hand-Held and Augmented Reality Wearable Displays during Outdoor Navigation with Functional Near Infrared Spectroscopy.

PubMed

McKendrick, Ryan; Parasuraman, Raja; Murtza, Rabia; Formwalt, Alice; Baccus, Wendy; Paczynski, Martin; Ayaz, Hasan

2016-01-01

Highly mobile computing devices promise to improve quality of life, productivity, and performance. Increased situation awareness and reduced mental workload are two potential means by which this can be accomplished. However, it is difficult to measure these concepts in the "wild". We employed ultra-portable battery operated and wireless functional near infrared spectroscopy (fNIRS) to non-invasively measure hemodynamic changes in the brain's Prefrontal cortex (PFC). Measurements were taken during navigation of a college campus with either a hand-held display, or an Augmented reality wearable display (ARWD). Hemodynamic measures were also paired with secondary tasks of visual perception and auditory working memory to provide behavioral assessment of situation awareness and mental workload. Navigating with an augmented reality wearable display produced the least workload during the auditory working memory task, and a trend for improved situation awareness in our measures of prefrontal hemodynamics. The hemodynamics associated with errors were also different between the two devices. Errors with an augmented reality wearable display were associated with increased prefrontal activity and the opposite was observed for the hand-held display. This suggests that the cognitive mechanisms underlying errors between the two devices differ. These findings show fNIRS is a valuable tool for assessing new technology in ecologically valid settings and that ARWDs offer benefits with regards to mental workload while navigating, and potentially superior situation awareness with improved display design.

Into the Wild: Neuroergonomic Differentiation of Hand-Held and Augmented Reality Wearable Displays during Outdoor Navigation with Functional Near Infrared Spectroscopy

PubMed Central

McKendrick, Ryan; Parasuraman, Raja; Murtza, Rabia; Formwalt, Alice; Baccus, Wendy; Paczynski, Martin; Ayaz, Hasan

2016-01-01

Highly mobile computing devices promise to improve quality of life, productivity, and performance. Increased situation awareness and reduced mental workload are two potential means by which this can be accomplished. However, it is difficult to measure these concepts in the “wild”. We employed ultra-portable battery operated and wireless functional near infrared spectroscopy (fNIRS) to non-invasively measure hemodynamic changes in the brain’s Prefrontal cortex (PFC). Measurements were taken during navigation of a college campus with either a hand-held display, or an Augmented reality wearable display (ARWD). Hemodynamic measures were also paired with secondary tasks of visual perception and auditory working memory to provide behavioral assessment of situation awareness and mental workload. Navigating with an augmented reality wearable display produced the least workload during the auditory working memory task, and a trend for improved situation awareness in our measures of prefrontal hemodynamics. The hemodynamics associated with errors were also different between the two devices. Errors with an augmented reality wearable display were associated with increased prefrontal activity and the opposite was observed for the hand-held display. This suggests that the cognitive mechanisms underlying errors between the two devices differ. These findings show fNIRS is a valuable tool for assessing new technology in ecologically valid settings and that ARWDs offer benefits with regards to mental workload while navigating, and potentially superior situation awareness with improved display design. PMID:27242480

Social oppression, psychological vulnerability, and unprotected intercourse among young Black men who have sex with men.

PubMed

Huebner, David M; Kegeles, Susan M; Rebchook, Gregory M; Peterson, John L; Neilands, Torsten B; Johnson, Wayne D; Eke, Agatha N

2014-12-01

Young Black men who have sex with men (YBMSM) are at extraordinarily high risk for HIV infection. Given their dual minority identity, they experience multiple forms of social oppression-racism, homophobia, and poverty. This study tested a model for how these forces contribute to their sexual risk behavior. YBMSM (n = 1,289) from 2 Texas cities completed a 1-time assessment of sexual behaviors and psychosocial variables. Structural equation modeling was used to characterize relationships among variables. Experiences of racism, homophobia, and socioeconomic distress were all associated with unprotected anal intercourse (UAI) either directly or indirectly in a manner largely consistent with Díaz's (1997, 1998) model of the effects of social oppression. Racism, homophobia, and socioeconomic distress were each associated with specific psychological vulnerabilities, which were in turn associated with participation in difficult sexual situations (e.g., in a public setting), and then UAI. The effects of racism were largely mediated by depressive symptoms and participation in difficult sexual situations. Homophobia was mediated by depressive symptoms, social support, and internalized homophobia. The effects of socioeconomic distress were partially mediated by decreased social support and greater participation in difficult sexual situations. Socioeconomic distress also had a significant direct effect on UAI not explained by the proposed mediators. Social oppression contributes to YBMSM's psychological vulnerabilities, participation in difficult sexual situations, and their UAI. Interventions to reduce sexual risk in YBMSM should address socioeconomic disadvantage, homophobia, and racism, as well as the psychological challenges that social oppression creates for them.

Bioinformatics: indispensable, yet hidden in plain sight?

PubMed

Bartlett, Andrew; Penders, Bart; Lewis, Jamie

2017-06-21

Bioinformatics has multitudinous identities, organisational alignments and disciplinary links. This variety allows bioinformaticians and bioinformatic work to contribute to much (if not most) of life science research in profound ways. The multitude of bioinformatic work also translates into a multitude of credit-distribution arrangements, apparently dismissing that work. We report on the epistemic and social arrangements that characterise the relationship between bioinformatics and life science. We describe, in sociological terms, the character, power and future of bioinformatic work. The character of bioinformatic work is such that its cultural, institutional and technical structures allow for it to be black-boxed easily. The result is that bioinformatic expertise and contributions travel easily and quickly, yet remain largely uncredited. The power of bioinformatic work is shaped by its dependency on life science work, which combined with the black-boxed character of bioinformatic expertise further contributes to situating bioinformatics on the periphery of the life sciences. Finally, the imagined futures of bioinformatic work suggest that bioinformatics will become ever more indispensable without necessarily becoming more visible, forcing bioinformaticians into difficult professional and career choices. Bioinformatic expertise and labour is epistemically central but often institutionally peripheral. In part, this is a result of the ways in which the character, power distribution and potential futures of bioinformatics are constituted. However, alternative paths can be imagined.

The Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS): a Pre-test Study.

PubMed

de Jong, Merel; Tamminga, Sietske J; de Boer, Angela G E M; Frings-Dresen, Monique H W

2016-06-02

Returning to and continuing work is important to many cancer survivors, but also represents a challenge. We know little about subjective work outcomes and how cancer survivors perceive being returned to work. Therefore, we developed the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS). Our aim was to pre-test the items of the initial QWLQ-CS on acceptability and comprehensiveness. In addition, item retention was performed by pre-assessing the relevance scores and response distributions of the items in the QWLQ-CS. Semi-structured interviews were conducted after cancer survivors, who had returned to work, filled in the 102 items of the QWLQ-CS. To improve acceptability and comprehensiveness, the semi-structured interview inquired about items that were annoying, difficult, confusing, twofold or redundant. If cancer survivors had difficulty explaining their opinion or emotion about an item, the interviewer used verbal probing technique to investigate the cancer survivor's underlying thoughts. The cancer survivors' comments on the items were analysed, and items were revised accordingly. Decisions on item retention regarding the relevance of items and the response distributions were made by means of pre-set decision rules. The 19 cancer survivors (53 % male) had a mean age of 51 ± 11 years old. They were diagnosed between 2009 and 2013 with lymphoma, leukaemia, prostate cancer, breast cancer, or colon cancer. Acceptability of the QWLQ-CS was good - none of the items were annoying - but 73 items were considered difficult, confusing, twofold or redundant. To improve acceptability, for instance, the authors replaced the phrase 'disease' with 'health situation' in several items. Consequently, comprehensiveness was improved by the authors rephrasing and adjusting items by adding clarifying words, such as 'in the work situation'. The pre-assessment of the relevance scores resulted in a sufficient number of cancer survivors indicating the items as relevant to their quality of working life, and no evident indication for uneven response distributions. Therefore, all items were retained. The 104 items of the preliminary QWLQ-CS were found relevant, acceptable and comprehensible by cancer survivors who have returned to work. The QWLQ-CS is now suitable for larger sample sizes of cancer survivors, which is necessary to test the psychometric properties of this questionnaire.

Balancing obligations: should written information about life-sustaining treatment be neutral?

PubMed Central

Xafis, Vicki; Wilkinson, Dominic; Gillam, Lynn; Sullivan, Jane

2015-01-01

Parents who are facing decisions about life-sustaining treatment for their seriously ill or dying child are supported by their child's doctors and nurses. They also frequently seek other information sources to help them deal with the medical and ethical questions that arise. This might include written or web-based information. As part of a project involving the development of such a resource to support parents facing difficult decisions, some ethical questions emerged. Should this information be presented in a strictly neutral fashion? Is it problematic if narratives, arguments or perspectives appear to favour stopping over continuing life-sustaining treatment? Similar questions might arise with written materials about decisions for adults, or for other ethically contentious decisions. This paper explores the meaning of ‘balance’ in information provision, focusing particularly on written information about life-sustaining treatment for children. We contrast the norm of non-directiveness in genetic counselling with the shared decision-making model often endorsed in end-of-life care. We review evidence that parents do not find neutrality from medical professionals helpful in discussions. We argue that balance in written information must be understood in the light of the aim of the document, the most common situation in which it will be used, and any existing biases. We conclude with four important strategies for ensuring that non-neutral information is nevertheless ethically appropriate. PMID:24763219

Communication about euthanasia in general practice: opinions and experiences of patients and their general practitioners.

PubMed

Borgsteede, Sander D; Deliens, Luc; Graafland-Riedstra, Corrie; Francke, Anneke L; van der Wal, Gerrit; Willems, Dick L

2007-05-01

Public opinion and professional organisations dominate the euthanasia debate, and there is a need to understand the opinions of people confronted with euthanasia. The aim of this study was to investigate whether patients and their GPs talk about euthanasia, and if so, how they communicate about this. Qualitative, semi-structured interviews were held with 20 GPs and 30 of their patients in primary care in the Netherlands, where euthanasia is legalised. The patients had a life expectancy of less than 6 months, and cancer, heart failure or chronic obstructive pulmonary disease as underlying disease. Many patients did not communicate about euthanasia with their GP. Neither the patient nor the GP were clear in formulating their expectations concerning future decision making. The initial patient-GP communication consisted of an exchange of opinions about situations in which euthanasia would be desirable. GPs had different opinions about who should initiate communication, and found it difficult to judge the right moment to talk. It is essential to pay attention to education in communication about dying and euthanasia and to train the GPs to gain insight in the patient's end-of-life preferences, and to direct care at the best possible quality of life.

Questions That Science Teachers Find Difficult (II).

ERIC Educational Resources Information Center

Goodwin, Alan

2003-01-01

Presents some questions that science teachers find difficult. Focuses on three further questions relating to "simple" everyday situations that are normally explained in terms of the kinetic theory of matter. Identifies looking at the difference between chemical and physical changes as the most problematic question. (Author/YDS)

Clinical Holistic Medicine: The Case Story of Anna. III. Rehabilitation of Philosophy of Life During Holistic Existential Therapy for Childhood Sexual Abuse

PubMed Central

Ventegodt, Søren; Clausen, Birgitte; Merrick, Joav

2006-01-01

When we experience life events with overwhelming emotional pain, we can escape this pain by making decisions (in our mind) that transfer responsibility from our existence to the surrounding world. By doing this, we slowly destroy the essence of our being, health, quality of life, and ability to function. The case of Anna is an excellent example of such a systematic destruction of self, done to survive the extreme pressure from childhood abuse and sexual abuse. The case study shows that the damage done to us by traumatic events is not on our body or soul, but rather our philosophy of life. The important consequence is that we can heal our existence by letting go of the negative decisions taken in the past painful and traumatic situations. By letting go of the life-denying sentences, we come back to life and take responsibility for our own life and existence. The healing of Annas existence was done by existential holistic therapy. Although the processing did not always run smoothly, as she projected very charged material on the therapists on several occasions, the process resulted in full health and a good quality of life due to her own will to recover and heal completely. The case illustrates the inner logic and complexity of intensive holistic therapy at the most difficult moment, where only a combination of intensive medical, psychiatric, and sexological treatment could set her free. In the paper, we also present a meta-perspective on intensive holistic therapy and its most characteristic phases. PMID:17370004

Clinical holistic medicine: the case story of Anna. III. Rehabilitation of philosophy of life during holistic existential therapy for childhood sexual abuse.

PubMed

Ventegodt, Søren; Clausen, Birgitte; Merrick, Joav

2006-03-07

When we experience life events with overwhelming emotional pain, we can escape this pain by making decisions (in our mind) that transfer responsibility from our existence to the surrounding world. By doing this, we slowly destroy the essence of our being, health, quality of life, and ability to function. The case of Anna is an excellent example of such a systematic destruction of self, done to survive the extreme pressure from childhood abuse and sexual abuse. The case study shows that the damage done to us by traumatic events is not on our body or soul, but rather our philosophy of life. The important consequence is that we can heal our existence by letting go of the negative decisions taken in the past painful and traumatic situations. By letting go of the life-denying sentences, we come back to life and take responsibility for our own life and existence. The healing of Anna's existence was done by existential holistic therapy. Although the processing did not always run smoothly, as she projected very charged material on the therapists on several occasions, the process resulted in full health and a good quality of life due to her own will to recover and heal completely. The case illustrates the inner logic and complexity of intensive holistic therapy at the most difficult moment, where only a combination of intensive medical, psychiatric, and sexological treatment could set her free. In the paper, we also present a meta-perspective on intensive holistic therapy and its most characteristic phases.

Critical Thinking: The Importance of Teaching.

ERIC Educational Resources Information Center

Strickland, Glen

Modern society is full of examples of people's inability to employ techniques of critical thinking in everyday situations. Learning to think critically is important because within this complex society, individuals are constantly placed into situations where difficult choices must be made. An ability to analyze critically available alternatives…

Pregnancy in a woman with proportionate (primordial) dwarfism: a case report and literature review.

PubMed

Vance, C E; Desmond, M; Robinson, A; Johns, J; Zacharin, M; Savarirayan, R; König, K; Warrillow, S; Walker, S P

2012-09-01

Primordial dwarfism is a rare form of severe proportionate dwarfism which poses significant challenges in pregnancy. A 27-year-old with primordial dwarfism (height 97 cm, weight 22 kg) and coexisting morbidities of familial hypercholesterolaemia and hypertension presented to our unit. Early pregnancy was complicated by difficult blood pressure control, sinus tachycardia, biochemical hyperthyroidism and insulin-requiring gestational diabetes. Delivery was indicated at 24 weeks with uncontrollable hypertension, progressive renal impairment and intrauterine growth restriction. A caesarean section was performed under general anaesthesia, resulting in the delivery of a 486 g male infant. This case highlights the difficulties of managing pregnancy in a woman with primordial dwarfism. Her limited capacity to respond to the physiological demands of pregnancy created a life-threatening situation, culminating in profound preterm birth.

Psychological problems of Turkish migrants in West Germany.

PubMed

Suzuki, P T

1981-04-01

The path of adjustment for Turkish migrants--young and old, male and female--to a highly industralized Western society is a difficult one fraught with parlous conditions over which they have little control, largely because of Germany attitudes toward and treatment of Gastarbeiter in general and Turks in particular. Holding other variables constant, the psychological problems discerned as unique to Turkish Gastarbeiter are on the rise. These problems are of such a dimension that they clearly show the urgent need for Germans, the German government and its agencies, the Turkish government, and mental health professionals to come to grips with the existing situation. A program should be devised that (1) prepares the Turks for their new life before emigration; (2) educate the host country to lessen prejudice and heighten appreciation of the alien culture.

[Localized purpura revealing vascular prosthetic graft infection].

PubMed

Boureau, A S; Lescalie, F; Cassagnau, E; Clairand, R; Connault, J

2013-07-01

Prosthetic graft infection after vascular reconstruction is a rare but serious complication. We report a case of infection occurring late after implantation of an iliofemoral prosthetic vascular graft. The Staphylococcus aureus infection was revealed by vascular purpura localized on the right leg 7 years after implantation of a vascular prosthesis. This case illustrates an uncommonly late clinical manifestation presenting as an acute infection 7 years after the primary operation. In this situation, the presentation differs from early infection, which generally occurs within the first four postoperative months. Diagnosis and treatment remain a difficult challenge because prosthetic graft infection is a potentially life-threatening complication. Morbidity and mortality rates are high. Here we detail specific aspects of the clinical and radiological presentation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Court Appointed Volunteers for Abused and Neglected Children.

PubMed

Justin, Renate G.

2002-02-01

A court appointed special advocate (CASA) volunteer is a trained citizen who is appointed by a judge to represent the best interests of an abused and neglected child in court. An independent voice, the volunteer gathers information and reports to the court. The CASA volunteer works in close cooperation with other professionals, physicians, lawyers, social workers, and teachers to find the most suitable permanent placement for a victimized child, whether it be a foster home, parental home, or adoptive home. Another function for CASA volunteers is to be supportive to the child during a time of uncertainty in his or her life and to help the youngster adjust to new and changing situations; the CASA volunteer may be the only consistent adult presence during this difficult period of transition.

Leadership and Work-Life Balance.

PubMed

Mattock, Sarah L

2015-01-01

Simply stated, work-life balance is something that is both difficult to define and difficult to achieve. Leaders, throughout the continuum of trauma care, need to have a sound understanding of what work-life balance means and set an example of a healthy work-life balance for those they lead. This article offers strategies for enhancing work-life balance and challenges individuals to use self-reflection as a means to furthering their personal and professional growth.

[Withdrawal of artificial nutrition and hydration in severe stroke: medical, legal and ethical considerations].

PubMed

Tannier, C; Crozier, S; Zuber, M; Constantinides, Y; Delezie, E; Gisquet, E; Grignoli, N; Lamy, C; Louvet, F; Pinel, J-F

2015-02-01

In the majority of cases, severe stroke is accompanied by difficulty in swallowing and an altered state of consciousness requiring artificial nutrition and hydration. Because of their artificial nature, nutrition and hydration are considered by law as treatment rather basic care. Withdrawal of these treatments is dictated by the refusal of unreasonable obstinacy enshrined in law and is justified by the risk of severe disability and very poor quality of life. It is usually the last among other withholding and withdrawal decisions which have already been made during the long course of the disease. Reaching a collegial consensus on a controversial decision such as artificial nutrition and hydration withdrawal is a difficult and complex process. The reluctance for such decisions is mainly due to the symbolic value of food and hydration, to the fear of "dying badly" while suffering from hunger and thirst, and to the difficult distinction between this medical act and euthanasia. The only way to overcome such reluctance is to ensure flawless accompaniment, associating sedation and appropriate comfort care with a clear explanation (with relatives but also caregivers) of the rationale and implications of this type of decision. All teams dealing with this type of situation must have thoroughly thought through the medical, legal and ethical considerations involved in making this difficult decision. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

The nature of advocacy vs. paternalism in nursing: clarifying the 'thin line'.

PubMed

Zomorodi, Meg; Foley, Barbara Jo

2009-08-01

This paper is an exploration of the concepts of advocacy and paternalism in nursing and discusses the thin line between the two. Nurses are involved in care more than any other healthcare professionals and they play a central role in advocating for patients and families. It is difficult to obtain a clear definition of advocacy, yet the concepts of advocacy and paternalism must be compared, contrasted, and discussed extensively. In many situations, only a thin line distinguishes advocacy from paternalism. A literature search was conducted using PubMed and CINAHL databases (2000-2008) as well as a library catalogue for texts. Four case stories were described in order to discuss the 'thin line' between advocacy and paternalism and develop communication strategies to eliminate ambiguity. Weighing the ethical principles of beneficence and autonomy helps to clarify advocacy and paternalism and provides an avenue for discussion among nurses practicing in a variety of settings. Advocacy and paternalism should be discussed at interdisciplinary rounds, and taken into consideration when making patient care decisions. It is difficult to clarify advocacy vs. paternalism, but strategies such as knowing the patient, clarifying information, and educating all involved are initial steps in distinguishing advocacy from paternalism. Truly 'knowing' patients, their life experiences, values, beliefs and wishes can help clarify the 'thin line' and gain a grasp of these difficult to distinguish theoretical concepts.

Ethical challenges in surgery as narrated by practicing surgeons

PubMed Central

Torjuul, Kirsti; Nordam, Ann; Sørlie, Venke

2005-01-01

Background The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. Methods Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. Conclusion The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity. PMID:15737235

Chinese familial tradition and Western influence: a case study in Singapore on decision making at the end of life.

PubMed

Ho, Zheng Jie Marc; Radha Krishna, Lalit Kumar; Yee, Chung Pheng Alethea

2010-12-01

Decision making for an incompetent patient at the end of life is difficult for both family members and physicians alike. Often, palliative care teams are tasked with weaving through opinions, emotions, and goals in search for an amenable solution. Occasionally, these situations get challenging. We present the case of an elderly Chinese Singaporean with metastatic cancer, whose family and physicians had conflicting goals of care. The former was adamant on treating the patient's disease with an untested drug, whereas the latter aimed to treat his symptoms with more conventional medication. Drug-drug interactions prevented treatment with both. Beginning with a discussion of the patient's best interest, we delve into the Singaporean context to show how culture affects medical decision making. Confucianism and filial piety are the values on which this family's workings were based. In an analysis of what this entails, we attempt to explain the significant and assertive family involvement in the decision-making process and their insistence on using novel medications, having exhausted conventional interventions. Within this mix were Western influences, too. Through the Internet, family members have become more informed and empowered in decision making, wresting the traditional paternalistic role of physicians in favor of "patient autonomy." An understanding of such dynamic facets will help better tailor culturally appropriate approaches to such complex situations. Copyright © 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Managing Difficult, Frustrating, and Hostile Conversations: Strategies for Savvy Administrators. Second Edition

ERIC Educational Resources Information Center

Kosmoski, Georgia J.; Pollack, Dennis R.

2005-01-01

The second edition of this best-selling resource provides new and updated content influenced by the feedback of over 250 school administrators. "Managing Difficult, Frustrating, and Hostile Conversations" uncovers safe and effective strategies for dispelling common sensitive situations such as handling legitimate complaints, controlling those…

Ambulatory Assessment in Panic Disorder and Specific Phobia

ERIC Educational Resources Information Center

Alpers, Georg W.

2009-01-01

Anxiety disorders are among the most prevalent mental disorders. In panic disorder, panic attacks often occur at unpredictable times, making it difficult to study these episodes in the laboratory. In specific phobias, symptoms occur in very circumscribed situations and specific triggers are sometimes difficult to reproduce in the laboratory.…

Coping with Stress in Difficult Times.

ERIC Educational Resources Information Center

Terrill, Jerry L.

1993-01-01

Generally, amount of stress generated by difficult situations is inversely proportional to one's perceived control over them. Stressed-out principals are advised to work on their attitude, create new personal focus (a hobby or exercise program), initiate new professional focus, be good to themselves, rely on well-established support systems, and…

“Doctor” or “darling”? Decoding the communication partner from ECoG of the anterior temporal lobe during non-experimental, real-life social interaction

PubMed Central

Derix, Johanna; Iljina, Olga; Schulze-Bonhage, Andreas; Aertsen, Ad; Ball, Tonio

2012-01-01

Human brain processes underlying real-life social interaction in everyday situations have been difficult to study and have, until now, remained largely unknown. Here, we investigated whether electrocorticography (ECoG) recorded for pre-neurosurgical diagnostics during the daily hospital life of epilepsy patients could provide a way to elucidate the neural correlates of non-experimental social interaction. We identified time periods in which patients were involved in conversations with either their respective life partners (Condition 1; C1) or attending physicians (Condition 2; C2). These two conditions can be expected to differentially involve subfunctions of social interaction which have been associated with activity in the anterior temporal lobe (ATL), including the temporal pole (TP). Therefore, we specifically focused on ECoG recordings from this brain region and investigated spectral power modulations in the alpha (8–12 Hz) and theta (3–5 Hz) frequency ranges, which have been previously assumed to play an important role in the processing of social interaction. We hypothesized that brain activity in this region might be sensitive to differences in the two interaction situations and tested whether these differences can be detected by single-trial decoding. Condition-specific effects in both theta and alpha bands were observed: the left and right TP exclusively showed increased power in C1 compared to C2, whereas more posterior parts of the ATL exhibited similar (C1 > C2) and also contrary (C2 > C1) effects. Single-trial decoding accuracies for classification of these effects were highly above chance. Our findings demonstrate that it is possible to study the neural correlates of human social interaction in non-experimental conditions. Decoding the identity of the communication partner and adjusting the speech output accordingly may be useful in the emerging field of brain-machine interfacing for restoration of expressive speech. PMID:22973215

The Intensive Care Lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive care.

PubMed

Arora, C; Savulescu, J; Maslen, H; Selgelid, M; Wilkinson, D

2016-11-08

Resuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit (NICU), meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people (non-health professionals) regarding resource allocation decisions in the NICU. The study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing. The majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival (P = 0.001), life expectancy (P = 0.0001), and cost of treatment (P = 0.01). In the classic 'lifeboat' scenario, all but two respondents were utilitarian. This survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment.

A Situative Response to the Conundrum of Formative Assessment

ERIC Educational Resources Information Center

Hickey, Daniel T.

2015-01-01

While formative assessment is popular, it is difficult to evaluate and improve. In some settings, it may actually reduce disciplinary learning by competing with other more productive activities, making those activities less engaging, and narrowing curricular goals. Situative approaches to educational assessment offer a solution by (a) blurring the…

A Portable Presentation Package for Audio-Visual Instruction. Technical Documentary Report.

ERIC Educational Resources Information Center

Smith, Edgar A.; And Others

The Portable Presentation Package is a prototype of an audiovisual equipment package designed to facilitate technical training in remote areas, situations in which written communications are difficult, or in situations requiring rapid presentation of instructional material. The major criteria employed in developing the package were (1) that the…

The life mission theory IV. Theory on child development.

PubMed

Ventegodt, Søren; Merrick, Joav

2003-12-11

We can identify five important needs that children have: the need for acknowledgment, acceptance, awareness or attention, respect, and care. If these needs are not met, children will modify themselves by denying central parts of their nature in order to adjust to their parents and the situation at large. When a child denies his or her talents, powers, and gender or aspects thereof, he or she loses quality of life, the ability to function, and physical or mental health. The loss of ability takes the form of diminished social ability, psychosexual potency, joy, energy, and fantasy while playing, as well as diminished ability to concentrate, focus, and learn. Many modifications result in a child with severely damaged self-confidence, self-worth, and poor performance. A child more or less deprived of self-worth cannot enjoy, give, or receive. A child deprived of emotions turns cold, rational, asocial, socially stiff, uncomfortable, and in the extreme case...intentionally "evil". When a child denies his or her own sex, it becomes invisible, uninteresting, and vague or becomes like the opposite sex in behavior and appearance. The general holistic solution to the vast diversity of symptoms in children with low quality of life is to improve the situation for the child and give the child the holding and support he or she needs. It is very important to realize that a negative belief often has survival value to the child as it helps the child to avoid taking responsibility for problems, which really belong to the parents or other adults. Children have a fine capability for spontaneous healing, and seem to enter this process more easily than adults, given sufficient holding. The symptoms of children with poor thriving ability are often difficult to understand, as they are caused by a complex combination of self-modification in five existential dimensions. This often leads to complex medical diagnosis, giving the idea that the child is sick and without therapeutic reach, while sufficient holding could solve the problem. If holding and support of the child is not enough, the situation must be carefully analyzed to find other possible causes of poor quality of life, health, and functional ability. Education of the parent in holding is often mandatory. Most children with bad thriving ability can thus be helped by simple means.

7 CFR 624.4 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... occurrence that could cause significant damage to property or threaten human life in the near future. (e)(1...) Exigency means those situations that demand immediate action to avoid potential loss of life or property..., cause new damages or the potential loss of life if action to remedy the situation is not taken...

7 CFR 624.4 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... occurrence that could cause significant damage to property or threaten human life in the near future. (e)(1...) Exigency means those situations that demand immediate action to avoid potential loss of life or property..., cause new damages or the potential loss of life if action to remedy the situation is not taken...

A course for nurses to handle difficult communication situations. A randomized controlled trial of impact on self-efficacy and performance.

PubMed

Doyle, Daniel; Copeland, H Liesel; Bush, Donna; Stein, Linda; Thompson, Scott

2011-01-01

to evaluate the impact of a communication skills course for nurses on how to handle difficult communication situations in their daily work. a 7-h course was developed using a construct of "Awareness, Feelings, Listen, Solve" (AFLS). A pedagogy of experiential, learner-centered learning was adopted. The course evaluation used a randomized controlled design with pre- and post-measures of self-efficacy and performance. forty-one nurses volunteered and thirty-three nurses completed all assigned parts of the study. On self-assessment, there was significant improvement for self-efficacy (F=24.43, p<0.001), but not for emotional awareness. On performance, there was no significant improvement between intervention and control groups (F=3.46, p=0.073). a short course for nurses on handling difficult communication situations achieved significant improvements in self-efficacy but not in performance. teaching communication skills in community-based settings is important for the safety and effectiveness of patient care. Sponsoring organizations should weigh trade-offs between feasibility and achievement of measurable improvements in performance. One possible approach is to focus on specific communication skills rather than a full suite of skills. 2010 Elsevier Ireland Ltd. All rights reserved.

The effect of life expectancy on aggression and generativity: a life history perspective.

PubMed

Dunkel, Curtis S; Mathes, Eugene; Papini, Dennis R

2010-09-23

Following a model that is inclusive of both dispositional and situational influences on life-history behaviors and attitudes, the effect of life expectancies on aggression and generativity was examined. Consistent with the hypotheses it was found that shorter life expectancies led to an increase in the desire to aggress and a decrease in the desire to engage in generative behaviors. The results are discussed in terms of how life history theory can be used to frame research on person-situation interactions.

Serious Illness, Injury, and Death in Child Protection and Preparation for End-of-Life Situations among Child Welfare Services Workers

ERIC Educational Resources Information Center

Csikai, Ellen L.; Herrin, Charlotte; Tang, Maggie; Church, Wesley T., II

2008-01-01

A mailed survey of child welfare workers in one southern state assessed various aspects of encounters with end-of-life situations in practice. Findings revealed that child deaths, children with life-threatening or life-limiting illnesses, and parental deaths were most commonly encountered and that coworkers were relied on for support. Many had no…

Collaborating to Cut Costs in Higher Education

ERIC Educational Resources Information Center

Hassett, Tracy

2017-01-01

Tuition prices at colleges and universities are high. It is also true that salaries and benefits are the single biggest chunk of every higher education institution's (HEI) budget. And one of the largest and most difficult costs to contain is group employee health insurance. The situation is particularly difficult for smaller New England HEIs…

Exploring the Relationship between School Principals' Burnout Situation and Life Satisfaction

ERIC Educational Resources Information Center

Karakose, Turgut; Kocabas, Ibrahim; Yirci, Ramazan; Esen, Coskun; Celik, Mustafa

2016-01-01

The purpose of this study is to explore school administrations' burnout situation and life satisfaction levels and the relationship between burnout and life satisfaction. The study was designed with the screening model. The research sample consists of 92 school principals and vice principals. Research data was collected with "Maslach Burnout…

Street Life: Aggravated and Sexual Assaults among Homeless and Runaway Adolescents.

ERIC Educational Resources Information Center

Terrell, Nathanial Eugene

1997-01-01

Examines aggravated and sexual assaults among 240 runaway and homeless adolescents (RHAs) in Des Moines (Iowa). Results suggest RHAs are at risk of life-threatening situations on the streets due to aggressive and abusive parents. Additionally, street life situations have significant impacts on the probability that RHAs will be victims of…

Marketing communications in nonbusiness situations or why it's so hard to sell brotherhood like soap.

PubMed

Rothschild, M L

1979-01-01

Marketing tools, techniques, and theories developed in the private sector can be applied in the public and nonprofit sectors; however, their limitations must be recognized. Nonbusiness communications campaigns should consider the involvedness (high or low) of the situation and the relevant segments, available positive and negative reinforcers, nonmonetary costs, the level of latent demand, and the wide range of communications alternatives. 5 hypotheses can be proposed regarding communications effectiveness outside of the private sector: 1) the lower the perceived personal value to the individual, relative to the cost, the more difficult the behavior change task and the lower the likelihood of success of marketing communications; 2) the lower the latent or pre-existing demand for the object, the more difficult the behavior change task and the lower the likelihood of marketing communications success; 3) the greater the involvement level of the object, situation, or issue, the more difficult the behavior change task and the lower the likelihood of marketing success; 4) the greater the past involvement level of the individual, the more difficult the behavior change task and the lower the likelihood of success; and 5) the greater the level of participation needed within the society, the more difficult the behavior change and the lower the likelihood of sucess of marketing communications. Many nonbusiness issues exist in either very high or very low involvement environments, calling for an enlarged set of communications strategies. More attention should be given to communications alternatives such as movies, television programs, and in-home and in-school educational communications, especially since it appears that public service spots are not very effective. Finally, more research is needed to generate and test the effectiveness of various marketing strategies aimed at overcoming inherent characteristics that suggest a low likelihood of success.

Social Learning in the Schools Through Psychodrama.

ERIC Educational Resources Information Center

Allen, Doris Twitchell

Psychodrama is the acting out of difficult situations one has experienced. It gives the actors and spectators the chance to try out alternative solutions to problem situations. When these problems are acted out, the actors become better acquainted with themselves and their peers. This awareness becomes a dominant determinant of future behavior.…

What Teachers Can Do for Children Living in Difficult Circumstances

ERIC Educational Resources Information Center

Lovitt, Thomas C.

2010-01-01

Thousands of children are living in stressful and dysfunctional situations. Scores of them reside in conditions replete with drugs or alcohol. As a court appointed special advocate (CASA), this author has advocated for children who have been abused or neglected and whose situations are involved in the courts, more specifically in the dependency…

Learning to Play--Common Concerns for the Visually Impaired Preschool Child.

ERIC Educational Resources Information Center

Recchia, Susan L.

Certain play situations are very difficult for young visually impaired children. This booklet focuses on three areas of play: exploring toys and materials, making transitions from one activity to another, and playing with other children. Through anecdotal descriptions of common situations encountered by caregivers, the booklet discusses why these…

[End-of-life and euthanasia, an intensive care team's experience].

PubMed

Baruteau, J; Devilliers, A; François, I; Blettery, B

2002-04-20

The improvement in the medical techniques used in intensive care units over the last 30 years has led to a different approach towards the end of life and death. Our study has underlined the feelings of all the staff of an intensive care unit towards the various difficulties engendered by death and the question of euthanasia. Conducted in the particular context of an intensive care unit, this work is a survey on the staff's feelings and factual experiences, in order to promote discussions on this painful subject. Sixty-one percent of the persons surveyed declared that euthanasia was ethically acceptable. The patients take the initiative of the request (92%) and the cohesion of the team is unanimously required. Pain and corporeal deterioration are the first motivations. Euthanasia is a difficult question, sometimes impassionate, and the care units have to consider whether they are concerned by the quality of their patients' care. The press regularly issues reports on this. But beyond these quantified questions, the staff who care for these ill patients are often very discreet. The regular confrontation with this situation changes the medical team's view of the profession.

Cochlear implant: the family's perspective.

PubMed

Vieira, Sheila de Souza; Dupas, Giselle; Chiari, Brasilia Maria

2018-07-01

To understand the family's experience of a child who uses a cochlear implant (CI). Specifically, to identify the difficulties, changes, and feelings entailed by deafness and the use of the CI; the coping strategies; and to understand the role of the family for the child with a CI. Qualitative research, using Symbolic Interactionism and Straussian Grounded Theory as the theoretical and methodological frameworks, respectively. Data collection instrument: semi-structured interview. A total of 9 families (32 individuals) participated in the study. The children's ages ranged from 6 to 11 years old (mean = 8.9 years old). Their experience is described in the following categories: Having to fight for results, Coping with difficult situations, Recognizing that you are not alone, Learning to overcome, and Having one's life restored by the implant. Cochlear implantation changes the direction of the child and the family's life by restoring the child's opportunity to hear and to obtain good results in her personal, social, and academic development. Even after implantation, the child continues to experience difficulties and requires the family's mobilization in order to be successful. The family is the principal actor in the process of the child's rehabilitation.

Pediatric advanced life support and sedation of pediatric dental patients.

PubMed

Kim, Jongbin

2016-03-01

Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency situations, basic life support is most important. However, emergencies in young children mostly involve breathing. Therefore, physicians who treat pediatric dental patients should learn PALS. It is necessary for the physician to regularly renew training every two years to be able to immediately implement professional skills in emergency situations. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is absolutely necessary to be able to immediately implement professional skills in emergency situations.

Effects of an expressive writing intervention on a group of public employees subjected to work relocation.

PubMed

Tarquini, Matteo; Di Trani, Michela; Solano, Luigi

2016-02-15

Pennebaker's writing technique has yielded good results on health, psychological and performance dimensions. In spite of the positive outcomes, the technique has rarely been applied directly within the workplace and its effects on burnout have never been tested. 18 public employees subjected to work relocation were asked to write about their present work situation or another difficult event of their life (Writing Group), while another 17 were not assigned any writing task (Control Group). To assess whether there was an improvement in burnout, alexithymia and psychological well-being in the Writing Group compared with the baseline measurement and the Control Group. While the baseline levels in the Writing and Control Groups in the 3 dimensions considered were similar, scores in the Writing Group at both a second (1 month after the end of the procedure) and third measurement (7 months after the end) improved when compared with the baseline, whereas those in the Control Group worsened. Pennebaker's writing technique appears to promote adaptive coping strategies in stressful situations, and to increase occupational and psychological well-being as well as the ability to process emotions. It also appears to buffer the negative effects of work-related stress.

Different views on ethics: how animal ethics is situated in a committee culture.

PubMed

Ideland, M

2009-04-01

Research that includes non-human animal experimentation is fundamentally a dilemmatic enterprise. Humans use other animals in research to improve life for their own species. Ethical principles are established to deal with this dilemma. But despite this ethical apparatus, people who in one way or another work with animal experimentation have to interpret and understand the principles from their individual points of view. In interviews with members of Swedish animal ethics committees, different views on what the term ethics really means were articulated. For one member, the difficult ethical dilemma of animal experimentation is the lack of enriched cages for mice. For another, the ethical problem lies in regulations restraining research. A third member talks about animals' right not to be used for human interests. These different views on "ethics" intersect once a month in the animal ethics committee meetings. There is no consensus on what constitutes the ethical problem that the members should be discussing. Therefore, personal views on what ethics means, and hierarchies among committee members, characterise the meetings. But committee traditions and priorities of interpretation as well are important to the decisions. The author discusses how "ethics" becomes situated and what implications this may have for committees' decisions.

Quality of life, psychological characteristics, and adjustment in parents of children with Attention-Deficit/Hyperactivity Disorder.

PubMed

Cappe, Emilie; Bolduc, Mélanie; Rougé, Marie-Caroline; Saiag, Marie-Claude; Delorme, Richard

2017-05-01

This study investigated quality of life and adjustment mechanisms in parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD). Ninety parents of children with ADHD completed a sociodemographic questionnaire and self-assessment scales to measure their perceived stress, social support, sense of control, coping strategies and quality of life. ADHD in children negatively affected parents' quality of life, especially their psychological well-being and personal fulfillment. Family and couple relationships, as well as daily life activities, were also affected. The severity of the disorder, perceiving the situation as a threat or a loss, feeling guilty and holding on to irrational beliefs were related to emotion-focused coping strategies and to a poorer quality of life. Furthermore, hyperactivity index and stress ratings relative to perceiving the situation as a threat or a loss, and adopting emotion-focused coping strategies, predicted poorer quality of life. In contrast, perceiving the situation as challenging was related to a greater sense of control and personal fulfillment. Moreover, perceiving the situation as challenging and adopting problem-focused coping strategies predicted better quality of life. The findings highlight the negative effects of ADHD on parent psychological adjustment and underline the need to recommend training programs that improve parenting skills, parents' perceptions concerning their child's behavior disorder and parental functioning.

Use of heat-pressed leucite reinforced porcelain in "difficult" veneer cases: a clinical report.

PubMed

Rouse, J S

1996-11-01

Two clinical situations are presented where a heat-pressed leucite reinforced ceramic veneer system was used. For these situations the system was advantageous when veneers (1) required bulk or variable thicknesses or (2) were under load from function and parafunctional activity. This porcelain veneer system addressed some of the concerns associated with standard feldspathic porcelain and castglass systems. Practitioners should consider its use for situations that require a stronger veneer material.

[The nursing profession regarding limitation of life support treatment in the intensive care units. Technical and practical features].

PubMed

Falcó-Pegueroles, A

2009-01-01

The scientific and technical developments in medicine in the recent decades have greatly helped to increase life expectancy and quality of life of many patients. In hospitals, this technological scenario has clearly influenced patient care, for example, in the Intensive Medicine Departments, leading to new clinical perspectives and has made the growing complexity of giving treatment and making decisions more evident. In some cases, it is difficult to predict how beneficial intensive medical care can be when there is no reasonable prospect of improving the patient's health, prolonging their life in situations with poor prognosis or dramatically reducing their quality of life. The clinical diagnosis of irreversibility, through indicators of severity and principles of beneficence, autonomy and justice in the professional conduct are the elements that give rise to the consideration of withholding and withdrawing treatment in the critical patient. However, there are other factors that need to be taken into consideration and that are analyzed by professional ethics and bioethics. It is from this approach that any decision involving withholding and withdrawing treatment should be taken so that these decisions can be considered estimable form an ethical point of view. The nursing professional in intensive care units is expected to actively participate in decision making by contributing with their humanizing vision and care ethics. They should be aware of their contribution in the medical team behaving, representing and encouraging the requirements of bioethics.

What are families most grateful for after receiving palliative care? Content analysis of written documents received: a chance to improve the quality of care.

PubMed

Aparicio, María; Centeno, Carlos; Carrasco, José Miguel; Barbosa, Antonio; Arantzamendi, María

2017-09-06

Family members are involved in the care of palliative patients at home and therefore, should be viewed as important sources of information to help clinicians better understand the quality palliative care service patients receive. The objective of the study was to analyse what is valued most by family carers undergoing bereavement of a palliative care home service in order to identify factors of quality of care. Qualitative exploratory study based on documentary analysis. Content analysis of 77 gratitude documents received over 8 years by a palliative home service in Odivelas, near Lisbon (Portugal) was undertaken, through an inductive approach and using investigator triangulation. Frequency of distinct categories was quantitatively defined. Three different content categories emerged from the analysis: a) Recognition of the care received and the value of particular aspects of care within recognised difficult situations included aspects such as kindness, listening, attention to the family, empathy, closeness, affection and the therapeutic relationships established (63/77 documents); b) Family recognition of the achievements of the palliative care team (29/77) indicated as relief from suffering for the patient and family, opportunity of dying at home, help in facing difficult situations, improvement in quality of life and wellbeing, and feeling of serenity during bereavement; c) Messages of support (45/77) related to the need of resources provided. The relational component emerges as an underlying key aspect of family carers' experience with palliative care home service. Family carers show spontaneous gratitude for the professionalism and humanity found in palliative care. The relational component of care emerges as key to achieve a high quality care experience of palliative care homes service, and could be one indicator of quality of palliative care.

