Identifying the unmet health needs of patients with congenital hypogonadotropic hypogonadism using a web-based needs assessment: implications for online interventions and peer-to-peer support.

BACKGROUND: Patients with rare diseases such as congenital hypogonadotropic hypogonadism (CHH) are dispersed, often challenged to find specialized care and face other health disparities. The internet has the potential to reach a wide audience of rare disease patients and can help connect patients and specialists. Therefore, this study aimed to: (i) determine if web-based platforms could be effectively used to conduct an online needs assessment of dispersed CHH patients; (ii) identify the unmet health and informational needs of CHH patients and (iii) assess patient acceptability regarding patient-centered, web-based interventions to bridge shortfalls in care. METHODS: A sequential mixed-methods design was used: first, an online survey was conducted to evaluate health promoting behavior and identify unmet health and informational needs of CHH men. Subsequently, patient focus groups were held to explore specific patient-identified targets for care and to examine the acceptability of possible online interventions. Descriptive statistics and thematic qualitative analyses were used. RESULTS: 105 male participants completed the online survey (mean age 37 ± 11, range 19-66 years) representing a spectrum of patients across a broad socioeconomic range and all but one subject had adequate healthcare literacy. The survey revealed periods of non-adherence to treatment (34/93, 37%) and gaps in healthcare (36/87, 41%) exceeding one year. Patient focus groups identified lasting psychological effects related to feelings of isolation, shame and body-image concerns. Survey respondents were active internet users, nearly all had sought CHH information online (101/105, 96%), and they rated the internet, healthcare providers, and online community as equally important CHH information sources. Focus group participants were overwhelmingly positive regarding online interventions/support with links to reach expert healthcare providers and for peer-to-peer support. CONCLUSION: The web-based needs assessment was an effective way to reach dispersed CHH patients. These individuals often have long gaps in care and struggle with the psychosocial sequelae of CHH. They are highly motivated internet users seeking information and tapping into online communities and are receptive to novel web-based interventions addressing their unmet needs.

Is my hand connected to my body? The impact of body continuity and arm alignment on the virtual hand illusion

When a rubber hand is placed on a table top in a plausible position as if part of a person"s body, and is stroked synchronously with the person"s corresponding hidden real hand, an illusion of ownership over the rubber hand can occur (Botvinick and Cohen 1998). A similar result has been found with respect to a virtual hand portrayed in a virtual environment, a virtual hand illusion (Slater et al. 2008). The conditions under which these illusions occur have been the subject of considerable study. Here we exploited the flexibility of virtual reality to examine four contributory factors: visuo-tactile synchrony while stroking the virtual and the real arms, body continuity, alignment between the real and virtual arms, and the distance between them. We carried out three experiments on a total of 32 participants where these factors were varied. The results show that the subjective illusion of ownership over the virtual arm and the time to evoke this illusion are highly dependent on synchronous visuo-tactile stimulation and on connectivity of the virtual arm with the rest of the virtual body. The alignment between the real and virtual arms and the distance between these were less important. It was found that proprioceptive drift was not a sensitive measure of the illusion, but was only related to the distance between the real and virtual arms.

How diverse is Cologne Carnival? How migrants appropriate popular art spaces

The present article contributes to the ongoing academic debate on migrants' appropriation of artistic and political spaces in Germany. Cologne, one of the largest cities in Germany, is an interesting example of the tension between political discourse centred around multiculturalism and cultural segregation processes. The 'no fool is illegal' carnival organised by asylum seekers shows their capacity to act, as they reinvent an old local tradition by reinterpreting medieval rituals. Today, different groups and associations appropriate this festive art space: migrants, gays and lesbians, feminists and far-left groups either organise their own parties or take part in the official parties and parades as separate groups. As a result, the celebration of diversity figures on the local political agenda and becomes part of the official carnival festivities. This leads to a blurring of boundaries, whereby mainstream popular culture becomes more and more influenced by multicultural elements.

