Can metaphors and analogies improve communication with seriously ill patients?

OBJECTIVE: It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills. DESIGN: Cross-sectional observational study of audio-recorded conversations between patients and physicians. SETTING: Three outpatient oncology practices. PATIENTS: Ninety-four patients with advanced cancer and 52 physicians. INTERVENTION: None. MAIN OUTCOME MEASURES: Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate. RESULTS: In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p < 0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0-11 versus mean 0.6, range 0-5; sign rank test p < 0.001). Physicians who used more metaphors elicited better patient ratings of communication (rho = 0.27; p = 0.006), as did physicians who used more analogies (Spearman rho = 0.34; p < 0.001). CONCLUSIONS: The use of metaphors and analogies may enhance physicians' ability to communicate.

Teaching and cognitive outcomes in A-levels and Advanced GNVQ's: Case studies from Science and Business Studies Classrooms

The purpose of the paper is to demonstrate how a research diary methodology, designed to analyse A-level and GNVQ classrooms, can be a powerful tool for examining pedagogy and quality of learning at the level of case study. Two subject areas, science and business studies, are presented as cases. Twelve teachers and thirty-four students were studied over a four-week period in May 1997 and contrasts were drawn between lessons from three A-level physics teachers/three Advanced GNVQ science teachers and two A-level business/economics teachers/four Advanced GNVQ business teachers. Lessons were analysed within a cognitive framework which distinguishes between conceptual and procedural learning and emphasizes the importance of metacognition and epistemological beliefs. Two dimensions of lessons were identified: pedagogical activities (e.g. teacher-led explanation, teacher-led guidance on a task, question/answer sessions, group discussions, working with IT) and cognitive outcomes (e.g. structuring and memorizing facts, understanding concepts and arguments, critical thinking, problem-solving, learning core skills, identifying values). Immediately after each lesson, teachers and students (three per class) completed structured research diaries with respect to the above dimensions. Data from the diaries reveal general and unique features of the lessons. Time-ofyear effects were evident (examinations pending in May), particularly in A-level classrooms. Students in business studies classes reported a wider range of learning activities and greater variety in cognitive outcomes than did students in science classes. Science students self-rating of their ability to manage and direct their own learning was generally low. The phenomenological aspects of the classrooms were consistently linked to teachers' lesson plans and what their teaching objectives were for those particular students at that particular time of the year.

Examining architects' performance in Nigeria private and public sectors building projects

Abstract: Purpose – The aim of this paper is to examine and compare the performance of architects with respect to clients' rating of importance over a set of performance criteria in Nigerian public and private sector building projects. Design/methodology/approach – A survey involving clients from both public and private sectors of recently completed building projects in Nigeria was undertaken. Data analysis includes comparing similarities and differences using standardised ratio, Mann Whitney U and Wilcoxon tests. Findings – The results show that private sector clients are likely to be more concerned with cost, while public sector clients are more concerned with buildability of design. A total of 79 per cent of the criteria were similarly selected by both sectors with respect to importance of the criteria. Architects need to improve their performance significantly in about 82 per cent of the whole set of 28 criteria. The architects performed better in the public sector than the private sector and 14 per cent of the criteria were indicated as being statistically different in terms of architects' performance. Originality/value – The results provide feedback which can be incorporated in architects' future projects so as to ensure successful project implementation in the building delivery process.

Citizenship Attributes as the Basis for Intergroup Differentiation:Implicit and Explicit Intergroup Evaluations

Recent research (e.g. Barnes, Auburn & Lee, 2004) suggests that citizenship opportunities and resources may be afforded or denied to individuals according to their group memberships. We consider how the generic processes of intergroup differentiation by which groups are socially devalued and excluded can reflect divergent conceptualizations of citizenship among different groups. As part of a wider investigation of social exclusion, a combination of methods was used to investigate the relative intergroup perceptions of residents from more and less affluent areas in Limerick city, Ireland. Participants (n=214) completed the implicit association test and rated a fictional character on a series of citizenship-relevant dimensions. All participants displayed negative
implicit associations with designated disadvantaged areas in Limerick. The results of the explicit prejudice assessment illustrated that these negative associations are matched by a lower overall attribution of positive characteristics to residents from these areas relative to residents from a more affluent area. On examination of each group’s relative rating of traits, residents from less affluent
areas appear doubly disadvantaged as they are devalued in terms of both outgroup and ingroup understandings of citizenship attributes.