The Function Analysis of Informationization in New Rural Cooperatives Medical Service Management

NASA Astrophysics Data System (ADS)

Zhou, Yuefeng; Liu, Min

The establishment of new rural cooperative medical system is an important action for comprehensive affluent society. It is an important measure for Central Party Committee and State Council to solve "three rural" issue effectively and to overall urban and rural, regional, coordinated economic and social development, building a well-off society in the new situation. It has important role to alleviate farmers to see a doctor expensively, see a doctor difficultly, reduce the burden on farmers and improve their level of health protection and quality of life, solve the problem of poor because of illness and the problem of returning poor due to illness, promote the production and rural economic development and stability in the rural areas. This article will analyze the function of informationization in new rural cooperative medical service management selectively.

[Contempt and hatred: sociologic indications for an approach to current juvenile violence].

PubMed

Goudet, B

1999-03-01

Violence is present in all forms of society that impose limits that must not be surpassed (murder, incest ...) in order for social life to be possible. But these limits are always broken. Youth are, in this respect, in a difficult situation, especially those from marginalized areas. Victims of contempt and exclusion, they react through violent acts; to violence experienced because of excessive constraints in school, they respond with violence. This juvenile violence calls for macro-social responses that return credibility to the institutional system often corrupt and responsible for hidden social violence. It also calls for micro-social actions, especially within the community. These actions may allow for awareness of violence generating phenomena, the discovery of obstacles to exercising rights, and the make-up of conflicts and their resolution in negotiation procedures.

Pregnancy in a woman with proportionate (primordial) dwarfism: a case report and literature review

PubMed Central

Vance, C E; Desmond, M; Robinson, A; Johns, J; Zacharin, M; Savarirayan, R; König, K; Warrillow, S; Walker, S P

2012-01-01

Primordial dwarfism is a rare form of severe proportionate dwarfism which poses significant challenges in pregnancy. A 27-year-old with primordial dwarfism (height 97 cm, weight 22 kg) and coexisting morbidities of familial hypercholesterolaemia and hypertension presented to our unit. Early pregnancy was complicated by difficult blood pressure control, sinus tachycardia, biochemical hyperthyroidism and insulin-requiring gestational diabetes. Delivery was indicated at 24 weeks with uncontrollable hypertension, progressive renal impairment and intrauterine growth restriction. A caesarean section was performed under general anaesthesia, resulting in the delivery of a 486 g male infant. This case highlights the difficulties of managing pregnancy in a woman with primordial dwarfism. Her limited capacity to respond to the physiological demands of pregnancy created a life-threatening situation, culminating in profound preterm birth. PMID:27582869

A psychology for pedagogy: intelligence testing in USSR in the 1920s.

PubMed

Leopoldoff, Irina

2014-08-01

This article examines a case of intelligence testing conducted in the mid-1920s, while considering the broader political and scientific context of Soviet life. Guided by questions about the status and influence of mental measurement in Russian society, previously and after the revolution, as well as asking about the main actors in the fields linked to testing, such as psychology, pedagogy, and pedology, during this tumultuous period. To answer these questions, journals and difficult-to-access archival sources were used, which provided evidence regarding the enthusiasm psychological testing had on scholars in the 1920s and the institutional support they received for their surveys. The article offers some hints concerning why this was so and why this situation changed completely a decade later. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Euthanasia from the perspective of hospice care.

PubMed

Gillett, G

1994-01-01

The hospice believes in the concept of a gentle and harmonious death. In most hospice settings there is also a rejection of active euthanasia. This set of two apparently conflicting principles can be defended on the basis of two arguments. The first is that doctors should not foster the intent to kill as part of their moral and clinical character. This allows proper sensitivity to the complex and difficult situation that arises in many of the most difficult terminal care situations. The second argument turns on the seduction of technological solutions to human problems and the slippery slope that may arise in the presence of a quick and convenient way of dealing with problems of death and dying.

Foregrounding Sociomaterial Practice in Our Understanding of Affordances: The Skilled Intentionality Framework.

PubMed

van Dijk, Ludger; Rietveld, Erik

2016-01-01

Social coordination and affordance perception always take part in concrete situations in real life. Nonetheless, the different fields of ecological psychology studying these phenomena do not seem to make this situated nature an object of study. To integrate both fields and extend the reach of the ecological approach, we introduce the Skilled Intentionality Framework that situates both social coordination and affordance perception within the human form of life and its rich landscape of affordances. We argue that in the human form of life the social and the material are intertwined and best understood as sociomateriality. Taking the form of life as our starting point foregrounds sociomateriality in each perspective we take on engaging with affordances. Using ethnographical examples we show how sociomateriality shows up from three different perspectives we take on affordances in a real-life situation. One perspective shows us a landscape of affordances that the sociomaterial environment offers. Zooming in on this landscape to the perspective of a local observer, we can focus on an individual coordinating with affordances offered by things and other people situated in this landscape. Finally, viewed from within this unfolding activity, we arrive at the person's lived perspective: a field of relevant affordances solicits activity. The Skilled Intentionality Framework offers a way of integrating social coordination and affordance theory by drawing attention to these complementary perspectives. We end by showing a real-life example from the practice of architecture that suggests how this situated view that foregrounds sociomateriality can extend the scope of ecological psychology to forms of so-called "higher" cognition.

Foregrounding Sociomaterial Practice in Our Understanding of Affordances: The Skilled Intentionality Framework

PubMed Central

van Dijk, Ludger; Rietveld, Erik

2017-01-01

Social coordination and affordance perception always take part in concrete situations in real life. Nonetheless, the different fields of ecological psychology studying these phenomena do not seem to make this situated nature an object of study. To integrate both fields and extend the reach of the ecological approach, we introduce the Skilled Intentionality Framework that situates both social coordination and affordance perception within the human form of life and its rich landscape of affordances. We argue that in the human form of life the social and the material are intertwined and best understood as sociomateriality. Taking the form of life as our starting point foregrounds sociomateriality in each perspective we take on engaging with affordances. Using ethnographical examples we show how sociomateriality shows up from three different perspectives we take on affordances in a real-life situation. One perspective shows us a landscape of affordances that the sociomaterial environment offers. Zooming in on this landscape to the perspective of a local observer, we can focus on an individual coordinating with affordances offered by things and other people situated in this landscape. Finally, viewed from within this unfolding activity, we arrive at the person’s lived perspective: a field of relevant affordances solicits activity. The Skilled Intentionality Framework offers a way of integrating social coordination and affordance theory by drawing attention to these complementary perspectives. We end by showing a real-life example from the practice of architecture that suggests how this situated view that foregrounds sociomateriality can extend the scope of ecological psychology to forms of so-called “higher” cognition. PMID:28119638

Difficult intubation: are you prepared for it?

PubMed

Balcom, C

1994-01-01

The endotracheal intubation of a patient for surgery requires an anaesthetist who is aided by a skilled and experienced helper. This paper explores reasons why some patients are difficult to intubate. Some are predictable on pre-operative assessment and others are not. Suggestions are given on how the helper is useful to the anaesthetist in this potentially critical situation.

[Climacteric--medicalization, minimalization or normalization?].

PubMed

Hovelius, B; Ekström, H; Esseveld, J; Landgren, B M; Vinge, E

2000-12-13

Women's experiences and ideas about the climacteric are not in accord with the biomedical model, in which the climacteric and the menopause are characterized as being a risk factor for various diseases and a cause of "estrogen deficiency", a hormonal disease which is assumed to persist during the rest of life. The biomedical model may lead to medicalization and pathologizing, increasing the subordination of women and making them dependent on the health care system. Women who use hormonal therapy during the climacteric have many characteristics differentiating them from women who do not use such therapy. Thus, epidemiological studies will be difficult to interpret with respect to the long term effects of hormonal therapy. It is argued that the consultation for women of middle-age should be characterized by a holistic view of the woman taking account of her gender identity, life conditions and life situation. Such a view should focus on the woman's own ideas as to diagnostic procedures, treatment and solutions. In view of the lack of knowledge about the pros and cons of hormonal therapy, women themselves should make the decision, and such decisions should be encouraged. Also, the efforts directed towards women's compliance to hormonal therapy can be questioned. Women's climacteric symptoms should neither be medicalized, pathologized or minimized.

Sustaining life or prolonging dying? Appropriate choice of conservative care for children in end-stage renal disease: an ethical framework.

PubMed

Dionne, Janis M; d'Agincourt-Canning, Lori

2015-10-01

Due to technological advances, an increasing number of infants and children are surviving with multi-organ system dysfunction, and some are reaching end-stage renal disease (ESRD). Many have quite limited life expectancies and may not be eligible for kidney transplantation but families request dialysis as alternative. In developed countries where resources are available there is often uncertainty by the medical team as to what should be done. After encountering several of these scenarios, we developed an ethical decision-making framework for the appropriate choice of conservative care or renal replacement therapy in infants and children with ESRD. The framework is a practical tool to help determine if the burdens of dialysis would outweigh the benefits for a particular patient and family. It is based on the four topics approach of medical considerations, quality-of-life determinants, patient and family preferences and contextual features tailored to pediatric ESRD. In this article we discuss the basis of the criteria, provide a practical framework to guide these difficult conversations, and illustrate use of the framework with a case example. While further research is needed, through this approach we hope to reduce the moral distress of care providers and staff as well as potential conflict with the family in these complex decision-making situations.

Development of a methodology for electronic waste estimation: A material flow analysis-based SYE-Waste Model.

PubMed

Yedla, Sudhakar

2016-01-01

Improved living standards and the share of services sector to the economy in Asia, and the use of electronic equipment is on the rise and results in increased electronic waste generation. A peculiarity of electronic waste is that it has a 'significant' value even after its life time, and to add complication, even after its extended life in its 'dump' stage. Thus, in Indian situations, after its life time is over, the e-material changes hands more than once and finally ends up either in the hands of informal recyclers or in the store rooms of urban dwellings. This character makes it extremely difficult to estimate electronic waste generation. The present study attempts to develop a functional model based on a material flow analysis approach by considering all possible end uses of the material, its transformed goods finally arriving at disposal. It considers various degrees of uses derived of the e-goods regarding their primary use (life time), secondary use (first degree extension of life), third-hand use (second degree extension of life), donation, retention at the respective places (without discarding), fraction shifted to scrap vendor, and the components reaching the final dump site from various end points of use. This 'generic functional model' named SYE-Waste Model, developed based on a material flow analysis approach, can be used to derive 'obsolescence factors' for various degrees of usage of e-goods and also to make a comprehensive estimation of electronic waste in any city/country. © The Author(s) 2015.

Basic Guidelines for Victims of Rape and Sexual Offenses. Revised Edition.

ERIC Educational Resources Information Center

Maryland State Commission for Women, Baltimore.

This brochure presents guidelines for victims of rape and sexual offenses in preparation for the legal and medical procedures which will follow the reporting of such an assault. The brochure states the hope that these guidelines will be useful to a victim in regaining control over the situation and in managing a difficult situation effectively.…

How Older Adults and Their Families Perceive Family Talk about Aging-Related EOL Issues: A Dialectical Analysis.

PubMed

Egbert, Nichole; Child, Jeffrey T; Lin, Mei-Chen; Savery, Carol; Bosley, Tammy

2017-04-17

For older adults, approaching end-of-life (EOL) brings unique transitions related to family relationships. Unfortunately, most families greatly underestimate the need to discuss these difficult issues. For example, parents approaching EOL issues often struggle with receiving assistance from others, avoiding family conflict, and maintaining their sense of personhood. In addition, discussions of EOL issues force family members to face their parents' mortality, which can be particularly difficult for adult children to process emotionally. This study explored aging issues identified by aging parents and their families as they traverse these impending EOL changes. Ten focus groups of seniors ( n = 65) were conducted. Focus groups were organized according to race (African-American/European-American), gender, and whether the older adult was living independently or in an assisted care facility. When asked open-ended questions about discussing aging and EOL issues with family members, participants revealed tensions that led us to consider Relational Dialectics Theory as a framework for analysis. The predominant tension highlighted in this report was certainty versus uncertainty, with the two sub-themes of sustained life versus sustained personhood and confronting versus avoiding EOL issues. For these data, there were more similarities than differences as a result of gender, race, or living situation than one might expect, although culture and financial status were found to be influential in the avoidance of EOL discussions. The results of this study help to provide additional insight into relational dialectics related to aging, EOL, and the importance of communication in facilitating family coping.

[Pain and treatment, clinical situations and lines of questioning].

PubMed

Malaquin-Pavan, Evelyne

2010-10-01

The pain provoked by a treatment is difficult to understand by professionals, individually or collectively. Guilt, a feeling of powerlessness or doubt can arise with the healthcare worker who witnesses it or performs the treatment, and lead him/her to avoid talking about it, once the treatment is carried out. The study of clinical situations aims to incite reflection among teams to improve understanding of the complexity of these situations, influenced by the representations, perceptions and emotions of everyone involved.

Factors associated with life jacket use among cabin sailboat and day sailor boaters in the United States.

PubMed

Spitzer, Natalie; Phillips, Maile T; Chow, Wendy; Mangione, Thomas W

2018-06-01

In 2015, drowning accounted for 68% of the 626 recreational boating related deaths in the United States. Although life jackets are estimated to prevent between 50% to 80% of boating deaths, approximately 83% of sailboat-related drowning victims were reported to not be wearing life jackets. Life jacket use among adult boaters has remained consistently low across most boat types and may vary by boater, boating, and environmental conditions. Although many risky environmental and boating factors may be associated with a higher risk of boating death, drowning occurs in all situations and it is useful to understand adult life jacket wearing behaviors in differing boating situations. This study uses observational survey data from 61318 adult sailors collected during the summer months of 1999 - 2017 from 124 selected study sites across 30 states in the US. Life jacket use was compared for day sailors and cabin sailboats by multiple boating, boater, and environmental conditions using Chi-square tests for equality of proportions. Results of these tests led to a choice of 3 informative and scientifically compelling variables to summarize variation in life jacket use for each sailboat type. Odds ratios were calculated comparing life jacket use from each boating situation to the lowest risk situation as determined by the 3 selected variables. These variables were represented in a tree diagram, detailing the additive impact of each factor. Following these analyses, all boating conditions were categorized to be risky or non-risky and a count variable was created for each observation based on the number of risks present. Cochran-Armitage trend tests were conducted to test for linearity in life jacket use for both boat types. The overall life jacket wear rate was higher among adults in day sailor sailboats (51.6%) compared to cabin sailboats (13.8%) and in all measured demographic, boating, and environmental circumstances. Comparing high-risk cabin sailboat conditions of low water temperatures, small boat size, and high wind speed to the lowest-risk situation accounted for a 23.3% range in life jacket wear rate (OR=4.7). Comparing high-risk day sailor sailboat conditions of small boat size, one boater on board, and choppy/rough wave height to the lowest-risk situation accounted for a 39.3% range in life jacket wear rate (OR=5.9). For both boat types, the number of risks present and life jacket wear rate exhibited a statistically significant positive linear relationship at p<0.0001. Study results suggest that boaters are aware of the connection between life jacket use and drowning prevention and are more likely to wear life jackets when boating in conditions perceived to be risky. Boating safety promotion efforts should recommend adult life jacket use in all boating situations, as seemingly non-risky conditions may still result in drownings. Copyright © 2018. Published by Elsevier Ltd.

Sex life and role identity in Taiwanese women during menopause: a qualitative study.

PubMed

Yang, Cheng-Fang; Kenney, Nancy J; Chang, Ting-Chen; Chang, Shiow-Ru

2016-04-01

Our goal was to examine Taiwanese women's perspectives on the way menopause affected their sexual behaviour to gain an in-depth understanding of their experiences during this transition. Physical symptoms associated with menopause may affect women's sexual experiences. Little is known about how menopause-related changes in sexual behaviour may affect role identity of women living in a modernizing urban culture that is still strongly rooted in traditional beliefs and attitudes. This was a qualitative study involving face-to-face interviews using open-ended questions. During 2011-2012, eighteen peri or postmenopausal women visiting a medical clinic for gynaecological examinations or treatment were interviewed about their sexual experiences. Responses were analysed for common themes. Four themes were identified about the effects of menopause on women's sex life: (1) changes in physical responses during sex; (2) the acceptance/non-acceptance of the current situation; (3) sexual pressure related to their marital role; (4) efforts to improve sexual interest or activity. Menopause-related physical changes often (but not always) made sexual interactions difficult. But women's responses to the changes varied. Some used sexual discomfort as a reason to avoid sexual intercourse. Others sought to improve their sexual encounters through behavioural modifications or hormone therapy. Given the variety of reactions to the impact of menopause on sexual behaviour/relationships seen here, it is clear that health professionals need to assess of each woman's specific situation and be prepared to recommend a variety of behavioural or hormonal treatment options. © 2015 John Wiley & Sons Ltd.

Personality-situation transactions from adolescence to old age.

PubMed

Wrzus, Cornelia; Wagner, Gert G; Riediger, Michaela

2016-05-01

People presumably choose and create their daily environments according to their personality. Prior research shows that, for example, more extraverted people engage more often in social situations, and more conscientious people engage more often in work-related activities compared with less extraverted or less conscientious people, respectively. The current study examined such personality-situation transactions in people's daily life. Based on the assumption that older people know themselves and their personality better than younger people, we investigated whether momentary and proximate personality-situation associations (i.e., changing from 1 type of situation into another) increase with older age. Three-hundred and 78 people aged 14 to 82 years described their Big Five traits and took part in a 3-week experience-sampling phase. Using mobile-phone based assessments in daily life, participants reported on average 55 times on their momentary situation. Multilevel modeling results showed that personality-situation associations varied with the age of participants. Some of the "established" personality-situation associations, such as for extraversion and time spent with friends or conscientiousness and time spent with work activities, were only observed in adolescence and young adulthood. In contrast, other personality-situation associations appeared only in late adulthood, such as for openness and time spent with friends. Yet most personality-situation associations did not vary significantly with people's age. In addition, personality traits predicted maintaining or entering personality-congruent situations. The latter results point to the active role of personality in shaping one's environment. The findings imply that some personality-situation transactions may be largely similarly across the life span. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Quality of life in stroke survivor-caregiver dyads: a new conceptual framework and longitudinal study protocol.

PubMed

Savini, Serenella; Buck, Harleah G; Dickson, Victoria Vaughan; Simeone, Silvio; Pucciarelli, Gianluca; Fida, Roberta; Matarese, Maria; Alvaro, Rosaria; Vellone, Ercole

2015-03-01

To describe a new conceptual framework and the research protocol of a study designed to examine the quality of life in stroke survivor-caregiver dyads. Stroke has a significant impact on the patient-caregiver dyad. Few studies have been guided by a specific conceptual framework which considers the interactions among pre-existing situations prior to stroke, the new situation caused by the stroke and the moderating effects of environmental and caregiver-related variables. Longitudinal study. A sample of stroke survivor-caregiver dyads will be enrolled at patient discharge from rehabilitation hospitals and will be surveyed every 3 months for 1-year. Hypotheses generated from the conceptual framework will test predictors, mediators and moderators of stroke survivor and caregiver quality of life from the pre-existing situation prior to the stroke, the new situation mediation poststroke and situation moderators. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, December 2013. This study seeks to identify variables in the pre-existing situation prior to the stroke (e.g. living condition), the new situation mediation poststroke (e.g. type of stroke and caregiver burden) as well as situation moderators (e.g. social support) that influence stroke survivor-caregiver dyad's quality of life across the stroke trajectory. Also, the study will inform clinical practice and research by identifying variables that are potentially modifiable and therefore amenable to intervention. The proposed framework will also be helpful for future research focused on stroke survivor-caregiver dyads. © 2014 John Wiley & Sons Ltd.

A transactional framework for pediatric rehabilitation: shifting the focus to situated contexts, transactional processes, and adaptive developmental outcomes.

PubMed

King, Gillian; Imms, Christine; Stewart, Debra; Freeman, Matt; Nguyen, Tram

2018-07-01

A paradigm shift is taking place in pediatric rehabilitation research, practice, and policy - a shift towards the real-life contexts of clients rather than requiring clients to navigate the world of pediatric rehabilitation. This article proposes a conceptual framework to bring about a broader awareness of clients' lives and transactional processes of change over the life course. The framework draws attention to transactional processes by which individuals, situated in life contexts, change and adapt over the life course and, in turn, influence their contextual settings and broader environments. This framework is based on (a) basic tenets derived from foundational theories taking a life course perspective to change, and (b) transactional processes identified from relevant pediatric rehabilitation models that bring these foundational theories into the pediatric rehabilitation sphere. The framework identifies three types of transactional processes relevant to pediatric rehabilitation: facilitative, resiliency, and socialization processes. These processes describe how contexts and people mutually influence each other via opportunities and situated experiences, thus facilitating capacity, adaptation to adversity, and socialization to new roles and life transitions. The utility of the framework is considered for research, practice, service organizations, and policy. Implications for Rehabilitation The framework supports practitioners going beyond person and environment as separate entities, to provide services to the "situated person" in real-life contexts The framework shifts the focus from "body structures/functions" and "person in activity" to "person in changing and challenging life contexts" Working from a transactional perspective, practitioner-client conversations will change; practitioners will view client situations through a lens of opportunities and experiences, assess client experiences in real-life contexts, and strive to create context-based therapy opportunities The framework suggests the benefit of greater focus on resiliency processes to support client self-efficacy, self-determination, and autonomy, and socialization processes to enhance ability to enact new life roles at times of transition.

Informed consent and moral integrity.

PubMed Central

Gillett, G R

1989-01-01

Informed consent is required for any medical procedure although the situations in which it is given are beset by uncertainties and indeterminacies. These make medicolegal scrutiny of such situations very difficult. Although some people find the decision in the Sidaway case incomprehensible because of its continuing regard for a 'professional practice standard' in informed consent, I will argue that an important fact in many cases is the moral integrity of the doctor concerned and the pattern of his practice. This may provide the only morally principled and legally accessible evidence enabling a correct decision to be made in a difficult case. Although the epistemological significance of a professional practice standard is thereby defended the 'prudent patient standard' for what counts as consent is left intact. PMID:2795625

Situational reaction and planning

NASA Technical Reports Server (NTRS)

Yen, John; Pfluger, Nathan

1994-01-01

One problem faced in designing an autonomous mobile robot system is that there are many parameters of the system to define and optimize. While these parameters can be obtained for any given situation determining what the parameters should be in all situations is difficult. The usual solution is to give the system general parameters that work in all situations, but this does not help the robot to perform its best in a dynamic environment. Our approach is to develop a higher level situation analysis module that adjusts the parameters by analyzing the goals and history of sensor readings. By allowing the robot to change the system parameters based on its judgement of the situation, the robot will be able to better adapt to a wider set of possible situations. We use fuzzy logic in our implementation to reduce the number of basic situations the controller has to recognize. For example, a situation may be 60 percent open and 40 percent corridor, causing the optimal parameters to be somewhere between the optimal settings for the two extreme situations.

[Optimistic perspectives in communicating difficult news on fetal development].

PubMed

Ostermann, Ana Cristina; Frezza, Minéia; Rosa, Rafael Machado

2017-08-21

Communicating diagnostic news in health contexts is a potentially difficult event for all parties involved. However, despite this task's presence in the physician-patient context, it is rarely addressed during clinical training. The current study thus aimed to describe and evaluate how difficult news can be toned down during genetic counseling sessions involving cases of fetal syndromes and/or malformations. The study analyzed 33 naturalistic interactions (i.e. real situations), taped and transcribed, according to the theoretical and methodological perspective of Conversation Analysis, with an ethnomethodological basis. These interactions consisted of sessions in clinical genetics with pregnant women seen at the fetal medicine service of a reference hospital for maternal and child health in the Brazilian Unified National Health System (SUS). The analysis showed that communicating difficult news can be accompanied by optimistic perspectives that are scaled-up according to each situation's severity. In the absence of a positive diagnosis, the appointments can conclude with positive aspects such as recommendations for palliative care, so that the patient always leaves the appointment with some kind of recommendation. This study proposes to innovate and expand the scope of studies on communicating difficult news in the physician-patient relationship in Brazil, precisely by developing an analysis of real interactions in genetic counseling and thus providing interactional backing for training health professionals that deal with this challenge in their routine work.

Complaints of neurotic patients that are of interest for a cardiologist.

PubMed

Sobański, Jerzy A; Klasa, Katarzyna; Popiołek, Lech; Rutkowski, Krzysztof; Dembińska, Edyta; Mielimąka, Michał; Cyranka, Katarzyna; Müldner-Nieckowski, Łukasz; Smiatek-Mazgaj, Bogna; Rodziński, Paweł

2015-01-01

Patients in various areas of medicine report symptoms that are unexplained by other medical reasons than psychological/psychiatric. Some of them urgently seek treatment due to cardiovascular complaints, mostly rapid heart rate, palpitations and chest pain. Typical cardiac investigations, usually showing no organic reasons for these conditions, bring little information about stressful life events and psychological predispositions of these patients. Identification of coexistence of "cardiac" symptoms with other symptoms typical for neurotic disorders and difficult life circumstances may facilitate not only psychiatric diagnosis but also evaluation by cardiologists, primary care physicians, and other specialists. To determine the psychosocial context of psychogenic "pseudocardiac" symptoms and their coexistence with other symptoms in patients with neurotic disorders. Medical records of patients from the years 1980-2002 that included self-administered questionnaires transformed into an anonymised database were examined. An analysis of the relationship between symptoms reported in the Symptom Checklist and biographical circumstances described in the Life Inventory before admission to a psychotherapy day clinic for patients with neurotic disorders was performed using simple logistic regression with estimation of odds ratios and their 95% confidence intervals. The symptoms of tachycardia/palpitations and chest pain were very common, present in most subjects, and were significantly associated with such circumstances as suboptimal conflict solving by passive aggression or quarrels, uncertainty in the relationship, a sense of being inferior to the partner, and poor financial situation. In addition, these "pseudocardiac" symptoms were also associated with such childhood reminiscences as origin from a large low income family, feeling that the family of origin was inferior to others, and experience of parental hostility or lack of support. Physicians of all specialties who deal with patients experiencing pseudocardiac symptoms should expect their psychological background and perform a simple interview to identify the presence of adverse biographical circumstances described above. Identification and discussing these difficult experiences with the patients may help to convince them to seek psychological support or psychotherapy.

Career Development of Managers and Executives: A Compendium.

DTIC Science & Technology

1983-06-01

Organizational or community security. A desire to stabilize the total life situation; tends to accept the organization’s definition of one’s career... life . This study reported from the point of view of individuals, con- cluding that people tend to gravitate to work situations that are consistent...technically- oriented organization should accommodate the fact of life that occupa- tional. differences are reflected in different mind-sets, and that

Portal vein thrombosis: a clinician-oriented and practical review.

PubMed

Handa, Pankaj; Crowther, Mark; Douketis, James D

2014-07-01

With advances in modern imaging techniques, portal vein thrombosis (PVT) is being increasingly diagnosed. It has a wide ranging clinical spectrum from being an asymptomatic state to a potentially life-threatening situation. It is not unusual to find it as an incidental finding in the abdominal imagings done for other reasons. It is commonly associated with cirrhosis and abdominal malignancies and also has a strong association with prothrombotic disorders. It is often difficult for the clinicians to decide whether PVT is acute or chronic. This poses great challenges to its management strategies that include anticoagulants, thrombolysis, and surgical options. Timely diagnosis and appropriate management have great bearings on its outcomes of morbidity and mortality. In this clinician-oriented review, we have provided a concise review of clinical aspects of PVT and discussed various management strategies while addressing the common questions that come to a physician's mind dealing with such a patient. © The Author(s) 2013.

A novel heuristic algorithm for capacitated vehicle routing problem

NASA Astrophysics Data System (ADS)

Kır, Sena; Yazgan, Harun Reşit; Tüncel, Emre

2017-09-01

The vehicle routing problem with the capacity constraints was considered in this paper. It is quite difficult to achieve an optimal solution with traditional optimization methods by reason of the high computational complexity for large-scale problems. Consequently, new heuristic or metaheuristic approaches have been developed to solve this problem. In this paper, we constructed a new heuristic algorithm based on the tabu search and adaptive large neighborhood search (ALNS) with several specifically designed operators and features to solve the capacitated vehicle routing problem (CVRP). The effectiveness of the proposed algorithm was illustrated on the benchmark problems. The algorithm provides a better performance on large-scaled instances and gained advantage in terms of CPU time. In addition, we solved a real-life CVRP using the proposed algorithm and found the encouraging results by comparison with the current situation that the company is in.

Self-transcendence and well-being in homeless adults.

PubMed

Runquist, Jennifer J; Reed, Pamela G

2007-03-01

This study examines the relationships of spiritually and physically related variables to well-being among homeless adults. A convenience sample of 61 sheltered homeless persons completed the Spiritual Perspective Scale, the Self-Transcendence Scale, the Index of Well-Being, and items measuring fatigue and health status. The data were subjected to correlational and multiple regression analysis. Positive, significant correlations were found among spiritual perspective, self-transcendence, health status, and well-being. Fatigue was inversely correlated with health status and well-being. Self-transcendence and health status together explained 59% of the variance in well-being. The findings support Reed's theory of self-transcendence, in which there is the basic assumption that human beings have the potential to integrate difficult life situations. This study contributes to the growing body of evidence that conceptualizes homeless persons as having spiritual, emotional, and physical capacities that can be used by health care professionals to promote well-being in this vulnerable population.

Executing Medical Guidelines on the Web: Towards Next Generation Healthcare

NASA Astrophysics Data System (ADS)

Argüello, M.; Des, J.; Fernandez-Prieto, M. J.; Perez, R.; Paniagua, H.

There is still a lack of full integration between current Electronic Health Records (EHRs) and medical guidelines that encapsulate evidence-based medicine. Thus, general practitioners (GPs) and specialised physicians still have to read document-based medical guidelines and decide among various options for managing common non-life-threatening conditions where the selection of the most appropriate therapeutic option for each individual patient can be a difficult task. This paper presents a simulation framework and computational test-bed, called V.A.F. Framework, for supporting simulations of clinical situations that boosted the integration between Health Level Seven (HL7) and Semantic Web technologies (OWL, SWRL, and OWL-S) to achieve content layer interoperability between online clinical cases and medical guidelines, and therefore, it proves that higher integration between EHRs and evidence-based medicine can be accomplished which could lead to a next generation of healthcare systems that provide more support to physicians and increase patients' safety.

[The importance of psychosocial care].

PubMed

Menyhért, Mónika; Csikós, Agnes; Radványi, Ildikó; Busa, Csilla

2014-09-14

Psychosocial support is very important for cancer patients, because it affects the quality of life of the patients and the course of the disease. It helps the family to deal with difficult situations and prepare for future challenges. The aim of this study was to analyse the psychosocial care in the Pécs-Baranyai Hospice Foundation and answer the following questions: what are the characteristics of psychosocial care and how many people receive this support. It was a retrospective study. During the 8 years examined, 36% of the patients (273 persons) asked or proposed by anyone psychosocial support for the family. However, meeting between the patient and expert evolved only in 49% of the 273 patients and, thus, only 18% of the patients received psychosocial support. In the Pécs-Baranya Hospice Foundation less patients received psychosocial support, than those who would need it. Psychosocial care is not yet an integral part of hospice care in practice.

[Ulcerating Herpes simplex infections in intensive care patients].

PubMed

Fischer, M; Wohlrab, J; Radke, J; Marsch, W C; Soukup, J

2002-11-01

Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.

[Psychiatric patients, dialysis, kidney transplant: case report and discussion].

PubMed

Melamed, Yuval; Klein, Osnat; Bzura, Georgina; Finkel, Boris; Bleich, Avi; Bernheim, Jack

2005-05-01

Psychiatric patients' coping capacity with various life situations is limited due to their mental illness. This difficulty is even more pronounced when dealing with severe physical conditions such as kidney failure, the need for dialysis and kidney transplant. In the past, similar to patients who suffered from additional physical conditions, patients with major psychiatric disorders, long-term psychotic illness such as schizophrenia, were not considered candidates for dialysis treatment. Although these attitudes have changed, there is still concern that psychiatric patients would find it difficult to cooperate with the long-term treatment required following kidney transplant, and that lack of careful adherence to medication regimens could lead to rejection of the implant. This article describes five mentally ill individuals who suffer from terminal kidney failure, and illustrates the dilemma associated with dialysis and kidney transplant in psychiatric patients. Close cooperation between the psychiatric staff and the nephrology team can lead to the hoped for outcomes.

Giant perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass.

PubMed

Wang, Edward; Blackham, Ruth; Tan, Jeremy; Hamdorf, Jeffrey

2017-04-11

Perforation of a marginal ulcer (MU) is a complication of Roux -en-Y gastric bypass that can be life-threatening. We report a case of a perforated MU that presented 7 months after surgery with several interesting points for discussion. Firstly, the presentation of the ulcer was cryptic with unreliable investigations. Secondly, the ulcer presented again even after anastomotic revision surgery. Finally, the ulcer and the sepsis associated with perforation presented after months of poor nutritional intake with profound hypoalbuminaemia. Perforated MUs causing malnutrition pose clinicians with the difficult decision of which operation to offer; patch repair, revision of the anastomosis or reversal surgery. This case illustrates that primary reversal surgery for a perforated recurrent MU may be the most appropriate surgical management in this clinical situation. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Situational Strategies for Self-Control

PubMed Central

Duckworth, Angela L.; Gendler, Tamar Szabó; Gross, James J.

2015-01-01

Exercising self-control is often difficult, whether declining a drink in order to drive home safely, passing on the chocolate cake to stay on a diet, or ignoring text messages to finish reading an important paper. But enacting self-control isn’t always difficult, particularly when it takes the form of proactively choosing or changing situations in ways that weaken undesirable impulses or potentiate desirable ones. Examples of situational self-control include the partygoer who chooses a seat far from where drinks are being poured, the dieter who asks the waiter not to bring around the dessert cart, and the student who goes to the library without a cell phone. Using the process model of self-control, we argue that the full range of self-control strategies can be organized by considering the timeline of the developing tempting impulse. Because impulses tend to grow stronger over time, situational self-control strategies—which can nip a tempting impulse in the bud— may be especially effective in preventing undesirable action. Ironically, we may underappreciate situational self-control for the same reason it is so effective, namely that by manipulating our circumstances to advantage we are often able to minimize the in-the-moment experience of intrapsychic struggle typically associated with exercising self-control. The supreme art of war is to subdue the enemy without fighting.—Sun Tzu, The Art of War PMID:26817725

Women's health status in Poland in the transition to a market economy.

PubMed

Wróblewska, Wiktoria

2002-03-01

Since 1989 Poland has been experiencing large-scale social and economic changes as a result of the reforms associated with the transition to a market economy. This study uses a 1996 Health Survey of over 20,000 women to examine the impact of the new socio-economic situation and of women's multiple roles on their health at the early stage of transition. We investigated the importance of selected economic, socio-demographic and cultural determinants in explaining differences in women's health status in Poland, focusing on education level, (un)employment, living conditions, marital status, smoking and life style. There are health inequalities between men and women in Poland based on life expectancy, chronic diseases and health self-assessment. Some of these, especially the large differences between life expectancy at working ages, may be attributed to the difficult socio-economic situation. The multivariate analysis of women's self-assessed health and morbidity from selected chronic diseases indicated substantial inequalities in health. Together with the behavioural and cultural risk factors recognized by medicine, such as obesity, lack of physical exercise and smoking, the paper shows the crucial role of economic factors in influencing Polish women's health. Women whose financial position is poor are more likely to assess their health as less than good, to suffer from respiratory and circulatory systems' diseases and report neurotic problems. Other factors, strongly connected with the transition process in Poland, which contribute to health problems are lack of employment and low educational level, particularly for younger women. Women's marital and parental status are also important predictors of some categories of health problems; however, their influence varies for women of different ages. Our survey also supports the thesis that loneliness in old age, defined on the basis of living in a one-person household, may be negatively correlated with health status.

[End of life conflicts in palliative care: a systematic review of the literature].

PubMed

Mpinga, Emmanuel Kabengele; Chastonay, Philippe; Rapin, Charles-Henri

2006-09-01

To evaluate the extent and the quality of the research related to End of life conflicts in palliative care from 1995 to 2004. Accessible Literature of several electronic data bases (BDSP, Cinhal, Cochrane, Francis, Medline, Psychinfo, Saphir, Scopus and Web of science) as well as the grey literature. Studies published in French and English between 1995 and 2004 reporting end of life conflicts, tensions, disagreements, disputes in the context of palliative care. One hundred and two studies were included (87.2% published in English, 12.8% in French). Study designs include revues 27.4%), cross-sections 18.6% and case studies 18.6%. Reported conflicts are related to ethical issues 26.2%, to care 19.1%, to tensions between professionals and patients or families 11.1%, to team experiences 9%. Six studies 5.8% give prevalence figures of conflicts. Half of the studies 51.3% identify possible causes of conflicts: communication issues, euthanasia and suicide assistance demands, autonomy of patients, non respect of advance directives, cultural differences. Ten studies 9.8% identify specifically some effects of the conflicts: moral distress of patients; stress, burn out and guilt of health professionals; lack of trust between doctors and patients or families. Conflicts are mainly resolved through mediation and ethical discussions. Research data on end of life conflicts is scarce at all levels (quantity, quality, methods, social impact, and epistemology). A better understanding of end of life conflict might foster a more adequate management of difficult situations and ultimately a more peaceful death of patients, mourning of families and every day work of health professionals

Pain and tactile dissociation, derealization and depersonalization symptoms in women and recalled traumatic events in childhood, adolescence and early adulthood.

PubMed

Smiatek-Mazgaj, Bogna; Sobański, Jerzy A; Rutkowski, Krzysztof; Klasa, Katarzyna; Dembińska, Edyta; Müldner-Nieckowski, Łukasz; Cyranka, Katarzyna; Mielimąka, Michał

2016-01-01

The symptoms of dissociation, depersonalization and derealization are often associated with exposure of patients to mental and physical injuries, usually occurring in childhood. Most of these observations were carried out in populations of patients with various disorders (posttraumatic, conversion-dissociation, personality disorders - especially borderline), who reported their exposure to adverse life circumstances through questionnaire interviews. Assessment of the risk associated with various traumatic events in childhood and adolescence concerning the symptoms of pain and tactile dissociation, depersonalization and derealization. The coexistence of the earlier life circumstances and the currently existing symptoms was examined on the basis of KO "0" Symptom Checklist and Life Inventory, completed prior to treatment in a day hospital for neurotic disorders. In the group of 2582 women, patients of a day hospital for neurotic and personality disorders, the symptoms of pain and tactile dissociation, depersonalization and derealization were present in 24-36 % of patients, while the maximum severity of these symptoms reported approximately 4-8 % of patients. The studied patients reported the exposure during childhood and adolescence (before 18yo) to numerous traumatic events of varying severity and frequency, including hostility of one parent (approximately 5% of respondents), the sexual initiation before 13yo (1%), worse than peers material conditions (23%), harassment of the family of origin (2%), reluctance of their peers (9%). Conducted regression analysis showed illustrated by the coefficients OR (odds ratios) a statistically significant relationship between the majority of the analyzed symptoms and many of the listed events, such as being regarded as worse than siblings, mother's anger in the situation of the patient's disease in childhood, lack of support, indifference of parent, poverty and worseness of the family of origin, inferior position in the classroom and the school grades, total sexual unawareness, incest or its attempt. The symptoms of dissociation, depersonalization and derealization occurred in significantly more patients reporting burdening life events - difficult situations in childhood and adolescence. Therefore, in clinical practice in patients presenting such symptoms, regardless of diagnosis (e. g. a specific neurotic disorder), we can expect revealing information about such events.

An investigation of the role of some person and situation variables in multiple cue probability learning.

PubMed

Bayindir, Mustafa; Bolger, Fergus; Say, Bilge

2016-07-19

Making decisions using judgements of multiple non-deterministic indicators is an important task, both in everyday and professional life. Learning of such decision making has often been studied as the mapping of stimuli (cues) to an environmental variable (criterion); however, little attention has been paid to the effects of situation-by-person interactions on this learning. Accordingly, we manipulated cue and feedback presentation mode (graphic or numeric) and task difficulty, and measured individual differences in working memory capacity (WMC). We predicted that graphic presentation, fewer cues, and elevated WMC would facilitate learning, and that person and task characteristics would interact such that presentation mode compatible with the decision maker's cognitive capability (enhanced visual or verbal WMC) would assist learning, particularly for more difficult tasks. We found our predicted main effects, but no significant interactions, except that those with greater WMC benefited to a larger extent with graphic than with numeric presentation, regardless of which type of working memory was enhanced or number of cues. Our findings suggest that the conclusions of past research based predominantly on tasks using numeric presentation need to be reevaluated and cast light on how working memory helps us learn multiple cue-criterion relationships, with implications for dual-process theories of cognition.

Practical implications of pre-employment nurse assessments.

PubMed

Kuthy, James E; Ramon, Cheree; Gonzalez, Ronald; Biddle, Dan A

2013-01-01

Hiring nurses is a difficult task that can have serious repercussions for medical facilities. If nurses without proper skills are hired, patients can suffer from insufficient quality of care and potentially life-threatening conditions. Nurse applicants' technical knowledge is extremely important to avoid negative outcomes; however, there are soft skills that factor into their success, such as bedside manner, personality, communication, and decision making. In order for medical facilities to select and maintain high-performing nurse staff, hiring managers must incorporate evaluations for these types of skills in their hiring process. The current study focused on using content/criterion-related validation design to create assessments by which nurse applicants can be evaluated for both technical knowledge/skills and soft skills. The study included participation of more than 876 nursing staff members. To rank applicants on divergent skills, 3 assessment types were investigated, resulting in the creation of an assessment with 3 components. The clinical, situational, and behavioral components that were created measure applicants' job knowledge, interpersonal competency in medical facility-related situations, and aspects of personality and behavior, respectively. Results indicate that using the assessment can predict 45% of a nurse applicant's future job performance. Practical implications include hiring and maintaining a higher quality of nurses and decreased hiring costs.