Género y cultura popular

En uno de los capítulos de Los Simpson, la pequeña Lisa compra, emocionada, la última versión de Stacy Malibú (el equivalente a nuestra Barbie). La novedad consiste en que después de 50 años de existencia, la muñeca habla. Pero para consternación de Lisa, el repertorio de frases es de lo más indignante: "Me encantaría que en la escuela enseñaran a ir de compras", "¡Vamos a hornear unas galletas para los chicos!" o "No me preguntes: sólo soy una chica (risita vacua)". Obviamente, la comprometida y concienciada Lisa no puede quedarse de brazos cruzados y pide a su madre que la lleve a la fábrica de Stacy Malibú para presentar sus quejas. La conversación entre ambas es enormemente reveladora: aunque Marge apoya a su hija e insiste en que siempre defienda sus ideas, considera que quizás está yendo más allá de lo razonable en su denuncia de que toda una generación de niñas se comportará como Stacy Malibú y la tomará como modelo y, finalmente, concluye en tono conciliador: "Yo tuve una Stacy Malibú de pequeña y no me ha pasado nada.¡Vamos a olvidarnos de estos problemas con un gran bol de helado de fresa!". La respuesta de Lisa no deja lugar a dudas; poniendo en funcionamiento a la muñeca y situándola frente a su madre, oímos a Stacy diciendo: "¡Vamos a olvidarnos de estos problemas con un gran bol de helado de fresa!". Huelgan los comentarios.

Género y cultura popular

En uno de los capítulos de Los Simpson, la pequeña Lisa compra, emocionada, la última versión de Stacy Malibú (el equivalente a nuestra Barbie). La novedad consiste en que después de 50 años de existencia, la muñeca habla. Pero para consternación de Lisa, el repertorio de frases es de lo más indignante: "Me encantaría que en la escuela enseñaran a ir de compras", "¡Vamos a hornear unas galletas para los chicos!" o "No me preguntes: sólo soy una chica (risita vacua)". Obviamente, la comprometida y concienciada Lisa no puede quedarse de brazos cruzados y pide a su madre que la lleve a la fábrica de Stacy Malibú para presentar sus quejas. La conversación entre ambas es enormemente reveladora: aunque Marge apoya a su hija e insiste en que siempre defienda sus ideas, considera que quizás está yendo más allá de lo razonable en su denuncia de que toda una generación de niñas se comportará como Stacy Malibú y la tomará como modelo y, finalmente, concluye en tono conciliador: "Yo tuve una Stacy Malibú de pequeña y no me ha pasado nada.¡Vamos a olvidarnos de estos problemas con un gran bol de helado de fresa!". La respuesta de Lisa no deja lugar a dudas; poniendo en funcionamiento a la muñeca y situándola frente a su madre, oímos a Stacy diciendo: "¡Vamos a olvidarnos de estos problemas con un gran bol de helado de fresa!". Huelgan los comentarios.

How diverse is Cologne Carnival? How migrants appropriate popular art spaces

The present article contributes to the ongoing academic debate on migrants' appropriation of artistic and political spaces in Germany. Cologne, one of the largest cities in Germany, is an interesting example of the tension between political discourse centred around multiculturalism and cultural segregation processes. The 'no fool is illegal' carnival organised by asylum seekers shows their capacity to act, as they reinvent an old local tradition by reinterpreting medieval rituals. Today, different groups and associations appropriate this festive art space: migrants, gays and lesbians, feminists and far-left groups either organise their own parties or take part in the official parties and parades as separate groups. As a result, the celebration of diversity figures on the local political agenda and becomes part of the official carnival festivities. This leads to a blurring of boundaries, whereby mainstream popular culture becomes more and more influenced by multicultural elements.

Effect of image resolution manipulation in rearfoot angle measurements obtained with photogrammetry

The aim of this study was to investigate the influence of image resolution manipulation on the photogrammetric measurement of the rearfoot static angle. The study design was that of a reliability study. We evaluated 19 healthy young adults (11 females and 8 males). The photographs were taken at 1536 pixels in the greatest dimension, resized into four different resolutions (1200, 768, 600, 384 pixels) and analyzed by three equally trained examiners on a 96-pixels per inch (ppi) screen. An experienced physiotherapist marked the anatomic landmarks of rearfoot static angles on two occasions within a 1-week interval. Three different examiners had marked angles on digital pictures. The systematic error and the smallest detectable difference were calculated from the angle values between the image resolutions and times of evaluation. Different resolutions were compared by analysis of variance. Inter- and intra-examiner reliability was calculated by intra-class correlation coefficients (ICC). The rearfoot static angles obtained by the examiners in each resolution were not different (P > 0.05); however, the higher the image resolution the better the inter-examiner reliability. The intra-examiner reliability (within a 1-week interval) was considered to be unacceptable for all image resolutions (ICC range: 0.08-0.52). The whole body image of an adult with a minimum size of 768 pixels analyzed on a 96-ppi screen can provide very good inter-examiner reliability for photogrammetric measurements of rearfoot static angles (ICC range: 0.85-0.92), although the intra-examiner reliability within each resolution was not acceptable. Therefore, this method is not a proper tool for follow-up evaluations of patients within a therapeutic protocol.