Laugh-aware virtual agent and its impact on user amusement

In this paper we present a complete interactive system en- abled to detect human laughs and respond appropriately, by integrating the information of the human behavior and the context. Furthermore, the impact of our autonomous laughter-aware agent on the humor experience of the user and interaction between user and agent is evaluated by sub- jective and objective means. Preliminary results show that the laughter-aware agent increases the humor experience (i.e., felt amusement of the user and the funniness rating of the film clip), and creates the notion of a shared social experience, indicating that the agent is useful to elicit posi- tive humor-related affect and emotional contagion.

Avaliação do potencial reprodutivo de touros através do exame andrológico

Este trabalho refere-se às atividades do estágio de Mestrado Integrado em Medicina Veterinária, apresentando-se casuística no âmbito dos planos sanitários e atividade clínica acompanhados. Como tema para discussão optou-se pela avaliação de touros através do exame andrológico. Após revisão bibliográfica analisaram-se dados obtidos pela VetAl (2008- 2012) caracterizando a população dos touros de carne no Sul de Portugal. Dos 184 touros avaliados foram aprovados 72,28 %, aumentando a probabilidade de reprovação tendencialmente com idade. Em parâmetros reprodutivos importantes como perímetro testicular existe influência de: idade (p<0,001), raça (p<0,05) e Pontuação da Condição Corporal (PCC) (p<0,05). Encontraram-se correlações significativas entre parâmetros tais como perímetro testicular e idade (p<0,001; r=0,52), PCC e parâmetros seminais microscópicos (p<0,05) e dos vários parâmetros entre si. O exame andrológico é essencial para estimar o potencial reprodutivo dos touros e importa fomentar a sua realização em Portugal para melhorar os níveis de fertilidade e rentabilidade das explorações; Abstract Rating of bulls’ reproductive potential through breeding soundness evaluation This document reports the activities of the traineeship for the Master in Veterinary Medicine, including the presentation of the number of cases attended during herd health plans and clinical activity. The theme chosen for discussion was bull fertility through breeding soundness evaluation. Data obtained by Vetal (2008-2012) were analyzed, according to the state of the art, with the aim of characterizing beef bulls’ population in Southern Portugal. Out of 184 bulls evaluated, 72,28 % were approved, unsuccessful outcome apparently increases with age. Scrotal circumference was significantly influenced by: age (p<0,001), breed (p<0,05) and Body Condition Scoring (BCS) (p<0,05). Correlations were significant between scrotal circumference and age (p<0,001; r=0,52), between BCS and microscopic semen evaluation parameters (p<0,05) and between these semen evaluation parameters. The breeding soundness evaluation is essential to assess bulls’ reproductive potential and routine performance of this exam should be encouraged in Portugal to improve fertility and herd profitability.

Situative Risikofaktoren von Korruption – Gelegenheit allein macht keine Diebe

In diesem Beitrag werden die Ergebnisse von sieben Datenhebungen zur Relevanz situativer Risikofaktoren für Korruption aus den Jahren 2010 bis 2013 vorgestellt. In fünf quantitativen Datenerhebungen wurden folgende sechs Faktoren untersucht: Dauer der Korruptionsbeziehung, Vorteilshöhe, Art der Vorteilsempfänger, Entdeckungswahrscheinlichkeit, Vorliegen einer persönliche Notlage und situative Unsicherheit. In zwei qualitativen Datenerhebungen wurde mit offenen Fragen nach situativen Einflussfaktoren von Korruption gefragt. Erwartungswidrig erwiesen sich die untersuchten Faktoren als weitgehend irrelevant für die Bewertung von Korruption sowie für das Meldeverhalten bei beobachteter Korruption. Zu vermuteten ist, dass situative Risikofaktoren nicht unmittelbar, sondern indirekt über vom Umfeld geteilte mögliche Rechtfertigungen korrupter Handlungen im Alltag wirken. Die durchgängig nicht signifikanten Ergebnisse lassen daran zweifeln, dass korruptes Handeln maßgeblich durch situative Risikofaktoren beeinflussbar ist.