Communication and cooperation in networked environments: an experimental analysis.

PubMed

Galimberti, C; Ignazi, S; Vercesi, P; Riva, G

2001-02-01

Interpersonal communication and cooperation do not happen exclusively face to face. In work contexts, as in private life, there are more and more situations of mediated communication and cooperation in which new online tools are used. However, understanding how to use the Internet to support collaborative interaction presents a substantial challenge for the designers and users of this emerging technology. First, collaborative Internet environments are designed to serve a purpose, so must be designed with intended users' tasks and goals explicitly considered. Second, in cooperative activities the key content of communication is the interpretation of the situations in which actors are involved. So, the most effective way of clarifying the meaning of messages is to connect them to a shared context of meaning. However, this is more difficult in the Internet than in other computer-based activities. This paper tries to understand the characteristics of cooperative activities in networked environments--shared 3D virtual worlds--through two different studies. The first used the analysis of conversations to explore the characteristics of the interaction during the cooperative task; the second analyzed whether and how the level of immersion in the networked environments influenced the performance and the interactional process. The results are analyzed to identify the psychosocial roots used to support cooperation in a digital interactive communication.

Issues in conducting cross-cultural research: implementation of an agreed international protocol [corrected] designed by the WHOQOL Group for the conduct of focus groups eliciting the quality of life of older adults.

PubMed

Hawthorne, Graeme; Davidson, Natasha; Quinn, Kathryn; McCrate, Farah; Winkler, Ines; Lucas, Ramona; Kilian, Reinhold; Molzahn, Anita

2006-09-01

Multi-centre and cross-cultural research require the use of common protocols if the results are to be either pooled or compared. All too often adherence to protocols is not discussed in reports and where it is reported poor adherence is frequently noted. This paper discusses the use of international guidelines developed by WHOQOL Field Centres to conduct and report focus groups aimed at eliciting key concepts of quality of life among older adults. This was the first step in the development of the WHOQOL-OLD instrument. Although there was overall adherence to the agreed guidelines, there were some differences in the level of reporting, even after participating Field Centres had the opportunity to explain their reports. The reasons for these discrepancies are reported. It is concluded that because of local situations, it is difficult to achieve identical implementation of multi-centre cross-cultural protocols and that the highest standards of auditing are required if findings are to be compared. Suggestions for how such protocols can be improved are given.

[Psychosexual functioning of women after breast cancer therapy].

PubMed

Mroczek, Bozena; Kurpas, Donata; Grochans, Elzbieta; Kuszmar, Grazyna; Rotter, Iwona; Zułtak-Baczkowska, Katarzyna; Karakiewicz, Beata

2012-01-01

The study was to assess psychosexual functioning of women after breast cancer treatment, since this problem is very rarely discussed in Polish professional literature. Our study involved 103 women after breast cancer treatment. The questionnaire was based on the Likert scale, the Beck Depression Inventory, and the authors' own questions. Some 52% of respondents were operated in 2002-2008; 93% had a radical mastectomy or a breast-sparing operation without reconstruction. About 71% accepted themselves before falling ill, and 65% regarded themselves as pretty. After surgery 57% felt attractive as sexual partners, 48.5% found it difficult to look at themselves naked, and 37.9% were embarrassed in their partners' presence. Some 26.21% of the women had a very good and 42.71% had a satisfactory sexual life before the disease. Following surgery, 54% did not notice any changes in their partners' behaviour, 14% avoided intimate situations, and 11% have not had sexual intercourse since the operation. In the relationships where sex was important, the quality of sexual intercourse improved. A factor which contributes to successful sexual life of a woman is her acceptance of her body and her feeling of attractiveness.

Difficulties in everyday life: young persons with attention-deficit/hyperactivity disorder and autism spectrum disorders perspectives. A chat-log analysis.

PubMed

Ahlström, Britt H; Wentz, Elisabet

2014-01-01

This study focuses on the everyday life of young persons with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). There are follow-up studies describing ADHD, and ASD in adults, and residual impairments that affect life. Few qualitative studies have been conducted on the subject of their experiences of everyday life, and even fewer are from young persons' perspectives. This study's aim was to describe how young persons with ADHD and ASD function and how they manage their everyday life based on analyses of Internet-based chat logs. Twelve young persons (7 males and 5 females aged 15-26) diagnosed with ADHD and ASD were included consecutively and offered 8 weeks of Internet-based Support and Coaching (IBSC). Data were collected from 12 chat logs (445 pages of text) produced interactively by the participants and the coaches. Qualitative content analysis was applied. The text was coded and sorted into subthemes and further interpreted into themes. The findings revealed two themes: "fighting against an everyday life lived in vulnerability" with the following subthemes: "difficult things," "stress and rest," and "when feelings and thoughts are a concern"; and the theme "struggling to find a life of one's own" with the following subthemes: "decide and carry out," "making life choices," and "taking care of oneself." Dealing with the problematic situations that everyday encompasses requires personal strength and a desire to find adequate solutions, as well as to discover a role in society. This study, into the provision of support and coaching over the Internet, led to more in-depth knowledge about these young persons' everyday lives and revealed their ability to use IBSC to express the complexity of everyday life for young persons with ADHD and ASD. The implications of the findings are that using online coaching makes available new opportunities for healthcare professionals to acknowledge these young persons' problems.

Rendezvous with IQ: Metacognition in Real-Life Situations

ERIC Educational Resources Information Center

Al-Hilawani, Yasser A.

2018-01-01

The purpose of this study was to examine the relationship between metacognition as measured in real-life situations and IQ scores as reflected by performance on the Raven Standard Progressive Matrices Scale. It is also intended in this study to report on whether or not there were significant differences in performance on the metacognitive…

Situational and Intrapersonal Predictors of School and Life Satisfaction of Elementary School Students

ERIC Educational Resources Information Center

Drost, Amy Linden

2012-01-01

This study examined predictors of school and life satisfaction of fifth-grade students. Two situational predictor variables (school climate and school stress) and two intrapersonal predictor variables (locus of control and academic self-concept) were examined. It was hypothesized that positive school climate, low levels of school stress, internal…

High use of over-the-counter analgesic; possible warnings of reduced quality of life in adolescents - a qualitative study.

PubMed

Skarstein, Siv; Lagerløv, Per; Kvarme, Lisbeth Gravdal; Helseth, Sølvi

2016-01-01

Use of over-the-counter analgesics among adolescents has increased markedly. High consumption of over-the-counter analgesics among adolescents is associated with frequent pain, lower self-esteem, reduced sleep, lower educational ambition, binge drinking, higher caffeine consumption, and part-time employment. Knowledge about life experiences of adolescents who frequently use over-the-counter analgesics may be useful to prevent health problems. The purpose of the study was to increase knowledge about adolescents who suffer from frequent pain and have a high consumption of over-the-counter analgesics. A qualitative study, employing one-on-one, in-depth interviews using a thematic interview guide. Data were collected in Norway in 2013-2014. Three boys and sixteen girls; aged 14-16 years, who continuously consumed over-the-counter analgesics were recruited from ten high schools in urban and suburban districts. Candidate participants were excluded if they were medically diagnosed with an acute or chronic illness, requiring extended use of over-the-counter analgesics within the last year. The interviews were taped, transcribed and analysed as text according to Kvale's three contexts of interpretation: self-understanding, common sense and theory. All participants disclosed unresolved physical and psychosocial distress characterized as pain. Frequent pain from various body parts made everyday life challenging. Methods of pain self-appraisal and over-the-counter analgesics use often mimicked maternal patterns. Participants reported being raised under unpredictable circumstances that contributed to long lasting family conflicts and peer-group problems. Participants wanted to feel appreciated and to be socially and academically successful. However, pain reduced their ability to manage everyday life, hampered experienced possibilities for success, and made social settings difficult. Childhood experiences influence how adolescents experience pain and use over-the-counter analgesics. Coping with difficult situations or attempting to mask symptoms with over-the-counter analgesics can perpetuate and amplify underlying problems. High consumption of over-the-counter analgesics and frequent pain may be warning signs of adolescents with possible health threatening conditions and reduced quality of life. These adolescent might be in need of support from school nurses and General Practitioners. This study identifies new perspectives that may lead to novel approaches to identify, guide, and support adolescents with frequent pain and high consumption of over-the-counter analgesics.

Gender differences in patients with heart failure.

PubMed

Strömberg, Anna; Mårtensson, Jan

2003-04-01

The aim of this literature review was to review and discuss the differences between men and women with heart failure with regard to epidemiology, aetiology, diagnostics, prognosis, pharmacological and non-pharmacological treatment, and the impact of heart failure on psychosocial factors and healthcare utilisation. Two primary health care resources, MEDLINE and CINAHL, were selected to review the current literature. In MEDLINE, 234 abstracts dealing with heart failure and gender/sex were found and in CINAHL, 20 abstracts. Men have a higher incidence of heart failure, but the overall prevalence rate is similar in both sexes, since women survive longer after the onset of heart failure. Women tend to be older when diagnosed with heart failure and more often have diastolic dysfunction than men. The extent of sex differences in treatment, hospital cost and quality of care can partly be explained by age differences. The life situations for men and women with heart failure are different. Physical and social restrictions affecting daily life activities are experienced as most bothersome for men, whereas restrictions affecting the possibility to support family and friends are most difficult to accept for women. Women with heart failure ascribe more positive meanings to their illness. Despite this, women seem to experience a lower overall quality of life than men. The known gender differences in patients with heart failure need to be highlighted in guidelines as well as implemented in standard care.

TU-D-201-00: Use of End-Of-Life Brachytherapy Devices

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

2015-06-15

Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices:more » remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning of “end-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications of “end-of-life” policy Review other possible approaches to “end-of-life” issue.« less

TU-D-201-03: Proposed Solutions to End-Of-Life Issue

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ouhib, Z.

2015-06-15

Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices:more » remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning of “end-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications of “end-of-life” policy Review other possible approaches to “end-of-life” issue.« less

TU-D-201-01: Definition and Purpose of End-Of-Life for Brachytherapy Devices and Software

DOE Office of Scientific and Technical Information (OSTI.GOV)

Melhus, C.

2015-06-15

Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices:more » remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning of “end-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications of “end-of-life” policy Review other possible approaches to “end-of-life” issue.« less

[End-of-Life Care in Intensive Care Units: Nursing strategies of family involvement at the end of life].

PubMed

Cyrol, Katharina; Fröhlich, Martin R; Piatti, Francesca; Imhof, Lorenz

2018-06-01

Background: Family members of people dying in the intensive care unit (ICU) are exposed to many stress factors and they often do not experience involvement in End-of-Life (EoL) situations. For example, they criticize a low degree of participation in patients care, delayed or incomplete information and lack of privacy. Even nursing staff is facing various obstacles in EoL situations in ICUs. Aim: This study investigates strategies used by ICU nursing staff in German-speaking Switzerland to increase family members participation in situations at the end of life. Method: Data was collected by conducting 12 semi-structured interviews using an approach based on Grounded Theory. A model was developed to explain nursing strategies for family involvement in EoL situations in the ICU. Conclusions: Nurses provide personal space and tranquillity for family members and allow them to be present at any time. Against this background, they support family members and enable them to say goodbye consciously to a loved one. Subsequent work should examine the effectiveness of the strategies described, particularly in terms of stress reactions displayed by family members in the aftermath of EoL situations. In practice, family members should be provided space for privacy. The entire healthcare team is recommended to identify and pursue common values and objectives. Moreover, intradisciplinary exchange and mentoring need to be encouraged. In order to prepare future nursing staff for EoL situations in the ICU, recognizing and promoting their educational skills is mandatory.

From Abstinence to Relapse: A Preliminary Qualitative Study of Drug Users in a Compulsory Drug Rehabilitation Center in Changsha, China

PubMed Central

Yang, Mei; Mamy, Jules; Gao, Pengcheng; Xiao, Shuiyuan

2015-01-01

Background Relapse among abstinent drug users is normal. Several factors are related to relapse, but it remains unclear what individuals’ actual life circumstances are during periods of abstinence, and how these circumstances facilitate or prevent relapse. Objective To illuminate drug users’ experiences during abstinence periods and explore the real-life catalysts and inhibitors contributing to drug use relapse. Method Qualitative in-depth interviews were conducted with 20 drug users recruited from a compulsory isolated drug rehabilitation center in Changsha. The interviews were guided by open-ended questions on individuals’ experiences in drug use initiation, getting addicted, treatment history, social environment, abstinence, and relapse. Participants were also encouraged to share their own stories. Interviews were digitally recorded and fully transcribed. The data of 18 participants who reported abstinence experiences before admission were included in the analyses. The data were analyzed using a thematic analysis with inductive hand coding to derive themes. Results Most drug users were able to successfully abstain from drugs. During abstinence, their lives were congested with challenges, such as adverse socioeconomic conditions, poor family/social support, interpersonal conflicts, and stigma and discrimination, all of which kept them excluded from mainstream society. Furthermore, the police’s system of ID card registration, which identifies individuals as drug users, worsened already grave situations. Relapse triggers reported by the participants focused mainly on negative feelings, interpersonal conflicts, and stressful events. Craving was experienced but not perceived as a relapse trigger by most participants. Conclusions This study of in-depth interview with drug users found evidence of situations and environments they live during abstinence appear rather disadvantaged, making it extremely difficult for them to remain abstinent. Comprehensive programs on relapse prevention that acknowledge these disadvantages are implicated. PMID:26107639

In search of the glass ceiling: gender and recruitment to management in Norway's state bureaucracy.

PubMed

Storvik, Aagoth Elise; Schøne, Pål

2008-12-01

There are still fewer female than male managers in Norway's state bureaucracy. This article asks if there are organizational barriers which prevent women from entering these positions. Is there really a glass ceiling, or must one look outside the organizational environment to find an explanation? Is it rather the case that the scarcity of female managers is caused by women's own preferences or their life situations outside work? Or do both contribute to the situation? The study shows that female managers are treated just as well as male managers in central parts of the state bureaucracy. Employers give equal shares of respect and attention to both genders. Female managers are encouraged to apply for the same number of jobs as men and are offered an equal number of jobs as men when they apply; in fact, women are offered more jobs than men, when one controls for the number of job applications. This indicates that organizational barriers are not the problem. The study also shows that there are no differences in work orientation between male and female managers. Female managers are just as ambitious as male managers. Nor do female managers find it more difficult than male managers to combine work and family life. So, how can one explain the low number of female managers? The study shows that one reason can be that female managers apply for management jobs less often than their male colleagues. The cause of this seems to be anticipated discrimination rather than lack of ambition or self-confidence. However, this slows down women's movement into higher management positions in the state bureaucracy.

Parents Studying Medicine – the dichotomy of studying with a family

PubMed Central

Iden, Kirstin; Nürnberger, Frank; Sader, Robert; Dittrich, Winand

2012-01-01

Introduction: In this article the personal study and life situation of parents who are also medical students at the Medical School of the Goethe University Frankfurt am Main is discussed. There is a special focus on the topics “studying with children” and “family-friendly university”, which have been present in discussions about university development and in the daily life of academics, especially during the last decade. The workgroup “Individual Student Services” at the medical faculty at the Goethe University tries to meet the necessities of the individual study courses and to support the study success with a new counselling and student service concept. Methods: The experience of parents studying medicine was recorded in semi-structured interviews (Date: April 2010), which were held as part of the sponsored pilot project on part-time medical studies (“Pilot Project Part-time Medical Studies”). Additionally, study results from the Medical School of the Goethe University Frankfurt am Main were integrated as well as a literature analysis. Results: It was found that the teaching demands and support services, which have been suggested and needed for years now, have been partially implemented and are without sufficient support at the faculty level to date. Thus the current situation of medical students with children is still difficult and seems a big challenge for everyone involved. Solution: As part of the “Individual Student Services” a new pilot project on part-time medical studies was established in November 2009. Only the use of new, unconventional and innovative ideas allows universities to adequately support the changing and heterogeneous student population and support them to successfully completing their medical studies. PMID:22558026

[Organising and supporting the end of life when faced with a refusal of care].

PubMed

Rautureau, Pascal

2018-04-01

Often ethically complex, end-of-life situations can mean nursing teams are confronted with a refusal of care. Through a representative clinical situation, a nurse describes the support provided by a multidisciplinary team, in the home, to comply with the wishes of a person at the end of life, support the family, anticipate possible difficulties and organise adapted care which respects all those concerned. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

The Impact of the Current Economic Crisis on the Demand for Higher Education: An Analysis of Spanish Distance Education Universities

ERIC Educational Resources Information Center

Reina-Paz, María Dolores; Rodríguez-Oromendía, Ainhoa; Sevilla-Sevilla, Claudia

2012-01-01

Spain is currently experiencing a difficult economic situation, and in recent years a significant change has been observed in the behavior of the demand for educational programs as a result of this situation. Recent studies reveal a change in student demand that does not have the same effect on all academic institutions. Bearing this behavior in…

The Importance of Combat Ethics Training: Solidifying Marines Footing on the Moral High Ground

DTIC Science & Technology

2009-01-01

dilemma is often described as the choice between two potentially negative options. According to Marine Corps doctrine, an ethical dilemma is "the necessity...basis. There are situations where finding the morality in one of two negative courses is difficult, however this is not a situation ~--- - -- ---where...includes leadership, professionalism, and innovation in the military. implemented, and organizationally cumbersome. The reality is that younger Marine

Quality of life of French Canadian parents raising a child with autism spectrum disorder and effects of psychosocial factors.

PubMed

Cappe, Émilie; Poirier, Nathalie; Sankey, Carol; Belzil, Andréa; Dionne, Carmen

2018-04-01

This study aimed to investigate the quality of life of parents of a child with autism spectrum disorder in Quebec. Seventy-seven participants completed a questionnaire with socio-biographic information and five self-assessed scales, to measure perceived stress, social support and control, coping strategies, and quality of life. Perception of their child's autonomy level, of the severity of the disorder, of the family's income, as well as changes in their professional or familial organization influenced parents' quality of life. Perceiving their situation as a threat predicted poor quality of life, whereas satisfaction of social support predicted good quality of life. In addition, parents who used problem solving and support-seeking coping strategies had a better relationship with their child, whereas those who used more emotion-centered coping strategies struggled. Lastly, parents who felt they had the power to contribute to their child's development were more satisfied and less disturbed. Beyond the parents' actual situation, our results underscore the importance of paying attention to their own perception of the situation in order to provide them with appropriate support.

Eight Personal Characteristics Associated with the Power to Live with Disasters as Indicated by Survivors of the 2011 Great East Japan Earthquake Disaster.

PubMed

Sugiura, Motoaki; Sato, Shosuke; Nouchi, Rui; Honda, Akio; Abe, Tsuneyuki; Muramoto, Toshiaki; Imamura, Fumihiko

2015-01-01

People perceive, judge, and behave differently in disasters and in a wide range of other difficult situations depending on their personal characteristics. The power to live, as captured by characteristics that are advantageous for survival in such situations, has thus far been modeled in arbitrary ways. Conceptualizing such characteristics in more objective ways may be helpful for systematic preparations for future disasters and life difficulties. Here, we attempted to identify the major factors of the power to live by summarizing the opinions of survivors of the 2011 Great East Japan Earthquake disaster. We conducted personal interviews with 78 survivors about their survival experiences and elicited their opinions about the power to live as relevant to those experiences. We then incorporated these opinions into a questionnaire that was completed by 1400 survivors. Factor analysis identified eight factors related to the power to live: leadership, problem solving, altruism, stubbornness, etiquette, emotional regulation, self-transcendence, and active well-being. All factors had sufficient internal construct validity, and six of them showed significant associations with one or more measures of survival success in the disaster, including immediate tsunami evacuation, problem solving in refugee situations, recovery during reconstruction, physical health, and mental health. Overall, the personal characteristics described by the eight factors largely overlap with those described in previous arbitrary models. Further research should investigate the domains, phases, and contexts in which each factor contributes to survival, address whether the factors are rooted in nature or in nurture, and explore their psychological or physiological bases.

Eight Personal Characteristics Associated with the Power to Live with Disasters as Indicated by Survivors of the 2011 Great East Japan Earthquake Disaster

PubMed Central

Sugiura, Motoaki; Sato, Shosuke; Nouchi, Rui; Honda, Akio; Abe, Tsuneyuki; Muramoto, Toshiaki; Imamura, Fumihiko

2015-01-01

People perceive, judge, and behave differently in disasters and in a wide range of other difficult situations depending on their personal characteristics. The power to live, as captured by characteristics that are advantageous for survival in such situations, has thus far been modeled in arbitrary ways. Conceptualizing such characteristics in more objective ways may be helpful for systematic preparations for future disasters and life difficulties. Here, we attempted to identify the major factors of the power to live by summarizing the opinions of survivors of the 2011 Great East Japan Earthquake disaster. We conducted personal interviews with 78 survivors about their survival experiences and elicited their opinions about the power to live as relevant to those experiences. We then incorporated these opinions into a questionnaire that was completed by 1400 survivors. Factor analysis identified eight factors related to the power to live: leadership, problem solving, altruism, stubbornness, etiquette, emotional regulation, self-transcendence, and active well-being. All factors had sufficient internal construct validity, and six of them showed significant associations with one or more measures of survival success in the disaster, including immediate tsunami evacuation, problem solving in refugee situations, recovery during reconstruction, physical health, and mental health. Overall, the personal characteristics described by the eight factors largely overlap with those described in previous arbitrary models. Further research should investigate the domains, phases, and contexts in which each factor contributes to survival, address whether the factors are rooted in nature or in nurture, and explore their psychological or physiological bases. PMID:26132753

Novel nursing terminologies for the rapid response system.

PubMed

Wong, Elizabeth

2009-01-01

Nursing terminology with implications for the rapid response system (RRS) is introduced and proposed: critical incident nursing diagnosis (CIND), defined as the recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication; critical incident nursing intervention, defined as any indirect or direct care registered nurse-initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a CIND; and critical incident control, defined as a response that attempts to reverse a life-threatening condition. The current literature, research studies, meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. The current nursing diagnoses, nursing interventions, and nursing outcomes listed in the North American Nursing Diagnosis Association International Classification, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), respectively, are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of such standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations when activating the RRS. The North American Nursing Diagnosis Association International Classification, NIC, and NOC are urged to refine their classifications and include CIND, critical incident nursing intervention, and critical incident control. The RRS should incorporate standardized nursing terminology to describe patient care during life-threatening situations. Refining the diagnoses, interventions, and outcomes classifications will permit nursing researchers, among others, to conduct studies on the efficacy of the proposed novel nursing terminology when providing care to patients during life-threatening situations. In addition, including the proposed novel nursing terminology in the RRS offers a means of improving care in such situations.

Speech perception and quality of life of open-fit hearing aid users

PubMed Central

GARCIA, Tatiana Manfrini; JACOB, Regina Tangerino de Souza; MONDELLI, Maria Fernanda Capoani Garcia

2016-01-01

ABSTRACT Objective To relate the performance of individuals with hearing loss at high frequencies in speech perception with the quality of life before and after the fitting of an open-fit hearing aid (HA). Methods The WHOQOL-BREF had been used before the fitting and 90 days after the use of HA. The Hearing in Noise Test (HINT) had been conducted in two phases: (1) at the time of fitting without an HA (situation A) and with an HA (situation B); (2) with an HA 90 days after fitting (situation C). Study Sample Thirty subjects with sensorineural hearing loss at high frequencies. Results By using an analysis of variance and the Tukey’s test comparing the three HINT situations in quiet and noisy environments, an improvement has been observed after the HA fitting. The results of the WHOQOL-BREF have showed an improvement in the quality of life after the HA fitting (paired t-test). The relationship between speech perception and quality of life before the HA fitting indicated a significant relationship between speech recognition in noisy environments and in the domain of social relations after the HA fitting (Pearson’s correlation coefficient). Conclusions The auditory stimulation has improved speech perception and the quality of life of individuals. PMID:27383708

Swedish mothers and fathers of children with cancer: perceptions of well-being, social life, and quality care.

PubMed

Enskär, Karin; Hamrin, Elisabeth; Carlsson, Marianne; von Essen, Louise

2011-01-01

The overall aim was to describe and compare well-being, social life, and quality care among parents of children with cancer with respect to mothers versus fathers and whether the children were on versus. off treatment. The Life Situation Scale for Parents (LSS-P) was answered by 320 parents, comprising 85 mothers and 71 fathers of children on treatment, and 93 mothers and 71 fathers of children off treatment. The results show that the well-being of parents of children with cancer is affected by their child's situation, and that they experience such things as economic strain and a sense of being dependent on the care provided, especially during the child's treatment phase. Mothers whose children are receiving treatment see their life situation as less satisfying, and report being sadder and having lower self-esteem.

Arithmetic in Daily Life and Literacy. Literacy Lessons.

ERIC Educational Resources Information Center

Dalbera, Claude

In order not to waste the time of the people working hard and sacrificing to become literate, literacy must offer them a real opportunity to change their life situation. Although many literacy programs are designed to fit the everyday lives and situations of their students, the same is not true for programs that teach arithmetic. Most adults…

The Role of Person Versus Situation in Life Satisfaction: A Critical Examination

ERIC Educational Resources Information Center

Heller, Daniel; Watson, David; Hies, Remus

2004-01-01

Two main theoretical approaches have been put forward to explain individual differences in life satisfaction: top-down (i.e., personological) and bottom-up (i.e., situational). The authors examine the relative merit of these 2 approaches and the psychological processes underlying top-down models. Consistent with a top-down approach, meta-analytic…

Learning to Live Safely: Persisting Life Situation No. 6. A Resource Guide for the Wisconsin EMR Curriculum.

ERIC Educational Resources Information Center

Quackenboss, Rita, Ed.; And Others

Presented in the resource guide for the Wisconsin curriculum for educable mentally retarded students are safety education teaching units. Learning to Live Safely" is the sixth in a series of persisting life situations. The guide lists behavioral objectives, activities, and annotated resource materials (with distributors' addresses) for…

Virtual Task-Based Situated Language-Learning with "Second Life": Developing EFL Pragmatic Writing and Technological Self-Efficacy

ERIC Educational Resources Information Center

Abdallah, Mahmoud M. S.; Mansour, Marian M.

2015-01-01

This paper reports on an experimental research study that aimed at investigating the effectiveness of employing a virtual task-based situated language learning (TBSLL) environment mediated by Second Life (SL) in developing EFL student teachers' pragmatic writing skills and their technological self-efficacy. To reach this goal, a control-only…

Metacognition in Real Life Situations and Study Skills and Habits: Two Types of Processes

ERIC Educational Resources Information Center

Al-Hilawani, Yasser A.

2016-01-01

The relationship between metacognition in real life situations and study skills and habits was examined using a sample of college students. Results showed no significant relationship between these two variables nor was there a significant relationship between study skills and reaction time as measured on the metacognitive test. However, there was…

Linear and nonlinear acoustic wave propagation in the atmosphere

NASA Technical Reports Server (NTRS)

Hariharan, S. I.; Yu, Ping

1988-01-01

The investigation of the acoustic wave propagation theory and numerical implementation for the situation of an isothermal atmosphere is described. A one-dimensional model to validate an asymptotic theory and a 3-D situation to relate to a realistic situation are considered. In addition, nonlinear wave propagation and the numerical treatment are included. It is known that the gravitational effects play a crucial role in the low frequency acoustic wave propagation. They propagate large distances and, as such, the numerical treatment of those problems become difficult in terms of posing boundary conditions which are valid for all frequencies.

Medical ethics in pediatric critical care.

PubMed

Orioles, Alberto; Morrison, Wynne E

2013-04-01

Ethically charged situations are common in pediatric critical care. Most situations can be managed with minimal controversy within the medical team or between the team and patients/families. Familiarity with institutional resources, such as hospital ethics committees, and national guidelines, such as publications from the American Academy of Pediatrics, American Medical Association, or Society of Critical Care Medicine, are an essential part of the toolkit of any intensivist. Open discussion with colleagues and within the multidisciplinary team can also ensure that when difficult situations arise, they are addressed in a proactive, evidence-based, and collegial manner. Copyright © 2013 Elsevier Inc. All rights reserved.

Mental health trajectories and their embeddedness in work and family circumstances: a latent state-trait approach to life-course trajectories.

PubMed

Cullati, Stéphane; Courvoisier, Delphine S; Burton-Jeangros, Claudine

2014-09-01

Mental health trajectories are known to be influenced by work and family circumstances. However, few studies have examined both of these influences simultaneously in a longitudinal manner. The life-course perspective stresses the importance of examining trajectories in terms of both stable and dynamic components. In this article we use structural equation models (latent state-trait, LST) to distinguish the stable and situational components of mental health trajectories and hypothesise that situational mental health is influenced by satisfaction with work and family, and this effect differs by gender. An analysis of data from a nationally representative sample of 1616 working Swiss residents (2000-2006) shows that mental health trajectories are mostly stable and only slightly sensitive to situational influences. However, situational influences in a given wave do predict situational influences in the next wave. Satisfaction with work and family influences situational mental health in both genders, but the impact is greater for men. In conclusion, the LST approach allows for the examination of mental health trajectories from a life-course perspective by distinguishing stable and situational components. Mental health trajectories are more stable and constant than they are dependent on work and family circumstances, and men are more sensitive to family circumstances than women. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons.

Prostatitis

MedlinePlus

Prostatitis Overview Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in ... produces fluid (semen) that nourishes and transports sperm. Prostatitis often causes painful or difficult urination. Other symptoms ...

4 Healthy Ways to Deal With Emotions

Cancer.gov

Emotions can be a healthy, normal response to difficult situations and people. But sometimes they can feel overwhelming, and we reach for other things – like cigarettes or “comfort foods” to deal.

Sexual risk as an outcome of social oppression: data from a probability sample of Latino gay men in three U.S. cities.

PubMed

Díaz, Rafael M; Ayala, George; Bein, Edward

2004-08-01

Based on data from a probability sample of 912 Latino gay men in 3 U.S. cities, a multivariate model of sexual risk was tested, including experiences of homophobia, racism, and poverty as predictors. Participants reported multiple instances of verbal and physical abuse, rude mistreatment, and discrimination on account of their sexual orientation and their race or ethnicity. Many reported experiences of poverty, such as inability to pay for basic necessities of food or shelter. Men who reported more instances of social discrimination and financial hardship were more psychologically distressed and more likely to participate in "difficult" sexual situations, as predicted. Participation in difficult sexual situations mediates the effects of social oppression and psychological distress on sexual risk behavior. (c) 2004 APA

Non-specific chronic orofacial pain patients' experiences of everyday life situations: a qualitative study.

PubMed

Wolf, Eva; Nilner, Maria; Petersson, Kerstin

2016-01-01

Chronic orofacial pain is a complex condition with consequences that affect daily living. The aim was to analyse nonspecific chronic orofacial pain patients'experiences of everyday life situations, using a qualitative approach. Eleven women and 3 men (21 to 77years) were selected through a purposive sampling among chronic orofacial pain patients referred to the Faculty of Odontology's orofacial pain unit at Malmö University, Malmö Sweden. All selected subjects agreed to participate. Data were obtained via two thematic in-depth interviews with each subject. Interviews were taped and transcribed verbatim.Text dealing with the subjects' daily experiences was identified in all interviews and analysed using qualitative content analysis that focused on manifest content. In everyday life situations, the analysis of nonspecific chronic orofacial pain patients' narrations exposed a fear of conflict, of personal weakness, and of the intangible; they also exposed self-blame and avoidance of fear-triggering situations. Eight of the 14 subjects did not spontaneously mention any situation in which they were content during daily living. When the patients spoke about everyday life experiences, the main finding was that unpleasant emotions dominated the subjects'experiences. In conclusion, the chronic orofacial pain condition cannot be understood as an isolated phenomenon; it must be considered in rela- tion to the person who is suffering from the condition.

Integration of immigrants into a new culture is related to poor sleep quality.

PubMed

Voss, Ursula; Tuin, Inka

2008-08-10

This article reports on the relationship between cultural influences on life style, coping style, and sleep in a sample of female Portuguese immigrants living in Germany. Sleep quality is known to be poorer in women than in men, yet little is known about mediating psychological and sociological variables such as stress and coping with stressful life circumstances. Migration constitutes a particularly difficult life circumstance for women if it involves differing role conceptions in the country of origin and the emigrant country. The study investigated sleep quality, coping styles and level of integration in a sample of Portuguese (N = 48) and Moroccan (N = 64) immigrant women who took part in a structured personal interview. Sleep quality was poor in 54% of Portuguese and 39% of Moroccan women, which strongly exceeds reports of sleep complaints in epidemiologic studies of sleep quality in German women. Reports of poor sleep were associated with the degree of adoption of a German life style. Women who had integrated more into German society slept worse than less integrated women in both samples, suggesting that non-integration serves a protective function. An unusually large proportion of women preferred an information-seeking (monitoring) coping style and adaptive coping. Poor sleep was related to high monitoring in the Portuguese but not the Moroccan sample. Sleep quality appears to be severely affected in women with a migration background. Our data suggest that non-integration may be less stressful than integration. This result points to possible benefits of non-integration. The high preference for an information-seeking coping style may be related to the process of migration, representing the attempt at regaining control over an uncontrollable and stressful life situation.

Integration of immigrants into a new culture is related to poor sleep quality

PubMed Central

Voss, Ursula; Tuin, Inka

2008-01-01

Background This article reports on the relationship between cultural influences on life style, coping style, and sleep in a sample of female Portuguese immigrants living in Germany. Sleep quality is known to be poorer in women than in men, yet little is known about mediating psychological and sociological variables such as stress and coping with stressful life circumstances. Migration constitutes a particularly difficult life circumstance for women if it involves differing role conceptions in the country of origin and the emigrant country. Methods The study investigated sleep quality, coping styles and level of integration in a sample of Portuguese (N = 48) and Moroccan (N = 64) immigrant women who took part in a structured personal interview. Results Sleep quality was poor in 54% of Portuguese and 39% of Moroccan women, which strongly exceeds reports of sleep complaints in epidemiologic studies of sleep quality in German women. Reports of poor sleep were associated with the degree of adoption of a German life style. Women who had integrated more into German society slept worse than less integrated women in both samples, suggesting that non-integration serves a protective function. An unusually large proportion of women preferred an information-seeking (monitoring) coping style and adaptive coping. Poor sleep was related to high monitoring in the Portuguese but not the Moroccan sample. Conclusion Sleep quality appears to be severely affected in women with a migration background. Our data suggest that non-integration may be less stressful than integration. This result points to possible benefits of non-integration. The high preference for an information-seeking coping style may be related to the process of migration, representing the attempt at regaining control over an uncontrollable and stressful life situation. PMID:18691437

Quality of Life and Child Development. Working Papers in Early Childhood Development 20.

ERIC Educational Resources Information Center

Amar, Jose Juan Amar

In Latin America and the Caribbean, poverty is not merely a problem of marginalized communities. It is the situation in which 240 million people--50 percent of the population--are living. This report describes research undertaken by the Quality of Life Project, which aims to improve the situation of children in these disadvantaged communities. The…

Relatives in end-of-life care--part 2: a theory for enabling safety.

PubMed

Ohlén, Joakim; Andershed, Birgitta; Berg, Christina; Frid, Ingvar; Palm, Carl-Axel; Ternestedt, Britt-Marie; Segesten, Kerstin

2007-02-01

To develop a goal-oriented praxis theory for enabling safety for relatives when an adult or older patient is close to end-of-life. This is the second part of a project focusing on the situation and needs of relatives in end-of-life care. Our interpretation of the existing corpus of knowledge pertaining to the needs of close relatives in this situation showed the significance of relatives' need for safety. The theory was developed step-by-step, through triangulation of critical review of empirical research in the field, our own clinical experiences from end-of-life care, renewed literature searches and theoretical reasoning. The foundation for the theory is taken from the ethical intention of the philosopher Paul Ricoeur. From this, the theory focuses on relatives in the context of end-of-life care with the goal of enabling safety. This is proposed by four aphorisms functioning as safety enablers and these are directed towards the professional's approach and attitude, the relative's concern for the patient, the specific situation for the relative and the patient's end-of-life period as a period in the life of the relative. Implications for end-of-life practice are considered and include aspects for promotion of just institutions in end-of-life care, the significance of negotiated partnership in end-of-life care, enabling safety for relatives living in existential and practical uncertainty in connection with end-of-life care and diversity of relatives' preferences as they live through this particular period.

Person/Situation Selection Research: The Problem of Identifying Salient Situational Dimensions. Research Report No. 13.

ERIC Educational Resources Information Center

Schneider, Benjamin

The study was concerned with the persistent problem in conducting person/situation research--the identification of relevant dimensions or features of the situation. Since the usual strategy for discovering relevant perceptual dimension of organizational life is to ask organizational employees to respond to a set of predetermined questions, this…

Recruitment of child soldiers in Nepal: Mental health status and risk factors for voluntary participation of youth in armed groups.

PubMed

Kohrt, Brandon A; Yang, Minyoung; Rai, Sauharda; Bhardwaj, Anvita; Tol, Wietse A; Jordans, Mark J D

2016-08-01

Preventing involuntary conscription and voluntary recruitment of youth into armed groups are global human rights priorities. Pathways for self-reported voluntary recruitment and the impact of voluntary recruitment on mental health have received limited attention. The objective of this study was to identify risk factors for voluntarily joining armed groups, as well as the association of conscription status and mental health. In Nepal, interviews were conducted with 258 former child soldiers who participated in a communist (Maoist) revolution. Eighty percent of child soldiers joined 'voluntarily'. Girls were 2.07 times as likely to join voluntarily (95% CI, 1.03-4.16, p =0.04). Among girls, 51% reported joining voluntarily because of personal connections to people who were members of the armed group, compared to 22% of boys. Other reasons included escaping difficult life situations (36%), inability to achieve other goals in life (28%), and an appealing philosophy of the armed group (32%). Poor economic conditions were more frequently endorsed among boys (22%) than girls (10%). Voluntary conscription was associated with decreased risk for PTSD among boys but not for girls. Interventions to prevent voluntary association with armed groups could benefit from attending to difficulties in daily life, identifying non-violent paths to achieve life goals, and challenging the political philosophy of armed groups. Among boys, addressing economic risk factors may prevent recruitment, and prevention efforts for girls will need to address personal connections to armed groups, as it has important implications for preventing recruitment through new methods, such as social media.

Recruitment of child soldiers in Nepal: Mental health status and risk factors for voluntary participation of youth in armed groups

PubMed Central

Kohrt, Brandon A.; Yang, Minyoung; Rai, Sauharda; Bhardwaj, Anvita; Tol, Wietse A.; Jordans, Mark J. D.

2016-01-01

Preventing involuntary conscription and voluntary recruitment of youth into armed groups are global human rights priorities. Pathways for self-reported voluntary recruitment and the impact of voluntary recruitment on mental health have received limited attention. The objective of this study was to identify risk factors for voluntarily joining armed groups, as well as the association of conscription status and mental health. In Nepal, interviews were conducted with 258 former child soldiers who participated in a communist (Maoist) revolution. Eighty percent of child soldiers joined ‘voluntarily’. Girls were 2.07 times as likely to join voluntarily (95% CI, 1.03–4.16, p=0.04). Among girls, 51% reported joining voluntarily because of personal connections to people who were members of the armed group, compared to 22% of boys. Other reasons included escaping difficult life situations (36%), inability to achieve other goals in life (28%), and an appealing philosophy of the armed group (32%). Poor economic conditions were more frequently endorsed among boys (22%) than girls (10%). Voluntary conscription was associated with decreased risk for PTSD among boys but not for girls. Interventions to prevent voluntary association with armed groups could benefit from attending to difficulties in daily life, identifying non-violent paths to achieve life goals, and challenging the political philosophy of armed groups. Among boys, addressing economic risk factors may prevent recruitment, and prevention efforts for girls will need to address personal connections to armed groups, as it has important implications for preventing recruitment through new methods, such as social media. PMID:27524877

Study protocol: Determinants of participation and quality of life of adolescents with cerebral palsy: a longitudinal study (SPARCLE2)

PubMed Central

2010-01-01

Background Children and adults with impairments such as cerebral palsy have lower participation in life situations than able-bodied people. Less is known about their subjective perception of their lives, called their quality of life. During adolescence, rapid physical and psychological changes occur; although these may be more difficult for disabled than for able-bodied adolescents, little research has examined the lives of disabled adolescents. In 2003-4 a European Union funded project, SPARCLE, visited 818 children aged 8-12 years with cerebral palsy, sampled from population-based registers in nine European regions. The quality of life reported by these disabled children was similar to that of the general population but their participation was lower; levels of participation varied between countries even for children with similar severity of cerebral palsy. We are currently following up these children, now aged 13-17 years, to identify (i) to what extent contemporaneous factors (pain, impairment, psychological health and parental stress) predict their participation and quality of life, (ii) what factors modify how participation and quality of life at age 8-12 years are associated with participation and quality of life in adolescence, and (iii) whether differences between European countries in participation and quality of life can be explained by variations in environmental factors. Methods/Design Trained researchers will visit families to administer questionnaires to capture the adolescents' type and severity of impairment, socio-demographic characteristics, participation, quality of life, psychological health, pain, environmental access and parental stress. We will use multivariable models (linear, logistic or ordinal) to assess how adolescent participation, quality of life, psychological health, pain, environmental access and parental stress, vary with impairment and socio-demographic characteristics and, where possible, how these outcomes compare with general population data. For participation and quality of life, longitudinal analyses will assess to what extent these are predicted by corresponding levels in childhood and what factors modify this relationship. Structural equation modelling will be used to identify indirect relationships mediated by other factors. PMID:20504349

To end life or not to prolong life: the effect of message framing on attitudes toward euthanasia.

PubMed

Gamliel, Eyal

2013-05-01

People ascribe "euthanasia" different values and view it differently. This study hypothesized that a different framing of objectively the same euthanasia situations would affect people's attitudes toward it. Indeed, "positive" framing of euthanasia as not prolonging life resulted in more support for both passive and active euthanasia relative to "negative" framing of the objectively same situations as ending life. Two experiments replicated this pattern using either continuous measures of attitude or dichotomous measures of choice. The article offers two theoretical explanations for the effect of message framing on attitudes toward euthanasia, discusses implications of this effect, and suggests future research.

Communication after laryngectomy: an assessment of quality of life.

