The effect of African Americans' ethnographic paradigms and cultural explanatory model of breast cancer in framing the male partner's attitudes and behaviors about the woman's breast cancer diagnosis

The disparate burden of breast cancer-related morbidity and mortality experienced by African American women compared with women of other races is a topic of intense debate in the medical and public health arenas. The anomaly is consistently attributed to the fact that at diagnosis, a large proportion of African American women have advanced-stage disease. Extensive research has documented the impacts of cultural factors and of socioeconomic factors in shaping African American women's breast-health practices; however, there is another factor of a more subtle influence that might have some role in establishing these women's vulnerability to this disease: the lack of or perceived lack of partner support. Themes expressed in the research literature reflect that many African American breast cancer patients and survivors consider their male partners as being apathetic and nonsupportive. ^ The purpose of this study was to learn how African American couples' ethnographic paradigms and cultural explanatory model of breast cancer frame the male partners' responses to the women's diagnosis and to assess his ability to cope and willingness to adapt to the subsequent challenges. The goal of the study was to determine whether these men's coping and adaptation skills positively or negatively affect the women's self-care attitudes and behaviors. ^ This study involved 4 African American couples in which the woman was a breast cancer survivor. Participants were recruited through a community-based cancer support group and a church-based cancer support group. Recruitment sessions were held at regular meetings of these organizations. Accrual took 2 months. In separate sessions, each male partner and each survivor completed a demographic survey and a questionnaire and were interviewed. Additionally, the couples were asked to participate in a communications activity (Adinkra). This activity was not done to fulfill any part of the study purpose and was not included in the data analysis; rather, it was done to assess its potential use as an intervention to promote dialogue between African American partners about the experience of breast cancer. ^ The questionnaire was analyzed on the basis of a coding schema and the interview responses were analyzed on the principles of hermeneutic phenomenology. In both cases, the instruments were used to determine whether the partner's coping skills reflected a compassionate attitude (positive response) versus an apathetic attitude (negative response) and whether his adaptation skills reflected supportive behaviors (the positive response) versus nonsupportive behaviors (the negative response). Overall, the women's responses showed that they perceived of their partners as being compassionate, yet nonsupportive, and the partner's perceived of themselves likewise. Only half of the women said that their partners' coping and adaptation abilities enabled them to relinquish traditional concepts of control and focus on their own well-being. ^ The themes that emerged indicate that African American men's attitudes and behaviors regarding his female partner's diagnosis of breast cancer and his ability to cope and willingness to adapt are influenced by their ritualistic mantras, folk beliefs, religious teachings/spiritual values, existential ideologies, socioeconomic status, and environmental factors and by their established perceptions of what causes breast cancer, what the treatments and outcomes are, and how the disease affects the entire family, particularly him. These findings imply that a culturally specific intervention might be useful in educating African American men about breast cancer and their roles in supporting their female partners, physically and psychologically, during diagnosis, treatment, and recovery. ^

Standards and specifications to manage accessibility issues in e-learning

Despite the acknowledged need of providing a personalized and adaptive learning process for all, current learning management systems do not properly cover personalization and accessibility issues and they are still struggling to support the reusability requirements coming from the pervasive usage of standards. There is a lack of frameworks for providing layered-based infrastructure covering the interoperability required to manage the whole range of standards, applications and services needed to meet accessibility and adaptations needs of lifelong learning services.

Affect and the Problem of Evil

A central aspect of the problem of evil or the argument from evil is the intensity or quantity of suffering. This quantity is conceived of as something objective and fixed. But because our experience is in part constituted and interpreted by our effectual orientation, there is no such objective quantum of suffering. But where there is no objective quantum of suffering, the argument from evil collapses. Here we begin by examining the connection between the philosophical and existential dimensions of the problem of and argument from evil as suffering. Next we consider the role of the affect in the constitution and interpretation of experience generally, together with implications for the argument from suffering. Third, we look at how a key affectual element of the argument from evil might undercut that argument. And finally, we consider a proposal to categorize suffering as a species of moral or spiritual failure, as affectually wrong.

Review of Desalination and Concentrate Management Issues for Increasing Drinking Water Supplies

Water quantity and quality issues worldwide are causing nations to consider alternate sources for drinking water. Desalination and other membrane processes for treatment of seawater and brackish inland waters have been in use for the past quarter century and are growing in use worldwide. These treatment processes create a highly concentrated waste stream in which the principal constituents are dissolved solids. This report provides an overview of desalination methods and the methods available to dispose of this waste stream. Innovative technologies being studied for possible future use are also discussed.

On the status of conversion in present-day American English: controversial issues and corpus-based study

This paper examines both theoretical and practical issues related to conversion. A quite detailed characterization of the 5329 instances identified in a 300.000-word corpus of American English written in the late 90s is provided. The examples are grouped according to the type of conversion involved. Frequency and the internal structure of words are also considered and compared with the results obtained by earlier scholars. In spite of the limitations that a corpus study imposes, the conclusions obtained seem to suggest that any item, independent of its morphological structure, may undergo conversion and this may happen in any register. Moreover, conversion seems to be an important source of new items in American English nowadays.