O papel das TIC no desenvolvimento da criatividade : percepções dos professores de EVT e EV e construção de critérios de avaliação

Tese de mestrado, Ciências da Educação (Tecnologias Educativas), Universidade de Lisboa, Instituto de Educação, 2010

pH Limitations in environmental geochemical monitoring

Senior thesis written for Oceanography 445

Estágio curricular na empresa Consulfrio

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Mecânica

Influência do alinhamento do pé nos Ajustes Posturais Antecipatórios em crianças com Paralisia Cerebral

Introdução: A dificuldade na organização dos ajustes posturais antecipatórios (APAs) é frequentemente associada ao défice de controlo postural (CP) em crianças/jovens com um quadro motor de hemiplegia espástica, resultante de paralisia cerebral. As alterações biomecânicas da tibiotársica e do pé são características comummente observadas nestas crianças/jovens e influenciam o CP na sua globalidade. Objectivo(s): descrever o comportamento dos APAs associados ao início da marcha, face à modificação do alinhamento do pé em crianças/jovens com hemiplegia espástica, após 12 semanas de intervenção, segundo o Conceito Bobath-TND e aplicação de uma Ligadura Funcional (LF). Métodos: Foram avaliadas quatro crianças/jovens num momento inicial (M0) e após 12 semanas de intervenção e de aplicação de uma LF (M1). Recorrendo à eletromiografia de superfície, registaram-se os timings de activação dos músculos tibial anterior, solear, recto abdominal e erector da espinha (bilateralmente). O início do movimento foi calculado a partir da alteração do sinal obtido através da plataforma de pressões. Recorreu-se à aplicação da TMFM-88 para avaliar a função motora global e à aplicação da CIF-CJ para classificar a funcionalidade mediante as actividades e a participação. Procedeu-se ao registo de imagem para facilitar a observação/avaliação das componentes de movimento das crianças/jovens em estudo. Resultados: Após o período de intervenção, verificou-se uma modificação nos valores dos timings de ativação dos músculos em análise, que se aproximaram da janela temporal definida como APAs, bem como na distribuição de carga na base de suporte, nos scores da TMFM-88 e nos qualificadores das “Actividades e Participação”, sugestivos de uma melhor organização dos mecanismos de controlo postural. Conclusão: As crianças/jovens em estudo evidenciaram, após uma intervenção de fisioterapia baseada no Conceito Bobath- TND e aplicação de uma LF, uma evolução favorável tanto ao nível do CP da tibiotársica e do pé, apresentando timings de ativação muscular temporalmente mais ajustados à tarefa, com repercussões positivas nas actividades e participação.

Relações entre o tipo de respiração, as funções executivas e o comportamento numa amostra de crianças do ensino básico

Envolvido na necessidade emergente de associar a Saúde à Educação e da importância e proeminência que a literatura tem manifestado sobre a respiração e as suas implicações na aprendizagem, este estudo pretende explorar e identificar as principais características anátomo-fisiológicas de alunos com RN e RO, apresentar as alterações do comportamento em alunos com RN e alunos com RO, expôr as modificações das funções executivas em alunos com RN e alunos com RO e a relação entre as funções executivas e o comportamento em alunos com RN e alunos com RO. Foram avaliados 169 alunos do 2º ciclo de escolaridade da Escola Eb2/3 de São João da Madeira na respiração, no comportamento e funções executivas – com recurso à adaptação da Avaliação Miofuncional Orofacial – MBGR, do Questionário de Autoavaliação para Jovens (Youth Self Report) e do Inventário de Classificação Comportamental de Funções Executivas – ICCFE-C/A (versão para crianças/adolescentes). Usou-se a avaliação miofuncional orofacial para se obter a caraterização do modo respiratório e das alterações miofuncionais na amostra; e o questionário de autoavaliação comportamental e o inventário de classificação comportamental de funções executivas para verificar a existência de relação entre o desempenho comportamental e funções executivas com o modo respiratório. Os alunos com modo respiratório predominantemente oral apresentam maior incidência de alterações miofuncionais e de modificações comportamentais e nas funções executivas em comparação de alunos com respiração predominantemente nasal.