PubMed

Carr, M M; Schmidbauer, J A; Majaess, L; Smith, R L

2000-01-01

The purpose of this study was to examine quality of life in laryngectomees using different methods of communication. A survey was mailed to all the living laryngectomees in Nova Scotia. Patients were asked to rate their ability to communicate in a number of common situations, to rate their difficulty with several communication problems, and to complete the EORTC QLQ-C30 quality-of-life assessment tool. Sixty-two patients responded (return rate of 84%); 57% were using electrolaryngeal speech, 19% esophageal speech, and 8.5% tracheoesophageal speech. These groups were comparable with respect to age, sex, first language, education level, and years since laryngectomy. There were very few differences between these groups in ability to communicate in social situations and no difference in overall quality of life as measured by these scales. The most commonly cited problem was difficulty being heard in a noisy environment. Despite the fact that tracheoesophageal speech is objectively most intelligible, there does not seem to be a measurable improvement in quality of life or ability to communicate in everyday situations over electrolaryngeal or esophageal speakers.

Tips for safety in endoscopic submucosal dissection for colorectal tumors

PubMed Central

Naito, Yuji; Murakami, Takaaki; Hirose, Ryohei; Ogiso, Kiyoshi; Inada, Yutaka; Abdul Rani, Rafiz; Kishimoto, Mitsuo; Nakanishi, Masayoshi; Itoh, Yoshito

2017-01-01

In Japan, endoscopic submucosal dissection (ESD) becomes one of standard therapies for large colorectal tumors. Recently, the efficacy of ESD has been reported all over the world. However, it is still difficult even for Japanese experts in some situations. Right-sided location, large tumor size, high degree of fibrosis, difficult manipulation is related with the difficulty. However, improvements on ESD devices, suitable strategies, and increase of operators’ experiences enable us to solve these problems. In this chapter, we introduce recent topics about various difficult factors of colorectal ESD and the tips such as strategy, devices, injection, and traction method [Pocket-creation method (PCM) etc.]. PMID:28616400

Post-event processing in social anxiety disorder after real-life social situations - An ambulatory assessment study.

PubMed

Helbig-Lang, Sylvia; von Auer, Maxie; Neubauer, Karolin; Murray, Eileen; Gerlach, Alexander L

2016-09-01

Excessive post-mortem processing after social situations, a core symptom of social anxiety disorder (SAD), is thought to contribute to the perpetuation of social anxiety by consolidating negative self-schemata. Empirical findings on actual mechanisms underlying this so-called Post-Event Processing (PEP) are still scarce. The present study sought to identify variables associated with the experience of PEP after real-life social situations in a sample of 49 individuals diagnosed with SAD. Using an ambulatory assessment approach, individuals were asked to report on each distressing social event experienced during one week. A total of 192 events were captured. Hierarchical linear modeling indicated that next to trait social anxiety, the type of social situation (performance vs. interaction situations), self-focused attention, safety behavior use, and negative affect predicted levels of PEP after social situations. These findings add to the growing literature that emphasizes the importance of situational factors for the experience of PEP, and highlight potential venues to prevent it. Copyright © 2016 Elsevier Ltd. All rights reserved.

On the usefulness of the concept of presence in virtual reality applications

NASA Astrophysics Data System (ADS)

Mestre, Daniel R.

2015-03-01

Virtual Reality (VR) leads to realistic experimental situations, while enabling researchers to have deterministic control on these situations, and to precisely measure participants' behavior. However, because more realistic and complex situations can be implemented, important questions arise, concerning the validity and representativeness of the observed behavior, with reference to a real situation. One example is the investigation of a critical (virtually dangerous) situation, in which the participant knows that no actual threat is present in the simulated situation, and might thus exhibit a behavioral response that is far from reality. This poses serious problems, for instance in training situations, in terms of transfer of learning to a real situation. Facing this difficult question, it seems necessary to study the relationships between three factors: immersion (physical realism), presence (psychological realism) and behavior. We propose a conceptual framework, in which presence is a necessary condition for the emergence of a behavior that is representative of what is observed in real conditions. Presence itself depends not only on physical immersive characteristics of the Virtual Reality setup, but also on contextual and psychological factors.

Life stories of people on sick leave from work because of mild mental illness, pain and fatigue.

PubMed

Brataas, Hildfrid V; Evensen, Aud E

2015-01-01

Many people experience some form of mild mental illness, chronic pain and fatigue feelings that lead to long-term absences from the workplace. The article examines narrations about developmental experiences and adult life of people in need of back to work rehabilitation. Narrative interviews were analyzed within a qualitative content analyses design. The sample was purposive, with 16 working-age adults at rehabilitation because of mild mental illnesses, chronic pain, and fatigue feelings. Ethical approval, was obtained from The Regional Committee for Medical Research Ethics, Health Region Central Norway. Reference no.: 2010/1323. There were stories about more or less stressful childhoods. In adult life, there were turns at various ages from meaningful work engagement, to struggle in private life from long lasting strain, stressful family situations or crises. Illness may develop when experiencing crises or strain over time in private situations, this in combination with expectations and requirements in working life. Not only working environments, but also the private situations, life history events, and self-esteem of individuals, should be taken into consideration in the rehabilitation program. There is a need of research on working life that support the employee's positive self-image, and on effective rehabilitation when needed.

Ethical reflections on end-of-life signs and symptoms in the intensive care setting: a place for neuromuscular blockers?

PubMed

Daubin, Cédric; Haddad, Lise; Folscheid, Dominique; Boyer, Alexandre; Chalumeau-Lemoine, Ludivine; Guisset, Olivier; Hubert, Philippe; Pillot, Jérôme; Robert, René; Dreyfuss, Didier

2014-01-01

The death of a loved one is often an ordeal and a tragedy for those who witness it, as death is not merely the end of a life, but also the end of an existence, the loss of a unique individual who is special and irreplaceable. In some situations, end-of-life signs, such as agonal gasps, can be an almost unbearable "sight" because the physical manifestations are hard to watch and can lead to subjective interpretation and irrational fears. Ethical unease arises as the dying patient falls prey to death throes and to the manifestations of ebbing life and the physician can only stand by and watch. From this point on, medicine can put an end to suffering by the use of neuromuscular blockade, but in so doing life ceases at the same time. It is difficult, however, not to respond to the distress of loved ones and caregivers. The ethical problem then becomes the shift from the original ethical concern, i.e. the dying patient, to the patient's loved ones. Is such a rupture due to a difference in nature or a difference in degree, given that the dying patient remains a person and not a thing as long as the body continues to lead its own life, expressed through movement and sound? Because there cannot be any simple and unequivocal answer to this question, the SRLF Ethics Commission is offering ethical reflections on end-of-life signs and symptoms in the intensive care setting, and on the use of neuromuscular blockade in this context, with presentations on the subject by two philosophers and members of the SRLF Ethics Commission, Ms Lise Haddad and Prof Dominique Folscheid. The SRLF Ethics Commission hopes to provide food for thought for everyone on this topic, which undoubtedly calls for further contributions, the aim being not to provide ready-made solutions or policy, but rather to allow everyone to ponder this question in all conscience.

[Palliative care after neonatal intensive care: Contributions of Leonetti Law and remaining challenges].

PubMed

Kuhn, P; Dillenseger, L; Cojean, N; Escande, B; Zores, C; Astruc, D

2017-02-01

The 2005 enactment of the "Patients' rights and end-of-life care" act, known as the Leonetti law, has been accompanied by practical changes in the processes of withdrawal and withholding of active life-sustaining treatments. This law has also promoted the implementation of palliative care in perinatal medicine to avoid unreasonable therapeutic interventions and to preserve the dying patient's quality of life and human dignity. Recently, a new law has been voted by the French National Assembly and new reflections on the ethical aspects of the end of life in neonatal medicine should resume again within the French Society of Neonatology in the working group on ethical issues in neonatology. This is why it appears important to discuss the perceived benefits and the persistent difficulties related to the implementation of the Leonetti law in neonatology. Collegiality in the decision-making processes as well as withdrawal and withholding of life-sustaining treatments that were already present in the practices of many centers has been stipulated within a legal framework and promoted in clinical practice. It has brought serenity within perinatal nursing and medical teams. It has helped them face the always-difficult end-of-life situations with parents and deal with decision-making processes in an intense emotional climate. However, new questions inherent to the law have appeared. The most important ones concern the withholding of artificial nutrition and hydration, the time pressure in the management of the decision-making process, and the management of the duration of palliative care. Challenges remain in addressing various persistent ethical dilemmas such as the possible survival of newborns with significant brain lesions detected after the period of life-sustaining treatments that have allowed their survival. The new law carried by Mr. Clayes and Mr. Léonetti should provide answers to some of these ethical issues, but it would probably not solve all of them. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Ethics, empiricism and uncertainty].

PubMed

Porz, R; Zimmermann, H; Exadaktylos, A K

2011-01-01

Accidents can lead to difficult boundary situations. Such situations often take place in the emergency units. The medical team thus often and inevitably faces professional uncertainty in their decision-making. It is essential to communicate these uncertainties within the medical team, instead of downplaying or overriding existential hurdles in decision-making. Acknowledging uncertainties might lead to alert and prudent decisions. Thus uncertainty can have ethical value in treatment or withdrawal of treatment. It does not need to be covered in evidence-based arguments, especially as some singular situations of individual tragedies cannot be grasped in terms of evidence-based medicine. © Georg Thieme Verlag KG Stuttgart · New York.

Probability: A Matter of Life and Death

ERIC Educational Resources Information Center

Hassani, Mehdi; Kippen, Rebecca; Mills, Terence

2016-01-01

Life tables are mathematical tables that document probabilities of dying and life expectancies at different ages in a society. Thus, the life table contains some essential features of the health of a population. Probability is often regarded as a difficult branch of mathematics. Life tables provide an interesting approach to introducing concepts…

'BREAKS' Protocol for Breaking Bad News.

PubMed

Narayanan, Vijayakumar; Bista, Bibek; Koshy, Cheriyan

2010-05-01

Information that drastically alters the life world of the patient is termed as bad news. Conveying bad news is a skilled communication, and not at all easy. The amount of truth to be disclosed is subjective. A properly structured and well-orchestrated communication has a positive therapeutic effect. This is a process of negotiation between patient and physician, but physicians often find it difficult due to many reasons. They feel incompetent and are afraid of unleashing a negative reaction from the patient or their relatives. The physician is reminded of his or her own vulnerability to terminal illness, and find themselves powerless over emotional distress. Lack of sufficient training in breaking bad news is a handicap to most physicians and health care workers. Adherence to the principles of client-centered counseling is helpful in attaining this skill. Fundamental insight of the patient is exploited and the bad news is delivered in a structured manner, because the patient is the one who knows what is hurting him most and he is the one who knows how to move forward. Six-step SPIKES protocol is widely used for breaking bad news. In this paper, we put forward another six-step protocol, the BREAKS protocol as a systematic and easy communication strategy for breaking bad news. Development of competence in dealing with difficult situations has positive therapeutic outcome and is a professionally satisfying one.

‘BREAKS’ Protocol for Breaking Bad News

PubMed Central

Narayanan, Vijayakumar; Bista, Bibek; Koshy, Cheriyan

2010-01-01

Information that drastically alters the life world of the patient is termed as bad news. Conveying bad news is a skilled communication, and not at all easy. The amount of truth to be disclosed is subjective. A properly structured and well-orchestrated communication has a positive therapeutic effect. This is a process of negotiation between patient and physician, but physicians often find it difficult due to many reasons. They feel incompetent and are afraid of unleashing a negative reaction from the patient or their relatives. The physician is reminded of his or her own vulnerability to terminal illness, and find themselves powerless over emotional distress. Lack of sufficient training in breaking bad news is a handicap to most physicians and health care workers. Adherence to the principles of client-centered counseling is helpful in attaining this skill. Fundamental insight of the patient is exploited and the bad news is delivered in a structured manner, because the patient is the one who knows what is hurting him most and he is the one who knows how to move forward. Six-step SPIKES protocol is widely used for breaking bad news. In this paper, we put forward another six-step protocol, the BREAKS protocol as a systematic and easy communication strategy for breaking bad news. Development of competence in dealing with difficult situations has positive therapeutic outcome and is a professionally satisfying one. PMID:21811349

How to estimate understanding: professionals' assessment of loved ones' insight into a patient's fatal disease.

PubMed

Benkel, Inger; Wijk, Helle; Molander, Ulla

2014-04-01

Loved ones of a patient with an incurable disease will accompany the patient to the end of life. Health care professionals must discuss difficult matters with loved ones and be sure that they really understand the seriousness of the patient's disease. The study explore how the professionals do when they explore the grounds on which they make their assessment of loved ones' insight into a patient's fatal disease. A qualitative design was chosen to gain deeper knowledge of professionals' perception of loved ones' understanding. The transcribed interviews were analysed using content analysis giving a richer understanding of the meaning of the content. The participants assessed loved ones' insight into the fatal disease based on the course and content of the conversations they had with the loved ones. The professionals' assessments were based on how the loved ones talked and expressed themselves in words and behavior and on the type of questions posed by the loved ones. The loved ones' observations and hope as denial or a strategy also contributed to their assessment. Ways to communicate with loved ones are crucial when making an assessment. The different ways loved ones use hope and other strategies made it problematic for the professionals to use these as indicators of state of mind in this matter. Training in conversation skills could be one way to support professionals when discussing and managing these difficult situations.

Northern Shenandoah public mobility project evaluation

DOT National Transportation Integrated Search

2003-06-01

Developing new intelligent transportation systems to meet unusual challenges in rural areas where ITS implementation is limited is difficult in part because there are few similar examples to use as guides. In such situations, it is critical to conduc...

Estimating cull in northern hardwoods

Treesearch

W.M. Zillgitt; S.R. Gevorkiantz

1946-01-01

Cull in northern hardwood stands is often very heavy and is difficult to estimate. To help clarify this situation and aid the average cruiser to become more accurate in his estimates, the study reported here should prove very helpful.

A model for educational feedback based on clinical communication skills strategies: beyond the "feedback sandwich".

PubMed

Milan, Felise B; Parish, Sharon J; Reichgott, Michael J

2006-01-01

Feedback is an essential tool in medical education, and the process is often difficult for both faculty and learner. There are strong analogies between the provision of educational feedback and doctor-patient communication during the clinical encounter. Relationship-building skills used in the clinical setting-Partnership, Empathy, Apology, Respect, Legitimation, Support (PEARLS)-can establish trust with the learner to better manage difficult feedback situations involving personal issues, unprofessional behavior, or a defensive learner. Using the stage of readiness to change (transtheoretical) model, the educator can "diagnose" the learner's stage of readiness and employ focused interventions to encourage desired changes. This approach has been positively received by medical educators in faculty development workshops. A model for provision of educational feedback based on communication skills used in the clinical encounter can be useful in the medical education setting. More robust evaluation of the construct validity is required in actual training program situations.

[Personal resources and nursing work: a research on coping strategies and job satisfaction].

PubMed

Formentin, Silvia; Dallago, Lorenza; Negrisolo, Adriana

2009-01-01

The coping (ability to face a difficult situation), is an essential resource for nurses, because it increases the effective functioning in the working environment, job satisfaction and individual level of wellness. The aim of this study is to explore the relationship between coping strategies and job satisfaction. A self report questionnaire was administered to all the nurses working in health services and hospitals of Padua province and to free lance nurses members of the College of Nurses, to collect information on coping strategies and job satisfaction. 2264 questionnaires were returned (71%). Active coping strategies are adopted mainly from older nurses while avoiding strategies are prevalent among younger. An association was observed between job satisfaction and active coping strategies, aimed at problem solving: active strategies increase job satisfaction while avoiding strategies descrease it. Individual coping strategies implemented to face difficult situations are associated to job satisfaction.

Knowing Loved Ones’ End-of-Life Health Care Wishes: Attachment Security Predicts Caregivers’ Accuracy

PubMed Central

Turan, Bulent; Goldstein, Mary K.; Garber, Alan M.; Carstensen, Laura L.

2011-01-01

Objective At times caregivers make life-and-death decisions for loved ones. Yet very little is known about the factors that make caregivers more or less accurate as surrogate decision makers for their loved ones. Previous research suggests that in low stress situations, individuals with high attachment-related anxiety are attentive to their relationship partners’ wishes and concerns, but get overwhelmed by stressful situations. Individuals with high attachment-related avoidance are likely to avoid intimacy and stressful situations altogether. We hypothesized that both of these insecure attachment patterns limit surrogates’ ability to process distressing information and should therefore be associated with lower accuracy in the stressful task of predicting their loved ones’ end-of-life health care wishes. Methods Older patients visiting a medical clinic stated their preferences toward end-of-life health care in different health contexts and surrogate decision makers independently predicted those preferences. For comparison purposes, surrogates also predicted patients’ perceptions of everyday living conditions so that surrogates’ accuracy of their loved ones’ perceptions in non-stressful situations could be assessed. Results Surrogates high on either type of insecure attachment dimension were less accurate in predicting their loved ones’ end-of-life health care wishes. Interestingly, even though surrogates’ attachment-related anxiety was associated with lower accuracy of end-of-life health care wishes of patients, it was associated with higher accuracy in the non-stressful task of predicting their everyday living conditions. Conclusions Attachment orientation plays an important role in accuracy about loved ones’ end-of-life health care wishes. Interventions may target emotion regulation strategies associated with insecure attachment orientations. PMID:22081941

New trends in the Japanese medical system in 2002.

PubMed

Motomatsu, Kenichi; Hirata, Natsuko; Imamura, Toko

2002-07-01

The Japanese have enjoyed the longest average life span in the world for these ten years. The universal health insurance system with free access and low cost seems to play the most important role among the proposed causes. We didn't need to worry about the charges at hospitals when we consulted a doctor, although we had to pay a premium in proportion to our income, and we received a national benefit which was money-paid by tax-payers. Unfortunately, the economic depression started around 1990 has driven us to a difficult situation. We are now planning several new policies to prevent the bankruptcy of the universal health insurance system due to the reduction of the medical expenditure. New attempts, such as reduction in the number of hospital beds, shortening of the average hospital stay, introduction of a long-term care insurance system, and the reduction of fee schedule by 2.7% from April 2002, and so on are being considered. On the other hand, the percentage of medical expenditure to GDP in Japan is the lowest, along with England, among the developed countries. Having realized that the poor medical system was due to low medical expenditure, the British government decided to raise the budget of the national health service. The situation concerning medical expenditure in Japan might become the worst among developed countries in the near future.

Design and test of a situation-augmented display for an unmanned aerial vehicle monitoring task.

PubMed

Lu, Jen-Li; Horng, Ruey-Yun; Chao, Chin-Jung

2013-08-01

In this study, a situation-augmented display for unmanned aerial vehicle (UAV) monitoring was designed, and its effects on operator performance and mental workload were examined. The display design was augmented with the knowledge that there is an invariant flight trajectory (formed by the relationship between altitude and velocity) for every flight, from takeoff to landing. 56 participants were randomly assigned to the situation-augmented display or a conventional display condition to work on 4 (number of abnormalities) x 2 (noise level) UAV monitoring tasks three times. Results showed that the effects of situation-augmented display on flight completion time and time to detect abnormalities were robust under various workload conditions, but error rate and perceived mental workload were unaffected by the display type. Results suggest that the UAV monitoring task is extremely difficult, and that display devices providing high-level situation-awareness may improve operator monitoring performance.

Nice or effective? Social problem solving strategies in patients with major depressive disorder.

PubMed

Thoma, Patrizia; Schmidt, Tobias; Juckel, Georg; Norra, Christine; Suchan, Boris

2015-08-30

Our study addressed distinct aspects of social problem solving in 28 hospitalized patients with Major Depressive Disorder (MDD) and 28 matched healthy controls. Three scenario-based tests assessed the ability to infer the mental states of story characters in difficult interpersonal situations, the capacity to freely generate good strategies for dealing with such situations and the ability to identify the best solutions among less optimal alternatives. Also, standard tests assessing attention, memory, executive function and trait empathy were administered. Compared to controls, MDD patients showed impaired interpretation of other peoples' sarcastic remarks but not of the mental states underlying other peoples' actions. Furthermore, MDD patients generated fewer strategies that were socially sensitive and practically effective at the same time or at least only socially sensitive. Overall, while the free generation of adequate strategies for difficult social situations was impaired, recognition of optimal solutions among alternatives was spared in MDD patients. Higher generation scores were associated with higher trait empathy and cognitive flexibility scores. We suggest that this specific pattern of impairments ought to be considered in the development of therapies addressing impaired social skills in MDD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Butler, W.

Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices:more » remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning of “end-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications of “end-of-life” policy Review other possible approaches to “end-of-life” issue.« less

Condition-dependence, genotype-by-environment interactions and the lek paradox.

PubMed

Kokko, Hanna; Heubel, Katja

2008-09-01

The lek paradox states that maintaining genetic variation necessary for 'indirect benefit' models of female choice is difficult, and two interrelated solutions have been proposed. 'Genic capture' assumes condition-dependence of sexual traits, while genotype-by-environment interactions (GEIs) offer an additional way to maintain diversity. However, condition-dependence, particularly with GEIs, implies that environmental variation can blur the relationship between male displays and offspring fitness. These issues have been treated separately in the past. Here we combine them in a population genetic model, and show that predictions change not only in magnitude but also in direction when the timing of dispersal between environments relative to the life cycle is changed. GEIs can dramatically improve the evolution of costly female preferences, but also hamper it if much dispersal occurs between the life history stage where condition is determined and mating. This situation also arises if selection or mutation rates are too high. In general, our results highlight that when evaluating any mechanism promoted as a potential resolution of the lek paradox, it is not sufficient to focus on its effects on genetic variation. It also has to be assessed to what extent the proposed mechanism blurs the association between male attractiveness and offspring fitness; the net balance of these two effects can be positive or negative, and often strongly context-dependent.

Condition-dependence, genotype-by-environment interactions and the lek paradox.

PubMed

Kokko, Hanna; Heubel, Katja

2008-02-01

The lek paradox states that maintaining genetic variation necessary for 'indirect benefit' models of female choice is difficult, and two interrelated solutions have been proposed. 'Genic capture' assumes condition-dependence of sexual traits, while genotype-by-environment interactions (GEIs) offer an additional way to maintain diversity. However, condition-dependence, particularly with GEIs, implies that environmental variation can blur the relationship between male displays and offspring fitness. These issues have been treated separately in the past. Here we combine them in a population genetic model, and show that predictions change not only in magnitude but also in direction when the timing of dispersal between environments relative to the life cycle is changed. GEIs can dramatically improve the evolution of costly female preferences, but also hamper it if much dispersal occurs between the life history stage where condition is determined and mating. This situation also arises if selection or mutation rates are too high. In general, our results highlight that when evaluating any mechanism promoted as a potential resolution of the lek paradox, it is not sufficient to focus on its effects on genetic variation. It also has to be assessed to what extent the proposed mechanism blurs the association between male attractiveness and offspring fitness; the net balance of these two effects can be positive or negative, and often strongly context-dependent.

Life Cycle Assessment of Biogas Production in Small-scale Household Digesters in Vietnam

PubMed Central

Vu, T. K. V.; Vu, D. Q.; Jensen, L. S.; Sommer, S. G.; Bruun, S.

2015-01-01

Small-scale household digesters have been promoted across Asia as a sustainable way of handling manure. The major advantages are that they produce biogas and reduce odor. However their disadvantages include the low recycling of nutrients, because digestate is dilute and therefore difficult to transport, and the loss of biogas as a result of cracks and the intentional release of excess biogas. In this study, life cycle assessment (LCA) methodology was used to assess the environmental impacts associated with biogas digesters in Vietnam. Handling 1,000 kg of liquid manure and 100 kg of solid manure in a system with a biogas digester reduced the impact potential from 4.4 kg carbon dioxide (CO2) equivalents to 3.2 kg CO2 equivalents compared with traditional manure management. However, this advantage could easily be compromised if digester construction is considered in the LCA or in situations where there is an excess of biogas which is intentionally released. A sensitivity analysis showed that biogas digesters could be a means of reducing global warming if methane emissions can be kept low. In terms of eutrophication, farms with biogas digesters had 3 to 4 times greater impacts. In order to make biogas digesters sustainable, methods for recycling digestates are urgently required. PMID:25715690

How Spoken Language Comprehension is Achieved by Older Listeners in Difficult Listening Situations.

PubMed

Schneider, Bruce A; Avivi-Reich, Meital; Daneman, Meredyth

2016-01-01

Comprehending spoken discourse in noisy situations is likely to be more challenging to older adults than to younger adults due to potential declines in the auditory, cognitive, or linguistic processes supporting speech comprehension. These challenges might force older listeners to reorganize the ways in which they perceive and process speech, thereby altering the balance between the contributions of bottom-up versus top-down processes to speech comprehension. The authors review studies that investigated the effect of age on listeners' ability to follow and comprehend lectures (monologues), and two-talker conversations (dialogues), and the extent to which individual differences in lexical knowledge and reading comprehension skill relate to individual differences in speech comprehension. Comprehension was evaluated after each lecture or conversation by asking listeners to answer multiple-choice questions regarding its content. Once individual differences in speech recognition for words presented in babble were compensated for, age differences in speech comprehension were minimized if not eliminated. However, younger listeners benefited more from spatial separation than did older listeners. Vocabulary knowledge predicted the comprehension scores of both younger and older listeners when listening was difficult, but not when it was easy. However, the contribution of reading comprehension to listening comprehension appeared to be independent of listening difficulty in younger adults but not in older adults. The evidence suggests (1) that most of the difficulties experienced by older adults are due to age-related auditory declines, and (2) that these declines, along with listening difficulty, modulate the degree to which selective linguistic and cognitive abilities are engaged to support listening comprehension in difficult listening situations. When older listeners experience speech recognition difficulties, their attentional resources are more likely to be deployed to facilitate lexical access, making it difficult for them to fully engage higher-order cognitive abilities in support of listening comprehension.

Life situation of adults with congenital limb reduction deficiency in Sweden.

PubMed

Sjöberg, Lis; Nilsagård, Ylva; Fredriksson, Carin

2014-01-01

To describe the current life situation of adults with congenital limb reduction deficiencies (CLRD), living in Sweden, regarding their main daily occupation, leisure activities and self-reported general health. A cross-sectional survey was conducted using a study-specific questionnaire, sent by post. Hundred and seventeen persons with different extent, forms and levels of CLRD (mean age 33 years) responded to the questionnaire. Work or study was the main occupation for 86% of the participants and 50% had completed a college or university education. About 7% were unemployed and 3% were on sick leave. The participants were highly involved in social and physical activities during leisure time. The majority reported good or very good general health. This study is the first investigation of the life situation of adults with CLRD described with a perspective from Swedish society. The participants were educated and worked to a great extent, which corresponds well to the Swedish population as a whole. Further research is needed, especially with a focus on the internal perspective of life situation, different aspects of work capacity, occurences of strain injuries and the benefit of assistive devices among adults with CLRD. Implications for Rehabilitation People with CLRD require a health care system with a multi-professional rehabilitation team offering regular contact during their life time. Educational system offering study counselling on all education levels (from primary school to university) is an important type of support for people with any kind of deficiency, in order to find suitable education and profession. Work is of importance for an acceptable life situation. Rehabilitation for people with CLRD should emphasise facilitating their ability to work, through engagement in individual personal capacity and self-efficacy. The majority of people with CLRD are users of prostheses and assistive devices. The benefits of the devices are basic but the rehabilitation should also include aspects of usability and use worthiness for individuals in performing their daily activities.

Life Domain Satisfactions as Predictors of Overall Life Satisfaction Among Workers: Evidence from Chile.

PubMed

Loewe, Nicolas; Bagherzadeh, Mehdi; Araya-Castillo, Luis; Thieme, Claudio; Batista-Foguet, Joan Manuel

2014-01-01

This article examines the subjective antecedents of life satisfaction of workers. Adopting a 'bottom-up' perspective, we assessed the unique influence that satisfaction with multiple life domains have on evaluative judgments of overall life satisfaction. Based on a nationwide sample of 530 Chilean workers, we simultaneously tested the effects of seven life domain satisfactions that have been consistently included in extant models of life satisfaction and subjective well-being. These were satisfaction with health, financial situation, social relationships, one's self-worth, leisure-time, family, and work. Having controlled for age and gender, results showed that satisfaction with one's financial situation was the dominant predictor of overall life satisfaction of workers, with a weight of .36. Satisfaction with family, work, and health had effects of .25, .14, and .14, respectively. Interestingly, satisfaction with one's self-worth, leisure-time, and social relationships did not have statistically significant effects on life satisfaction, although the first two showed t values near the critical value.

[Ethical considerations in mass casualty situation].

PubMed

Priel, I E; Dolev, E

2001-07-01

Mass casualty is a situation, in which, the physician is compelled to make critical decisions under heavy pressure load, due to severe shortage in time, personnel and information. This task is extremely difficult to fulfill, as the physician has to consider not only professional tools, but needs also to utilize ethical principles, in order to provide the best possible care to most of the casualties who might benefit from it. By definition, in the mass casualty situation the medical facility lacks temporarily the ability to deliver effective therapy to all, as the injured outnumber the medical capacity for a given time. The ethical conflicts and dilemmas that arise during such an event are enormous. Amazingly, only a few articles have addressed the issue of ethical considerations during mass casualty situation. Ethical decision making is based on four principles: beneficence, nonmaleficence, autonomy and justice. Compassion, trustworthiness, discernment and integrity are the four qualities required from those practicing medicine. These virtues should be manifested in mass casualty situations, one of the most demanding situations a physician may face.

Living with a mentally ill parent: exploring adolescents' experiences and perspectives.

PubMed

Trondsen, Marianne V

2012-02-01

Although a considerable body of research has described the implications of parental mental illness, the perspectives of children and adolescents have rarely been addressed. In this article, I explore adolescents' experiences in everyday life, based on an action-oriented study of a Norwegian online self-help group for adolescents (aged 15 to 18) with mentally ill parents. The analysis was conducted through participant observation of the group for 2 years. The adolescents experienced a variety of difficult challenges related to their parent's mental illness: lack of information and openness; unpredictability and instability; fear; loneliness; and loss and sorrow. However, they also discussed strategies for active management of the challenges arising from the family situation. I argue that these adolescents can be understood as vulnerable as well as active participants in managing their everyday lives. I emphasize the importance of including perspectives of children and adolescents in further research so as to improve health care for families with parental mental illness.

Close-up of Shuttle tire after LSRA test

NASA Technical Reports Server (NTRS)

1995-01-01

One of the final tests of the CV-990 Landing Systems Research Aircraft (LSRA) in August, 1995 at NASA's Dryden Flight Research Center, Edwards, California, resulted in the destruction of the wheel, following a fire caused by a mixture of heat, aluminum particles, and rubber. Following successful tests of tire wear at Edwards and the Kennedy Space Center, Fl., this series of roll-on-rim tests determined the failure modes ofwheels for the space shuttle. The aluminum wheel locked in postion and was ground to within four inches of the axle before the test concluded. The series of 155 test missions for the space shuttle program provided extensive data about the life and endurance of the shuttle tire systems and helped raise the shuttle crosswind landing limits at Kennedy. Project engineer Christopher J. Nagy said, 'NASA pilots Gordon Fullerton and Terry Rager did a superb job of flying the aircraft in many difficult test situations, at speeds higher than the aircraft was intended to land, without once losing a single flight.'

Recurrent laughter-induced syncope.

PubMed

Gaitatzis, Athanasios; Petzold, Axel

2012-07-01

Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its causes are sometimes difficult to diagnose. Apart from vasovagal attacks, other benign, neurally mediated syncopes include "situational" syncopes, which occur after urination, coughing, swallowing, or defecation. A healthy 42-year-old male patient presented to the neurology clinic with a long history of faints triggered by spontaneous laughter, especially after funny jokes. Physical and neurological examination, and electroencephalography and magnetic resonance imaging were unremarkable. There was no evidence to suggest cardiogenic causes, epilepsy, or cataplexy and a diagnosis of laughing syncope was made. Laughter-induced syncope is usually a single event in the majority of cases, but may present as recurrent attacks as in our case. Some cases occur in association with underlying neurological conditions. Prognosis is good in the case of neurally mediated attacks. Laughter may not be recognized by physicians as a cause of syncope, which may lead to unnecessary investigations or misdiagnosis, and affect patients' quality of life.

The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: a review of the literature.

PubMed

Ferrer-García, Marta; Gutiérrez-Maldonado, José

2012-01-01

This article reviews research into the use of virtual reality in the study, assessment, and treatment of body image disturbances in eating disorders and nonclinical samples. During the last decade, virtual reality has emerged as a technology that is especially suitable not only for the assessment of body image disturbances but also for its treatment. Indeed, several virtual environment-based software systems have been developed for this purpose. Furthermore, virtual reality seems to be a good alternative to guided imagery and in vivo exposure, and is therefore very useful for studies that require exposure to life-like situations but which are difficult to conduct in the real world. Nevertheless, review highlights the lack of published controlled studies and the presence of methodological drawbacks that should be considered in future studies. This article also discusses the implications of the results obtained and proposes directions for future research. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Recommendations for initial antiretroviral treatment in HIV-infected children. Update 2003].

PubMed

2004-03-01

Highly active antiretroviral therapy in HIV-infected children has been associated with a dramatic decrease in progression to AIDS and HIV-related deaths, and infected children currently have an excellent quality of life. Antiretroviral drugs cannot eradicate the virus, although they can achieve a situation of latent infection. However, chronic use of these drugs has multiple adverse effects, the most important of which are metabolic complications. The large number of drugs required and patient characteristics such as age, tolerance to drugs, adherence, and social problems make unifying the criteria for initial therapy in HIV-infected children difficult. A balance should be sought between not delaying the start of treatment, to avoid immunologic deterioration, and minimizing the long-term adverse effects of the therapy. The present treatment recommendations are adapted from international guidelines and are based on a literature review and on our own experience. Our group previously published recommendations on the treatment of HIV-infected children and the aim of the present article is to provide an update.

Management of multiple sclerosis: the role of coping self-efficacy and self-esteem.

PubMed

Mikula, Pavol; Nagyova, Iveta; Vitkova, Marianna; Szilasiova, Jarmila

2018-02-07

Patients with multiple sclerosis (MS) engage in various coping behaviours in order to manage their disease. The aim of this study is to find out if the self-esteem of patients is associated with coping strategies - problem-focused (e.g. making a plan of action when confronted with a problem); emotion focused (e.g. get emotional support from community); and focused on stopping unpleasant emotions and thoughts (e.g. keeping oneself from feeling sad), and if it can enhance or hinder coping efforts in the disease management. We collected data from 155 consecutive MS patients who completed the Coping Self-Efficacy Scale (CSE) and the Rosenberg Self-esteem Scale (RSE). Explained variance for problem-focused coping, emotion-focused coping, and coping focused on stopping unpleasant emotions and thoughts was 33, 24, and 31%, respectively. Self-esteem seems to be associated with coping strategies indicating that feelings of self-worth are linked with the ability to handle difficult life situations and can be helpful in chronic disease management.

Investigating the associations between hydration and exercise performance: methodology and limitations.

PubMed

Maughan, Ronald J

2012-11-01

Loss of body water, if sufficiently severe, impairs most physiological functions, but the body water content fluctuates over the course of a normal day with no implications for physical or mental performance. The point at which an effect of dehydration becomes apparent has been the subject of much debate, in part, at least, because of the different tests that have been applied, differences in the methodologies used to induce dehydration and also because of differences in the fitness and other physiological characteristics of the subjects studied. The act of drinking itself and the conscious denial of access to water will also have implications for subjective responses to the exercise task. In many published studies, it is difficult to separate the effects of ingestion of water from those of carbohydrate, electrolytes, and other drink components. Nevertheless, there is good evidence that drinking appropriate amounts of water, especially cold water, can enhance exercise performance in many situations. © 2012 International Life Sciences Institute.

Eliciting change in at-risk elders (ECARE): evaluation of an elder abuse intervention program.

PubMed

Mariam, Lydia Morris; McClure, Regina; Robinson, J B; Yang, Janet A

2015-01-01

The current study evaluated the effectiveness of a community-based elder abuse intervention program that assists suspected victims of elder abuse and self-neglect through a partnership with local law enforcement. This program, Eliciting Change in At-Risk Elders, involves building alliances with the elder and family members, connecting the elder to supportive services that reduce risk of further abuse, and utilizing motivational interviewing-type skills to help elders overcome ambivalence regarding making difficult life changes. Risk factors of elder abuse decreased over the course of the intervention and nearly three-quarters of participants made progress on their treatment goal, advancing at least one of Prochaska and DiClemente's (1983) stages of change (precontemplation, contemplation, preparation, action, and maintenance). Forty-three percent of elders moved into the stages of action and maintenance regarding their goal. The usefulness of eliciting change via longer-term relationships with vulnerable elders in entrenched elder abuse situations is discussed.

The role of vocal individuality in conservation

PubMed Central

Terry, Andrew MR; Peake, Tom M; McGregor, Peter K

2005-01-01

Identifying the individuals within a population can generate information on life history parameters, generate input data for conservation models, and highlight behavioural traits that may affect management decisions and error or bias within census methods. Individual animals can be discriminated by features of their vocalisations. This vocal individuality can be utilised as an alternative marking technique in situations where the marks are difficult to detect or animals are sensitive to disturbance. Vocal individuality can also be used in cases were the capture and handling of an animal is either logistically or ethically problematic. Many studies have suggested that vocal individuality can be used to count and monitor populations over time; however, few have explicitly tested the method in this role. In this review we discuss methods for extracting individuality information from vocalisations and techniques for using this to count and monitor populations over time. We present case studies in birds where vocal individuality has been applied to conservation and we discuss its role in mammals. PMID:15960848

Two case reports of unexpected tracheal agenesis in the neonate: 3 C's beyond algorithms for difficult airway management.

PubMed

Grass, Beate; Simma, Leopold; Reinehr, Michael; Zimmermann, Urs; Gysin, Claudine; Henze, Georg; Cannizzaro, Vincenzo

2017-02-08

Handling neonates with postnatal respiratory failure due to congenital airway malformations implies knowledge about emergency management of unexpected difficult airway. In these stressful situations both technical and communication skills of the caretakers are essential. Two cases with prenatally unknown tracheal agenesis are reported. In the presented cases, airway malformation and subsequent difficulties upon endotracheal intubation were not adequately communicated between caretakers. We discuss the aspects of culture, communication, and capnography.

[Teenagers' drawings in transcultural consultations].

PubMed

Simon, Amalini; Titia Rizzi, Alice

The place of teenagers' drawings has been studied as part of a transcultural consultation, based on the creativity of the children of migrants. When speaking is difficult, drawings enable teenagers to show another dimension of their internal world. Aravin, a young Tamil boy, who lacked the necessary words, was able to express all the complexity of his thoughts through his drawings, finally being able to formulate in the group the difficult situations which he was drawing. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Cognitive and Affective Aspects of Creative Option Generation in Everyday Life Situations

PubMed Central

Schweizer, T. Sophie; Schmalenberger, Katja M.; Eisenlohr-Moul, Tory A.; Mojzisch, Andreas; Kaiser, Stefan; Funke, Joachim

2016-01-01

Which factors influence a human being’s ability to develop new perspectives and be creative? This ability is pivotal for any context in which new cognitions are required, such as innovative endeavors in science and art, or psychotherapeutic settings. In this article, we seek to bring together two research programs investigating the generation of creative options: On the one hand, research on option generation in the decision-making literature and, on the other hand, cognitive and clinical creativity research. Previous decision-making research has largely neglected the topic of generating creative options. Experiments typically provided participants with a clear set of options to choose from, but everyday life situations are less structured and allow countless ways to react. Before choosing an option, agents have to self-generate a set of options to choose from. Such option generation processes have only recently moved to the center of attention. The present study examines the creative quality of self-generated options in daily life situations. A student sample (N = 48) generated options for action in 70 briefly described everyday life scenarios. We rated the quality of the options on three dimensions of creativity- originality, feasibility, and divergence -and linked these qualities to option generation fluency (speed and number of generated options), situational features like the familiarity and the affective valence of the situation in which the options were generated, and trait measures of cognitive performance. We found that when situations were familiar to the participant, greater negative affective valence of the situation was associated with more originality and divergence of generated options. We also found that a higher option generation fluency was associated with a greater maximal originality of options. We complete our article with a joint research agenda for researchers in the decision-making field focusing on option generation and, on the other hand, researchers working on the cognitive and clinical aspects of creativity. PMID:27536258

Cognitive and Affective Aspects of Creative Option Generation in Everyday Life Situations.

PubMed

Schweizer, T Sophie; Schmalenberger, Katja M; Eisenlohr-Moul, Tory A; Mojzisch, Andreas; Kaiser, Stefan; Funke, Joachim

2016-01-01

Which factors influence a human being's ability to develop new perspectives and be creative? This ability is pivotal for any context in which new cognitions are required, such as innovative endeavors in science and art, or psychotherapeutic settings. In this article, we seek to bring together two research programs investigating the generation of creative options: On the one hand, research on option generation in the decision-making literature and, on the other hand, cognitive and clinical creativity research. Previous decision-making research has largely neglected the topic of generating creative options. Experiments typically provided participants with a clear set of options to choose from, but everyday life situations are less structured and allow countless ways to react. Before choosing an option, agents have to self-generate a set of options to choose from. Such option generation processes have only recently moved to the center of attention. The present study examines the creative quality of self-generated options in daily life situations. A student sample (N = 48) generated options for action in 70 briefly described everyday life scenarios. We rated the quality of the options on three dimensions of creativity- originality, feasibility, and divergence -and linked these qualities to option generation fluency (speed and number of generated options), situational features like the familiarity and the affective valence of the situation in which the options were generated, and trait measures of cognitive performance. We found that when situations were familiar to the participant, greater negative affective valence of the situation was associated with more originality and divergence of generated options. We also found that a higher option generation fluency was associated with a greater maximal originality of options. We complete our article with a joint research agenda for researchers in the decision-making field focusing on option generation and, on the other hand, researchers working on the cognitive and clinical aspects of creativity.

The Situations Bank, a Tool for Curriculum Design Focused on Daily Realities: The Case of the Reform in Niger

ERIC Educational Resources Information Center

Charland, Patrick; Cyr, Stéphane

2013-01-01

In the context of the curriculum reform in Niger, the authors describe the process of developing a situations bank which focusses on everyday life situations in Niger. The bank plays a central role in the formulation of new study programmes guided by the so-called "situated" approach. The authors also describe various issues that arose…

[Pre-hospital management of adults with life-threatening emergencies].

