Caring for Alaska Native prostate cancer survivors in primary care: a survey of Alaska Tribal Health System providers.

BACKGROUND: Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care. OBJECTIVE: To describe the experiences and attitudes of primary care providers within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors. DESIGN: In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers' level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items. RESULTS: Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary care provider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either "moderately" or "very" comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice. CONCLUSIONS: These data suggest that most primary care providers in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial.

Measuring the Severity of Negative and Traumatic Events.

We devised three measures of the general severity of events, which raters applied to participants' narrative descriptions: 1) placing events on a standard normed scale of stressful events, 2) placing events into five bins based on their severity relative to all other events in the sample, and 3) an average of ratings of the events' effects on six distinct areas of the participants' lives. Protocols of negative events were obtained from two non-diagnosed undergraduate samples (n = 688 and 328), a clinically diagnosed undergraduate sample all of whom had traumas and half of whom met PTSD criteria (n = 30), and a clinically diagnosed community sample who met PTSD criteria (n = 75). The three measures of severity correlated highly in all four samples but failed to correlate with PTSD symptom severity in any sample. Theoretical implications for the role of trauma severity in PTSD are discussed.

Autobiographical memories of anxiety-related experiences.

Ninety-nine undergraduate students retrieved three memories associated with each of the five emotional experiences: panic, trauma, worry, social anxiety, and feeling content. Subsequently, they answered 24 questions assessing properties of each memory, including the vividness and perceived accuracy of the memories and sensory, emotional, and anxiety-related experiences during retrieval. Memories were coded for affective tone and specificity. Results indicated that panic-related and trauma-related memories were rated similarly as content memories, but that they generally were associated with more imagery and emotional experiencing than worry-related or social anxiety-related memories. Participants experienced panic and worry symptoms to the greatest degree when they retrieved panic-related and trauma-related memories. All anxiety-related memories were characterized by more negative tone than content memories. Panic-related and trauma-related memories were more specific than worry-related, social anxiety-related, and content memories. These findings can explain partially why individuals with some, but not all, anxiety disorders experience enhanced memory for threatening material.

IMPROMPTU: FROM PUBLISHER'S IMPULSE TO AN ESTABLISHED SMALL­ SCALE GENRE IN PIANO LITERATURE

The word 'impromptu' began to appear in music literature in the early 19th century, specifically as title for a relatively short composition written for solo piano. The first impromptus appear to have been named so by the publishers. However, the composers themselves soon embraced the title to indicate, for the most part, fairly short character pieces. Impromptus do not follow any specific structural pattern, although many are cast in ternary form. The formal design ranges from strict compound ternary in the early impromptus to through-composed and variation forms. The peak of impromptu's popularity undoubtedly came during the middle and late19th century. However, they are still being composed today, albeit much less frequently. Although there have been many variants of impromptus in relation to formal design and harmonic language over the years, the essence of impromptu remains the same: it is still a short character piece with a general feeling of spontaneity. Overall, impromptus may be categorized into several different groups: some appear as part of a larger cycle, such as Dvorak's G minor Impromptu from his Piano Pieces, B. 110; many others use an element of an additional genre that enhances the character ofthe impromptu, such as Liszt's Valse-Impromptu and Antonio Bibalo's Tango Impromptu; yet another group consists of works based on opera themes, such as Liszt's Impromptu Brillant sur des themes de Rossini et Spontini and Czerny's Impromptus et variations sur Oberon, Op. 134. My recording project includes well-known impromptus, such as Schubert's Op. 142 and the four by Chopin, as well as lesser known works that have not been performed or recorded often. There are four impromptus that have been recorded here for the first time, including those written by Leopold Godowsky, Antonio Bibalo, Altin Volaj, and Nikolay Mazhara. I personally requested the two last named composers to contribute impromptus to this project. My selection represents works by twenty composers and reflects the different types of impromptus that have been encountered through almost three hundred years of the genre's existence, from approximately 1817 (VoriSek) to 2008 (Volaj and Mazhara).

Systematic review and metasummary of attitudes toward research in emergency medical conditions

Emergency departments are challenging research settings, where truly informed consent can be difficult to obtain. A deeper understanding of emergency medical patients' opinions about research is needed. We conducted a systematic review and meta-summary of quantitative and qualitative studies on which values, attitudes, or beliefs of emergent medical research participants influence research participation. We included studies of adults that investigated opinions toward emergency medicine research participation. We excluded studies focused on the association between demographics or consent document features and participation and those focused on non-emergency research. In August 2011, we searched the following databases: MEDLINE, EMBASE, Google Scholar, Scirus, PsycINFO, AgeLine and Global Health. Titles, abstracts and then full manuscripts were independently evaluated by two reviewers. Disagreements were resolved by consensus and adjudicated by a third author. Studies were evaluated for bias using standardised scores. We report themes associated with participation or refusal. Our initial search produced over 1800 articles. A total of 44 articles were extracted for full-manuscript analysis, and 14 were retained based on our eligibility criteria. Among factors favouring participation, altruism and personal health benefit had the highest frequency. Mistrust of researchers, feeling like a 'guinea pig' and risk were leading factors favouring refusal. Many studies noted limitations of informed consent processes in emergent conditions. We conclude that highlighting the benefits to the participant and society, mitigating risk and increasing public trust may increase research participation in emergency medical research. New methods for conducting informed consent in such studies are needed.