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ‘death rattle’, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ‘noisy breathing’ for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.

Psychological and Interpersonal Implications of Believing that Everything is One: Identity, Personality, Values, and Worldviews

For thousands of years, people from a variety of philosophical, religious, spiritual, and scientific perspectives have believed in the fundamental unity of all that exists, and this belief appears to be increasingly prevalent in Western cultures. The present research was the first investigation of the psychological and interpersonal implications of believing in oneness. Self-report measures were developed to assess three distinct variants of the belief in oneness – belief in the fundamental oneness of everything, of all living things, and of humanity – and studies examined how believing in oneness is associated with people’s self-views, attitudes, personality, emotions, and behavior. Using both correlational and experimental approaches, the findings supported the hypothesis that believing in oneness is associated with feeling greater connection and concern for people, nonhuman animals, and the environment, and in being particularly concerned for people and things beyond one’s immediate circle of friends and family. The belief is also associated with experiences in which everything is perceived to be one, and with certain spiritual and esoteric beliefs. Although the three variations of belief in oneness were highly correlated and related to other constructs similarly, they showed evidence of explaining unique variance in conceptually relevant variables. Belief in the oneness of humanity, but not belief in the oneness of living things, uniquely explained variance in prosociality, empathic concern, and compassion for others. In contrast, belief in the oneness of living things, but not belief in oneness of humanity, uniquely explained variance in beliefs and concerns regarding the well-being of nonhuman animals and the environment. The belief in oneness is a meaningful existential belief that is endorsed to varying degrees by a nontrivial portion of the population and that has numerous implications for people’s personal well-being and interactions with people, animals, and the natural world.

Policy mixes for resource efficiency – conceptual issues, design and assessment challenges

Since the 1950s the global consumption of natural resources has skyrocketed, both in magnitude and in the range of resources used. Closely coupled with emissions of greenhouse gases, land consumption, pollution of environmental media, and degradation of ecosystems, as well as with economic development, increasing resource use is a key issue to be addressed in order to keep the planet Earth in a safe and just operating space. This requires thinking about absolute reductions in resource use and associated environmental impacts, and, when put in the context of current re-focusing on economic growth at the European level, absolute decoupling, i.e., maintaining economic development while absolutely reducing resource use and associated environmental impacts. Changing behavioural, institutional and organisational structures that lock-in unsustainable resource use is, thus, a formidable challenge as existing world views, social practices, infrastructures, as well as power structures, make initiating change difficult. Hence, policy mixes are needed that will target different drivers in a systematic way. When designing policy mixes for decoupling, the effect of individual instruments on other drivers and on other instruments in a mix should be considered and potential negative effects be mitigated. This requires smart and time-dynamic policy packaging. This Special Issue investigates the following research questions: What is decoupling and how does it relate to resource efficiency and environmental policy? How can we develop and realize policy mixes for decoupling economic development from resource use and associated environmental impacts? And how can we do this in a systemic way, so that all relevant dimensions and linkages—including across economic and social issues, such as production, consumption, transport, growth and wellbeing­—are taken into account? In addressing these questions, the overarching goals of this Special Issue are to: address the challenges related to more sustainable resource-use; contribute to the development of successful policy tools and practices for sustainable development and resource efficiency (particularly through the exploration of socio-economic, scientific, and integrated aspects of sustainable development); and inform policy debates and policy-making. The Special Issue draws on findings from the EU and other countries to offer lessons of international relevance for policy mixes for more sustainable resource-use, with findings of interest to policy makers in central and local government and NGOs, decision makers in business, academics, researchers, and scientists.

The Issue with Issues Management: An Engagement Approach to Integrate Gender and Emotion into Issues Management

Using sexual assault on college campuses as a context for interrogating issues management, this study offers a normative model for inclusive issues management through an engagement approach that can better account for the gendered and emotional dimensions of issues. Because public relations literature and research have offered little theoretical or practical guidance for how issues managers can most effectively deal with issues such as sexual assault, this study represents a promising step forward. Results for this study were obtained through 32 in-depth interviews with university issues managers, six focus groups with student populations, and approximately 92 hours of participant observation. By focusing on inclusion, this revised model works to have utility for an array of issues that have previously fallen outside of the dominant masculine and rationale spheres that have worked to silence marginalized publics’ experiences. Through adapting previous issues management models to focus on inclusion at the heart of a strategic process, and engagement as the strategy for achieving this, this study offers a framework for ensuring more voices are heard—which enables organizations to more effectively communicate with their publics. Additionally, findings from this research may also help practitioners at different types of organizations develop better, and proactive, communication strategies for handling emotional and gendered issues as to avoid negative media attention and work to change organizational culture.