PubMed

Wattel, Francis; Dubois, François

2012-01-01

In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas, fewer voluntary firemen, hospital reorganization, tight funding, difficulties of medical dispatching, and the varying skills of "first-on-the-scene "emergency workers. Grievances include late emergency responses, inappropriate medical care, and dispatching to the wrong facility. This raises the question of equal opportunity for all in a country with widely varying geographic features and population density. Improvement in the system's efficiency will require a series of objectives to be met in varied and complementary--Enhanced functional coordination, by speeding up the deployment of the ANTARES digital radio-frequency transmission network (Adaptation Nationale des Transmissions Aux Risques Et aux Secours).--Implementation of a network of emergency services with varying degrees of emergency healthcare management related to the technical nature of the facilities. Three levels of emergency healthcare must be made available: level 1 is provided by local hospitals, level 2 includes support facilities available in general hospitals (not necessarily the nearest hospital), and level 3 provides specialized healthcare in large and/or training hospitals with specialized departments. Life-threatening emergency situations are to be handled by level 2 or 3 facilities. Specific facilities must be selected as reference centers. In France, the ARS (Agences Régionales de Santé) is in charge of this procedure, as it provide funding for healthcare continuity--Reducing inequalities in access to emergency care. This will involve improving the network of SDIS brigades, making local medical facilities more responsive, delegating more medical procedures, on-site telemedicine, providing more helicopters equipped with healthcare facilities, more automated external defibrillators, and more dedicated neuro-vascular units.--First aid training must be made widely available. The French National Academy of Medicine has approved ten recommendations regarding organization and facilities.

Dealing with the difficult older patient.

PubMed

Laurence, M K

1986-05-15

Physicians are often asked to intervene when elderly patients in acute or long-term care facilities are disruptive, demanding or abusive. Though medication may be the immediate response, it often fails to solve the problem, which, being situational and behavioural, calls for a situational and behavioural solution. An organized approach to solving such problems is presented that takes into account the interactions among the patient, family, staff, setting and circumstances. The role of the physician as leader in the process is also discussed.

Latent class analysis of the feared situations of social anxiety disorder: A population-based study.

PubMed

Peyre, Hugo; Hoertel, Nicolas; Rivollier, Fabrice; Landman, Benjamin; McMahon, Kibby; Chevance, Astrid; Lemogne, Cédric; Delorme, Richard; Blanco, Carlos; Limosin, Frédéric

2016-12-01

Little is known about differences in mental health comorbidity and quality of life in individuals with social anxiety disorder (SAD) according to the number and the types of feared situations. Using a US nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions, we performed latent class analysis to compare the prevalence rates of mental disorders and quality of life measures across classes defined by the number and the types of feared social situations among individuals with SAD. Among the 2,448 participants with a lifetime diagnosis of SAD, we identified three classes of individuals who feared most social situations but differed in the number of feared social situations (generalized severe [N = 378], generalized moderate [N = 1,049] and generalized low [N = 443]) and a class of subjects who feared only performance situations [N = 578]. The magnitude of associations between each class and a wide range of mental disorders and quality of life measures were consistent with a continuum model, supporting that the deleterious effects of SAD on mental health may increase with the number of social situations feared. However, we found that individuals with the "performance only" specifier may constitute an exception to this model because these participants had significantly better mental health than other participants with SAD. Our findings give additional support to the recent changes made in the DSM-5, including the introduction of the "performance only" specifier and the removal of the "generalized" specifier to promote the dimensional approach of the number of social fears. © 2016 Wiley Periodicals, Inc.

An Aristotelian Account of Minimal Chemical Life

NASA Astrophysics Data System (ADS)

Bedau, Mark A.

2010-12-01

This paper addresses the open philosophical and scientific problem of explaining and defining life. This problem is controversial, and there is nothing approaching a consensus about what life is. This raises a philosophical meta-question: Why is life so controversial and so difficult to define? This paper proposes that we can attribute a significant part of the controversy over life to use of a Cartesian approach to explaining life, which seeks necessary and sufficient conditions for being an individual living organism, out of the context of other organisms and the abiotic environment. The Cartesian approach contrasts with an Aristotelian approach to explaining life, which considers life only in the whole context in which it actually exists, looks at the characteristic phenomena involving actual life, and seeks the deepest and most unified explanation for those phenomena. The phenomena of life might be difficult to delimit precisely, but it certainly includes life's characteristic hallmarks, borderline cases, and puzzles. The Program-Metabolism-Container (PMC) model construes minimal chemical life as a functionally integrated triad of chemical systems, which are identified as the Program, Metabolism, and Container. Rasmussen diagrams precisely depict the functional definition of minimal chemical life. The PMC model illustrates the Aristotelian approach to life, because it explains eight of life's hallmarks, one of life's borderline cases (the virus), and two of life's puzzles.

An Aristotelian account of minimal chemical life.

PubMed

Bedau, Mark A

2010-12-01

This paper addresses the open philosophical and scientific problem of explaining and defining life. This problem is controversial, and there is nothing approaching a consensus about what life is. This raises a philosophical meta-question: Why is life so controversial and so difficult to define? This paper proposes that we can attribute a significant part of the controversy over life to use of a Cartesian approach to explaining life, which seeks necessary and sufficient conditions for being an individual living organism, out of the context of other organisms and the abiotic environment. The Cartesian approach contrasts with an Aristotelian approach to explaining life, which considers life only in the whole context in which it actually exists, looks at the characteristic phenomena involving actual life, and seeks the deepest and most unified explanation for those phenomena. The phenomena of life might be difficult to delimit precisely, but it certainly includes life's characteristic hallmarks, borderline cases, and puzzles. The Program-Metabolism-Container (PMC) model construes minimal chemical life as a functionally integrated triad of chemical systems, which are identified as the Program, Metabolism, and Container. Rasmussen diagrams precisely depict the functional definition of minimal chemical life. The PMC model illustrates the Aristotelian approach to life, because it explains eight of life's hallmarks, one of life's borderline cases (the virus), and two of life's puzzles.

Each life stage matters: the importance of assessing the response to climate change over the complete life cycle in butterflies.

PubMed

Radchuk, Viktoriia; Turlure, Camille; Schtickzelle, Nicolas

2013-01-01

As ectothermic organisms, butterflies have widely been used as models to explore the predicted impacts of climate change. However, most studies explore only one life stage; to our best knowledge, none have integrated the impact of temperature on the vital rates of all life stages for a species of conservation concern. Besides, most population viability analysis models for butterflies are based on yearly population growth rate, precluding the implementation and assessment of important climate change scenarios, where climate change occurs mainly, or differently, during some seasons. Here, we used a combination of laboratory and field experiments to quantify the impact of temperature on all life stages of a vulnerable glacial relict butterfly. Next, we integrated these impacts into an overall population response using a deterministic periodic matrix model and explored the impact of several climate change scenarios. Temperature positively affected egg, pre-diapause larva and pupal survival, and the number of eggs laid by a female; only the survival of overwintering larva was negatively affected by an increase in temperature. Despite the positive impact of warming on many life stages, population viability was reduced under all scenarios, with predictions of much shorter times to extinction than under the baseline (current temperature situation) scenario. Indeed, model predictions were the most sensitive to changes in survival of overwintering larva, the only stage negatively affected by warming. A proper consideration of every stage of the life cycle is important when designing conservation guidelines in the light of climate change. This is in line with the resource-based habitat view, which explicitly refers to the habitat as a collection of resources needed for all life stages of the species. We, therefore, encourage adopting a resource-based habitat view for population viability analysis and development of conservation guidelines for butterflies, and more generally, other organisms. Life stages that are cryptic or difficult to study should not be forsaken as they may be key determinants in the overall response to climate change, as we found with overwintering Boloria eunomia larvae. © 2012 The Authors. Journal of Animal Ecology © 2012 British Ecological Society.

Thinking Skills: A Necessity for '90s Marketing Students.

ERIC Educational Resources Information Center

Magee, Robert C.; Schmidt, B. June

1994-01-01

Explains why real-life situations requiring the use of thinking skills are an effective way to teach marketing. Examples using situations derived from interviews with bank employees are provided. (SK)

Category Learning Research in the Interactive Online Environment Second Life

NASA Technical Reports Server (NTRS)

Andrews, Jan; Livingston, Ken; Sturm, Joshua; Bliss, Daniel; Hawthorne, Daniel

2011-01-01

The interactive online environment Second Life allows users to create novel three-dimensional stimuli that can be manipulated in a meaningful yet controlled environment. These features suggest Second Life's utility as a powerful tool for investigating how people learn concepts for unfamiliar objects. The first of two studies was designed to establish that cognitive processes elicited in this virtual world are comparable to those tapped in conventional settings by attempting to replicate the established finding that category learning systematically influences perceived similarity . From the perspective of an avatar, participants navigated a course of unfamiliar three-dimensional stimuli and were trained to classify them into two labeled categories based on two visual features. Participants then gave similarity ratings for pairs of stimuli and their responses were compared to those of control participants who did not learn the categories. Results indicated significant compression, whereby objects classified together were judged to be more similar by learning than control participants, thus supporting the validity of using Second Life as a laboratory for studying human cognition. A second study used Second Life to test the novel hypothesis that effects of learning on perceived similarity do not depend on the presence of verbal labels for categories. We presented the same stimuli but participants classified them by selecting between two complex visual patterns designed to be extremely difficult to label. While learning was more challenging in this condition , those who did learn without labels showed a compression effect identical to that found in the first study using verbal labels. Together these studies establish that at least some forms of human learning in Second Life parallel learning in the actual world and thus open the door to future studies that will make greater use of the enriched variety of objects and interactions possible in simulated environments compared to traditional experimental situations.

International Metadata Standards and Enterprise Data Quality Metadata Systems

NASA Technical Reports Server (NTRS)

Habermann, Ted

2016-01-01

Well-documented data quality is critical in situations where scientists and decision-makers need to combine multiple datasets from different disciplines and collection systems to address scientific questions or difficult decisions. Standardized data quality metadata could be very helpful in these situations. Many efforts at developing data quality standards falter because of the diversity of approaches to measuring and reporting data quality. The one size fits all paradigm does not generally work well in this situation. I will describe these and other capabilities of ISO 19157 with examples of how they are being used to describe data quality across the NASA EOS Enterprise and also compare these approaches with other standards.

High-frequency imaging radar for robotic navigation and situational awareness

NASA Astrophysics Data System (ADS)

Thomas, David J.; Luo, Changan; Knox, Robert

2011-05-01

With increasingly available high frequency radar components, the practicality of imaging radar for mobile robotic applications is now practical. Navigation, ODOA, situational awareness and safety applications can be supported in small light weight packaging. Radar has the additional advantage of being able sense through aerosols, smoke and dust that can be difficult for many optical systems. The ability to directly measure the range rate of an object is also an advantage in radar applications. This paper will explore the applicability of high frequency imaging radar for mobile robotics and examine a W-band 360 degree imaging radar prototype. Indoor and outdoor performance data will be analyzed and evaluated for applicability to navigation and situational awareness.

Disease-related social situation in family of children with chronic kidney disease--parents` assessment. A multicentre study.

PubMed

Kiliś-Pstrusińska, Katarzyna; Medyńska, Anna; Adamczyk, Piotr; Bałasz-Chmielewska, Irena; Grenda, Ryszard; Kluska-Jóźwiak, Agnieszka; Leszczyńska, Beata; Olszak-Szot, Ilona; Miklaszewska, Monika; Szczepańska, Maria; Tkaczyk, Marcin; Wasilewska, Anna; Zachwieja, Katarzyna; Zajączkowska, Maria; Ziółkowska, Helena; Zagożdżon, Ilona; Zwolińska, Danuta

2014-01-01

Chronic kidney disease (CKD) in children burdens life of patients and their families. Little is known about parents` assessment of families' social situation. However, the knowledge of the details of a patient's and his family's life standards might influence modification and optimization of applied therapy. Therefore, the main goal of the present study was to explore the selected elements of life situation of patients suffering with CKD as well as their parents, depending on the CKD stage and appropriate treatment. Cross-sectional national study was conducted. A total of 203 children with CKD and 388 their parent-proxies (196 women and 192 men) were enrolled into this study. Patient data and questionnaires filled by both parents, concerning social-demographic parameters and assessment of changes in families after CKD diagnosis in the child, were analysed. CKD children are being brought up in proper families whose financial situation is not good. Children need help in process of education. Perception of current situation differed between both parents in the change of the income source, taking care of CKD child, change in social relations and evaluating relations with medical staff. Parents do not obtain proper support from social workers. Families of CKD children require support in area of financial and educational help for school children. The discrepancies in evaluation of family situation between mothers and fathers of ill children might be the source of conflicts possibly resulting in worsening the outcome for CKD children.

Reducing Unintended Pregnancies Through Web-Based Reproductive Life Planning and Contraceptive Action Planning among Privately Insured Women: Study Protocol for the MyNewOptions Randomized, Controlled Trial.

PubMed

Chuang, Cynthia H; Velott, Diana L; Weisman, Carol S; Sciamanna, Christopher N; Legro, Richard S; Chinchilli, Vernon M; Moos, Merry-K; Francis, Erica B; Confer, Lindsay N; Lehman, Erik B; Armitage, Christopher J

2015-01-01

The Affordable Care Act mandates that most women of reproductive age with private health insurance have full contraceptive coverage with no out-of-pocket costs, creating an actionable time for women to evaluate their contraceptive choices without cost considerations. The MyNewOptions study is a three-arm, randomized, controlled trial testing web-based interventions aimed at assisting privately insured women with making contraceptive choices that are consistent with their reproductive goals. Privately insured women between the ages of 18 and 40 not intending pregnancy were randomly assigned to one of three groups: 1) a reproductive life planning (RLP) intervention, 2) a reproductive life planning enriched with contraceptive action planning (RLP+) intervention, or 3) an information only control group. Both the RLP and RLP+ guide women to identify their individualized reproductive goals and contraceptive method requirements. The RLP+ additionally includes a contraceptive action planning component, which uses if-then scenarios that allow the user to problem solve situations that make it difficult to be adherent to their contraceptive method. All three groups have access to a reproductive options library containing information about their contraceptive coverage and the attributes of alternative contraceptive methods. Women completed a baseline survey with follow-up surveys every 6 months for 2 years concurrent with intervention boosters. Study outcomes include contraceptive use and adherence. ClinicalTrials.gov identifier: NCT02100124. Results from the MyNewOptions study will demonstrate whether web-based reproductive life planning, with or without contraceptive action planning, helps insured women make patient-centered contraceptive choices compared with an information-only control condition. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Importance of leadership in cardiac arrest situations: from simulation to real life and back.

PubMed

Hunziker, Sabnina; Tschan, Franziska; Semmer, Norbert K; Marsch, Stephan

2013-04-18

The 2010 American Heart Association guidelines now recommend leadership training in Advanced Cardiac Life Support courses. In this review we provide a comprehensive summary of data derived from clinical studies that investigated the importance of leadership in cardiopulmonary resuscitation (CPR). Only a few, mostly observational, studies have been conducted under real-life conditions because of the high heterogeneity of the situations, difficulties in capturing the initial phase of CPR, and ethical issues. Well-controlled studies in the human simulator can fill existing gaps and provide important insights. High-fidelity video-assisted simulator studies from different research groups have shown that a prolonged process of teambuilding is associated with significant shortcomings in CPR, whereas effective leadership improves team performance. In addition, randomised controlled studies have provided evidence that medical students receiving leadership training subsequently showed improved CPR performance, which was sustained after a follow up of 4 months. In addition, leadership is influenced by gender and other factors such as emotional stress. Future studies are needed to investigate cultural differences and how findings from the simulator can be transferred to real-life situations.

Wearable cardioverter defibrillator: a life vest till the life boat (ICD) arrives.

PubMed

Francis, Johnson; Reek, Sven

2014-01-01

It is well established that implantable cardioverter defibrillator (ICD) is a life saving device ensuring protection against life threatening ventricular arrhythmias. But there are certain situations like a recent myocardial infarction where the standard guidelines do not recommend the implantation of an ICD while the patient can still be at a risk of demise due to a life threatening ventricular arrhythmia. There could also be a temporary indication for protection while explanting an infected ICD system. The wearable cardioverter defibrillator (WCD) is a device which comes to the rescue in such situations. In this brief review, we discuss the historical aspects of the development of a WCD, technical aspects as well as the clinical trial data and real world scenario of its use. Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Intervening as a passenger in drinking/driving situations.

PubMed

Smith, Mary Jane; Kennison, Monica; Gamble, Susan; Loudin, Barbara

2004-08-01

This study sought to query adolescents about drinking/driving situations and interventions used in these circumstances. A human science qualitative method was used to analyze descriptions of situations and interventions to gain the perspective of the life world of the young person. Findings include the drinking/driving situations of entangled, endangered, and stranded. Passenger interventions included persuading, interfering, planning ahead, and threatening. Practice, education, and research implications for those who work with adolescents are offered.

Developing Online Emergency Room Case Study Role Play for Medical Students.

ERIC Educational Resources Information Center

Doiron, J. A. Gilles; Isaac, John R.

In the face of panic and life-threatening situations in a hospital emergency room (ER), doctors must rely on well-defined procedures to assess the situation and respond appropriately. Because decisions to act must not only be timely, but also ingrained and swift, practice and experience in a wide range of situations is essential. This paper…

Greece: Socio-cultural Information. The Education of Migrant Workers' Children: Dossiers for the Intercultural Training of Teachers.

ERIC Educational Resources Information Center

Ragoussis, Nikolaos

The report provides information on the social situation, the family, and the education system in Greece. The social situation is discussed in terms of the Greek political system, forms of society and social stratification, the linguistic situation, religions represented, social life and relationships, and 14 holidays and festivals. Information on…

Sounding the Alarm.

ERIC Educational Resources Information Center

Cordasco, Jerry M.

2000-01-01

Explains the use of alarms and other early-detection devices to effectively protect students in life-threatening fire situations. Ohio State University's multidiscipline approach to life safety is illustrated. (GR)

Achieving That Elusive "Leadership Zone"

ERIC Educational Resources Information Center

Martin, Ann M.

2016-01-01

Reaching the "leadership zone" happens when librarians tap into the extraordinary skills lying within to overcome obstacles and transform sometimes-difficult situations into meaningful outcomes. Maturing into an experienced leader who stays in the leadership zone requires knowledge, training, and practice. This article provides tactical…

Inspiring us to inspire others.

PubMed

2004-07-01

All nurses who genuinely care about older people will have encountered difficult situations that necessitate understanding, help and support. At times like this, good leaders can be crucial. They can make the difference between us mustering resources to overcome the challenges, and being overwhelmed by them.

Improving working equine welfare in 'hard-win' situations, where gains are difficult, expensive or marginal.

PubMed

Pritchard, Joy; Upjohn, Melissa; Hirson, Tamsin

2018-01-01

Brooke is a non-government organisation with working equine welfare programmes across Africa, Asia and Latin America. In 2014, staff from ten country programmes were asked to identify 'no-win' situations (subsequently reframed as 'hard-wins')-where improving equine welfare is proving difficult, expensive and/or marginal-in order to inform strategic decisions on how to approach, manage and mitigate for such situations. The Delphi-type consultation process had three phases. Round 1 posed five questions in the form of a workshop, survey and semi-structured interviews. Round 2 re-presented key themes and sense-checked initial conclusions. Round 3 reviewed the nature and prevalence of hard-win situations at an international meeting of all participants. Reasons given for hard-win situations included: no economic or social benefit from caring for working animals; poor resource availability; lack of empathy for working equids or their owners among wider stakeholders; deep-seated social issues, such as addiction or illegal working; areas with a high animal turnover or migratory human population; lack of community cooperation or cohesion; unsafe areas where welfare interventions cannot be adequately supported. Participants estimated the prevalence of hard-win situations as 40-70% of their work. They suggested some current ways of working that may be contributing to the problem, and opportunities to tackle hard-wins more effectively. Respondents agreed that if equine welfare improvements are to span generations of animals, interventions cannot rely on relatively simple, technical knowledge-transfer strategies and quick-wins alone. Programmes need to be more flexible and iterative and less risk-averse in their approaches to embedding good equine welfare practices in all relevant actors. Consultation recommendations informed development of Brooke's new global strategy, a revised organisational structure and redefinition of roles and responsibilities to streamline ways to approach hard-wins in the complex environments and socio-economic contexts in which working equids are found.

Improving working equine welfare in ‘hard-win’ situations, where gains are difficult, expensive or marginal

PubMed Central

Pritchard, Joy; Hirson, Tamsin

2018-01-01

Purpose Brooke is a non-government organisation with working equine welfare programmes across Africa, Asia and Latin America. In 2014, staff from ten country programmes were asked to identify ‘no-win’ situations (subsequently reframed as ‘hard-wins’)—where improving equine welfare is proving difficult, expensive and/or marginal—in order to inform strategic decisions on how to approach, manage and mitigate for such situations. Methods The Delphi-type consultation process had three phases. Round 1 posed five questions in the form of a workshop, survey and semi-structured interviews. Round 2 re-presented key themes and sense-checked initial conclusions. Round 3 reviewed the nature and prevalence of hard-win situations at an international meeting of all participants. Results Reasons given for hard-win situations included: no economic or social benefit from caring for working animals; poor resource availability; lack of empathy for working equids or their owners among wider stakeholders; deep-seated social issues, such as addiction or illegal working; areas with a high animal turnover or migratory human population; lack of community cooperation or cohesion; unsafe areas where welfare interventions cannot be adequately supported. Participants estimated the prevalence of hard-win situations as 40–70% of their work. They suggested some current ways of working that may be contributing to the problem, and opportunities to tackle hard-wins more effectively. Conclusion and animal welfare implications Respondents agreed that if equine welfare improvements are to span generations of animals, interventions cannot rely on relatively simple, technical knowledge-transfer strategies and quick-wins alone. Programmes need to be more flexible and iterative and less risk-averse in their approaches to embedding good equine welfare practices in all relevant actors. Consultation recommendations informed development of Brooke’s new global strategy, a revised organisational structure and redefinition of roles and responsibilities to streamline ways to approach hard-wins in the complex environments and socio-economic contexts in which working equids are found. PMID:29408887

The Future Prospects of Modern Adolescents in the Life Course Perspective

ERIC Educational Resources Information Center

Bochaver, A. A.; Zhilinskaya, A. V.; Khlomov, K. D.

2017-01-01

The article examines trends in theoretical and applied concepts about the adolescent period and in particular about how adolescents develop life goals. We discuss the blurring of the boundaries of adolescence, the postponement of life decisions, and the difficult process of separating from parents as trends in modern adolescent life. Certain…

Career Transitions for Adults. Maine Guide. A Developmental Framework for Life Choices.

ERIC Educational Resources Information Center

Maine State Dept. of Educational and Cultural Services, Augusta. Bureau of Adult and Secondary Vocational Education.

This curriculum presents career, academic, and life skill activities to assist education and training organizations in developing and delivering comprehensive career development and life skill programs. It is designed for the out-of-school person who has life and work experiences and who wants to assess a current life or career situation. The…

Effects of early life adversity on cortisol/salivary alpha-amylase symmetry in free-ranging juvenile rhesus macaques.

PubMed

Petrullo, Lauren A; Mandalaywala, Tara M; Parker, Karen J; Maestripieri, Dario; Higham, James P

2016-11-01

Early life adversity (ELA) affects physiological and behavioral development. One key component is the relationship between the developing Hypothalamic-Pituitary-Adrenal (HPA) axis and the Sympathetic Nervous System (SNS). Recent studies suggest a relationship between early life adversity and asymmetry in cortisol (a measure of HPA activation) and salivary alpha-amylase (sAA: a correlate of SNS activation) responses to stress among human children, but to our knowledge there have been no comparable studies in nonhumans. Here, we investigate the responses of these two analytes in "low stress" and "high stress" situations in free-ranging juvenile rhesus macaques (Macaca mulatta) on Cayo Santiago, Puerto Rico. Behavioral data on maternal maltreatment were collected during the first 3months of life to determine individual rates of ELA, and saliva samples were collected from subjects noninvasively during juvenility. Irrespective of ELA, salivary alpha-amylase levels were lower in low stress situations and higher in high stress situations. For cortisol however, high ELA subjects exhibited higher low stress concentrations and blunted acute responses during high stress situations compared to moderate and low ELA subjects. Cortisol and sAA values were positively correlated among low ELA subjects, suggesting symmetry, but were uncorrelated or negatively correlated among moderate and high ELA subjects, suggesting asymmetry in these individuals. These findings indicate dysregulation of the stress response among juveniles maltreated during infancy: specifically, attenuated cortisol reactivity coupled with typical sAA reactivity characterize the stress response profiles of juveniles exposed to higher rates of ELA during the first 3months of life. Copyright © 2016 Elsevier Inc. All rights reserved.

Fantasy Proneness Correlates With the Intensity of Near-Death Experience.

PubMed

Martial, Charlotte; Cassol, Héléna; Charland-Verville, Vanessa; Merckelbach, Harald; Laureys, Steven

2018-01-01

Little is known about the personality characteristics of those who have experienced a "Near-Death Experience" (NDE). One interesting candidate is fantasy proneness. We studied this trait in individuals who developed NDEs in the presence (i.e., classical NDEs) or absence (i.e., NDEs-like) of a life-threatening situation. We surveyed a total of 228 individuals. From those, 108 qualified as NDE experiencers (i.e., Greyson NDE scale total score ≥7): 51 had their NDEs in the context of a life-threatening situation; 57 had their NDEs not related to a life-threatening situation. From those who did not meet the criteria to be considered "experiencers," 20 had their NDE in the absence of a life-threatening situation; 50 had faced death but did not recall a NDE and finally, 50 were healthy people without a history of life threat and/or NDE. All participants completed a measure of NDE intensity (the Greyson NDE scale) and a measure of fantasy proneness (the Creative Experiences Questionnaire). People reporting NDEs-like scored higher on fantasy proneness than those reporting classical NDEs, individuals whose experiences did not meet the NDE criteria and matched controls. By contrast, individuals reporting classical NDEs did not show different engagement in fantasy as matched controls. The reported intensity of the experiences was positively correlated with engagement in fantasy. Our findings support the view that strong engagement in fantasy by individuals recalling NDEs-like might make these persons more likely to report such subjective experiences when exposed to suitable physiological and/or psychological conditions (e.g., meditation, syncope).

A new low-cost method for difficult airway management in non-missile-penetrating cervical spine injury.

PubMed

Rabiu, Taopheeq B; Fadare, Amos E

2012-03-01

Accessing and maintaining the airway in penetrating cervical spine injury is a challenge for anaesthetists globally. This is more so in resource-poor settings, where advanced techniques for intubation in difficult airway situations are unavailable. We describe a new, low-cost, easily adaptable method of managing the airway used in a middle-aged man who sustained screw driver injury to the cervical spine with C4 Brown-Séquard syndrome. The deployment of readily available and cheap materials led to successful anaesthesia management of the patient.

The impact of an evolving profession on the frequency and perceived difficulty of ethical encounters among physical therapists in the clinic.

PubMed

Berg-Poppe, Patti; MacCabe, Angela; Karges, Joy

2018-05-14

Ethical decision making is situated within dynamic contexts specific to practice standards and environments, contemporary policy, and responsive educational systems. Reflecting on an evolving profession lends insight into the role of ethical codes of conduct. The purpose of this study was to gather information about the frequency and perceived difficulty physical therapists (PTs) experience with common ethical situations within contemporary clinical practice. PTs within the United States were invited to participate in an online questionnaire replicating a 1980 study. Subjects were 336 PTs from a variety of practice environments. Just 1 item was reported as moderately/extremely difficult by contemporary respondents, compared to 16 items in the 1980 study. The number of items meeting moderate/high encounter frequency was similar between the two groups (2015 = 16/19; 1980 = 15/19). While today's PTs report that they encounter ethical situations at a frequency similar to PTs in 1980, these same PTs report these ethical challenges as minimally difficult when compared to PTs responding to the 1980 survey. It is proposed that a move toward autonomous practice, the elevation of the entry level professional degree, and changing health care policy and environments have been influential in shaping these changes over time.

Risks in situations that are experienced as unfamiliar and confusing - the perspective of persons with dementia.

PubMed

Sandberg, Linda; Rosenberg, Lena; Sandman, Per-Olof; Borell, Lena

2017-05-01

An increasing number of people with dementia are ageing at home in Sweden and in other countries. In order to meet the safety requirements, knowledge about how persons with dementia experience risks is required. The aim of the study was to explore and better understand how persons with dementia, living at home, experience risks in their daily life and how they handle these situations. Twelve persons with dementia were interviewed using open-ended questions, and the data were analyzed using a content analysis approach. Findings showed that participants experienced situations fraught with risks in their daily life as unfamiliar and confusing. Previously familiar places became unfamiliar to them, and details did not come together. They were uncertain about what actually had happened. How the participants handled these situations in order to reduce the risks are described.

Strengthening rehabilitation services in Indonesia: A brief situation analysis.

PubMed

Nugraha, Boya; Setyono, Garry Rahardian; Defi, Irma Ruslina; Gutenbrunner, Christoph

2018-04-18

People with disability (PWD) in Indonesia are often neglected by society. Improving their life situation towards full participation in society is crucial. As a health strategy, rehabilitation can improve func-tioning, quality of life and participation in society. However, rehabilitation services in Indonesia need improvement. Making a situation analysis of rehabilitation services and their provision in the country is a pre-requisite to taking any action towards improvement. This paper compiles available data related to disability and rehabilitation services in Indonesia, using the Rehabilitation Services Assessment Tool (RSAT) as a framework. Gaps in provision were analysed, resulting in the compilation of a list of generic recommendations to improve rehabilitation services in the country. Indonesia faces many challenges in rehabilitation services, including the health workforce and the provision of services. This situation analysis and list of generic recommendations may be used in further discussions with relevant stakeholders in the country to develop a national strategy to strengthen rehabilitation services.

Rasch modeling to assess Albanian and South African learners' preferences for real-life situations to be used in mathematics: a pilot study.

PubMed

Kacerja, Suela; Julie, Cyril; Hadjerrouit, Said

2013-01-01

This paper reports on an investigation on the real-life situations students in grades 8 and 9 in South Africa and Albania prefer to use in Mathematics. The functioning of the instrument used to assess the order of preference learners from both countries have for contextual situations is assessed using Rasch modeling techniques. For both the cohorts, the data fit the Rasch model. The differential item functioning (DIF) analysis rendered 3 items operating differentially for the two cohorts. Explanations for these differences are provided in terms of differences in experiences learners in the two countries have related to some of the contextual situations. Implications for interpretation of international comparative tests are offered, as are the possibilities for the cross-country development of curriculum materials related to contexts that learners prefer to use in Mathematics.

Effect of a road safety training program on drivers' comparative optimism.

PubMed

Perrissol, Stéphane; Smeding, Annique; Laumond, Francis; Le Floch, Valérie

2011-01-01

Reducing comparative optimism regarding risk perceptions in traffic accidents has been proven to be particularly difficult (Delhomme, 2000). This is unfortunate because comparative optimism is assumed to impede preventive action. The present study tested whether a road safety training course could reduce drivers' comparative optimism in high control situations. Results show that the training course efficiently reduced comparative optimism in high control, but not in low control situations. Mechanisms underlying this finding and implications for the design of road safety training courses are discussed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Projective identification, self-disclosure, and the patient's view of the object: the need for flexibility.

PubMed

Waska, R T

1999-01-01

Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful. (The Journal of Psychotherapy Practice and Research 1999; 8:225-233)

Using Rasch Analysis to Validate the Motor Activity Log and the Lower Functioning Motor Activity Log in Patients With Stroke.

PubMed

Chuang, I-Ching; Lin, Keh-Chung; Wu, Ching-Yi; Hsieh, Yu-Wei; Liu, Chien-Ting; Chen, Chia-Ling

2017-10-01

The Motor Activity Log (MAL) and Lower-Functioning MAL (LF-MAL) are used to assess the amount of use of the more impaired arm and the quality of movement during activities in real-life situations for patients with stroke. This study used Rasch analysis to examine the psychometric properties of the MAL and LF-MAL in patients with stroke. This is a methodological study. The MAL and LF-MAL include 2 scales: the amount of use (AOU) and the quality of movement (QOM). Rasch analysis was used to examine the unidimensionality, item difficulty hierarchy, targeting, reliability, and differential item functioning (DIF) of the MAL and LF-MAL. A total of 403 patients with mild or moderate stroke completed the MAL, and 134 patients with moderate/severe stroke finished the LF-MAL. Evidence of disordered thresholds and poor model fit were found both in the MAL and LF-MAL. After the rating categories were collapsed and misfit items were deleted, all items of the revised MAL and LF-MAL exhibited ordering and constituted unidimensional constructs. The person-item map showed that these assessments were difficult for our participants. The person reliability coefficients of these assessments ranged from .79 to .87. No items in the revised MAL and LF-MAL exhibited bias related to patients' characteristics. One limitation is the recruited patients, who have relatively high-functioning ability in the LF-MAL. The revised MAL and LF-MAL are unidimensional scales and have good reliability. The categories function well, and responses to all items in these assessments are not biased by patients' characteristics. However, the revised MAL and LF-MAL both showed floor effect. Further study might add easy items for assessing the performance of activity in real-life situations for patients with stroke. © 2017 American Physical Therapy Association

Dream characteristics in a Brazilian sample: an online survey focusing on lucid dreaming

PubMed Central

Mota-Rolim, Sérgio A.; Targino, Zé H.; Souza, Bryan C.; Blanco, Wilfredo; Araujo, John F.; Ribeiro, Sidarta

2013-01-01

During sleep, humans experience the offline images and sensations that we call dreams, which are typically emotional and lacking in rational judgment of their bizarreness. However, during lucid dreaming (LD), subjects know that they are dreaming, and may control oneiric content. Dreaming and LD features have been studied in North Americans, Europeans and Asians, but not among Brazilians, the largest population in Latin America. Here we investigated dreams and LD characteristics in a Brazilian sample (n = 3,427; median age = 25 years) through an online survey. The subjects reported recalling dreams at least once a week (76%), and that dreams typically depicted actions (93%), known people (92%), sounds/voices (78%), and colored images (76%). The oneiric content was associated with plans for the upcoming days (37%), memories of the previous day (13%), or unrelated to the dreamer (30%). Nightmares usually depicted anxiety/fear (65%), being stalked (48%), or other unpleasant sensations (47%). These data corroborate Freudian notion of day residue in dreams, and suggest that dreams and nightmares are simulations of life situations that are related to our psychobiological integrity. Regarding LD, we observed that 77% of the subjects experienced LD at least once in life (44% up to 10 episodes ever), and for 48% LD subjectively lasted less than 1 min. LD frequency correlated weakly with dream recall frequency (r = 0.20, p < 0.01), and LD control was rare (29%). LD occurrence was facilitated when subjects did not need to wake up early (38%), a situation that increases rapid eye movement sleep (REMS) duration, or when subjects were under stress (30%), which increases REMS transitions into waking. These results indicate that LD is relatively ubiquitous but rare, unstable, difficult to control, and facilitated by increases in REMS duration and transitions to wake state. Together with LD incidence in USA, Europe and Asia, our data from Latin America strengthen the notion that LD is a general phenomenon of the human species. PMID:24368900

Dream characteristics in a Brazilian sample: an online survey focusing on lucid dreaming.

PubMed

Mota-Rolim, Sérgio A; Targino, Zé H; Souza, Bryan C; Blanco, Wilfredo; Araujo, John F; Ribeiro, Sidarta

2013-01-01

During sleep, humans experience the offline images and sensations that we call dreams, which are typically emotional and lacking in rational judgment of their bizarreness. However, during lucid dreaming (LD), subjects know that they are dreaming, and may control oneiric content. Dreaming and LD features have been studied in North Americans, Europeans and Asians, but not among Brazilians, the largest population in Latin America. Here we investigated dreams and LD characteristics in a Brazilian sample (n = 3,427; median age = 25 years) through an online survey. The subjects reported recalling dreams at least once a week (76%), and that dreams typically depicted actions (93%), known people (92%), sounds/voices (78%), and colored images (76%). The oneiric content was associated with plans for the upcoming days (37%), memories of the previous day (13%), or unrelated to the dreamer (30%). Nightmares usually depicted anxiety/fear (65%), being stalked (48%), or other unpleasant sensations (47%). These data corroborate Freudian notion of day residue in dreams, and suggest that dreams and nightmares are simulations of life situations that are related to our psychobiological integrity. Regarding LD, we observed that 77% of the subjects experienced LD at least once in life (44% up to 10 episodes ever), and for 48% LD subjectively lasted less than 1 min. LD frequency correlated weakly with dream recall frequency (r = 0.20, p < 0.01), and LD control was rare (29%). LD occurrence was facilitated when subjects did not need to wake up early (38%), a situation that increases rapid eye movement sleep (REMS) duration, or when subjects were under stress (30%), which increases REMS transitions into waking. These results indicate that LD is relatively ubiquitous but rare, unstable, difficult to control, and facilitated by increases in REMS duration and transitions to wake state. Together with LD incidence in USA, Europe and Asia, our data from Latin America strengthen the notion that LD is a general phenomenon of the human species.

End of Life Issues

MedlinePlus

... difficult. But by deciding what end-of-life care best suits your needs when you are healthy, ... making choices about the following: The goals of care (for example, whether to use certain medicines during ...

Student Discipline Data Tracker v.1

ERIC Educational Resources Information Center

Steel, Lawrence E.

2005-01-01

One of the most difficult tasks facing today's busy school administrative teams is tracking and managing student discipline. Administrators must balance the rights of students with cultivating classroom environments conducive to learning. Breakdowns in communication, procedure, and due process can lead to unpleasant situations, and ultimately, a…

A Different Method of Hepaticojejunostomy for Proximal Biliary Injuries

PubMed Central

Schaefer, Glennon

1996-01-01

The management of proximal biliary injuries presents a surgical challenge. Anastomoses can be difficult to perform and can have poor results. We describe a method of hepaticojejunostomy done from within the Roux-en-Y loop, which can be utilized in this situation. PMID:9184866

If cannot define and quantify Ecosystem Services consistently and systematically - we might be lost!

EPA Science Inventory

Imagine that every industrial sector, firm, municipality and state reported and classified their production using different definitions and units - Gross Domestic Product (GDP) would be impossible to calculate! This is precisely the difficult situation in which we find ourselves...

[Epidemic risks and their management in Łódź between 1945-1950].

PubMed

Sadowska, J

2000-01-01

The sanitary and anti-epidemic activities in Łódź between 1945-1950 were characterized by a determination to maintain the good health of the citizens. At that time Łódź just like other industrial conurbations, was in a very difficult economic, social and epidemiological situation. The multisector health care system, operative at the time, which was based on organizational structures from before 1939, effectively managed the risks of epidemics. In this difficult post-war period epidemics of endemic typhus, diphtheria and scarlet fever were successfully managed in Łódź, and the incidence of other acute infectious diseases decreased significantly. The sanitary conditions in the city also greatly improved. The structures of sanitary units were restored, and they in turn developed and enforced the outlines of anti-epidemic activities. The changes occurring after 1948, which aimed at the centralization of the national government, changed the range of responsibility of various institutions for the epidemiological situation in the country.

Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments.

PubMed

Morina, Nexhmedin; Ijntema, Hiske; Meyerbröker, Katharina; Emmelkamp, Paul M G

2015-11-01

In virtual reality exposure therapy (VRET), patients are exposed to virtual environments that resemble feared real-life situations. The aim of the current study was to assess the extent to which VRET gains can be observed in real-life situations. We conducted a meta-analysis of clinical trials applying VRET to specific phobias and measuring treatment outcome by means of behavioral laboratory tests or recordings of behavioral activities in real-life. Data sources were searches of databases (Medline, PsycInfo, and Cochrane). We included in total 14 clinical trials on specific phobias. Results revealed that patients undergoing VRET did significantly better on behavioral assessments following treatment than before treatment, with an aggregated uncontrolled effect size of g = 1.23. Furthermore, patients undergoing VRET performed better on behavioral assessments at post-treatment than patients on wait-list (g = 1.41). Additionally, results of behavioral assessment at post-treatment and at follow-up revealed no significant differences between VRET and exposure in vivo (g = -0.09 and 0.53, respectively). Finally, behavioral measurement effect sizes were similar to those calculated from self-report measures. The findings demonstrate that VRET can produce significant behavior change in real-life situations and support its application in treating specific phobias. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Development of Clinical Nursing Situations on Videotape for Use via Closed-Circuit Television in the Teaching of Nursing. Final Report.

ERIC Educational Resources Information Center

Allen, Moyra

To assess the effectiveness of videotapes depicting clinical situations in the teaching of nursing, videotapes were made of the everyday, real-life situations that persons and their families experience throughout their illness in various parts of Canada's health delivery system. Three validation sessions, attended by representatives of nursing…

Introducing "The Matrix Classroom" University Course Design That Facilitates Active and Situated Learning though Creating Two Temporary Communities of Practice

ERIC Educational Resources Information Center

Roberts, Emma; Sayer, Karen

2017-01-01

This paper illustrates a radical course design structured to create active and situated learning in which students participate in communities of practice within the classroom, replicating real-life work situations. This paper illustrates the approach through a People Management module, but the approach is also used across a range of disciplines…

Consequences Identification in Forecasting and Ethical Decision-making

PubMed Central

Stenmark, Cheryl K.; Antes, Alison L.; Thiel, Chase E.; Caughron, Jared J.; Wang, Xiaoqian; Mumford, Michael D.

2015-01-01

Forecasting involves predicting outcomes based on observations of the situation at hand. We examined the impact of the number and types of consequences considered on the quality of ethical decision-making. Undergraduates role-played several ethical problems in which they forecast potential outcomes and made decisions. Performance pressure (difficult demands placed on the situation) and interpersonal conflict (clashes among people in the problem situation) were manipulated within each problem scenario. The results indicated that the identification of potential consequences was positively associated with both higher quality forecasts and more ethical decisions. Neither performance pressure nor interpersonal conflict affected the quality of forecasts or decisions. Theoretical and practical implications of these findings and the use of this research approach are discussed. PMID:21460584

[Teaching basic life support to the general population. Alumni intervention analysis].

PubMed

Díaz-Castellanos, M A; Fernández-Carmona, A; Díaz-Redondo, A; Cárdenas-Cruz, A; García-del Moral, R; Martín-Lopez, J; Díaz-Redondo, T

2014-12-01

The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. A descriptive, cross-sectional study was made. A district in the province of Almería (Spain). Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas» conducted between 2003-2009. In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61±10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers. Copyright © 2013 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Regoaling: a conceptual model of how parents of children with serious illness change medical care goals

PubMed Central

2014-01-01

Background Parents of seriously ill children participate in making difficult medical decisions for their child. In some cases, parents face situations where their initial goals, such as curing the condition, may have become exceedingly unlikely. While some parents continue to pursue these goals, others relinquish their initial goals and generate new goals such as maintaining the child’s quality of life. We call this process of transitioning from one set of goals to another regoaling. Discussion Regoaling involves factors that either promote or inhibit the regoaling process, including disengagement from goals, reengagement in new goals, positive and negative affect, and hopeful thinking. We examine these factors in the context of parental decision making for a seriously ill child, presenting a dynamic conceptual model of regoaling. This model highlights four research questions that will be empirically tested in an ongoing longitudinal study of medical decision making among parents of children with serious illness. Additionally, we consider potential clinical implications of regoaling for the practice of pediatric palliative care. Summary The psychosocial model of regoaling by parents of children with a serious illness predicts that parents who experience both positive and negative affect and hopeful patterns of thought will be more likely to relinquish one set of goals and pursue a new set of goals. A greater understanding of how parents undergo this transition may enable clinicians to better support them through this difficult process. PMID:24625345

Receiving power through confirmation: the meaning of close relatives for people who have been critically ill.