Formation of the Employer Brand Image

The purpose of this study was to explore the employer brand image and its formation of a Finnish (yet international) service company in B2B sector. In the research qualitative case study method was used to explore the most preferred attributes in employer attraction, the employer brand perceptions towards the case company, and the effectors behind these brand perceptions among the prospective group of employees. The research was conducted through in-depth semistructured interviews among 23-30 undergraduate or graduate business students in Finnish universities close to their graduation. After deriving the attributes of an attractive employer, and exploring their relation to the case company, the employer brand image of the case company was determined and its attractiveness level evaluated. Moreover, the formation of the employer brand image was investigated and its sources detected. The most important factors for the target group in employer attractiveness were found to be company reputation and company culture/work atmosphere. Also career opportunities and international opportunities were seen important. The case company was found to hold a positive, attractive image on company culture and international opportunities, but failing to hold a good reputation as a fair employer. The main and most impactful source of employer brand image was former and current employees - directly or indirectly. Company’s own actions played only small part in employer brand formation as credibility is a critical factor in brand image formation and corporate communication found not to be perceived genuine. Based on the findings, suggestions for further employer branding were made.

Dr. Barry Keith Grant

Professor of Popular Culture and Film

The new woman, femininity and modernity in Margery Allingham's detective novels of the 1930s /

This thesis examines Death of a Ghost (1934), Flowers for the Judge (1935), Dancers in Mourning (1937), and The Fashion in Shrouds (1938), a group of detective novels by Margery Allingham that are differentiated from her other work by their generic hybridity. The thesis argues that the hybrid nature of this group of Campion novels enabled a highly skilled and insightful writer such as Allingham to negotiate the contradictory notions about the place of women that characterized the 1930s, and that in dOing so, she revealed the potential of one of the most popular and accessible genres, the detective novel of manners, to engage its readers in a serious cultural dialogue. The thesis also suggests that there is a connection between Allingham's exploration of modernity and femininity within these four novels and her personal circumstances. This argument is predicated upon the assumption that during the interwar period in England several social and cultural attitudes converged to challenge long-held beliefs about gender roles and class structure; that the real impact of this convergence was felt during the 1930s by the generation that had come of age in the previous decade-Margery Allingham's generation; and that that generation's ambivalence and confusion were reflected in the popular fiction of the decade. These attitudes were those of twentieth-century modernity--contradiction, discontinuity, fragmentation, contingency-and in the context of this study they are incorporated in a literary hybrid. Allingham uses this combination of the classical detective story and the novel of manners to examine the notion of femininity by juxtaposing the narrative of a longstanding patriarchal and hierarchical culture, embodied in the image of the Angel in the House, with that of the relatively recent rights and freedoms represented by the New Woman of the late nineteenth-century. Pierre Bourdieu's theory of social difference forms the theoretical foundation of the thesis's argument that through these conflicting narratives, as well as through the lives of her female characters, Allingham questioned the Hsocial myth" of the time, a prevailing view that, since the First World War, attitudes toward the appropriate role and sphere of women had changed.

Marginal/minority popular music : the concept of the "third space" and the case for "hybridities" of cultures/identities /