The practices of existential psychotherapists: Development and application of an observational grid

Within the major therapeutic paradigms, observational instruments have been developed to assess orientation-specific interventions or processes. However, to date, no such instrument exists to assess existential practices. Recent research indicates the key practices of existential therapists, and forms an empirical basis on which to develop an observatory grid. This paper describes the development of such a grid, and its exploratory testing with eight clients of four Portuguese existential psychotherapists. A total of 32 sessions were observed and both speaking turn and whole-session analysis showed that it was feasible to assess existential therapy using the instrument, although psychometric findings recommend further refinement of the tool. Session-rating data suggest that the chief practices applied by existential therapists were relational, followed by the use of hermeneutic interventions and reformulations. Interventions based on phenomenological and existential assumptions were observable in practice but limited in frequency. Further refinements and developments of the observational grid, together with additional research – using a range of therapists from different schools of existential therapy – are recommended.

One Step Forward: Contrasting The Effects Of Toe Clipping And Pit Tagging On Frog Survival And Recapture Probability.

Amphibians have been declining worldwide and the comprehension of the threats that they face could be improved by using mark-recapture models to estimate vital rates of natural populations. Recently, the consequences of marking amphibians have been under discussion and the effects of toe clipping on survival are debatable, although it is still the most common technique for individually identifying amphibians. The passive integrated transponder (PIT tag) is an alternative technique, but comparisons among marking techniques in free-ranging populations are still lacking. We compared these two marking techniques using mark-recapture models to estimate apparent survival and recapture probability of a neotropical population of the blacksmith tree frog, Hypsiboas faber. We tested the effects of marking technique and number of toe pads removed while controlling for sex. Survival was similar among groups, although slightly decreased from individuals with one toe pad removed, to individuals with two and three toe pads removed, and finally to PIT-tagged individuals. No sex differences were detected. Recapture probability slightly increased with the number of toe pads removed and was the lowest for PIT-tagged individuals. Sex was an important predictor for recapture probability, with males being nearly five times more likely to be recaptured. Potential negative effects of both techniques may include reduced locomotion and high stress levels. We recommend the use of covariates in models to better understand the effects of marking techniques on frogs. Accounting for the effect of the technique on the results should be considered, because most techniques may reduce survival. Based on our results, but also on logistical and cost issues associated with PIT tagging, we suggest the use of toe clipping with anurans like the blacksmith tree frog.

Impact Of Pharmacist Interventions On Drug-related Problems And Laboratory Markers In Outpatients With Human Immunodeficiency Virus Infection.

Substantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection. In this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia-University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load. After pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1-6.2) to 4.2 (95% CI =3.3-5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm(3) [95% CI =175.8-345.6] to 312.0 cells/mm(3) [95% CI =23.5-40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load. This study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.

It's all very well, in theory: Theoretical perspectives and their applications in contemporary pedagogical research

Current debates about educational theory are concerned with the relationship between knowledge and power and thereby issues such as who possesses a truth and how have they arrived at it, what questions are important to ask, and how should they best be answered. As such, these debates revolve around questions of preferred, appropriate, and useful theoretical perspectives. This paper overviews the key theoretical perspectives that are currently used in physical education pedagogy research and considers how these inform the questions we ask and shapes the conduct of research. It also addresses what is contested with respect to these perspectives. The paper concludes with some cautions about allegiances to and use of theories in line with concerns for the applicability of educational research to pressing social issues.

Evidence of a spotted fever-like rickettsia and a potential new vector from northeastern Australia

A spotted fever-like rickettsia was identified in a Hemaphysalis tick by polymerase chain reaction (PCR) amplification and sequencing of the 16S rDNA, ompA, and ompB genes. A comparison of these nucleotide sequences with those of other spotted fever group (SFG) rickettsiae revealed that the Hemaphysalis tick rickettsia was distinct from other previously reported strains. Phylogenetic analysis based on both ompA and ompB also indicates that the strain’s closest relatives are the agents of Thai tick typhus (Rickettsia honei strain TT-118) and Flinders Island spotted fever (R. honei). This study represents the first report of an R. honei-like agent from a Hemaphysalis tick in Australia and of a spotted fever group rickettsia from Cape York Peninsula, Queensland.

Concepts and tools for comprehensive sustainability assessments for tourism destinations: a comparative review

This paper reviews a wide range of tools for comprehensive sustainability assessments at whole tourism destinations, covering socio-cultural, economic and environmental issues. It considers their strengths, weaknesses and site specific applicability. It is intended to facilitate their selection (and combination where necessary). Tools covered include Sustainability Indicators, Environmental Impact Assessment, Life Cycle Assessment, Environmental Audits, Ecological Footprints, Multi-Criteria Analysis and Adaptive Environmental Assessment. Guidelines for evaluating their suitability for specific sites and situations are given as well as examples of their use.