PubMed

Engström, Asa; Söderberg, Siv

2007-09-01

This paper is a report of a study to elucidate the meaning of close relatives for people who have been critically ill and received care in an intensive care unit. Falling critically ill can bring about a difficult change in life. In previous reports such events are described as frightening experiences, and close relatives are described as an important source of support in this difficult situation. A purposive sample of 10 adults, eight men and two women, narrated how they experienced their close relatives during and after the time they were critically ill. The data were collected in 2004. The interview texts were transcribed and interpreted using a phenomenological hermeneutic approach influenced by the philosophy of Ricoeur. One major theme was identified, experiencing confirmation, with six sub-themes: receiving explanations; a feeling of being understood; a feeling of safety; gaining strength and will-power; having possibilities and realizing their value. Close relatives served as tools for the person who was ill, facilitating better communication and an increased ability to do various things. Simultaneously, feelings of dependence on the close relatives were expressed. There were descriptions of loneliness and fear in the absence of close relatives and, in order to feel safe, the participants wanted their close relatives to stay near them. Close relatives are vital, as they are the ill person's motivation to stay alive and to continue the struggle. Their presence is of great importance for the ill person and must be facilitated by staff.

Iron deficiency and new insights into therapy.

PubMed

Low, Michael Sy; Grigoriadis, George

2017-07-17

Iron deficiency and iron deficiency anaemia remain prevalent in Australia. The groups at highest risk are pre-menopausal women, socially disadvantaged people and those of Indigenous background. Diagnosing iron deficiency using a full blood examination and iron studies can be difficult and can be further complicated by concomitant inflammation. Results of iron studies should always be interpreted as an overall picture rather than focusing on individual parameters. In difficult clinical scenarios, soluble transferrin receptor assays can be useful. Management of iron deficiency involves identification and treatment of the cause of iron deficiency, as well as effective iron replacement. Clinicians should always take a detailed history and perform a comprehensive physical examination of a patient with iron deficiency. Patients should be monitored even if a likely cause of iron deficiency is identified. Patients who fail to respond to iron replacement or maintain iron status should be referred for further investigation, including endoscopy to exclude internal bleeding. Both enteral and parenteral iron are effective at replacing iron. For most adult patients, we recommend trialling daily oral iron (30-100 mg of elemental iron) as the first-line therapy. Safety and efficacy of intravenous iron infusions have improved with the availability of a newer formulation, ferric carboxymaltose. Patients who fail to respond to oral iron replacement can be safely managed with intravenous iron. Blood transfusion for iron deficiency anaemia should be reserved for life-threatening situations and should always be followed by appropriate iron replacement.

E-Counselling Implementation: Students' Life Stories and Counselling Technologies in Perspective

ERIC Educational Resources Information Center

Kolog, Emmanuel Awuni; Sutinen, Erkki; Vanhalakka-Ruoho, Marjatta

2014-01-01

Given the current global trend of mimicking real life situations into digital counselling games and its related digital counselling platforms, we decided to contextually understand from the Ghanaian senior high school students, their life challenges arising from their life stories. The study also explores the extent to which ICT is currently being…

Error Detection-Based Model to Assess Educational Outcomes in Crisis Resource Management Training: A Pilot Study.

PubMed

Bouhabel, Sarah; Kay-Rivest, Emily; Nhan, Carol; Bank, Ilana; Nugus, Peter; Fisher, Rachel; Nguyen, Lily Hp

2017-06-01

Otolaryngology-head and neck surgery (OTL-HNS) residents face a variety of difficult, high-stress situations, which may occur early in their training. Since these events occur infrequently, simulation-based learning has become an important part of residents' training and is already well established in fields such as anesthesia and emergency medicine. In the domain of OTL-HNS, it is gradually gaining in popularity. Crisis Resource Management (CRM), a program adapted from the aviation industry, aims to improve outcomes of crisis situations by attempting to mitigate human errors. Some examples of CRM principles include cultivating situational awareness; promoting proper use of available resources; and improving rapid decision making, particularly in high-acuity, low-frequency clinical situations. Our pilot project sought to integrate CRM principles into an airway simulation course for OTL-HNS residents, but most important, it evaluated whether learning objectives were met, through use of a novel error identification model.

Life satisfaction and life values in people with spinal cord injury living in three Asian countries: a multicultural study.

PubMed

Tasiemski, Tomasz; Priebe, Michael M; Wilski, Maciej

2013-03-01

To compare the differences in life satisfaction and life values among people with spinal cord injury (SCI) living in three economically similar Asian countries: India, Vietnam, and Sri Lanka. Cross-sectional and comparative investigation using the unified questionnaire. Indian Spinal Injuries Centre in New Delhi (India), Spinal Cord Rehabilitation Department of the Bach Mai Hospital in Hanoi (Vietnam), and Foundation for the Rehabilitation of the Disabled in Colombo (Sri Lanka). Two hundred and thirty-seven people with SCI using a wheelchair; 79 from India, 92 from Vietnam, and 66 from Sri Lanka. Life Satisfaction Questionnaire, Chinese Value Survey. People with SCI in Vietnam had significantly higher general life satisfaction than participants in India and Sri Lanka. Significant differences were identified in several demographic and life situation variables among the three Asian countries. With regard to "Traditional", "Universal", and "Personal" life values significant differences among three participating countries were identified in all domains. No significant relationships were identified between life satisfaction and life values for people with SCI in India, Vietnam, or Sri Lanka. It could be presumed that particular demographic and life situation variables are more powerful factors of life satisfaction following SCI than the dominant culture of a country expressed by life values.

The most common friend first immunization

NASA Astrophysics Data System (ADS)

Nian, Fu-Zhong; Hu, Cha-Sheng

2016-12-01

In this paper, a standard susceptible-infected-recovered-susceptible(SIRS) epidemic model based on the Watts-Strogatz (WS) small-world network model and the Barabsi-Albert (BA) scale-free network model is established, and a new immunization scheme — “the most common friend first immunization” is proposed, in which the most common friend’s node is described as being the first immune on the second layer protection of complex networks. The propagation situations of three different immunization schemes — random immunization, high-risk immunization, and the most common friend first immunization are studied. At the same time, the dynamic behaviors are also studied on the WS small-world and the BA scale-free network. Moreover, the analytic and simulated results indicate that the immune effect of the most common friend first immunization is better than random immunization, but slightly worse than high-risk immunization. However, high-risk immunization still has some limitations. For example, it is difficult to accurately define who a direct neighbor in the life is. Compared with the traditional immunization strategies having some shortcomings, the most common friend first immunization is effective, and it is nicely consistent with the actual situation. Project supported by the National Natural Science Foundation of China (Grant No. 61263019), the Program for International Science and Technology Cooperation Projects of Gansu Province, China (Grant No. 144WCGA166), and the Program for Longyuan Young Innovation Talents and the Doctoral Foundation of Lanzhou University of Technology, China.

[A case of Asperger's disorder with catatonia originally suspected of being catatonic schizophrenia].

PubMed

Saito, Shinnosuke; Yamaga, Kuniaki; Kobayashi, Toshiyuki; Kato, Satoshi

2011-01-01

We report the case of an adolescent male who presented with mutism, immobility, catalepsy, and mannerisms. The patient was admitted to our hospital with suspected catatonic schizophrenia; however, he was subsequently diagnosed with catatonia due to Asperger's disorder. The patient was a 16-year-old male. More than six months before presentation, his grandfather displayed bizarre and violent behavior. Subsequently, he began to experience catatonia, which eventually led to hospitalization. Treatment with diazepam improved his condition and, as no causal disorders other than Asperger's disorder were identified, he was diagnosed with catatonia. The patient had experienced persistent abuse by his mother during childhood; therefore, it is important to consider reactive attachment disorder (DSM-IV-TR) as a differential diagnosis. Among child and adolescent psychiatrists, catatonia is considered to occur at a high frequency among patients with autistic spectrum disorders. In contrast, general psychiatrists tend to consider catatonia as related to schizophrenia, which may be the reason why the diagnosis of our patient was difficult. We assume that the pathogenesis of catatonia in this case was death mimicry due to the subjective perception of a life-threatening situation. For the treatment of catatonia with autistic spectrum disorders, the efficacy of benzodiazepines and electroconvulsive therapy has been established. When a patient with an autistic spectrum disorder presents with motor functional disturbances, it is important to consider these disturbances as catatonia. Furthermore, it is also important to begin the treatment mentioned above even in the presence of definite psychogenic or situational factors.

Being a Victim of Medical Error in Brazil: An (Un)Real Dilemma

PubMed Central

Mendonça, Vitor Silva; Custódio, Eda Marconi

2016-01-01

Medical error stems from inadequate professional conduct that is capable of producing harm to life or exacerbating the health of another, whether through act or omission. This situation has become increasingly common in Brazil and worldwide. In this study, the aim was to understand what being the victim of medical error is like and to investigate the circumstances imposed on this condition of victims in Brazil. A semi-structured interview was conducted with twelve people who had gone through situations of medical error in their lives, creating a space for narratives of their experiences and deep reflection on the phenomenon. The concept of medical error has a negative connotation, often being associated with the incompetence of a medical professional. Medical error in Brazil is demonstrated by low-quality professional performance and represents the current reality of the country because of the common lack of respect and consideration for patients. Victims often remark on their loss of identity, as their social functions have been interrupted and they do not expect to regain such. It was found, however, little assumption of error in the involved doctors’ discourses and attitudes, which felt a need to judge the medical conduct in an attempt to assert their rights. Medical error in Brazil presents a punitive character and is little discussed in medical and scientific circles. The stigma of medical error is closely connected to the value and cultural judgments of the country, making it difficult to accept, both by victims and professionals. PMID:27403461

Indigenous Knowledge Approach to Successful Psychotherapies with Aboriginal Suicide Attempters.

PubMed

Mehl-Madrona, Lewis

2016-11-01

Suicide is disproportionately common among Aboriginal people in Canada. Life stories were collected from 54 Aboriginal suicide attempters in northern Saskatchewan. Constant comparison techniques and modified grounded theory identified common themes expressed. Three common plots/themes preceded suicide attempts: 1) relationship breakup, usually sudden, unanticipated, involving a third person; 2) being publicly humiliated by another person(s), accompanied by high levels of shame; and 3) high levels of unremitting, chronic life stress (including poverty) with relative isolation. We found 5 common purposes for suicide attempts: 1) to "show" someone how badly they had hurt the attempter, 2) to stop the pain, 3) to save face in a difficult social situation, 4) to get revenge, and 5) don't know/don't remember/made sense at the time, all stated by people who were under the influence of alcohol and/or drugs at the time of their suicide attempt. We found 5 common beliefs about death: 1) you just cease to exist, and everything just disappears; 2) you go into the spirit world and can see and hear everything that is happening in this world; 3) you go to heaven or hell; 4) you go to a better place; and 5) don't know/didn't think about it. The idea of personal and cultural continuity is essential to understanding suicide among First Nations youth. Interventions targeted to the individual's beliefs about death, purpose for suicide, and consistent with the life story (plot) in which they find themselves may be more successful than one-size-fits-all programs developed outside of aboriginal communities. © The Author(s) 2016.

[Arrived in Germany: When Children Who have Fled Tell their Stories].

PubMed

Gerarts, Katharina; Andresen, Sabine; Ravens-Sieberer, Ulrike; Klasen, Fionna

2016-12-01

Arrived in Germany: When Children Who have Fled Tell their Stories For this study, we listened to children who had fled with their families. We made a very conscious decision to focus on accompanied minors who have been displaced, because they go through the standard asylum system with their parent/guardian, which is why they often remain "invisible" as regards their own needs and their specific situation. We gave accompanied children who had fled a space where they could tell their stories and asked them to talk about their memories of their countries of origin, their experiences during their journey and on arrival in Germany, and their lives here, their concerns, but also their hopes and desires. The children presented here come from Afghanistan, Eritrea, Iran, Kosovo, Serbia and Syria. They therefore represent the countries from which people have set out on the always difficult, often life-threatening journey to Germany. And they represent the diversity of experiences of flight and arrival. Those responsible for this study come from various academic disciplines and areas of work. This was important to us in order to focus on the complexity of being a child and a child's everyday life under the conditions experienced while on the run. In view of the vulnerability of children, many challenges are regarded in a different light from previously, for example concerning the organisation of initial reception centres, education and care provisions, medical care, protected spaces and privacy. We want to encourage you to see these spaces, the bureaucratic procedures and coping with everyday life through the eyes of a child.

Ethics of palliative care in late-stage cancer management and end-of-life issues in a depressed economy.

PubMed

Chukwuneke, F N

2015-12-01

The Hippocratic Oath has often been referred to as the ethical foundation of medical practice with the key restriction "cause no harm" which is also the principle of benevolence in bioethics. In medical profession, the Oath still exemplifies the key virtues of a doctor in its emphasis on the obligations toward the well-being of the individual patient. In management of end-stage cancer in a depressed economy such as Nigeria, we frequently encounter a wide range of ethical issues that arise in the provision of palliative care mostly due to the prevailing economic situation and cultural setting. Since most of these patients came from a lower economic class of the society, with little or no formal education and lived at a subsistence level, they often find it difficult to provide the medications needed. In a poor setting where health inequity is rife, and ignorance and poverty are commonplace, a good understanding of medical ethics with a good model of health care system will contribute to the health professional's decision-making that will be in the best interest of the patients. Physicians must protect the lives of their patients and should never hasten their death. In end-stage cancer management, we have to relieve suffering and pains, promote palliative care, and give psychological support but never abandoning the patient or initiate terminating their life. This presentation is a clinical analysis of the ethical issues regarding the management of end-stage cancer patients in a poor economy with a critical overview of end-of-life issues in African perspective.

Dispositional optimism and self-assessed situation awareness in a Norwegian military training exercise.

PubMed

Eid, Jarle; Matthews, Michael D; Meland, Nils Tore; Johnsen, Bjørn Helge

2005-06-01

The current study examined the relationship between dispositional optimism and situation awareness. A sample of 77 Royal Norwegian Naval Academy and 57 Royal Norwegian Army Academy cadets were administered the Life Orientation Test prior to participating in a field-training exercise involving a series of challenging missions. Following an infantry mission component of the exercise, situation awareness was measured using the Mission Awareness Rating Scale (MARS), a self-assessment tool. The analysis indicated that dispositional optimism correlated negatively with situation awareness under these conditions. The role of intrapersonal variables in mediating situation awareness and decision-making in stressful situations is discussed.

Hard-Earned Wisdom: Exploratory Processing of Difficult Life Experience Is Positively Associated with Wisdom

ERIC Educational Resources Information Center

Weststrate, Nic M.; Glück, Judith

2017-01-01

Laypersons and experts believe that wisdom is cultivated through a diverse range of positive and negative life experiences. Yet, not all individuals with life experience are wise. We propose that one possible determinant of growth in wisdom from life experience is self-reflection. In a life span sample of adults (N = 94) ranging from 26 to 92…

Situation Change: Stability and Change of Situation Variables between and within Persons

PubMed Central

Rauthmann, John F.; Sherman, Ryne A.

2016-01-01

When, how, and why situations flow into one another is important for understanding dynamic personality processes, but the topic of situation change has traditionally been a thorny issue in personality/social psychology. We explore conceptual and methodological issues in research on situation change: (1) What is situation change, which variables could we measure, and how can situation change be methodologically captured and analyzed (at between- and within-person levels)? (2) Which person-situation transaction mechanisms (situation management strategies) could entail stability and change of situations in daily life? (3) How do single or repeated instances of situation change impact short-, middle-, and long-term outcomes (e.g., intra- and interpersonal adjustment)? Besides laying out a research program for situation change, we present preliminary data from participants who wore mini-video cameras recording their situations so that they could be rated later in the lab. We demonstrate rater consensus on when situations change, mean-level changes of situation characteristics across situations, similarity of situation characteristics across adjacent situations, and inter-individual differences in intra-individual situation change in change networks. PMID:26779068

Comforting Children and Families Who Grieve: Incorporating Spiritual Support

ERIC Educational Resources Information Center

Jerome, Annette

2011-01-01

Based on specific school and community tragedies, this article reviews difficult situations and how students' spiritual and religious beliefs were incorporated into school-based grief interventions. Suggestions are made to strengthen this often untapped resource, encouraging school-based mental health professionals to consult with community…

Measuring Learning through Cross Sectional Testing

ERIC Educational Resources Information Center

Lovett, Steve; Johnson, Jennie

2012-01-01

The measurement of student learning is becoming increasingly important in U.S. higher education. One way to measure learning is through longitudinal testing, but this becomes especially difficult when applied to cumulative learning within programs in situations of low persistence. In particular, many Hispanic Serving Institutions (HSIs) find…

Breaking Bad News to Parents.

ERIC Educational Resources Information Center

Miller, Susan A.

1996-01-01

Discusses the difficulty of breaking bad news to parents, whether the news pertains to center policy or a child's behavior. Provides strategies for presenting news and for helping parents to overcome difficult situations, including gathering facts in advance, arranging an appropriate time, and having resource materials available for parents. (MOK)

Emotional Awareness and Couples' Relationship Satisfaction

ERIC Educational Resources Information Center

Croyle, Kristin L.; Waltz, Jennifer

2002-01-01

This study examined the role of emotional awareness in couples' relationships and the effects of a tendency to respond to difficult couples' situations with "soft" emotions (including sadness and fear) versus "hard" emotions (including anger and resentment). Participants were 56 heterosexual couples who completed a measure of relationship…

Causal Responsibility and Counterfactuals

ERIC Educational Resources Information Center

Lagnado, David A.; Gerstenberg, Tobias; Zultan, Ro'i

2013-01-01

How do people attribute responsibility in situations where the contributions of multiple agents combine to produce a joint outcome? The prevalence of over-determination in such cases makes this a difficult problem for counterfactual theories of causal responsibility. In this article, we explore a general framework for assigning responsibility in…

Interviews with children of persons with a severe mental illness: investigating their everyday situation.

PubMed

Ostman, Margareta

2008-01-01

Research on children of persons with a severe mental illness focuses predominantly on parents' and others' perceptions. Children of mentally ill parents form a vulnerable group that has not been adequately paid attention to in psychiatric care institutions. Comparatively little is known about the children's recognition of their parents and the everyday situation of these families. The aim of the study was to investigate experiences of their life situation in children 10-18 years of age in a family with a parent with a severe mental illness. Eight children were interviewed concerning their everyday life situation. The interviews were analysed inspired from using thematic analysis. From the analysis of the material emerged aspects concerning the following themes: need for conversation, love for their family, maturity, experience of fear and blame, feelings of loneliness, responsibility and associated stigma. This study highlights the situation experienced by children of severely mentally ill persons who also are parents. The study may be found to be a basis for inspiring structured interventions and treatments programmes including children of the adult patients seeking psychiatric treatment.

Religiousness, spirituality, and coping with stress among late adolescents: A meaning-making perspective.

PubMed

Krok, Dariusz

2015-12-01

The purpose of this study was to examine the associations between religiousness, spirituality (R/S), and coping among late adolescents within a meaning-making perspective. Specifically, global meaning and situational meaning were examined as potential mediators. Two hundred and twenty one Polish participants (115 women and 106 men) completed the Religious Meaning System Questionnaire, the Self-description Questionnaire of Spirituality, the Meaning in Life Questionnaire, and the Situational Meaning Scale. Results of SEM analysis showed that R/S had both direct and indirect effects on coping, suggesting that global meaning and situational meaning served as partial mediators among late adolescents. The mediating role of global meaning and situational meaning may be more fully understood within the framework of the meaning-making model. Consistent with the model, individuals with higher levels of R/S had a propensity to experience stronger global meaning in life and situational meaning, which in turn contributed to more frequent using coping styles. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Blood Transfusion (For Parents)

MedlinePlus

... child to have the blood transfusion. If the situation is not a life-threatening emergency, two tests ... feeling extreme tiredness and help give them enough energy for the activities of daily life. Benefits like ...

Development of Integrated Flood Analysis System for Improving Flood Mitigation Capabilities in Korea

NASA Astrophysics Data System (ADS)

Moon, Young-Il; Kim, Jong-suk

2016-04-01

Recently, the needs of people are growing for a more safety life and secure homeland from unexpected natural disasters. Flood damages have been recorded every year and those damages are greater than the annual average of 2 trillion won since 2000 in Korea. It has been increased in casualties and property damages due to flooding caused by hydrometeorlogical extremes according to climate change. Although the importance of flooding situation is emerging rapidly, studies related to development of integrated management system for reducing floods are insufficient in Korea. In addition, it is difficult to effectively reduce floods without developing integrated operation system taking into account of sewage pipe network configuration with the river level. Since the floods result in increasing damages to infrastructure, as well as life and property, structural and non-structural measures should be urgently established in order to effectively reduce the flood. Therefore, in this study, we developed an integrated flood analysis system that systematized technology to quantify flood risk and flood forecasting for supporting synthetic decision-making through real-time monitoring and prediction on flash rain or short-term rainfall by using radar and satellite information in Korea. Keywords: Flooding, Integrated flood analysis system, Rainfall forecasting, Korea Acknowledgments This work was carried out with the support of "Cooperative Research Program for Agriculture Science & Technology Development (Project No. PJ011686022015)" Rural Development Administration, Republic of Korea

Spirituality, religiousness and coping in patients with schizophrenia: A cross sectional study in a tertiary care hospital.

PubMed

Das, Soumitra; Punnoose, Varghese Panickasseril; Doval, Nimisha; Nair, Vijayakrishnan Yathindran

2018-04-24

Religion is a form of coping that helps individuals to deal with a wide variety of difficult life situations. But most of the research in this field has been in acute patients of schizophrenia. Also, most of the research on religion and schizophrenia has focused on religion and spirituality as coping mechanisms, and research evaluating the relationship between spirituality/religiousness and repertoire of other coping skills is sparse. Our objective was to evaluate the association between spirituality, religiousness and coping skills in patients with schizophrenia in remission. Hence, a total of 48 consecutive patients with schizophrenia were assessed on Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale (PSP), WHO Quality of Life-Spirituality, Religiousness and Personal Belief scale (WHOQOL-SRPB) and Ways of Coping Checklist - Revised (WCC). Findings were described as patients who used more religiosity and spirituality as measured with WHO-SRPB domain score were better in their managing their stress as they used all the adaptive strategies like planful problem solving, positive reappraisal, distancing, self-controlling, seeking social support rather than maladaptive skills like confrontive coping and escape avoidance. A sound spiritual, religious, or personal belief system positively affects active and adaptive coping skills in patients with schizophrenia during remission, thus helping the individual to cope with illness related stressors. Copyright © 2018 Elsevier B.V. All rights reserved.

Mood effects on memory and executive control in a real-life situation.

PubMed

Lagner, Prune; Kliegel, Matthias; Phillips, Louise H; Ihle, Andreas; Hering, Alexandra; Ballhausen, Nicola; Schnitzspahn, Katharina M

2015-01-01

In the laboratory, studies have shown an inconsistent pattern of whether, and how, mood may affect cognitive functions indicating both mood-related enhancement as well as decline. Surprisingly, little is known about whether there are similar effects in everyday life. Hence, the present study aimed to investigate possible mood effects on memory and executive control in a real-life situation. Mood effects were examined in the context of winning in a sports competition. Sixty-one male handball players were tested with an extensive cognitive test battery (comprising memory and executive control) both after winning a match and after training as neutral baseline. Mood differed significantly between the two testing situations, while physiological arousal and motivation were comparable. Results showed lowered performance after the win compared with training in selected cognitive measures. Specifically, short-term and episodic memory performance was poorer following a win, whereas executive control performance was unaffected by condition. Differences in memory disappeared when emotional states after the match were entered as covariates into the initial analyses. Thus, findings suggest mood-related impairments in memory, but not in executive control processes after a positive real-life event.

Chronic Stress and Fatigue-Related Quality of Life after Mild-to-Moderate Traumatic Brain Injury (TBI)

PubMed Central

Bay, Esther; de-Leon, Marita B.

2010-01-01

Objective To determine relationships between chronic stress, fatigue-related quality of life (QOL-F) and related covariates after mild-to-moderate traumatic brain injury (TBI). Design Observational and cross-sectional Participants A total of 84 community-dwelling individuals with mild-to-moderate TBI recruited from multiple out-patient rehabilitation clinics assessed on average 15 months after injury. Method Data were collected with self-report surveys and chart abstraction. Measures Neurofunctional Behavioral Inventory, Perceived Stress Scale-14, Impact of Events Scale, McGill Pain Short-form Scale, and modified version of the Fatigue Impact Scale. Results Fatigue-related quality of life was associated with somatic symptoms, perceived situational stress, but not with event-related stress (PTSD symptoms) related to index TBI, pre-injury demographic, or post-injury characteristics. Somatic symptoms and chronic situational stress accounted for 42% of the variance in QOL (F). Conclusions QOL (F) in community-dwelling individuals with mild-to- moderate TBI is associated with chronic situational stress and somatic symptoms. Symptom management strategies may need to include general stress management to reduce fatigue burden and improve quality of life. PMID:21169862

Ethical reflections on end-of-life signs and symptoms in the intensive care setting: a place for neuromuscular blockers?

PubMed Central

2014-01-01

The death of a loved one is often an ordeal and a tragedy for those who witness it, as death is not merely the end of a life, but also the end of an existence, the loss of a unique individual who is special and irreplaceable. In some situations, end-of-life signs, such as agonal gasps, can be an almost unbearable “sight” because the physical manifestations are hard to watch and can lead to subjective interpretation and irrational fears. Ethical unease arises as the dying patient falls prey to death throes and to the manifestations of ebbing life and the physician can only stand by and watch. From this point on, medicine can put an end to suffering by the use of neuromuscular blockade, but in so doing life ceases at the same time. It is difficult, however, not to respond to the distress of loved ones and caregivers. The ethical problem then becomes the shift from the original ethical concern, i.e. the dying patient, to the patient’s loved ones. Is such a rupture due to a difference in nature or a difference in degree, given that the dying patient remains a person and not a thing as long as the body continues to lead its own life, expressed through movement and sound? Because there cannot be any simple and unequivocal answer to this question, the SRLF Ethics Commission is offering ethical reflections on end-of-life signs and symptoms in the intensive care setting, and on the use of neuromuscular blockade in this context, with presentations on the subject by two philosophers and members of the SRLF Ethics Commission, Ms Lise Haddad and Prof Dominique Folscheid. The SRLF Ethics Commission hopes to provide food for thought for everyone on this topic, which undoubtedly calls for further contributions, the aim being not to provide ready-made solutions or policy, but rather to allow everyone to ponder this question in all conscience. PMID:25045580

Conditions for the emergence of life on the early Earth: summary and reflections

PubMed Central

Jortner, Joshua

2006-01-01

This review attempts to situate the emergence of life on the early Earth within the scientific issues of the operational and mechanistic description of life, the conditions and constraints of prebiotic chemistry, together with bottom-up molecular fabrication and biomolecular nanofabrication and top-down miniaturization approaches to the origin of terrestrial life. PMID:17008225

Coping with Life-Threat and General Life Conflict: Two Diverse Beasts.

ERIC Educational Resources Information Center

Feifel, Herman

There is a widely held clincial contention that people use similar coping strategies in facing life-threatening situations as they do in dealing with general life quandries. To examine this hypothesis, male cancer patients (N=74), male heart disease patients (N=77), elderly persons (N=73), male patients with nonlife-threatening illnesses or…

Age and the Tenses of Life Satisfaction

PubMed Central

2013-01-01

Objective. People have a special capacity to live simultaneously in both chronological and biographical time. In this article, we examine reports of life satisfaction that span past, present, and future, considering how perceived changes in certain life domains are associated with overall perceived life trajectories. Methods. Analyses use men and women from the Midlife Development in the United States survey. We employ gender-stratified fixed effects regression models to examine the net effect of satisfaction with finances, partnerships/marriage, sex, contribution to others, work, health, and relationship with children on trajectories of overall life satisfaction. Results. Among men, partnership and financial satisfaction had the strongest association with life satisfaction. Women displayed a somewhat broader range of domains related to their trajectories of life satisfaction. Partnership was most important, but their sense of evolving life satisfaction was also tied to their relationship with their children, sexuality, work situation, contribution to others’ welfare, and financial situation. Discussion. We find several notable differences between men and women, but the most telling differences emerge among women themselves across chronological time. For women, partner satisfaction becomes considerably more important across the age groups, whereas sex, contribution to others, and relationships with children all decrease in their importance for overall life satisfaction. PMID:23704205

Intelligent Pilot Aids for Flight Re-Planning in Emergencies

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.

2002-01-01

Experimental studies were conducted with pilots to investigate the attributes of automation that would be appropriate for aiding pilots in emergencies. The specific focus of this year was on methods of mitigating automation brittleness. Brittleness occurs when the automatic system is used in circumstances it was not designed for, causing it to choose an incorrect action or make an inaccurate decision for the situation. Brittleness is impossible to avoid since it is impossible to predict every potential situation the automatic system will be exposed to over its life. However, operators are always ultimately responsible for the actions and decisions of the automation they are monitoring or using, which means they must evaluate the automation's decisions and actions for accuracy. As has been pointed out, this is a difficult thing for human operators to do. There have been various suggestions as to how to aid operators with this evaluation. In the study described in this report we studied how presentation of contextual information about an automatic system's decision might impact the ability of the human operators to evaluate that decision. This study focused on the planning of emergency descents. Fortunately, emergencies (e.g., mechanical or electrical malfunction, on-board fire, and medical emergency) happen quite rarely. However, they can be catastrophic when they do. For all predictable or conceivable emergencies, pilots have emergency procedures that they are trained on, but those procedures often end with 'determine suitable airport and land as quickly as possible.' Planning an emergency descent to an unplanned airport is a difficult task, particularly under the time pressures of an emergency. Automatic decision aids could be very efficient at the task of determining an appropriate airport and calculating an optimal trajectory to that airport. This information could be conveyed to the pilot through an emergency descent procedure listing all of the actions necessary to safely land the plane. However, there is still the potential problem of brittleness. This study examined the impact of contextual information in presentations of emergency descent procedures to see if they might impact the pilot's evaluation of the feasibility of the presented procedure. The study and its results are described in detail.

The Life Narrative at Midlife

ERIC Educational Resources Information Center

McAdams, Dan P.

2014-01-01

In a remarkably prescient chapter, Bertram Cohler (1982) reimagined the problems and the potentialities of psychological development across the life course as a distinctively human challenge in life narration. This chapter situates Cohler's original vision within the intellectual and scientific matrix of the late 1970s, wherein psychologists…

Surviving at extremes

NASA Astrophysics Data System (ADS)

Dougan, Lorna

2015-11-01

Wherever we look on Earth - even in the most inhospitable places - we find life. But how do organisms manage to survive such difficult conditions? Lorna Dougan explains how physicists are helping to unravel the properties of “extremophile” life.

Living with incurable oesophageal cancer. A phenomenological hermeneutical interpretation of patient stories.

PubMed

Missel, Malene; Birkelund, Regner

2011-09-01

The study explores how patients diagnosed with incurable oesophageal cancer experience living with the illness, and provides insight into and an understanding of the patients' situation, reality and phenomena in their life world. The method takes a phenomenological-hermeneutic approach, inspired by the French philosopher Paul Ricoeur's narrative theory on mimesis as the structure and process of the method, and Ricoeur's theory of interpretation for the analysis of patient stories. The stories materialise from narrative interviews, and the phenomena of the patients' life world results in an analysis of these stories. Through the analysis of the narrative interviews, phenomena of the patients' life world appear which are described in themes such as debut of the illness, denial, the person's own suspicion, existential turning point, despair, hope, the body, affirmation of irrevocable illness, acknowledgement of dying, life phenomena, relations and feeling of independence. The understanding of the patients' experiences is augmented and improved through a discussion of the themes in a philosophical perspective, drawing upon theoretical and philosophical viewpoints of Kierkegaard, Løgstrup, Merleau-Ponty, Ricoeur, Benner & Wrubel, and on empirical research. Based on the phenomena in the ill person's life world brought about by analysis, it seems that incurably ill oesophageal cancer patients find themselves in a complex life situation, in which they need more than an objective estimate and fulfilment of need from hospital service. Our study illustrates some perspectives on the life situation of the incurably ill, which will contribute to the improved development of supportive care in nursing. Copyright © 2010 Elsevier Ltd. All rights reserved.

Self-rated quality of life among the young unemployed and the young in work in northern Sweden.

PubMed

Hultman, Barbro; Hemlin, Sven

2008-01-01

This study analysed self-assessed quality of life (QoL), using a QoL questionnaire (Hörnquist's QLcs) covering life spheres, somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score "entire life", for young people aged 18-24 in a population-based cross-sectional study in northern Sweden. Of these, 651 were unemployed and 2802 were in work (employed, students and in military service). Results showed that the young unemployed exhibited poorer QoL than the young in work and the greatest difference was found regarding their financial situation. Young men rated somatic health and mental well-being higher than young women. However, QoL in other essential domains was rated higher by young women in work. Close friends and money reserve were important for all participants, no matter whether they were employed or not. The risk of being young and unemployed was greater if the person had a worse financial situation, shorter education, and fewer leisure activities with other people. Finally, it was concluded that while QoL is poorer when in unemployment - both for the young and those who are older (aged 25-64) - psychological well-being, in contrast to several previous studies, is even poorer for young people than for those who are older. This is worrying in a public health perspective and could have implications for unemployment policies for younger and less well-educated age groups.

Toward a Unified Science Curriculum.

ERIC Educational Resources Information Center

Showalter, Victor M.

The two major models of science curriculum change, textbook revision and national curriculum projects, are derived from, and reinforce, the present curriculum structure. This is undesirable in a time of increasing fluidity and change, because adaptation to new situations is difficult. Unified science, based on the premise that science is a unity,…

Elderly Refugees and Language Learning.

ERIC Educational Resources Information Center

Grognet, Allene Guss

For elderly refugees, coming from a variety of cultural situations and with varied educational backgrounds, transplantation to a new culture is an especially difficult process. There is no research evidence to suggest that older adults can not succeed in learning another language, although more deliberate efforts must be made to achieve this. In…

Learning about Functions through Learner-Generated Examples

ERIC Educational Resources Information Center

Dinkelman, Martha O.; Cavey, Laurie O.

2015-01-01

In many mathematics classrooms, the teacher provides "worked examples" to demonstrate how students should perform certain algorithms or processes. Some students find it difficult to generalize from the examples that teachers provide and cannot apply what they have learned in new situations (Watson and Mason 2002). Instead, teachers might…

Study Visit to Latin America: Three Examples of Community Development

ERIC Educational Resources Information Center

Classen-Bauer, Ingrid

1976-01-01

Three projects are described that were observed during a two-month study tour to Latin America in 1975: urban and rural community development in Bolivia; nonformal initial education in Peru; and international education in Argentina. The projects are carried out in situations involving particularly difficult social problems. (ND)

Using LabVIEW for Applying Mathematical Models in Representing Phenomena

ERIC Educational Resources Information Center

Faraco, G.; Gabriele, L.

2007-01-01

Simulations make it possible to explore physical and biological phenomena, where conducting the real experiment is impracticable or difficult. The implementation of a software program describing and simulating a given physical situation encourages the understanding of a phenomenon itself. Fifty-nine students, enrolled at the Mathematical Methods…

Understanding the Sales Process by Selling

ERIC Educational Resources Information Center

Bussière, Dave

2017-01-01

Experiential projects bring students closer to real-world situations. This is valuable in sales education because the complexities of the sales process are difficult to learn from a textbook. A student project was developed that involved the selling of advertising space in a one-time newspaper insert. The project included a substantial minimum…

Non-Suicidal Self-Injury in Adolescents

ERIC Educational Resources Information Center

Lloyd-Richardson, Elizabeth E.

2010-01-01

While awareness of non-suicidal self-injury (NSSI) appears to be increasing among school counselors, social workers, nurses, and others who work with youth, it remains one of the most difficult behaviors to encounter, with few professionals feeling well equipped to handle these situations. This introductory article aims to define NSSI, describe…

School Leader Relationships: The Need for Explicit Training on Rapport, Trust, and Communication

ERIC Educational Resources Information Center

Lasater, Kara

2016-01-01

An important aspect of school leadership is relationship development, but developing meaningful relationships as a school leader is challenging. School leader relationships are challenged by diverse stakeholder groups, varied contexts, and difficult situations. The complex nature of school leader relationships necessitates explicit training for…

Evolving the Role of Campus Security

ERIC Educational Resources Information Center

May, Vern

2008-01-01

One of the problems security professionals see in security is that there are few benchmarks to quantify the effectiveness of proactive security initiatives. This hurts them with funding support and also with ensuring community buy-in outside of crisis situations. The reactive nature of many institutions makes it difficult to move forward with…

Positive Discipline. ERIC Digest.

ERIC Educational Resources Information Center

ERIC Clearinghouse on Elementary and Early Childhood Education, Urbana, IL.

This ERIC Digest suggests methods and language that can be used in handling difficult, but common, situations involving young children. Discussion focuses on: (1) 12 methods of discipline that promote self-worth; (2) the process of creating a positive climate that promotes self-discipline; (3) harmful and negative disciplinary methods; and (4)…

La Disciplina Positiva (Positive Discipline). ERIC Digest.

ERIC Educational Resources Information Center

ERIC Clearinghouse on Elementary and Early Childhood Education, Urbana, IL.

This ERIC Digest suggests methods and language that can be used in handling difficult, but common, situations involving young children. The digest explains 12 methods of disciplining children that promote children's self-worth. These methods are: (1) showing children that the reasons for their actions are understood; (2) stating reasons; (3)…

Decreasing Damaging Effects of Stress-Bound Situations: Towards a New Model of Leadership under Stress

DTIC Science & Technology

1987-01-01

interviews encompassed a clinical interview and a critical incident interview . The clinical interview was semi-structured coaprising three aain...data. In the critical incident interview the subject was asked, first, to recall and to describe a particularly hard, difficult or threatening

The Ethical Climate of Public Schooling under New Public Management.

ERIC Educational Resources Information Center

Dempster, Neil; Freakley, Mark; Parry, Lindsay

2001-01-01

Today's competitive climate is pressuring public school educators to improve schools in an environment dominated by parent and consumer choice. This article draws on two studies involving Australian principals that illustrate difficult ethical situations. Most participants found the values of marketing and economic rationalism to be inconsistent…

Early Verb Learning: How Do Children Learn How to Compare Events?

ERIC Educational Resources Information Center

Childers, Jane B.; Parrish, Rebecca; Olson, Christina V.; Burch, Clare; Fung, Gavin; McIntyre, Kevin P.

2016-01-01

An important problem verb learners must solve is how to extend verbs. Children could use cross-situational information to guide their extensions; however, comparing events is difficult. In 2 studies, researchers tested whether children benefit from initially seeing a pair of similar events ("progressive alignment") while learning new…

Helping Secondary School Students Develop a Conceptual Understanding of Refraction

ERIC Educational Resources Information Center

Ashmann, Scott; Anderson, Charles W.; Boeckman, Heather

2016-01-01

Using real-world examples, ray diagrams, and a cognitive apprenticeship cycle, this paper focuses on developing students' conceptual (not mathematical) understanding of refraction. Refraction can be a difficult concept for students to comprehend if they do not have well-designed opportunities to practice explaining situations where reflection and…

Personal Self-Disclosure: Expectancy and Situational Effects

ERIC Educational Resources Information Center

Wilson, Melvin; Rappaport, Julian

1974-01-01

Male college students were randomly assigned to one of two conditions of specific expectancy, in which they were told that they would find it either easy or difficult to self-disclose to a stranger interviewer. The JSDQ, scored for anticipated self-disclosure, but not for recalled self-disclosure, predicted observed performance. (Author)

Using SysML to model complex systems for security.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cano, Lester Arturo

2010-08-01

As security systems integrate more Information Technology the design of these systems has tended to become more complex. Some of the most difficult issues in designing Complex Security Systems (CSS) are: Capturing Requirements: Defining Hardware Interfaces: Defining Software Interfaces: Integrating Technologies: Radio Systems: Voice Over IP Systems: Situational Awareness Systems.

Arab American Women Negotiating Identities

ERIC Educational Resources Information Center

Mango, Oraib

2012-01-01

Compared to the literature available on other ethnic groups in the United States, there is very little information about school experiences of Arab Americans (Nieto, 2003). This study examines the ways that Arab American women reported positioning themselves when faced with difficult situations related to stereotypical images of Arabs and Arab…

Developing a Foreign Language Fiction Collection on a Limited Budget

ERIC Educational Resources Information Center

Bissett, Cindy

2010-01-01

Libraries have limited budgets and Collection Development Librarians can be faced with difficult decisions in the spending of their allocated funds. This paper discusses how the Tasmanian Polytechnic Launceston Campus Library discovered a gap in their collection and addressed this situation without funding. The Library wished to purchase fiction…

Why Culture Matters: An Empirically-Based Pre-Deployment Training Program

DTIC Science & Technology

2005-09-01

conventions) to the increasingly more difficult to grasp inner layers (such as assumptions and values). Culture is shared among members of one group...depending on the context or situation. Culture is shared among , influences, and is shaped by members of a group, community, institution, and the

Conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease.

PubMed

Lindqvist, Gunilla; Heikkilä, Kristiina; Albin, Björn; Hjelm, Katarina

2013-04-01

To describe conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease (COPD) in different stages of the disease. A chronic disease like COPD affects not only the person living with the illness, but also the spouse. Significant tasks and demands are placed on husbands. COPD has for a long time been considered more a man's disease than a woman's disease, but according to new evidence COPD is a vast problem in women, which requires support from their spouses. The literature review did not reveal any previous studies concerning conceptions of daily life in men living with women suffering from COPD in different stages. A phenomenographic study was conducted. Data were collected from October 2008 to October 2009 through semi-structured interviews with 19 men living with a woman suffering from COPD. Two main descriptive categories were found: (1) unchanged life situation where no support was needed; (2) changed life situation related to severity of COPD, where support was needed. The categories were described from the perspective 'ME and my spouse'. Even in their caregiving situation, the men continued with their own life and activities and did not put themselves in second place. No support was needed from healthcare or municipality when the women had mild COPD, but this changed when the COPD progressed. The men felt that daily life was burdened, restricted and the partner relationship was affected, even if the disease had not reached the final stage. The COPD forced them gradually into a caregiving role, and their daily life changed. They become more of a caregiver than a spouse. The men experienced lack of knowledge and support, and they felt that health professionals and municipality did not care about them.