The topic of this thesis is marginaVminority popular music and the question of identity; the term "marginaVminority" specifically refers to members of racial and cultural minorities who are socially and politically marginalized. The thesis argument is that popular music produced by members of cultural and racial minorities establishes cultural identity and resists racist discourse. Three marginaVminority popular music artists and their songs have been chosen for analysis in support of the argument: Gil Scott-Heron's "Gun," Tracy Chapman's "Fast Car" and Robbie Robertson's "Sacrifice." The thesis will draw from two fields of study; popular music and postcolonialism. Within the area of popular music, Theodor Adorno's "Standardization" theory is the focus. Within the area of postcolonialism, this thesis concentrates on two specific topics; 1) Stuart Hall's and Homi Bhabha's overlapping perspectives that identity is a process of cultural signification, and 2) Homi Bhabha's concept of the "Third Space." For Bhabha (1995a), the Third Space defines cultures in the moment of their use, at the moment of their exchange. The idea of identities arising out of cultural struggle suggests that identity is a process as opposed to a fixed center, an enclosed totality. Cultures arise from historical memory and memory has no center. Historical memory is de-centered and thus cultures are also de-centered, they are not enclosed totalities. This is what Bhabha means by "hybridity" of culture - that cultures are not unitary totalities, they are ways of knowing and speaking about a reality that is in constant flux. In this regard, the language of "Otherness" depends on suppressing or marginalizing the productive capacity of culture in the act of enunciation. The Third Space represents a strategy of enunciation that disrupts, interrupts and dislocates the dominant discursive construction of US and THEM, (a construction explained by Hall's concept of binary oppositions, detailed in Chapter 2). Bhabha uses the term "enunciation" as a linguistic metaphor for how cultural differences are articulated through discourse and thus how differences are discursively produced. Like Hall, Bhabha views culture as a process of understanding and of signification because Bhabha sees traditional cultures' struggle against colonizing cultures as transforming them. Adorno's theory of Standardization will be understood as a theoretical position of Western authority. The thesis will argue that Adorno's theory rests on the assumption that there is an "essence" to music, an essence that Adorno rationalizes as structure/form. The thesis will demonstrate that constructing music as possessing an essence is connected to ideology and power and in this regard, Adorno's Standardization theory is a discourse of White Western power. It will be argued that "essentialism" is at the root of Western "rationalization" of music, and that the definition of what constitutes music is an extension of Western racist "discourses" of the Other. The methodological framework of the thesis entails a) applying semiotics to each of the three songs examined and b) also applying Bhabha's model of the Third Space to each of the songs. In this thesis, semiotics specifically refers to Stuart Hall's retheorized semiotics, which recognizes the dual function of semiotics in the analysis of marginal racial/cultural identities, i.e., simultaneously represent embedded racial/cultural stereotypes, and the marginal raciaVcultural first person voice that disavows and thus reinscribes stereotyped identities. (Here, and throughout this thesis, "first person voice" is used not to denote the voice of the songwriter, but rather the collective voice of a marginal racial/cultural group). This dual function fits with Hall's and Bhabha's idea that cultural identity emerges out of cultural antagonism, cultural struggle. Bhabha's Third Space is also applied to each of the songs to show that cultural "struggle" between colonizers and colonized produces cultural hybridities, musically expressed as fusions of styles/sounds. The purpose of combining semiotics and postcolonialism in the three songs to be analyzed is to show that marginal popular music, produced by members of cultural and racial minorities, establishes cultural identity and resists racist discourse by overwriting identities of racial/cultural stereotypes with identities shaped by the first person voice enunciated in the Third Space, to produce identities of cultural hybridities. Semiotic codes of embedded "Black" and "Indian" stereotypes in each song's musical and lyrical text will be read and shown to be overwritten by the semiotic codes of the first person voice, which are decoded with the aid of postcolonial concepts such as "ambivalence," "hybridity" and "enunciation."

Fade to black : picturing mortality in contemporary popular film /

This thesis attempts to understand representations of death in contemporary popular film within a framework that posits mortality as a category of particular social and political importance for the way we understand both individual subjectivity and social responsibility in the postmodern cultural moment. It addresses concerns over the social organizing categories of time and space, and performs a sustained consideration of predominant themes related to the popular representation of death, such as contingency, existential.meaning, and temporal finitude. Death consciousness and social consciousness are shown to be not just intertwined, but also vitally dependent on one another, and the analyses undertaken are ultimately aimed at making these intersections explicit in order • l to think through their potential implications for challenging consumer capitalist hegemony and envisioning the possibility of progressive social change through the lens of our mortality.

Identifying the psychosexual implications of radical radiation treatment in prostate cancer