Transformation in teaching : listening to every voice

Action research is a methodology that supports practitioner research. This study is an exploration of one researcher's practice using the living-theory approach to action research. Initially, my focus was to improve my practice by asking how I can facilitate transformative learning experiences with the teachers with whom I work. As part of this search, I examined the contradictions between my espoused and implicit values. In keeping with the evolving nature of my inquiry, I unveiled the telos that constituted the impetus for my search, which began as a tension about the quality of my interactions and ended as a quest to find my voice among the others'. I used personal narratives, journal entries, a videotaping session, interactions with critical friends and interviews with colleagues and administrators to engage in a process of continuing self- and interactive reflection. Throughout my study, I explored how theoretical concepts intertwine with personal experiences. In the final chapter, I share the possible connections between my living educational theory and a more general theory of transformative learning. I conclude my study with a look at the transformation process I underwent as a result of the study and the new questions I formulated as I began the action research spiral again.

Bonds away : baseball mythology and the 2007 home run chase

In 2007, Barry Bonds hit his 75 6th home run, breaking Hank Aaron's all-time record for most home runs in a Major League career. While it would be expected that such an accomplishment would induce unending praise and adulationfor the new record-holder, Bonds did not receive the treatment typically reserved for a beloved baseball hero. The purpose of this thesis is to assess media representations of the 2007 home run chase in order to shed light upon the factors which led to the mixed representations which accompanied BOlTds ' assault on Aaron's record. Drawingfrom Roland Barthes ' concept of myth, this thesis proposes that Bonds was portrayed in predominantly negative ways because he was seen as failing to embody the values of baseball's mythology. Using a qualitative content analysis of three major American newspapers, this thesis examines portrayals of Bonds and how he was shown both to represent and oppose elements from baseball's mythology, such as youth, and a distant, agrarian past. Recognizing the ways in which baseball is associated with American life, the media representations of Bonds are also evaluated to discern whether he was portrayed as personifYing a distinctly American set of values. The results indicate that, in media coverage of the 2007 home run chase, Bonds was depicted as a player of many contradictions. Most commonly, Bonds' athletic ability and career achievements were contrasted with unflattering descriptions of his character, including discussions of his alleged use of performance-enhancing substances. However, some coverage portrayed Bonds as embodying baseball myth. The findings contribute to an appreciation of the importance of historical context in examining media representations. This understanding is enhanced by an analysis of a selection of articles on Mark McGwire 's record-breaking season in 1998, and careful consideration of, and comparison to, the context under which Bonds performed in 2007. Findings are also shown to support the contemporary existence of a strong American baseball mythology. That Bonds is both condemned for failing to uphold the mythology and praised for personifYing it suggests that the values seen as inherent to baseball continue to act as an American cultural benchmark.

Peut-on donner d’une clause et reprendre de l’autre? Essai sur la cause comme instrument de contrôle de la cohérence matérielle du contrat

Peut-on donner d’une clause et reprendre de l’autre? Si deux siècles de décisions et de commentaires contradictoires empêchent de répondre à cette question avec la certitude et l’assurance auxquelles nous a habitué la doctrine civiliste, il est tout de même possible d’affirmer que le droit civil prohibe la clause qui permet à un contractant de se dédire totalement de son engagement. Privant l’engagement de son cocontractant de toute raison, et le contrat dans lequel elle se trouve de toute fonction, cette clause contracticide se heurte en effet à une notion fondamentale du droit commun des contrats : la cause. C’est pour éviter que ne soient validés les contrats qui ne présentent aucun intérêt pour l’une ou l’autre des parties que le législateur québécois a choisi d’importer – et de conserver, dans son article introductif du Livre des obligations, cette notion que l’on dit la plus symbolique du droit français des obligations. En effet, bien que son rôle soit fréquemment assumé par d’autres mécanismes, la cause demeure la gardienne des fonctions du contrat synallagmatique. À ce titre, elle permet non seulement d’annuler les contrats qui ne codifient aucun échange, mais également, et surtout, de contrôler ceux dont le contenu ne permet pas de matérialiser les avantages négociés. Octroyant au juge le pouvoir d’assurer que le contrat contienne les outils nécessaires et adaptés à la réalisation de l’opération qu’il a pour fonction de mettre en œuvre, la cause lui offre donc le moyen de garantir l’adéquation entre la fin et ses moyens, bref de contrôler la cohérence matérielle du contrat.