Toddler temperament and prenatal exposure to lead and maternal depression.

PubMed

Stroustrup, Annemarie; Hsu, Hsiao-Hsien; Svensson, Katherine; Schnaas, Lourdes; Cantoral, Alejandra; Solano González, Maritsa; Torres-Calapiz, Mariana; Amarasiriwardena, Chitra; Bellinger, David C; Coull, Brent A; Téllez-Rojo, Martha M; Wright, Robert O; Wright, Rosalind J

2016-06-16

Temperament is a psychological construct that reflects both personality and an infant's reaction to social stimuli. It can be assessed early in life and is stable over time Temperament predicts many later life behaviors and illnesses, including impulsivity, emotional regulation and obesity. Early life exposure to neurotoxicants often results in developmental deficits in attention, social function, and IQ, but environmental predictors of infant temperament are largely unknown. We propose that prenatal exposure to both chemical and non-chemical environmental toxicants impacts the development of temperament, which can itself be used as a marker of risk for maladaptive neurobehavior in later life. In this study, we assessed associations among prenatal and early life exposure to lead, mercury, poverty, maternal depression and toddler temperament. A prospective cohort of women living in the Mexico City area were followed longitudinally beginning in the second trimester of pregnancy. Prenatal exposure to lead (blood, bone), mercury, and maternal depression were assessed repeatedly and the Toddler Temperament Scale (TTS) was completed when the child was 24 months old. The association between each measure of prenatal exposure and performance on individual TTS subscales was evaluated by multivariable linear regression. Latent profile analysis was used to classify subjects by TTS performance. Multinomial regression models were used to estimate the prospective association between prenatal exposures and TTS performance. 500 mother-child pairs completed the TTS and had complete data on exposures and covariates. Three latent profiles were identified and categorized as predominantly difficult, intermediate, or easy temperament. Prenatal exposure to maternal depression predicted increasing probability of difficult toddler temperament. Maternal bone lead, a marker of cumulative exposure, also predicted difficult temperament. Prenatal lead exposure modified this association, suggesting that joint exposure in pregnancy to both was most toxic. Maternal depression predicts difficult temperament and concurrent prenatal exposure to maternal depression and lead predicts a more difficult temperament phenotype in 2 year olds. The role of temperament as an intermediate variable in the path from prenatal exposures to neurobehavioral deficits and other health effects deserves further study.

Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas.

PubMed

Kivelevitch, Dario; Frieder, Jillian; Watson, Ian; Paek, So Yeon; Menter, M Alan

2018-04-01

Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. Areas covered: This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. Expert opinion: Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.

Face transplant: is it feasible in developing countries?

PubMed

González-García, Ignacio; Lyra-González, Iván; Medina-Preciado, David; Guerrero-Torres, Alejandro; Ramos-Gallardo, Guillermo; Armendáriz-Borunda, Juan

2013-01-01

This article is based on the case of a 28-year-old woman who was involved in a car accident, with diagnosis of polytrauma, loss of left eye, and second- and third-degree burns over the left midface, rendering an exposed area of 8 cm wide and 19 cm length, ranging from glabella to mandible, with skull exposure and loss of left eye.A latissimus dorsi musculocutaneous free flap was transferred into the defect; left eye and nose prosthetics were necessary to restore normal appearance. Excellent results were obtained; reinsertion to patient's normal life and reinstatement of facial appearance were achieved with minimal costs and no postsurgical complications.Analysis of the current situation in developing countries demonstrates that technique and infrastructure do not represent a real challenge to carry on face transplants. However, socioeconomic reality in these societies makes it difficult to establish face transplant as a feasible therapeutic opportunity for the overwhelming majority of patients who are victims of severe facial damage.Therefore, strategies such as latissimus dorsi free flap remains as an excellent therapy to face off our complex facial reconstructive challenges in developing countries such as Mexico.

Ambiguity and judgments of obese individuals: no news could be bad news.

PubMed

Ross, Kathryn M; Shivy, Victoria A; Mazzeo, Suzanne E

2009-08-01

Stigmatization towards obese individuals has not decreased despite the increasing prevalence of obesity. Nonetheless, stigmatization remains difficult to study, given concerns about social desirability. To address this issue, this study used paired comparisons and cluster analysis to examine how undergraduates (n=189) categorized scenarios describing the health-related behaviors of obese individuals. The cluster analysis found that the scenarios were categorized into two distinct clusters. The first cluster included all scenarios with health behaviors indicating high responsibility for body weight. These individuals were perceived as unattractive, lazy, less likeable, less disciplined, and more deserving of their condition compared to individuals in the second cluster, which included all scenarios with health behaviors indicating low responsibility for body weight. Four scenarios depicted obese individuals with ambiguous information regarding health behaviors; three out of these four individuals were categorized in the high-responsibility cluster. These findings suggested that participants viewed these individuals as negatively as those who were responsible for their condition. These results have practical implications for reducing obesity bias, as the etiology of obesity is typically not known in real-life situations.

Developing a program for enhancing youth HIV treatment adherence and risk reduction.

PubMed

Fongkaew, Warunee; Udomkhamsuk, Warawan; Viseskul, Nongkran; Guptaruk, Marisa

2017-12-01

Youth living with HIV face difficult and challenging situations that decrease their adherence to antiretroviral medications. In this study, we developed a pilot program to enhance HIV treatment adherence and risk reduction among youth living with HIV based on collaboration with a community hospital involving a multi-disciplinary healthcare team. Participants were 25 youth living with HIV/AIDS, 18 caregivers, and 12 healthcare providers. The action research process comprised a preliminary stage and four phases of assessment, planning, implementation, and evaluation. This program used "edutainment", participatory learning, and multi-disciplinary collaboration to improve HIV treatment adherence and HIV risk behavior knowledge, motivation, and behavior. Education aimed to improve knowledge of antiretroviral drugs and HIV risk-taking behaviors. Motivation was directed at reframing beliefs and increasing positive attitudes of youth toward treatment adherence and raising awareness about safer sex behaviors. The behavioral skills focused on medication management in daily life activities, problem-solving, refusal and negotiation, and condom use. Findings provided preliminary evidence that the program was practical in a clinical context in a community hospital. © 2017 John Wiley & Sons Australia, Ltd.

Close-up of Shuttle tire after LSRA test

NASA Technical Reports Server (NTRS)

1995-01-01

One of the final tests of the CV-990 Landing Systems Research Aircraft (LSRA) in August, 1995 at NASA's Dryden Flight Research Center, Edwards, California, resulted in the destruction of the wheel, following a fire caused by a mixture of heat, aluminum particles, and rubber. Following successful tests of tire wear at Edwards and the Kennedy Space Center, Fla., this series of roll-on-rim tests determined the failure modes of wheels for the space shuttle. In one test, the aluminum wheel locked in position and was ground to within four inches of the axle before the test concluded. The series of 155 test missions for the space shuttle program provided extensive data about the life and endurance of the shuttle tire systems and helped raise the shuttle crosswind landing limits at Kennedy. Project engineer Christopher J. Nagy said, 'NASA pilots Gordon Fullerton and Terry Rager did a superb job of flying the aircraft in many difficult test situations, at speeds higher than the aircraft was intended to land, without once losing a single test flight.'

Verina Morton Jones, MD.

PubMed

Rishworth, Susan K

2012-01-01

The purpose of this historical article is to demonstrate, as the biography of Verina Morton Jones, MD, is uncovered, the difficulties inherent in researching original source material on the lives of 19th- and early 20th-century African American physicians as well as the great benefits derived from doing this research. The procedures used include basic archival research and close examination of published materials about her in the past, in conjunction with oral history. Original correspondence from Dr Morton Jones to her niece and nephew is used to illustrate events in her life and the thoughts and attitudes she expressed. Some of these thoughts and attitudes reflect those current situations in which African Americans found themselves, and others are quite unique, no doubt owing to her privileged position in the African American community. The principle conclusions reached include the great benefits derived from doing this kind of research, as difficult and time-consuming as that may be, with the enhanced knowledge and appreciation of the heritage of African American physicians, and insights into American social history during this period.

Breaking Bad News: An Evidence-Based Review of Communication Models for Oncology Nurses.

PubMed

Bumb, Meridith; Keefe, Joanna; Miller, Lindsay; Overcash, Janine

2017-10-01

A diagnosis of cancer is a stressful, difficult, and life-altering event. Breaking bad news is distressing to patients and families and is often uncomfortable for the nurse delivering it. Evidence-based communication models have been developed and adapted for use in clinical practice to assist nurses with breaking bad news.

. The purpose of this article is to provide an overview on breaking bad news and to review the utility of the SPIKES and PEWTER evidence-based communication models for oncology nurses.
. Perceptions of breaking bad news from the nurse and patient perspectives, as well as barriers and consequences to effective communication, will be presented. Clinical examples of possible situations of breaking bad news will demonstrate how to use the SPIKES and PEWTER models of communication when disclosing bad news to patients and their families.
. By using the evidence-based communication strategies depicted in this article, oncology nurses can support the delivery of bad news and maintain communication with their patients and their patients' families in an effective and productive manner.

Home monitoring and decision support for international liver transplant children.

PubMed

Song, Bianying; Schulze, Mareike; Goldschmidt, Imeke; Haux, Reinhold; Baumann, Ulrich; Marschollek, Michael

2013-01-01

Complications may occur after a liver transplantation, therefore proper monitoring and care in the post-operation phase plays a very important role. Sometimes, monitoring and care for patients from abroad is difficult due to a variety of reasons, e.g., different care facilities. The objective of our research for this paper is to design, implement and evaluate a home monitoring and decision support infrastructure for international children who underwent liver transplant operation. A point-of-care device and the PedsQL questionnaire were used in patients' home environment for measuring the blood parameters and assessing quality of life. By using a tablet PC and a specially developed software, the measured results were able to be transmitted to the health care providers via internet. So far, the developed infrastructure has been evaluated with four international patients/families transferring 38 records of blood test. The evaluation showed that the home monitoring and decision support infrastructure is technically feasible and is able to give timely alarm in case of abnormal situation as well as may increase parent's feeling of safety for their children.

Fatigue and mechanical properties of nickel-titanium endodontic instruments.

PubMed

Kuhn, Grégoire; Jordan, Laurence

2002-10-01

Shape memory alloys are increasingly used in superelastic conditions under complex cyclic deformation situations. In these applications, it is very difficult to predict the service life based on the theoretical law. In the present work, fatigue properties of NiTi engine-driven rotary files have been characterized by using differential scanning calorimetry (DSC) and mechanical testing (bending). The DSC technique was used to measure precise transformation. The degree of deformation by bending was studied with combined DSC and mechanical property measurements. In these cold-worked files, the high dislocation density influences the reorientation processes and the crack growth. Some thermal treatments are involved in promoting some changes in the mechanical properties and transformation characteristics. Annealing around 400 degrees C shows good results; the recovery allows a compromise between an adequate density for the R-Phase germination and a low density to limit the brittleness of these instruments. In clinical usage, it is important to consider different canal shapes. It could be proposed that only few cycles of use is safe for very curved canals but to follow the manufacturer's advise for straight canals.

“I am a Muslim and My Dad is an Alcoholic -- What Should I Do?”: Internet-Based Advice for Muslims about Alcohol

PubMed Central

Michalak, Laurence; Trocki, Karen; Katz, Kimberly

2010-01-01

This article analyzes 113 fatwas (pieces of advice from Muslim scholars) in response to Internet user-contributed questions about correct behavior in situations involving alcohol. The fatwas are from IslamOnline.net, a popular Islamic Web site. Most of the questions on the English site are submitted by individuals living in non-Muslim countries, who are more likely to confront difficult situations relating to alcohol. In spite of the general condemnation of alcohol consumption in Islam, many individuals face ethical dilemmas and feel the need to request advice about proper behavior in situations involving alcohol, relating to the family, society, work, and bodily purity, as well as more abstract theological questions. PMID:20514354

Emotional awareness and couples' relationship satisfaction.

PubMed

Croyle, Kristin L; Waltz, Jennifer

2002-10-01

This study examined the role of emotional awareness in couples' relationships and the effects of a tendency to respond to difficult couples' situations with "soft" emotions (including sadness and fear) versus "hard" emotions (including anger and resentment). Participants were 56 heterosexual couples who completed a measure of relationship satisfaction and two measures of emotional awareness, including one that was developed as part of this study. Results indicated that women were more emotionally aware than men in response to couples' situations, but not in response to general situations outside the relationship. In addition, higher levels of emotional awareness and a higher awareness of "hard" emotions were associated with decreased relationship satisfaction for women, but not for men. Discrepancy between partners' levels of awareness was related to lower satisfaction for both men and women.

Stomal construction: Technical tricks for difficult situations, prevention and treatment of post-operative complications.

PubMed

Sabbagh, C; Rebibo, L; Hariz, H; Regimbeau, J M

2018-02-01

The creation of a digestive stoma, whether it is a lateral stoma or a terminal stoma, is an essential gesture in colorectal surgery, but that may result in post-operative complications in 35% of patients. Surgeons are aware of the situations at the origin of complications, although there is little factual data in the literature to discriminate them. They are related to patient-specific factors (obesity, cirrhosis, portal hypertension) or to the underlying pathology (colon obstruction) or the conditions under which the intervention is performed (emergency). The aim of this review is to describe these different situations and the data from the literature that may allow reduction of the risk of an unsatisfactory or even complicated stoma. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Projective Identification, Self-Disclosure, and the Patient's View of the Object: The Need for Flexibility

PubMed Central

Waska, Robert T.

1999-01-01

Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful.(The Journal of Psychotherapy Practice and Research 1999; 8:225–233) PMID:10413442

[Hunger strike and forced feeding: a historical look at medical practices].

PubMed

Rieder, Jean-Pierre; Huber-Giseke, Tina; Getaz, Laurent; Kramer-Gauchat, Marie-Claire; Nyffenegger, Laurent; Gaspoz, Jean-Michel; Wolff, Hans

2010-12-01

Hunger strike is not a disease but a common situation in prisons. This article takes a historical look at medical practices in connection with the forced feeding of hunger strikers. We now know the fate of the strikers who were subjected to forced feeding. Depending on the context and the political situation in the country, the fate of these people, mostly political prisoners, is described as humiliating and abominable frequently ending in death or irreparable consequences. Particularly difficult for health professionals, this act raises clinical, ethical and legal questions and refers to the fundamental principles of medicine.

Computational Psychometrics for Modeling System Dynamics during Stressful Disasters.

PubMed

Cipresso, Pietro; Bessi, Alessandro; Colombo, Desirée; Pedroli, Elisa; Riva, Giuseppe

2017-01-01

Disasters can be very stressful events. However, computational models of stress require data that might be very difficult to collect during disasters. Moreover, personal experiences are not repeatable, so it is not possible to collect bottom-up information when building a coherent model. To overcome these problems, we propose the use of computational models and virtual reality integration to recreate disaster situations, while examining possible dynamics in order to understand human behavior and relative consequences. By providing realistic parameters associated with disaster situations, computational scientists can work more closely with emergency responders to improve the quality of interventions in the future.

The Role of MDMA (Ecstasy) in Coping with Negative Life Situations Among Urban Young Adults

PubMed Central

Moonzwe, Lwendo S.; Schensul, Jean J.; Kostick, Kristin M.

2011-01-01

This article examines the role of Ecstasy (MDMA or 3, 4-methylenedioxymethamphetamine) as a drug used for self-medication and coping with both short- and long-term negative life situations. We show that urban youth who do not have a specific diagnosed mental illness are more likely than those who have been diagnosed and have received treatment to use Ecstasy to cope with both situational stress and lifetime trauma. Diagnosed and treated youth sometimes self-medicate with other drugs, but do not choose Ecstasy for mediation of their psychological stress. We discuss the implications of self-medication with Ecstasy for mental health services to urban youth experiencing mental health disparities, and for the continued testing and prescription of MDMA for therapeutic use in controlled clinical settings. PMID:22111403

A situation-specific approach to measure attention in adults with ADHD: The everyday life attention scale (ELAS).

PubMed

Groen, Yvonne; Fuermaier, Anselm B M; Tucha, Lara; Weisbrod, Matthias; Aschenbrenner, Steffen; Tucha, Oliver

2018-03-14

This study describes the development and utility of a new self-report measure of attentional capacities of adults with Attention Deficit Hyperactivity Disorder (ADHD): the Everyday Life Attention Scale (ELAS). Different from previous attention scales, attentional capacities are rated for nine everyday situations. Study 1 investigated the factor structure, validity, and reliability of the ELAS in 1206 healthy participants. Confirmatory factor analysis supported a situation-specific approach which categorizes everyday attention into nine situation scales: Reading, Movie, Activity, Lecture, Conversation, Assignment, Cooking, Cleaning up, and Driving. Each scale was composed of ratings for sustained, focused, selective, and divided attention as well as motivation, and had good internal consistency. Most scales showed weak correlations with ADHD Symptoms, Executive Functioning, and Memory Efficacy. Study 2 further investigated the sensitivity of the ELAS in 80 adults with ADHD compared to matched healthy controls and a mixed clinical group of 56 patients diagnosed with other psychiatric disorders. Compared to healthy controls, patients with ADHD reported reduced attentional capacities with large effect sizes on all situation scales and had a substantially higher number of situations with impaired attention scores. The ELAS may become useful in the clinical evaluation of ADHD and related psychiatric disorders in adults.

Interrupting Life History: The Evolution of Relationship within Research

ERIC Educational Resources Information Center

Hallett, Ronald E.

2013-01-01

In this paper the author explores how relationships are defined within the context of constructing a life history. The life history of Benjamin, a homeless young man transitioning to adulthood, is used to illustrate how difficult it is to define the parameters of the research environment. During an "ethically important moment" in the…

Student Teachers' Views: What Is an Interesting Life Sciences Curriculum?

ERIC Educational Resources Information Center

de Villiers, Rian

2011-01-01

In South Africa, the Grade 12 "classes of 2008 and 2009" were the first to write examinations under the revised Life Sciences (Biology) curriculum which focuses on outcomes-based education (OBE). This paper presents an exploration of what students (as learners) considered to be difficult and interesting in Grades 10-12 Life Sciences…

Life satisfaction and life values in people with spinal cord injury living in three Asian countries: A multicultural study

PubMed Central

Tasiemski, Tomasz; Priebe, Michael M.; Wilski, Maciej

2013-01-01

Objective To compare the differences in life satisfaction and life values among people with spinal cord injury (SCI) living in three economically similar Asian countries: India, Vietnam, and Sri Lanka. Design Cross-sectional and comparative investigation using the unified questionnaire. Setting Indian Spinal Injuries Centre in New Delhi (India), Spinal Cord Rehabilitation Department of the Bach Mai Hospital in Hanoi (Vietnam), and Foundation for the Rehabilitation of the Disabled in Colombo (Sri Lanka). Participants Two hundred and thirty-seven people with SCI using a wheelchair; 79 from India, 92 from Vietnam, and 66 from Sri Lanka. Outcome measures Life Satisfaction Questionnaire, Chinese Value Survey. Results People with SCI in Vietnam had significantly higher general life satisfaction than participants in India and Sri Lanka. Significant differences were identified in several demographic and life situation variables among the three Asian countries. With regard to “Traditional”, “Universal”, and “Personal” life values significant differences among three participating countries were identified in all domains. No significant relationships were identified between life satisfaction and life values for people with SCI in India, Vietnam, or Sri Lanka. Conclusion It could be presumed that particular demographic and life situation variables are more powerful factors of life satisfaction following SCI than the dominant culture of a country expressed by life values. PMID:23809526

Temperament and parenting antecedents of individual differences in three-year-old boys' pride and shame reactions.

PubMed

Belsky, J; Domitrovich, C; Crnic, K

1997-06-01

To examine individual differences in pride and shame reactions of 3-year-olds and their temperamental and parenting antecedents, 110 boys were studied at ages 36 and 37 months in a "rigged" achievement situation. After being trained to complete explicitly stipulated "easy" and "difficult" tasks before a buzzer sounded, success and failure were manipulated by artificially "rigging" how much time the child had to work on these tasks. Children's facial, verbal, and postural reactions to success and failure were composited to create pride scores following success and shame scores following failure. As expected, pride reactions were greater following success on the difficult than on the easy task, and shame reactions were greater following failure on the easy than on the difficult task. Early temperament (at 12/13 months) proved unrelated to pride and shame. With respect to parenting, measurements composited across 15, 21, 27, and 33 months showed that mothers and fathers who were more positive in their parenting had children who displayed less pride, and that children whose parents (especially mothers) were more negative in their parenting evinced less shame. These counterintuitive findings are discussed in terms of differences between assessments of parenting obtained in this investigation of parenting antecedents and those obtained in other studies of parental responses in the achievement situation itself. Directions for future research are outlined.

Communal normalization in an online self-help group for adolescents with a mentally ill parent.

PubMed

Trondsen, Marianne V; Tjora, Aksel

2014-10-01

Although implications of parental mental illness are well documented, most children of mentally ill parents are left to manage their family situation with limited information and support. We explored the role of a Norwegian online self-help group for adolescents (aged 15 to 18) with a mentally ill parent. Through in-depth interviews with 13 participants, we found that the online self-help group provided "communal normalization" by which participants, through communication in the forum, made sense of everyday experiences and emotions arising from having a mentally ill parent. We identified three main aspects of this process-recognizability, openness, and agency-all of which were important for the adolescents' efforts to obtain support, to be supportive, and to handle everyday life situations better. Communal normalization might provide resources for significantly improving the participants' life situations, and could demonstrate similar potential for users in other situations characterized by stigma, loneliness, silence, and health worries. © The Author(s) 2014.

Projector Center: Using an Overhead Projector to Initiate Discussion of Life and Non-Life.

ERIC Educational Resources Information Center

Barman, Charles R.

1982-01-01

Describes a demonstration and role-playing activity focusing on differences between living/dead, definitions of living/dead, and situations in which active euthanasia could be morally right. (Author/JN)

Spelling and the Web

ERIC Educational Resources Information Center

Varnhagen, Connie K.; McFall, G. Peggy; Figueredo, Lauren; Takach, Bonnie Sadler; Daniels, Jason; Cuthbertson, Heather

2008-01-01

Correct spelling is increasingly important in our technological world. We examined children's and adults' Web search behavior for easy and more difficult to spell target keywords. Grade 4 children and university students searched for the life cycle of the lemming (easy to spell target keyword) or the ptarmigan (difficult to spell target keyword).…

The Impact of Socioeconomic Conditions, Social Networks, and Health on Frail Older People's Life Satisfaction: A Cross-Sectional Study

PubMed Central

Berglund, Helene; Hasson, Henna; Wilhelmson, Katarina; Dunér, Anna; Dahlin-Ivanoff, Synneve

2016-01-01

It has been shown that frailty is associated with low levels of well-being and life satisfaction. Further exploration is needed, however, to better understand which components constitute life satisfaction for frail older people and how satisfaction is related to other life circumstances. The aim of this study was to examine relationships between frail older people’s life satisfaction and their socioeconomic conditions, social networks, and health-related conditions. A cross-sectional study was conducted (n=179). A logistic regression analysis was performed, including life satisfaction as the dependent variable and 12 items as independent variables. Four of the independent variables made statistically significant contributions: financial situation (OR 3.53), social contacts (OR 2.44), risk of depression (OR 2.26), and self-rated health (OR 2.79). This study demonstrates that financial situation, self-rated health conditions and social networks are important components for frail older people’s life satisfaction. Health and social care professionals and policy makers should consider this knowledge in the care and service for frail older people; and actions that benefit life satisfaction – such as social support – should be promoted. PMID:27403463

Social cognition and social problem solving abilities in individuals with alcohol use disorder.

PubMed

Schmidt, Tobias; Roser, Patrik; Juckel, Georg; Brüne, Martin; Suchan, Boris; Thoma, Patrizia

2016-11-01

Up to now, little is known about higher order cognitive abilities like social cognition and social problem solving abilities in alcohol-dependent patients. However, impairments in these domains lead to an increased probability for relapse and are thus highly relevant in treatment contexts. This cross-sectional study assessed distinct aspects of social cognition and social problem solving in 31 hospitalized patients with alcohol use disorder (AUD) and 30 matched healthy controls (HC). Three ecologically valid scenario-based tests were used to gauge the ability to infer the mental state of story characters in complicated interpersonal situations, the capacity to select the best problem solving strategy among other less optimal alternatives, and the ability to freely generate appropriate strategies to handle difficult interpersonal conflicts. Standardized tests were used to assess executive function, attention, trait empathy, and memory, and correlations were computed between measures of executive function, attention, trait empathy, and tests of social problem solving. AUD patients generated significantly fewer socially sensitive and practically effective solutions for problematic interpersonal situations than the HC group. Furthermore, patients performed significantly worse when asked to select the best alternative among a list of presented alternatives for scenarios containing sarcastic remarks and had significantly more problems to interpret sarcastic remarks in difficult interpersonal situations. These specific patterns of impairments should be considered in treatment programs addressing impaired social skills in individuals with AUD.

The surgeon and the law on patient's rights for minors.

PubMed

Deneyer, M; Clybouw, C; De Groot, E; De Backer, A; Van den Brande, P; Vandenplas, Y

2011-01-01

The law of August 22nd, 2002 concerning patients' rights (LPR) gave a new dimension to the relationship between the physician and the patient. According to this law, it is up to the physician to judge if a patient is able to exercise his own rights or if the patient needs assistance from a representative. In the particular case of the patient being a minor, this often leads to a difficult situation because of the absence of validated criteria to evaluate the capacity of judgment of a minor patient. The triangular relationship physician-patient-parents might be hampered when the parents are involved in a divorce. In daily practice, there are many questions concerning the physicians' attitude towards the rights of the minor patient, particularly in cases of medical intervention. By means of case histories, we describe several problematic situations: the right of free choice of the physician, the right of the minor to obtain informational privacy, obtaining consent for a medical intervention. In cases where there is a divorce, the situation is even more difficult. Solutions are provided to act as effectively as possible in the minors' interests and to offer support to the physician. Note: According to article 388 of the Belgian Civil Code a minor is a person, either male or female, who has not attained the age of 18 years.

Preparing Children for Situational Crises.

ERIC Educational Resources Information Center

Wiszinckas, Evelyn

1982-01-01

Provides guidelines for parents to help children to deal with anxiety and stress resulting from major changes or new situations in the child's life. Advocates truth, repetition and pacing, proper timing, dialog, fostering familiarity, honest expression of feelings, mobilization of anxiety, encouraging play, and support as strategies for reducing…

Personality and Situation in the Prediction of Women's Life Patterns.

ERIC Educational Resources Information Center

Stewart, Abigail J.

1980-01-01

Marriage, achievement need, children and self-definition predicted negative career persistence and career activity patterns in some family situations. Self-definition was associated with professional career activity among unconstrained women, but with freelance activity among married mothers. Personality variables may predict behavior within broad…

Reliability and validity of the Turkish version of the situational self-efficacy scale for fruit and vegetable consumption in adolescents.

PubMed

Kadioglu, Hasibe; Erol, Saime; Ergun, Ayse

2015-01-01

The purpose of this research was to examine the psychometric properties of the Turkish version of the situational self-efficacy scale for vegetable and fruit consumption in adolescents. This was a methodological study. The study was conducted in four public secondary schools in Istanbul, Turkey. Subjects were 1586 adolescents. Content and construct validity were assessed to test the validity of the scale. The reliability was assessed in terms of internal consistency and test-retest reliability. For confirmatory factor analysis, χ(2) statistics plus other fit indices were used, including the goodness-of-fit index, the adjusted goodness-of-fit index, the nonnormed fit index, the comparative fit index, the standardized root mean residual, and the root mean square error of approximation. Pearson's correlation was used for test-retest reliability and item total correlation. The internal consistency was assessed by using Cronbach α. Confirmatory factor analysis strongly supported the three-component structure representing positive social situations (α = .81), negative effect situations (α = .93), and difficult situations (α = .78). Psychometric analyses of the Turkish version of the situational self-efficacy scale indicate high reliability and good content and construct validity. Researchers and health professionals will find it useful to employ the Turkish situational self-efficacy scale in evaluating situational self-efficacy for fruit and vegetable consumption in Turkish adolescents.

Seniors Online: Attitudes Toward the Internet and Coping With Everyday Life.

PubMed

Seifert, Alexander; Schelling, Hans Rudolf

2018-01-01

Many older people do not use the Internet. We investigated the attitudes of older people who do (onliners) or do not (offliners) use the Internet, to assess their views of the Internet and whether they see the Internet as a resource for coping with everyday life situations. Participants aged ≥65 years ( N = 1,037), living in Switzerland, were interviewed in a telephone survey. Descriptive and multivariate analyses were conducted. The data show (a) many of the respondents viewed the Internet as useful, in general, and for coping with everyday life situations; (b) onliners saw more positive aspects of the Internet than did offliners; and (c) among onliners, 53% agreed with the statement, "The Internet allows me to stay independent longer into old age." However, it appears that especially older onliners with a high affinity for technology will presumably use the Internet to cope with everyday life.

Development of a situation-specific theory for explaining health-related quality of life among older South Korean adults with type 2 diabetes.

PubMed

Chang, Sun Ju; Im, Eun-Ok

2014-01-01

The purpose of the study was to develop a situation-specific theory for explaining health-related quality of life (QOL) among older South Korean adults with type 2 diabetes. To develop a situation-specific theory, three sources were considered: (a) the conceptual model of health promotion and QOL for people with chronic and disabling conditions (an existing theory related to the QOL in patients with chronic diseases); (b) a literature review using multiple databases including Cumulative Index for Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and two Korean databases; and (c) findings from our structural equation modeling study on health-related QOL in older South Korean adults with type 2 diabetes. The proposed situation-specific theory is constructed with six major concepts including barriers, resources, perceptual factors, psychosocial factors, health-promoting behaviors, and health-related QOL. The theory also provides the interrelationships among concepts. Health care providers and nurses could incorporate the proposed situation-specific theory into development of diabetes education programs for improving health-related QOL in older South Korean adults with type 2 diabetes.

Life-Patterns, Choices, Careers: 1991-1998. Research Report 17.

ERIC Educational Resources Information Center

Dwyer, Peter; Harwood, Aramiha; Tyler, Debra

A follow-up study of participants in the "Life Patterns of the Post-1970 Generation" project (1,334 of 29,155 initial participants) focused on backgrounds, living situations, work and study involvement, and life experience and future expectations. Data indicated that 49 percent had attained a career job within 3 years of graduating. The…

Undergraduate nursing students' transformational learning during clinical training.

PubMed

Melin-Johansson, Christina; Österlind, Jane; Hagelin, Carina Lundh; Henoch, Ingela; Ek, Kristina; Bergh, Ingrid; Browall, Maria

2018-04-02

Undergraduate nursing students encounter patients at the end of life during their clinical training. They need to confront dying and death under supportive circumstances in order to be prepared for similar situations in their future career. To explore undergraduate nursing students' descriptions of caring situations with patients at the end of life during supervised clinical training. A qualitative study using the critical incident technique was chosen. A total of 85 students wrote a short text about their experiences of caring for patients at the end of life during their clinical training. These critical incident reports were then analysed using deductive and inductive content analysis. The theme 'students' transformational learning towards becoming a professional nurse during clinical training' summarises how students relate to patients and relatives, interpret the transition from life to death, feel when caring for a dead body and learn end-of-life caring actions from their supervisors. As a preparation for their future profession, students undergoing clinical training need to confront death and dying while supported by trained supervisors and must learn how to communicate about end-of-life issues and cope with emotional stress and grief.

[Advanced epitheliomas of the face: when to stop?].

PubMed

Martin, D; Pélissier, P; Barthélémy, I; Mondié, J M

1998-08-01

Progress in plastic surgery has allowed an ever increasing extension of the indications for facial reconstruction. Although carcinomas are now detected earlier and earlier, the practitioner is nevertheless faced, several times during his working life, with "historical" cases. Although it is fairly rare to observe long-term progression of squamous cell carcinomas, basal cell carcinomas can take on considerable proportions due to their very low metastatic risk. In these situations, the dilemma between conservative management and performing an inevitably major procedure is never easy to resolve. Moreover, it is often the discomfort experienced by the patient's family which encourages him to accept the operation. The objective of the procedure is more often aesthetic rather than curative, although this latter objective must always be attempted. Consequently, the practitioner should never hesitate to defer reconstruction for several months in order to ensure reliable local surveillance. The value of epitheses is clearly established in this situation. When a reconstruction can be performed, "major" measures are generally necessary, making use of all of the regional or even distant plastic surgery techniques used for facial surgery. However, microsurgery is a last resort indication, which should only be used when the various pedicle flaps have been exhausted. The microsurgical delay technique (Jean-Marie Servant's "apple turnover" technique) is particularly useful in these situations. In the light of seven clinical cases, the authors try to define the essential concepts of this type of management. In fact, the respective limits of active intervention and conservative management are defined by each surgeon's common sense and experience. The constant improvement of the quality of epitheses make them the current treatment of choice for the restoration of extensive defects. Lastly, one of the main factors to be considered before taking any treatment decision is the psychology of these patients, as it is always difficult to explain the discovery of lesions at this advanced stage.

Social identity and stroke: 'they don't make me feel like, there's something wrong with me'.

PubMed

Anderson, Sharon; Whitfield, Kyle

2013-12-01

Over 85% of the people survive stroke; and of those, over 80% are discharged to the community. However, the majority do not recover completely. Loss of identity is a commonly reported experience after stroke. Studies focus on the individual survivors' use of their own cognitive resources to adapt to change, rather than examining the effects of social interactions on stroke survivors' identities. Social relationships are the foundation upon which survivors rebuild skills to engage with the world, yet little is known about the ways in which families, friends and neighbours provide a context for the recreation of a sense of self and activities after stroke. This article draws on situational analysis grounded theory analysis of in-depth individual interviews with nine middle-aged survivors of stroke. In situational analysis, the original grounded theory methods proposed by Glaser and Strauss are used; however, the situational context, and how environments and relationships influence actions, is explicitly analysed. Our objective was to understand the ways in which family, social, and community resources might enhance stroke survivors' participation in personally meaningful activities over the long term. The qualitative accounts of these survivors reveal how social support helped them maintain or more importantly regain a position in society. Following any life-changing event, people's sense of self is fluid. A relevant social position entitles stroke survivors to become actively involved in setting their own goals and maintaining a positive identity. However, as these participants attested, stroke impaired their social position and resources to reject an imposed social position. It was difficult for these survivors to construct a valued social identity without the support of other people. Future studies should explore the consequences of social interactions with others and how social attitudes about stroke disability affects individual's activity options, professional practice, and ultimately development of a positive poststroke identity. © 2012 The Authors Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

Modeling flow, sediment transport and morphodynamics in rivers

USGS Publications Warehouse

Nelson, Jonathan M.; McDonald, Richard R.; Shimizu, Yasuyuki; Kimura, Ichiro; Nabi, Mohamed; Asahi, Kazutake

2016-01-01

Predicting the response of natural or man-made channels to imposed supplies of water and sediment is one of the difficult practical problems commonly addressed by fluvial geomorphologists. This problem typically arises in three situations. In the first situation, geomorphologists are attempting to understand why a channel or class of channels has a certain general form; in a sense, this is the central goal of fluvial geomorphology. In the second situation, geomorphologists are trying to understand and explain how and why a specific channel will evolve or has evolved in response to altered or unusual sediment and water supplies to that channel. For example, this would include explaining the short-term response of a channel to an unusually large flood or predicting the response of a channel to long-term changes in flow or sediment supply due to various human activities such as damming or diversions. Finally, geomorphologists may be called upon to design or assess the design of proposed man-made channels that must carry a certain range of flows and sediment loads in a stable or at least quasi-stable manner. In each of these three situations, the problem is really the same: geomorphologists must understand and predict the interaction of the flow field in the channel, the sediment movement in the channel and the geometry of the channel bed and banks. In general, the flow field, the movement of sediment making up the bed and the morphology of the bed are intricately linked; the flow moves the sediment, the bed is altered by erosion and deposition of sediment and the shape of the bed is critically important for predicting the flow. This complex linkage is precisely what makes understanding channel form and process such a difficult and interesting challenge.

Theory-Based Evaluation Meets Ambiguity: The Role of Janus Variables

ERIC Educational Resources Information Center

Dahler-Larsen, Peter

2018-01-01

As theory-based evaluation (TBE) engages in situations where multiple stakeholders help develop complex program theory about dynamic phenomena in politically contested settings, it becomes difficult to develop and use program theory without ambiguity. The purpose of this article is to explore ambiguity as a fruitful perspective that helps TBE face…

Promoting Middle School Students' Proportional Reasoning Skills through an Ongoing Professional Development Programme for Teachers

ERIC Educational Resources Information Center

Hilton, Annette; Hilton, Geoff; Dole, Shelley; Goos, Merrilyn

2016-01-01

Proportional reasoning, the ability to use ratios in situations involving comparison of quantities, is essential for mathematical competence, especially in the middle school years, and is an important determinant of success beyond school. Research shows students find proportional reasoning and its foundational concepts difficult. Proportional…

Wither the Welfare State: The New Global Adventures of Higher Education

ERIC Educational Resources Information Center

Shumar, Wesley

2014-01-01

This summary article situates the articles in this collection within the historical unfolding of the commodification and neoliberalisation of higher education. From the 1970s to the present, the article suggests that commodification and neoliberalisation are two social forces that in many nations are difficult to disentangle. It is important to…

Parental Rights and Release Authorizations

ERIC Educational Resources Information Center

McGinnis, Michelle H.; Getskow, Veronica; Dicker, Brian S.

2012-01-01

Potentially difficult and dangerous situations can arise when an early childhood program is faced with parental rights and child custody issues. This is particularly true when the parents are engaged in a fight. Nothing is as visceral as the fight over a child, and even the best of people can become deceitful or quite villainous. School owners…

College Instructors' Preparedness for Innovative Transformations in Higher Education

ERIC Educational Resources Information Center

Krasinskaia, L. F.

2012-01-01

Survey data show that instructors are aware of the need for changes in Russian higher education, but are rather demoralized by the difficult social and professional situation in which they work. And so, given the current functioning of higher education, a number of demotivating factors have an influence on instructors' satisfaction with their work…

[Refeeding in a teenager with an eating disorder; when the patient refuses, but the doctor is obliged to intervene].

PubMed

Nusman, C M; van Bellegem, A C M

2016-01-01

Young patients with eating disorders frequently present with physical complications. These young patients, who may decline to eat or drink can be difficult to treat. Knowledge of possible complications, diagnostic tools and the legal situation is necessary to provide optimal care.

Measuring Financial Capability and Its Determinants Using Survey Data

ERIC Educational Resources Information Center

Taylor, Mark

2011-01-01

Financial capability, or people's ability to manage and take control of their finances, is receiving increasing interest among policy makers as more people find themselves in difficult financial situations during the current economic downturn. We tackle the problem of how to measure financial capability--with a specific focus on making ends meet…

Information and knowledge management in support of sustainable forestry: a review

Treesearch

H. Michael Rauscher; Daniel L. Schmoldt; Harald Vacik

2007-01-01

For individuals, organizations and nations, success and even survival depend upon making good decisions. Doing so can be extremely difficult when problems are not well structured and situations are complex, as they are for natural resource management. Recent advances in computer technology coupled with the increase in accessibility brought about by the...

When Do First-Movers Have an Advantage? A Stackelberg Classroom Experiment

ERIC Educational Resources Information Center

Rebelein, Robert; Turkay, Evsen

2016-01-01

The timing of moves can dramatically affect firm profits and market outcomes. When firms choose output quantities, there is a first-mover advantage, and when firms choose prices, there is a second-mover advantage. Students often find it difficult to understand the differences between these two situations. This classroom experiment simulates each…

Importance of Empathy for Social Work Practice: Integrating New Science

ERIC Educational Resources Information Center

Gerdes, Karen E.; Segal, Elizabeth

2011-01-01

Empathy is more important than ever to a national population worried about difficult political and socioeconomic situations. During the last 10 years, an enormous amount of research has been carried out to elucidate the nature, mechanism, and function of empathy. New research from social-cognitive neuroscience and related fields indicates that,…

Introducing Scale Analysis by Way of a Pendulum

ERIC Educational Resources Information Center

Lira, Ignacio

2007-01-01

Empirical correlations are a practical means of providing approximate answers to problems in physics whose exact solution is otherwise difficult to obtain. The correlations relate quantities that are deemed to be important in the physical situation to which they apply, and can be derived from experimental data by means of dimensional and/or scale…

Procedural versus Content-Related Hints for Word Problem Solving: An Exploratory Study

ERIC Educational Resources Information Center

Kock, W. D.; Harskamp, E. G.

2016-01-01

For primary school students, mathematical word problems are often more difficult to solve than straightforward number problems. Word problems require reading and analysis skills, and in order to explain their situational contexts, the proper mathematical knowledge and number operations have to be selected. To improve students' ability in solving…

The Use of Touch in Therapy: Can We Talk?

ERIC Educational Resources Information Center

Taylor, Melanie A.

The empirical literature regarding the use of nonerotic touch in psychotherapy is reviewed. Theoretical and ethical concerns are discussed, including the taboo against touching clients, situations in which touch may be appropriate, and whether or not nonerotic touch leads to erotic touch. It is difficult to design controlled studies for ongoing…

The Difficult Patron Situation: A Window of Opportunity To Improve Library Service.

ERIC Educational Resources Information Center

Sarkodie-Mensah, Kwasi

2000-01-01

Discusses the problem library patron from various fronts: historical, personality traits, importance of complaints, nature and types of problem patrons and their behavior, technology and the newly-bred problem patron, strategies for dealing with problem patrons, and ensuring that library administrators and other supervisors understand the need to…

"I Just Have to Tell You": Pedagogical Encounters into the Emotional Terrain of Learning

ERIC Educational Resources Information Center

Tarc, Aparna Mishra

2013-01-01

Student engagements with difficult knowledge can produce strange effects. When learning from traumatic human histories students can become personally confronted by unthinkable knowledge of the other's existence. My inquiry situates itself in the emotional space of student disclosure that references particular conflicts with learning from…

Supporting Collaboration with Technology: Does Shared Cognition Lead to Co-Regulation in Medicine?

