Identity Change Impacts Autobiographical Reconstruction of Identity-Relevant Events: Influences of the Self-System on Remembering

The focus on how one is behaving, feeling, and thinking, provides a powerful source of self-knowledge. How is this self-knowledge utilized in the dynamic reconstruction of autobiographical memories? How, in turn, might autobiographical memories support identity and the self-system? I address these questions through a critical review of the literature on autobiographical memory and the self-system, with a special focus on the self-concept, self-knowledge, and identity. I then outline the methods and results of a prospective longitudinal study examining the effects of an identity change on memory for events related to that identity. Participant-rated memory characteristics, computer-generated ratings of narrative content and structure, and neutral-observer ratings of coherence were examined for changes over time related to an identity-change, as well as for their ability to predict an identity-change. The conclusions from this study are threefold: (1) when the rated centrality of an event decreases, the reported instances of retrieval, as well as the phenomenology associated with retrieval and the number of words used to describe the memory, also decrease; (2) memory accuracy (here, estimating past behaviors) was not influenced by an identity change; and (3) remembering is not unidirectional – characteristics of identity-relevant memories and the life story predict and may help support persistence with an identity (here, an academic trajectory).

Chaucer and the Disconsolations of Philosophy: Boethius, Agency, and Literary Form in Late Medieval Literature

This study argues that Chaucer's poetry belongs to a far-reaching conversation about the forms of consolation (philosophical, theological, and poetic) that are available to human persons. Chaucer's entry point to this conversation was Boethius's Consolation of Philosophy, a sixth-century dialogue that tried to show how the Stoic ideals of autonomy and self-possession are not simply normative for human beings but remain within the grasp of every individual. Drawing on biblical commentary, consolation literature, and political theory, this study contends that Chaucer's interrogation of the moral and intellectual ideals of the Consolation took the form of philosophical disconsolations: scenes of profound poetic rupture in which a character, sometimes even Chaucer himself, turns to philosophy for solace and yet fails to be consoled. Indeed, philosophy itself becomes a source of despair. In staging these disconsolations, I contend that Chaucer asks his readers to consider the moral dimensions of the aspirations internal to ancient philosophy and the assumptions about the self that must be true if its insights are to console and instruct. For Chaucer, the self must be seen as a gift that flowers through reciprocity (both human and divine) and not as an object to be disciplined and regulated.

Chapter one focuses on the Consolation of Philosophy. I argue that recent attempts to characterize Chaucer's relationship to this text as skeptical fail to engage the Consolation on its own terms. The allegory of Lady Philosophy's revelation to a disconsolate Boethius enables philosophy to become both an agent and an object of inquiry. I argue that Boethius's initial skepticism about the pretentions of philosophy is in part what Philosophy's therapies are meant to respond to. The pressures that Chaucer's poetry exerts on the ideals of autonomy and self-possession sharpen one of the major absences of the Consolation: viz., the unanswered question of whether Philosophy's therapies have actually consoled Boethius. Chapter two considers one of the Consolation's fascinating and paradoxical afterlives: Robert Holcot's Postilla super librum sapientiae (1340-43). I argue that Holcot's Stoic conception of wisdom, a conception he explicitly links with Boethius's Consolation, relies on a model of agency that is strikingly similar to the powers of self-knowledge that Philosophy argues Boethius to posses. Chapter three examines Chaucer's fullest exploration of the Boethian model of selfhood and his ultimate rejection of it in Troilus and Criseyde. The poem, which Chaucer called his "tragedy," belonged to a genre of classical writing he knew of only from Philosophy's brief mention of it in the Consolation. Chaucer appropriates the genre to explore and recover mourning as a meaningful act. In Chapter four, I turn to Dante and the House of Fame to consider Chaucer's self-reflections about his ambitions as a poet and the demands of truth-telling.

A pilot study of orthopaedic resident self-assessment using a milestones' survey just prior to milestones implementation.

OBJECTIVE: To pilot test if Orthopaedic Surgery residents could self-assess their performance using newly created milestones, as defined by the Accreditation Council on Graduate Medical Education. METHODS: In June 2012, an email was sent to Program Directors and administrative coordinators of the 154 accredited Orthopaedic Surgery Programs, asking them to send their residents a link to an online survey. The survey was adapted from the Orthopaedic Surgery Milestone Project. Completed surveys were aggregated in an anonymous, confidential database. SAS 9.3 was used to perform the analyses. RESULTS: Responses from 71 residents were analyzed. First and second year residents indicated through self-assessment that they had substantially achieved Level 1 and Level 2 milestones. Third year residents reported they had substantially achieved 30/41, and fourth year residents, all Level 3 milestones. Fifth year, graduating residents, reported they had substantially achieved 17 Level 4 milestones, and were extremely close on another 15. No milestone was rated at Level 5, the maximum possible. Earlier in training, Patient Care and Medical Knowledge milestones were rated lower than the milestones reflecting the other four competencies of Practice Based Learning and Improvement, Systems Based Practice, Professionalism, and Interpersonal Communication. The gap was closed by the fourth year. CONCLUSIONS: Residents were able to successfully self-assess using the 41 Orthopaedic Surgery milestones. Respondents' rate improved proficiency over time. Graduating residents report they have substantially, or close to substantially, achieved all Level 4 milestones. Milestone self-assessment may be a useful tool as one component of a program's overall performance assessment strategy.

Health Knowledge, Attitudes, and Practices among Street Children in LMICs

Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.

Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.

In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.

Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.

The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.

Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.