The purpose of this study was to determine whether there was any evidence of psychosexual morbidity among men who experienced radical radiation treatment for prostate cancer. With relatively little known or available retrospective data on the psychosexual implications of radical radiation treatment in men with prostate cancer, this study posited eight research questions which provided the basis for the research. Fifty men from Southern Ontario, between the ages of 52 to 78 years, were included in the study. They had been previously randomized to a clinical trial comparing radical radiation therapy by external beam radiation, or radical radiation using a combination of a temporary iridium implant plus external beam radiation, for localized or locally advanced prostate cancer. Assessment of sexual functioning, drive, attitudes, body image, and sexual satisfaction was drawn from a multidimensional approach, since psychosexuality was viewed as having an impact on biological, psychological, and sociological domains of functioning. Medical chart reviews, semi-structured interviews, demographical profiles of each participant, and the Derogatis Sexual Functioning Inventory (DSFI) were the methods used to collect data over a four-month period. Both quantitative and qualitative research methods were incorporated in the design and evaluation of the study. Frequencies, contingency analysis, Pearson's coefficient of correlation, t-tests, and ANOVA comprised the quantitative analysis. Data obtained from audio-taped interviews were analyzed qualitatively, and used for offering further insight and for facilitating the quantitative aspect of the analysis. Overall, there was sufficient evidence to suggest psychosexual morbidity among men who were treated with radiation therapy for prostate cancer. As well,there were a number of significant findings available to answer all of the posited research questions. The most significant findings were noted in post-treatment erectile ability and sexual activity. A post-treatment change in erectile ability was reported by eighty percent of men. Sixty percent of men noted a decrease in their ability to achieve an erection by reporting some morning stiffness only, penile rigidity insufficient for penetration, decreased control of erection, and loss of spontaneous erection. Other contributing factors associated with change in erectile status were: pain or altering sensation of orgasm, blood in ejaculate, pain and decreased amount of ejaculate, and penile numbness or pain. Eighty-two percent of men experienced a post-treatment change in sexual function, primarily due to the impact of decreasing erectile status. Only seven men reported that they experienced a decrease in desire mentally, whereas the vast majority did not experience any change in desire. Changes in foreplay, stress with optimal sexual positioning, and reduced spontaneity of sex, were other factors reported with the changes in sexual activity. The findings in this study broaden our understanding of what middle- to later-aged men feel and experience as they venture onward following treatment. This was the first study that evaluated available prospective data on pre-treatment erectile status and sexual activity. As well, this study was the first (with participant compliance rates of 100 percent) to have included an interview format to capture the views of such a large number of men. This study concluded with recommendations and implications for future research and practice as we move in the direction of understanding what is necessary for preserving psychosexual well being and enhancing quality of life in men treated with radiation therapy for prostate cancer.

Weight-preoccupation, personality and depression in university students : an interactionist perspective

The present research was designed to examine Beck's (1983; 1987) cognitive diathesis-stress model of depression in a new context. Specifically, this cross-sectional study investigated whether Beck's cognitive-personality traits of sociotropy and autonomy interacted with a specific daily hassle/stressor, weightpreoccupation, in the prediction of depressed mood in women and men. Weightpreoccupation was chosen as the particular daily stressor, because, according to Kanner, Coyne, Schaeffer, and Lazarus (1981). concern about weight and physical appearance were two of the most troublesome daily hassles among university students. ContraIy to current stereotypes, men also express concerns with weight and appearance (Cash, Winstead, &, landi, 1986), in both the direction of weight loss and weight/muscle gain (Drewnowski &, Yee, 1987). Thus, unique to this study was the examination of weight-preoccupation in men, not only in the direction of weight loss, but also in the direction of weight and muscle gain. Two hundred and fifty-one undergraduates were administered the revised SociotropyAutonomy Scale (SAS), the Beck Depression Inventory (BDij, the Hassles and Uplifts Scale, the Eating Disorders Inventory (EDI), and the Restraint Scale (RS). Through a process of model building, a final model was devised in which depression (ie., BDI total scores) was regressed on personality (Le., SAS Sociotropy) and weight-preoccupation (i.e., Drive for Thinness, Body Dissatisfaction, and the Restraint Scale). Separate hierarchical multiple regression analyses, with BDI as the dependent variable, were carried out for each of the 2 3 weight-preoccupation variables. Results revealed a specific congruent interaction between weight,..preoccupation and personality. Specifically, drive for thinness and body dissatisfaction interacted with sociotropy to predict depressed mood in both women and men, but the interaction between sociotropy and the Restraint Scale was marginal. Findings suggested that weight-preoccupied women and men experienced depressed mood to the extent that they were characterized as more highly sociotropic. As predicted, personality (i.e., sociotropy), moderated the relationship between daily stress (i.e., weight-preoccupation) and depression. Thus, results revealed that the proposed diathesis-stress model seemed to operate in the same manner for women and men. Moreover, the examination of weightpreoccupation among men (i.e., in the direction of both weight loss and weight/muscle gain) further revealed that, when curvilinearity was taken into account, highly sociotropic men, who had a low desire to gain weight and muscle mass (i.e., most likely those who desired to lose weight), experienced higher levels of depressed mood than those who had a "medium" desire for weight and muscle gain. However, the highest levels of depressed mood was experienced by highly sociotropic men who were highly weight-preoccupied in the direction of wanting to gain weight and muscle mass. In addition, possible reasons for the present fmdings, as wen as iimitations and impiicalions for future research are discussed.