ERIC Educational Resources Information Center

Lajoie, Susanne P.; Lu, Jingyan

2012-01-01

The theoretical distinctions between metacognition, self-regulation and self-regulated learning are often blurred which makes the definition of co-regulation in group learning situations even more difficult. We have started to explore co-regulation in the context of decision making in simulated emergencies where medical teams work together to…

Education for Human Rights. An International Perspective. Studies in Comparative Education.

ERIC Educational Resources Information Center

Ray, Douglas, Ed.; And Others

This book presents theoretical studies and national experiences of how education might respond to war, natural catastrophes, or disease, thereby making people more aware and successful at managing difficult situations. The volume's 15 authors, drawn from many parts of the world, deal with human rights (especially those of women, children,…

Collateral Damage Related to Rape and Interpersonal Violence in Higher Education

ERIC Educational Resources Information Center

Jones, Dan L.

2014-01-01

Collegiate communities are often faced with difficult situations from sexual assault, rape, and other forms of interpersonal violence. These events are not only tragic or traumatic for the individuals involved but also have ripple effects and create collateral damage within the campus community. Many universities are instituting bystander training…

Divorce and Special Education. PHP-c103

ERIC Educational Resources Information Center

PACER Center, 2004

2004-01-01

Every year the parents of a million American children are newly divorced. While divorce is difficult for all parties involved, children are often the most affected. If the children have disabilities and are involved with the special education system, the situation can be even more complex. The information in this document may help parents think…

Fighting Spam: Moving Email to the Cloud

ERIC Educational Resources Information Center

Schrader, Andrew

2011-01-01

On average, more than 90% of email is unwanted junk mail--spam. Many spam messages include annoying promotions for irrelevant products, but others include viruses and pornographic content, which can pose a severe legal issue for schools. Spam puts districts in a difficult situation as schools try to enhance learning in the classroom with advanced…

Adjustment Difficulties of American Students in Israeli Institutions of Higher Learning.

ERIC Educational Resources Information Center

Halpern, Jacob I.; Hodinko, Bernard A.

This paper examines the extent to which American undergraduate students find problems adjusting to study in Israeli colleges, universities, and yeshivot with respect to the Hebrew language, academic matters, personal situations, and living arrangements. The study asked 671 undergraduate American students studying in Israel how difficult it was for…

Coordinated Cybersecurity Incident Handling: Roles, Processes, and Coordination Networks for Crosscutting Incidents

DTIC Science & Technology

2011-06-01

ICCRTS 2011), Qu ?c City, Qu ?c, Canada, June 21-23, 2011. U.S. Government or Federal Rights License. 14. ABSTRACT To aid in the practice of...phases might be similarly difficult to identify or standardize. By far the most common situational awareness paradigm cited in our review was Mica

Defining Electric Potential Difference by Moving a Multimeter's Ground Probe

ERIC Educational Resources Information Center

Stoeckel, Marta R.

2018-01-01

The abstract nature of electric potential difference (voltage) can make it a difficult concept to grasp, but understanding the relative nature of voltage is central to developing a conceptual understanding of electric circuits. In laboratory situations, I see these conceptual difficulties manifest when students have difficulty placing voltmeter…

Sourcing While Reading Divergent Expert Accounts: Pathways from Views of Knowing to Written Argumentation

ERIC Educational Resources Information Center

Barzilai, Sarit; Tzadok, Eynav; Eshet-Alkalai, Yoram

2015-01-01

Sourcing is vital for knowledge construction from online information sources, yet learners may find it difficult to engage in effective sourcing. Sourcing can be particularly challenging when lay readers encounter conflicting expert accounts of controversial topics, a situation which is increasingly common when learning online. The aim of this…

Educational Outreach in a Large Retail Chain: Opportunities, Challenges, and Suggested Approaches.

ERIC Educational Resources Information Center

Ponessa, Joseph T.

2003-01-01

To raise public awareness about lead poison hazards associated with home repair/remodeling, literature was distributed and training for store employees conducted in large retail home centers. Although store managers were supportive, their hectic work situation made training difficult. Following outreach in 22 of 23 stores, postcards returned by…

Measuring the Impact of Technology on Nurse Workflow: A Mixed Methods Approach

ERIC Educational Resources Information Center

Cady, Rhonda Guse

2012-01-01

Background. Investment in health information technology (HIT) is rapidly accelerating. The absence of contextual or situational analysis of the environment in which HIT is incorporated makes it difficult to measure success or failure. The methodology introduced in this paper combines observational research with time-motion study to measure the…

Bilingual Gestures: The "Manual" Way of Informing the Notion of "Balanced Bilinguals"

ERIC Educational Resources Information Center

Sondermann, Kerstin

2013-01-01

Defining what makes a person bilingual is notoriously difficult and dependent on various factors like fluency, age of acquisition, and situational context, among others. The notion of a "balanced bilingual" is even more elusive and fraught with limitations regarding the proper assessment and linguistic profiling of bilinguals, leading to…

Helping Farmers Access Farmland: New Jersey's New Land Link Website

ERIC Educational Resources Information Center

Schilling, Brian J.; Marxen, Lucas J.; Everett, Jeffrey C.; Miller, Camille L.; Kimmel, David A.; Cook, Justine C.

2015-01-01

Access to land is a common obstacle for beginning farmers and established farmers seeking to expand their operations. Particularly in urban-influenced areas, leasing farmland is often more financially feasible than fee ownership. Locating available land or the right leasing situation, however, can be difficult. NJ Land Link (http://njlandlink.org)…

Refocusing the Vision: The Future of Instructional Technology

ERIC Educational Resources Information Center

Pence, Harry E.; McIntosh, Steven

2011-01-01

Two decades ago, many campuses mobilized a major effort to deal with a clear problem; faculty and students needed access to desktop computing technologies. Now the situation is much more complex. Responding to the current challenges, like mobile computing and social networking, will be ore difficult but equally important. There is a clear need for…

Making It Real: Using a Collaborative Simulation to Teach Crisis Communications

ERIC Educational Resources Information Center

Olson, K. S.

2012-01-01

Even seasoned public relations (PR) practitioners can find it difficult to handle communications during a crisis situation when the consequences of making poor decisions may seem overwhelming. This article shares results from using a collaborative simulation to teach college students about crisis communications in an advanced-level PR course.…

Cases for Teacher Development: Preparing for the Classroom

ERIC Educational Resources Information Center

Goldblatt, Patricia F., Ed.; Smith, Deirdre, Ed.

2005-01-01

With the recent and increasing attention to accountability and standards, teacher preparation programs are more than ever in need of tools that vicariously acquaint future teachers with the difficult situations they will face. This book is the perfect catalyst for this sort of teacher development. The cases encourage students to immerse themselves…

A Non-Mentalistic Cause-Based Heuristic in Human Social Evaluations

ERIC Educational Resources Information Center

Buon, Marine; Jacob, Pierre; Loissel, Elsa; Dupoux, Emmanuel

2013-01-01

In situations where an agent unintentionally causes harm to a victim, the agent's (harmless) intention typically carries "more" weight than his/her (harmful) causal role. Therefore, healthy adults typically judge leniently agents responsible for an accident. Using animated cartoons, we show, however, that in the presence of a difficult concurrent…

Who Does the Housework?

ERIC Educational Resources Information Center

Vierling-Claassen, Angela

2010-01-01

Ever had a roommate? Then you know that it can be difficult to share housekeeping duties. This article uses game theory to analyze situations in which there is a task to be done and two people who might do it. We then use our analysis to consider what game theory tells us about the gendered division of household labor.

The Glass Cliff: An Examination of the Female Superintendency in South Carolina

ERIC Educational Resources Information Center

Bowles, Blanche Boyd

2013-01-01

South Carolina public school districts are confronted with a series of difficult circumstances and rely more on female superintendents than the national average. The investigation of female South Carolina superintendents was guided by the glass cliff conceptual framework. The glass cliff represents situations where females are promoted over males…

Improving an inherently stressful situation: the role of communication during wildfire evacuations

Treesearch

Melanie Stidham; Eric Toman; Sarah M. McCaffrey; Bruce Schinder

2011-01-01

Wildfire evacuations are inherently stressful and homeowners have reported in previous studies that uncertainty over what is happening is perhaps one of the most stressful aspects. Although many difficult elements of evacuation cannot be mitigated and lives will certainly be disrupted, fire-management agencies can significantly reduce residents' uncertainty with...

Reading in the Social Studies.

ERIC Educational Resources Information Center

Ediger, Marlow

Reading social studies content presents situations in which selected pupils have not been as successful in learning as they might have been. Fast learners may find the content exceptionally easy to read, thus learning does not become the challenge it should be. Slow learners may find the content too difficult to comprehend. There are a variety of…

PubMed Central

Côté, L.; Clavet, D.; St-Hilaire, S.; Vaillancourt, C.; Blondeau, F.; Martineau, B.

1999-01-01

PROBLEM ADDRESSED: In addition to clinical instruction, residents need "people" skills that will enable them to deal with all sorts of patients in difficult clinical situations. We planned a series of 12 seminars to teach these skills to first-year residents. OBJECTIVES OF PROGRAM: To ask relevant questions typical of the patient-centred approach; with empathy and respect, to encourage patients to express their emotions; to become more aware of one's own emotions and reactions in one's work as a physician; to negotiate with patients, taking into account both the patient's agenda and one's own. MAIN COMPONENTS OF PROGRAM: Clinical problems drawn from a list of situations likely to involve difficult contact with patients were used to achieve program objectives. Various teaching methods (discussion, brief presentation, practical demonstration, role play) were used during the four stages of skills development: information, demonstration, practice, and feedback. Various tools were used to test the program. CONCLUSION: Proper planning requires ongoing exploration of objectives, content, teaching methods, and evaluation. This discussion of the teaching principles applied in planning our seminars might inspire others to develop similar programs. PMID:10349069

Life situation and identity among single older home-living people: A phenomenological–hermeneutic study

PubMed Central

Söderhamn, Ulrika; Söderhamn, Olle

2012-01-01

Being able to continue living in their own home as long as possible is the general preference for many older people, and this is also in line with the public policy in the Nordic countries. The aim of this study was to elucidate the meaning of self-care and health for perception of life situation and identity among single-living older individuals in rural areas in southern Norway. Eleven older persons with a mean age of 78 years were interviewed and encouraged to narrate their self-care and health experiences. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological–hermeneutic method inspired by the philosophy of Ricoeur. The findings are presented as a naïve reading, an inductive structural analysis characterized by two main themes; i.e., “being able to do” and “being able to be”, and a comprehensive interpretation. The life situation of the interviewed single-living older individuals in rural areas in southern Norway was interpreted as inevitable, appropriate and meaningful. Their identity was constituted by their freedom and self-chosen actions in their personal contexts. The overall impression was that independence and the ability to control and govern their own life in accordance with needs and preferences were ultimate goals for the study participants. PMID:22848230

Learning Evolution and the Nature of Science Using Evolutionary Computing and Artificial Life

ERIC Educational Resources Information Center

Pennock, Robert T.

2007-01-01

Because evolution in natural systems happens so slowly, it is difficult to design inquiry-based labs where students can experiment and observe evolution in the way they can when studying other phenomena. New research in evolutionary computation and artificial life provides a solution to this problem. This paper describes a new A-Life software…

Family planning and tradition: a view from northern Cameroon.

PubMed

Einterz, E M

1994-01-01

Sometimes efforts to improve the quality of life can hasten the destruction of a whole way of life, in which case the "beneficiaries" can lose much more than they gain. This presents health workers and planners with difficult choices.

Quality versus quantity: The complexities of quality of life determinations for neonatal nurses.

PubMed

Green, Janet; Darbyshire, Philip; Adams, Anne; Jackson, Debra

2017-11-01

The ability to save the life of an extremely premature baby has increased substantially over the last decade. This survival, however, can be associated with unfavourable outcomes for both baby and family. Questions are now being asked about quality of life for survivors of extreme prematurity. Quality of life is rightly deemed to be an important consideration in high technology neonatal care; yet, it is notoriously difficult to determine or predict. How does one define and operationalise what is considered to be in the best interest of a surviving extremely premature baby, especially when the full extent of the outcomes might not be known for several years? The research investigates the caregiving dilemmas often faced by neonatal nurses when caring for extremely premature babies. This article explores the issues arising for neonatal nurses when they considered the philosophical and ethical questions about quality of life in babies ≤24 weeks gestation. Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. Ethical considerations: Ethical processes and procedures have been adhered to by the researchers. A qualitative approach was used to analyse the data. The theme 'difficult choices' was generated which comprised three sub-themes: 'damaged through survival', 'the importance of the brain' and 'families are important'. The results show that neonatal nurses believed that quality of life was an important consideration; yet they experienced significant inner conflict and uncertainty when asked to define or suggest specific elements of quality of life, or to suggest how it might be determined. It was even more difficult for the nurses to say when an extremely premature baby's life possessed quality. Their previous clinical and personal experiences led the nurses to believe that the quality of the family's life was important, and possibly more so than the quality of life of the surviving baby. This finding contrasts markedly with much of the existing literature in this field. Quality of life for extremely premature babies was an important consideration for neonatal nurses; however, they experienced difficulty deciding how to operationalise such considerations in their everyday clinical practice.

Synoptic Control of Contrail Cirrus Life Cycles and Their Modification Due to Reduced Soot Number Emissions

NASA Astrophysics Data System (ADS)

Bier, A.; Burkhardt, U.; Bock, L.

2017-11-01

The atmospheric state, aircraft emissions, and engine properties determine formation and initial properties of contrails. The synoptic situation controls microphysical and dynamical processes and causes a wide variability of contrail cirrus life cycles. A reduction of soot particle number emissions, resulting, for example, from the use of alternative fuels, strongly impacts initial ice crystal numbers and microphysical process rates of contrail cirrus. We use the European Centre/Hamburg (ECHAM) climate model version 5 including a contrail cirrus modul, studying process rates, properties, and life cycles of contrail cirrus clusters within different synoptic situations. The impact of reduced soot number emissions is approximated by a reduction in the initial ice crystal number, exemplarily studied for 80%. Contrail cirrus microphysical and macrophysical properties can depend much more strongly on the synoptic situation than on the initial ice crystal number. They can attain a large cover, optical depth, and ice water content in long-lived and large-scale ice-supersaturated areas, making them particularly climate-relevant. In those synoptic situations, the accumulated ice crystal loss due to sedimentation is increased by around 15% and the volume of contrail cirrus, exceeding an optical depth of 0.02, and their short-wave radiative impact are strongly decreased due to reduced soot emissions. These reductions are of little consequence in short-lived and small-scale ice-supersaturated areas, where contrail cirrus stay optically very thin and attain a low cover. The synoptic situations in which long-lived and climate-relevant contrail cirrus clusters can be found over the eastern U.S. occur in around 25% of cases.

Fiscal Iconography

ERIC Educational Resources Information Center

Swartzentruber, Don

2011-01-01

The economy is often the feature story in our daily news. Synthesizing life is an essential skill for teenagers. The visual arts are a wonderful tool for students to process their situations and explore future aspirations. In this article, the author describes a lesson plan he developed to help students better understand their own situations, as…

Vignettes of Ambiguity

ERIC Educational Resources Information Center

Gotz, Ignacio L.

2010-01-01

This article is an exploration of ambiguity as it appears in various guises in philosophical, social, political, and educational situations. Among these situations is the experience of exile. The exploration is conducted by means of literary anecdotes and real-life instances, hence the use of vignettes. The suggestion is made that ambiguity can be…

Teaching Relaxation Skills in Physical Education

ERIC Educational Resources Information Center

Courtney, Anita

2005-01-01

"Stressed out" has become a way of life for many Americans. For children, stress comes from a variety of situations such as bullying, divorce, high stakes testing, and peer pressure. Because many children are not exposed to stress management techniques, stressful situations often result in unhealthy coping mechanisms such as overeating, "acting…

Course of life satisfaction in patients with depressive and addictive disorders after therapeutic intervention.

PubMed

Büssing, Arndt; Heusser, Peter; Mundle, Götz

2012-05-01

To analyse the course of life satisfaction during the clinic stay of patients with depressive and/or addictive disorders. In a cohort study, 199 patients with depressive and addictive diseases were asked to complete a series of questionnaires at the start and the end of their psychotherapeutic treatment (on average 4.2 ± 2.3 weeks later). The questionnaires were the Brief Multidimensional Life Satisfaction Scale (BMLSS), the Positive Life Construction/Contentedness/Well-Being Scale from the ERDA (Emotional/Rational Disease Acceptance) questionnaire, Beck's Depression Inventory and the revised Symptom Checklist (SCL-90-R). The psychotherapeutic interventions improved the clinical situation of the patients and resulted in strong effects with respect to positive life construction (d = 1.07) and moderate effects on life satisfaction (d = 0.71). Stronger effects were noted in patients with depressive disorders (d = 0.80) than in patients with addictive disorders (d = 0.69). Regression analyses revealed that pre-treatment life satisfaction can be explained negatively by an escape-avoidance strategy (Escape from Illness), and positively by positive life construction. In contrast, post-treatment life satisfaction can be explained negatively by psychological distress and depression, and positively by positive life construction and living with a partner. The hypothesis that life satisfaction changes are associated with the clinical situation of patients was confirmed. In particular, patients with depressive disorders profited from the psychotherapeutic interventions.

Genetic and environmental influences on temperament in the first year of life: the Puerto Rico Infant Twin Study (PRINTS).

PubMed

Silberg, Judy L; Miguel, Vivian Febo San; Murrelle, E Lenn; Prom, Elizabeth; Bates, John E; Canino, Glorisa; Egger, Helen; Eaves, Lindon J

2005-08-01

Three dimensions of temperament -- difficult temperament, unadaptablility and unsociability -- were assessed in the first year of life by maternal interview in twins born in Puerto Rico during 2001 and 2002. Eight hundred and sixty-five eligible mothers (80%) were traced and interviewed. Model-fitting results showed that additive genetic factors and the individual specific environment contributed to variation in all three dimensions. In addition, the pattern of variances and correlations suggested that sibling contrast effects influence ratings of difficult temperament. Moderate effects of the shared environment contributed to ratings of adaptability and sociability. There was a significant genetic correlation between difficult temperament and unadaptability. Genetic and environmental effects do not differ significantly between boys and girls. The study is the first population-based study of Puerto Rican twins and one of few to attempt the assessment of behavior in the first year. Preliminary results for difficult temperament and sociability were consistent with those in other populations and ages. In contrast, a significant effect of the shared environment on the temperamental trait of unadaptability has not been reported previously.

Frequency and Type of Situational Awareness Errors Contributing to Death and Brain Damage: A Closed Claims Analysis.

PubMed

Schulz, Christian M; Burden, Amanda; Posner, Karen L; Mincer, Shawn L; Steadman, Randolph; Wagner, Klaus J; Domino, Karen B

2017-08-01

Situational awareness errors may play an important role in the genesis of patient harm. The authors examined closed anesthesia malpractice claims for death or brain damage to determine the frequency and type of situational awareness errors. Surgical and procedural anesthesia death and brain damage claims in the Anesthesia Closed Claims Project database were analyzed. Situational awareness error was defined as failure to perceive relevant clinical information, failure to comprehend the meaning of available information, or failure to project, anticipate, or plan. Patient and case characteristics, primary damaging events, and anesthesia payments in claims with situational awareness errors were compared to other death and brain damage claims from 2002 to 2013. Anesthesiologist situational awareness errors contributed to death or brain damage in 198 of 266 claims (74%). Respiratory system damaging events were more common in claims with situational awareness errors (56%) than other claims (21%, P < 0.001). The most common specific respiratory events in error claims were inadequate oxygenation or ventilation (24%), difficult intubation (11%), and aspiration (10%). Payments were made in 85% of situational awareness error claims compared to 46% in other claims (P = 0.001), with no significant difference in payment size. Among 198 claims with anesthesia situational awareness error, perception errors were most common (42%), whereas comprehension errors (29%) and projection errors (29%) were relatively less common. Situational awareness error definitions were operationalized for reliable application to real-world anesthesia cases. Situational awareness errors may have contributed to catastrophic outcomes in three quarters of recent anesthesia malpractice claims.Situational awareness errors resulting in death or brain damage remain prevalent causes of malpractice claims in the 21st century.

Perceived quality of life in partners of patients undergoing treatment in somatic health, mental health, or substance use disorder units: a cross-sectional study.

PubMed

Birkeland, Bente; Weimand, Bente M; Ruud, Torleif; Høie, Magnhild M; Vederhus, John-Kåre

2017-08-30

This study explores (1) differences in socio-demographic, social/familial, and health variables and perceived quality of life (QoL) among partners of patients with somatic illness, mental illness, or substance use disorder (SUD); and (2) identifies factors associated with QoL. Participants (N = 213) in this cross-sectional study were recruited from inpatient or outpatient services in five hospitals in Norway, 2013-2014. QoL was measured by the QoL-5, a generic five-item questionnaire. Differences between groups were examined using Chi-square for categorical variables and Kruskal-Wallis for contiuous variables. Multiple linear regression analyses were used to examine factors associated with QoL. The mean QoL score was similar to that of a general population sample, and 13% of the sample had a markedly low QoL. Partners in the SUD group experienced worse socio-demographic conditions in terms of occupation and income, but QoL did not differ significantly among the three groups. In a regression model, perceived family cohesion was positively associated with QoL while psychological distress (Symptom Checklist-10) was negatively related to it. The model explained 56% of the variance in QoL. When patients are ill, clinicians should consider the partners' QoL, and brief QoL tools can be used to identify those who are struggling most. Reduced QoL is associated with higher psychological distress and lower family cohesion. Treatment initiatives focusing on these themes may serve as preventive measures to help the most vulnerable families cope with their difficult life situation.

Palliative care consultation in the process of organ donation after cardiac death.

PubMed

Kelso, Catherine McVearry; Lyckholm, Laurie J; Coyne, Patrick J; Smith, Thomas J

2007-02-01

Palliative care consultation has been demonstrated to be useful in many situations in which expert symptom management, communication around sensitive issues, and family support may serve to enhance or improve care. The process of organ donation is an example of this concept, specifically the process of donation after cardiac death (DCD). DCD allows patients with severe, irreversible brain injuries that do not meet standard criteria for brain death to donate organs when death is declared by cardiopulmonary criteria. The DCD method of donation has been deemed an ethically appropriate means of organ donation and is supported by the organ procurement and medical communities, as well as the public. The palliative care (PC) team can make a significant contribution to the care of the patient and family in the organ donation process. In this paper we describe the controlled DCD process at one institution that utilizes the PC team to provide expert end-of-life care, including comprehensive medical management and family support. PC skills and principles applicable to the DCD process include communication, coordination of care, and skillful ventilator withdrawal. If death occurs within 90 minutes of withdrawal of life support, organs may be successfully recovered for transplantation. If the patient survives longer than 90 minutes, his or her care continues to be provided by the PC team. Palliative care can contribute to standardizing quality end-of-life care practices in the DCD process and provide education for involved personnel. Further experience, research and national discussions will be helpful in refining these practices, to make this difficult and challenging experience as gentle and supportive as possible for the courageous families who participate in this process.

Indigenous Knowledge Approach to Successful Psychotherapies with Aboriginal Suicide Attempters

PubMed Central

2016-01-01

Introduction: Suicide is disproportionately common among Aboriginal people in Canada. Methods: Life stories were collected from 54 Aboriginal suicide attempters in northern Saskatchewan. Constant comparison techniques and modified grounded theory identified common themes expressed. Results: Three common plots/themes preceded suicide attempts: 1) relationship breakup, usually sudden, unanticipated, involving a third person; 2) being publicly humiliated by another person(s), accompanied by high levels of shame; and 3) high levels of unremitting, chronic life stress (including poverty) with relative isolation. We found 5 common purposes for suicide attempts: 1) to “show” someone how badly they had hurt the attempter, 2) to stop the pain, 3) to save face in a difficult social situation, 4) to get revenge, and 5) don’t know/don’t remember/made sense at the time, all stated by people who were under the influence of alcohol and/or drugs at the time of their suicide attempt. We found 5 common beliefs about death: 1) you just cease to exist, and everything just disappears; 2) you go into the spirit world and can see and hear everything that is happening in this world; 3) you go to heaven or hell; 4) you go to a better place; and 5) don’t know/didn’t think about it. Discussion: The idea of personal and cultural continuity is essential to understanding suicide among First Nations youth. Interventions targeted to the individual’s beliefs about death, purpose for suicide, and consistent with the life story (plot) in which they find themselves may be more successful than one-size-fits-all programs developed outside of aboriginal communities. PMID:27738250

Variances in family carers' quality of life based on selected relationship and caregiving indicators: A quantitative secondary analysis.

PubMed

Naef, Rahel; Hediger, Hannele; Imhof, Lorenz; Mahrer-Imhof, Romy

2017-06-01

To determine subgroups of family carers based on family relational and caregiving variables and to explore group differences in relation to selected carer outcomes. Family caregiving in later life holds a myriad of positive and negative outcomes for family members' well-being. However, factors that constitute family carers' experience and explain variances are less well understood. A secondary data analysis using cross-sectional data from a controlled randomised trial with community-dwelling people 80 years or older and their families. A total of 277 paired data sets of older persons and their family carers were included into the analysis. Data were collected via mailed questionnaires and a geriatric nursing assessment. A two-step cluster analysis was performed to determine subgroups. To discern group differences, appropriate tests for differences with Bonferroni correction were used. Two family carer groups were identified. The low-intensity caregiver group (57% of carers) reported high relationship quality and self-perceived ease of caregiving. In contrast, the high-intensity caregiver group (43% of carers) experienced significantly lower relationship quality, felt less prepared and appraised caregiving as more difficult, time intensive and burdensome. The latter cared for older, frailer and more dependent octogenarians and had significantly lower levels of quality of life and self-perceived health compared to the low-intensity caregiver group. A combination of family relational and caregiving variables differentiates those at risk for adverse outcomes. Family carers of frailer older people tend to experience higher strain, lower relationship quality and ability to work together as a family. Nurses should explicitly assess family carer needs, in particular when older persons are frail. Family carer support interventions should address caregiving preparedness, demand and burden, as well as concerns situated in the relationship. © 2016 John Wiley & Sons Ltd.

Spiritual needs of mothers with sick new born or premature infants-A cross sectional survey among German mothers.

PubMed

Büssing, Arndt; Waßermann, Undine; Christian Hvidt, Niels; Längler, Alfred; Thiel, Michael

2018-04-01

Spirituality is part of the basic needs of all humans, yet often undervalued by health professionals. Less is known about the spiritual needs of mothers of preterm or sick new born children. Identify unmet psychosocial and spiritual needs of these mothers, and to relate these needs to their perceived stress and impairments of life concerns. Anonymous cross-sectional survey with standardized instruments (e.g., Spiritual Needs Questionnaire) among 125 mothers of two paediatric departments in Germany. Mothers felt supported by their partner and hospital staff, and hospital staff assured 82% of them that they must not worry about their child's prognosis. They nevertheless did have specific unmet spiritual needs. Religious Needs and Existentialistic Needs scored lowest, while Giving/Generativity Needs were of moderate and Inner Peace Needs of strongest relevance. With respect to the expected diagnosis and prognosis of their child, there were no significant differences for their secular spiritual needs scores, but significant differences for Religious Needs which scored highest in mothers with children having an unclear prognosis (F=8.6; p=.004). Particularly Inner Peace Needs correlated with their stress perception (r=.34), impairments of life concerns (r=.25) and grief (r=.23). Mothers of sick born/premature children felt supported by the hospital team and their partner, but nevertheless experienced stress and daily life impairments, and particularly have unmet Inner Peace Needs. Addressing mothers' specific needs may help support them in their struggle with their difficult situation avoiding fears and insecurity and thus facilitating positive bonding to their child. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Abdominal war wounds--experiences from Red Cross field hospitals.

PubMed

Leppäniemi, Ari K

2005-01-01

The traditional approach to abdominal war wounds consists of triage, eche-loned care, and mandatory laparotomy for penetrating abdominal injuries, and it remains valid in modern conventional wars with well-organized evacuation and surgical services. Expectant management of abdominal casualties can be considered under difficult circumstances with a high influx of patients exhausting the available resources. This can occur in regional conflicts associated with mass movements of people and with collapsed infrastructure. While always combined with adequate fluid resuscitation, antibiotic treatment, and other supportive care, the expectant approach in patients with penetrating abdominal injuries could be indicated for asymptomatic patients with multiple fragment wounds or for patients presenting several days post-injury in good condition. The focus of surgical resources and competence should be on the majority of patients with intestinal perforation only, who need surgery to save life--but not necessarily on an urgent basis--and who have a good chance of survival. The limited availability of blood products to correct blood loss and coagulation factor deficiencies, and the lack of sophisticated monitoring of hemodynamic variables that call into question the value of a damage-control approach for the most severely injured. Even if the bleeding could be temporarily controlled, the subsequent need for adequate resuscitation before returning the patient to the operating room could be difficult to achieve and would result in incompletely resuscitated patients being reoperated while acidotic, coagulopathic, and even hypothermic. Perhaps, in mass casualty situations these patients should be recognized during triage or at least early during operation, and aggressive surgery should be replaced with adequate expectant management with sedation and analgesics.

Identifying fish diversity hot-spots in data-poor situations.

PubMed

Fonseca, Vinícius Prado; Pennino, Maria Grazia; de Nóbrega, Marcelo Francisco; Oliveira, Jorge Eduardo Lins; de Figueiredo Mendes, Liana

2017-08-01

One of the more challenging tasks in Marine Spatial Planning (MSP) is identifying critical areas for management and conservation of fish stocks. However, this objective is difficult to achieve in data-poor situations with different sources of uncertainty. In the present study we propose a combination of hierarchical Bayesian spatial models and remotely sensed estimates of environmental variables to be used as flexible and reliable statistical tools to identify and map fish species richness and abundance hot-spots. Results show higher species aggregates in areas with higher sea floor rugosity and habitat complexity, and identify clear richness hot-spots. Our findings identify sensitive habitats through essential and easy-to-use interpretation tools, such as predictive maps, which can contribute to improving management and operability of the studied data-poor situations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Urgent tracheostomy: four-year experience in a tertiary hospital.

PubMed

Costa, Liliana; Matos, Ricardo; Júlio, Sara; Vales, Fernando; Santos, Margarida

2016-01-01

Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute airway obstruction occurs or there are intubation difficulties. In these situations, surgical tracheostomy becomes extremely important. We retrospectively studied the patients who underwent surgical tracheostomy from 2011 to 2014 by an otolaryngologist team at the operating theater of the emergency department of a tertiary hospital. Indications, complications and clinical evolution of the patients were reviewed. The study included 56 patients (44 men and 12 women) with a median age of 55 years. The procedure was performed under local anesthesia in 21.4% of the patients. Two (3.6%) patients were subjected to conversion from cricothyrostomy to tracheostomy. Head and neck neoplasm was indicated in 44.6% of the patients, deep neck infection in 19.6%, and bilateral vocal fold paralysis in 10.7%. Stridor was the most frequent signal (51.8%). Of the 56 patients, 15 were transferred to another hospital. Among the other 41 patients, 21 were decannulated (average time: 4 months), and none of them were cancer patients. Complications occurred in 5 (12.2%) patients: hemorrhage in 3, surgical wound infection in 1, and cervico-thoracic subcutaneous emphysema in 1. No death was related to the procedure. Urgent tracheostomy is a life-saving procedure for patients with acute airway obstruction or with difficult intubation. It is a safe and effective procedure, with a low complication rate, and should be performed before the patient's clinical status turns into a surgical emergency situation.

Networks of Food Sharing Reveal the Functional Significance of Multilevel Sociality in Two Hunter-Gatherer Groups.

PubMed

Dyble, Mark; Thompson, James; Smith, Daniel; Salali, Gul Deniz; Chaudhary, Nikhil; Page, Abigail E; Vinicuis, Lucio; Mace, Ruth; Migliano, Andrea Bamberg

2016-08-08

Like many other mammalian and primate societies [1-4], humans are said to live in multilevel social groups, with individuals situated in a series of hierarchically structured sub-groups [5, 6]. Although this multilevel social organization has been described among contemporary hunter-gatherers [5], questions remain as to the benefits that individuals derive from living in such groups. Here, we show that food sharing among two populations of contemporary hunter-gatherers-the Palanan Agta (Philippines) and Mbendjele BaYaka (Republic of Congo)-reveals similar multilevel social structures, with individuals situated in households, within sharing clusters of 3-4 households, within the wider residential camps, which vary in size. We suggest that these groupings serve to facilitate inter-sexual provisioning, kin provisioning, and risk reduction reciprocity, three levels of cooperation argued to be fundamental in human societies [7, 8]. Humans have a suite of derived life history characteristics including a long childhood and short inter-birth intervals that make offspring energetically demanding [9] and have moved to a dietary niche that often involves the exploitation of difficult to acquire foods with highly variable return rates [10-12]. This means that human foragers face both day-to-day and more long-term energetic deficits that conspire to make humans energetically interdependent. We suggest that a multilevel social organization allows individuals access to both the food sharing partners required to buffer themselves against energetic shortfalls and the cooperative partners required for skill-based tasks such as cooperative foraging. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Japanese national health screening and intervention program aimed at preventing worsening of the metabolic syndrome.

PubMed

Kohro, Takahide; Furui, Yuji; Mitsutake, Naohiro; Fujii, Ryo; Morita, Hiroyuki; Oku, Shinya; Ohe, Kazuhiko; Nagai, Ryozo

2008-03-01

Similar to the healthcare systems in other industrialized countries, the Japanese healthcare system is facing the problem of increasing medical expenditure. In Japan, this situation may be primarily attributed to advanced technological developments, an aging population, and increasing patient demand. Japan also faces the problem of a declining youth population due to a low birth rate. Taken together, these problems present the healthcare system with a very difficult financial situation. Several reforms have been undertaken to contain medical expenditure, such as increasing employee copayment for health insurance from 10% to 20% in 1997 and from 20% to 30% in 2003 in order to curb unnecessary visits to medical institutions. Since the aging of the Japanese population is inevitable, a suitable method to contain medical expenditure may be to screen individuals who are likely to develop lifestyle-related diseases and conduct early intervention programs for them to prevent the development of diseases such as myocardial infarction or stroke that are costly to treat. If this goal is attained, it may contribute to the containment of medical expenditure as well as to improving the quality of life of the elderly. Therefore, the Japanese Ministry of Health, Labor and Welfare has decided to introduce a nationwide health screening and intervention program specifically targeting the metabolic syndrome commencing April 2008. Here, we discuss (1) the background of the Japanese healthcare system and the problems facing it, (2) the underlying objective and details of the new screening program, and (3) the expected impact of the program.

Choose Your Speed

PubMed Central

Gunston, David

1972-01-01

The pace of modern life is often quoted as a factor in mental ill-health although it is difficult to establish a scientific link. All the same, being able to 'pace' your life properly to suit the conditions is an important factor in personal stability. PMID:27671436

Sourcing Life Cycle Inventory Data

EPA Science Inventory

The collection and validation of quality lifecycle inventory (LCI) data can be the most difficult and time-consuming aspect of developing a life cycle assessment (LCA). Large amounts of process and production data are needed to complete the LCI. For many studies, the LCA analyst ...

Difficult Discharge in Pediatric Rehabilitation Medicine Causing Moral Distress.

PubMed

Green, Michael; Carter, Brian; Lasky, Andrew

2016-01-01

An ethical dimension exists in nearly all decisions made. Yet, there are clinical decisions in which the ethical dilemma is so difficult for the clinician that it results in moral distress. We present one example of a morally distressing situation in which care was provided for a child who had altered physical abilities after a trauma and was being discharged to a suboptimal family environment. Caring for a child with an acquired spinal cord injury requires significant resources. When a family is able to physically care for the child, but has demonstrated incomplete follow-through, the team is at risk for experiencing significant moral distress.

Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess.

PubMed

Thapa, Dennis B; Greene, Nathaniel H; Udani, Andrea G

2017-01-01

Intraoperative ventilatory failure is not an uncommon complication; however, acute endotracheal obstruction by a foreign body or blood clot can be difficult to quickly discriminate from other causes. Once the diagnosis is made, quick action is needed to restore ventilation. The ultimate solution is to exchange the endotracheal tube; however, there can be other ways of resolving this in situations where reintubation would be difficult or unsafe. This case report discusses such an event in an infant with multiple airway challenges including a retropharyngeal and anterior mediastinal abscess. We have also formulated a pathway based on various case reports involving complete ETT obstruction.

Financial abuse of older people by a family member: a difficult terrain for service providers in Australia.

PubMed

Adams, Valerie Margaret; Bagshaw, Dale; Wendt, Sarah; Zannettino, Lana

2014-01-01

Financial abuse by a family member is the most common form of abuse experienced by older Australians, and early intervention is required. National online surveys of 228 chief executive officers and 214 aged care service providers found that, while they were well placed to recognize financial abuse, it was often difficult to intervene successfully. Problems providers encountered included difficulties in detecting abuse, the need for consent before they could take action, the risk that the abusive family member would withdraw the client from the service, and a lack of resources to deal with the complexities inherent in situations of financial abuse.

Rehabilitation of Executive Functions in a Real-Life Setting: Goal Management Training Applied to a Person with Schizophrenia

PubMed Central

Levaux, M.-N.; Larøi, F.; Malmedier, M.; Offerlin-Meyer, I.; Danion, J.-M.; Van der Linden, M.

2012-01-01

The aim was to assess the efficacy of a modified version of Goal Management Training (GMT) in a person with schizophrenia who had difficulties in attaining the final goal for new and multitasking daily-life situations. GMT is designed to improve abilities in establishing goal-directed plans and carrying them out effectively. Beneficial effects of GMT were measured for several clinical questionnaires, laboratory tasks, and three real-life situations: meal preparation (trained, familiar); washing (nontrained, familiar); meeting preparation (nontrained, unfamiliar). The results revealed improvement in planning and on trained laboratory and meal preparation tasks and a generalization of GMT effects on nontrained laboratory and everyday tasks. Self-esteem also improved. Finally, a two-year followup indicated the durability of the beneficial effects. PMID:23094177

[Indicators, variables and obstacles to the life cycle of scientific and technical information in health. Experiences of the Centro Nacional de Información y Documentación en Salud in Mexico].

PubMed

Macías-Chapula, C A

1987-01-01

Indicators, variables and barriers to scientific and technical health information have been detected and described by CENIDS in Mexico within the life cycle of the information production model, covering the phases of: a) generation; b) institutionalization; c) maintenance/development; and d) distribution/dissemination. Emphasis is placed on the important role that play social, economic, demographic, and political factors of each developing country to conform their ideal information life cycle. After an analysis of the existing Mexican situation, and a short description of CENIDS' structure, organization, functions and services, CENIDS' short-term and mid-term projects, and suggestions for further research lines to improve the current situation in Mexico are also given.

Ethical principles in health research and review process.

PubMed

Tangwa, Godfrey B

2009-11-01

In this paper I want to reflect on the fundamental ethical principles and their application in different particular contexts, especially in health research and the ethics review process. Four fundamental ethical principles have been identified and widely discussed in bioethical literature. These principles namely are: autonomy or respect for others, beneficence, non-maleficence and justice. These principles have cross-cultural validity, relevance and applicability. Every real-life situation and every concrete particular case in which ethical decision-making is called-for is unique and different from all others; but the same fundamental ethical principles are relevant and used in addressing all such cases and situations. Very often ethical problems will present themselves in the form of dilemmas and it is then necessary to use the same fundamental principles to analyze the situations, to argue persuasively and cogently with competence for the best options or choices in such situations. The issues I will be dealing with in this paper are necessarily more abstract and theoretical, but we will be discussing them from a very practical viewpoint and impulse, with a view to application in concrete real-life situations. The paper ends with some sample practical examples of cases that the reader can use to test his/her grasp of the principles, how to apply them, how to balance them in differing situations and contexts and how to adjudicate between them when they seem to be in conflict.

The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters.

PubMed

Shapiro, Johanna; Rakhra, Pavandeep; Wong, Adrianne

2016-10-01

Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.

Difficult airway management practice patterns among anesthesiologists practicing in the United States: have we made any progress?

PubMed

Ezri, Tiberiu; Szmuk, Peter; Warters, R David; Katz, Jeffrey; Hagberg, Carin A

2003-09-01

To determine the extent instruction and practice in the use of airway devices and techniques varies among anesthesiologists practicing in the United States. Survey questionnaire. University medical center. Questionnaires were completed by American-trained anesthesiologists who attended the 1999 American Society of Anesthesiologists (ASA) Annual Meeting. Data collected included demographics, education, skills with airway devices/techniques, management of clinical difficult airway scenarios, and the use of the ASA Difficult Airway Algorithm. 1) DEMOGRAPHICS: 452 questionnaires were correctly completed; 62% attending anesthesiologists, 70% <50 years, 81% males, 44% from academic institutions, 63% >10 years of practice, 81% night duty, 77% board certified. 2) Education: 71% had at least one educational modality: difficult airway rotation, workshops, conferences, books, and simulators. 3) Skills: Miller blade 61%, Bullard laryngoscope 32%, LMA 86%, Combitube 43%, bougie 43%, exchangers 47%, cuffed oropharyngeal airway (COPA) 34%, retrograde 41%, transtracheal needle jet ventilation 34%, cricothyrotomy 21%, fiberoptics 59%, and blind nasal intubation 78%. The average reported use of special airway devices/techniques was 47.5%. 4) Management choices: failed intubation/ventilation: LMA (81%) and for all other situations: fiberoptic intubation. Use of ASA Difficult Airway Algorithm in clinical practice (86%). Fiberoptic intubation and the LMA are most popular in management of the difficult airway.

Lessons Learned from Six Decades of Radio Polarimetry

NASA Astrophysics Data System (ADS)

Wiesemeyer, Helmut; Güsten, R.; Kreysa, E.; Menten, K. M.; Morris, D.; Paubert, G.; Pillai, T.; Sievers, A.; Thum, C.

2018-01-01

The characterization of polarized emission from continuum radiation and spectral lines across large-scale galactic and extragalactic fields is a typical application of single-dish telescopes, from radio to far-infrared wavelengths. Despite its high analytical value, in many cases polarimetry was added to the design specifications of telescopes and their frontends only in advanced development stages. While in some situations the instrumental contamination of the Stokes parameters can be corrected, this becomes increasingly difficult for extended fields. This contribution summarizes the current situation at mm/submm telescopes. Strategies for post-observing polarization calibration are presented as well as methods to optimize the components in the beam path.