The Representation of Emotion in Autonomic and Central Nervous System Activity

Phenomenologically, humans effectively label and report feeling distinct emotions, yet the extent to which emotions are represented categorically in nervous system activity is controversial. Theoretical accounts differ in this regard, some positing distinct emotional experiences emerge from a dimensional representation (e.g., along axes of valence and arousal) whereas others propose emotions are natural categories, with dedicated neural bases and associated response profiles. This dissertation aims to empirically assess these theoretical accounts by examining how emotions are represented (either as disjoint categories or as points along continuous dimensions) in autonomic and central nervous system activity by integrating psychophysiological recording and functional neuroimaging with machine-learning based analytical methods. Results demonstrate that experientially, emotional events are well-characterized both along dimensional and categorical frameworks. Measures of central and peripheral responding discriminate among emotion categories, but are largely independent of valence and arousal. These findings suggest dimensional and categorical aspects of emotional experience are driven by separable neural substrates and demonstrate that emotional states can be objectively quantified on the basis of nervous system activity.

The Many Faces of Paul Hindemith

The purpose of this project is to present selected violin pieces by Paul Hindemith (1895-1963) against a backdrop of the diverse styles and traditions that he integrated in his music. For this dissertation project, selected violin sonatas by Hindemith were performed in three recitals alongside pieces by other German and Austro-German composers. These recitals were also recorded for archival purposes. The first recital, performed with pianist David Ballena on December 10, 2005, in Gildenhorn Recital Hall at the University of Maryland, College Park, included Violin Sonata Op.11, No. 1 (1918) by Paul Hindemith, Sonatina in D Major, Op. 137 (1816) by Franz Schubert, and Sonata in E-flat Major, Op.18 (1887) by Richard Strauss. The second recital, performed with pianist David Ballena on May 9, 2006, in Gildenhorn Recital Hall at the University of Maryland, included Sonata in E Minor, KV 304 (1778) by Wolfgang Amadeus Mozart, Sonata in E (1935) by Paul Hindemith, Romance for Violin and Orchestra No.1 in G Major (1800-1802) by Ludwig Van Beethoven, and Sonata for Violin and Piano in A minor, Op. 105 (1851) by Robert Schumann. The third recital, performed with David Ballena and Kai-Ching Chang on November 10, 2006 in Ulrich Recital Hall at the University of Maryland, included Violin Sonata Op.12 No.1 in D Major (1798) by Ludwig Van Beethoven, Sonata for Violin and Harpsichord No.4 in C Minor BWV 1017 (1720) by J.S. Bach, and Violin Sonata Op.11 No.2 (1918) by Paul Hindemith. For each of my dissertation recitals, I picked a piece by Hindemith as the core of the program then picked pieces by other composers that have similar key, similar texture, same number of movements or similar feeling to complete my program. Although his pieces used some classical methods of composition, he added his own distinct style: extension of chromaticism; his prominent use of interval of the fourth; his chromatic alteration of diatonic scale degrees; and his non-traditional cadences. Hindemith left behind a legacy of multi-dimensional, and innovative music capable of expressing both the old and the new aesthetics.

Effects of chronic mild traumatic brain injury on white matter integrity in iraq and afghanistan war veterans

Mild traumatic brain injury (TBI) is a common source of morbidity from the wars in Iraq and Afghanistan. With no overt lesions on structural MRI, diagnosis of chronic mild TBI in military veterans relies on obtaining an accurate history and assessment of behavioral symptoms that are also associated with frequent comorbid disorders, particularly posttraumatic stress disorder (PTSD) and depression. Military veterans from Iraq and Afghanistan with mild TBI (n = 30) with comorbid PTSD and depression and non-TBI participants from primary (n = 42) and confirmatory (n = 28) control groups were assessed with high angular resolution diffusion imaging (HARDI). White matter-specific registration followed by whole-brain voxelwise analysis of crossing fibers provided separate partial volume fractions reflecting the integrity of primary fibers and secondary (crossing) fibers. Loss of white matter integrity in primary fibers (P < 0.05; corrected) was associated with chronic mild TBI in a widely distributed pattern of major fiber bundles and smaller peripheral tracts including the corpus callosum (genu, body, and splenium), forceps minor, forceps major, superior and posterior corona radiata, internal capsule, superior longitudinal fasciculus, and others. Distributed loss of white matter integrity correlated with duration of loss of consciousness and most notably with "feeling dazed or confused," but not diagnosis of PTSD or depressive symptoms. This widespread spatial extent of white matter damage has typically been reported in moderate to severe TBI. The diffuse loss of white matter integrity appears consistent with systemic mechanisms of damage shared by blast- and impact-related mild TBI that involves a cascade of inflammatory and neurochemical events. © 2012 Wiley Periodicals, Inc.

Employment discrimination against transgender people and self-esteem.

The evocation of gender identity in company anti-discrimination policies is still very rare. This observation is also true forscientific studies. Very few researches have focused exclusively on transgender employees. Transgender are neither sick nor lesscompetent, and yet, the feeling of being strongly discriminated is shared by many transgender people. Such discrimination and thetype of causal attribution do not remain without any effect on the well-being of the concerned individuals. According to Crocker &Quinn (1998), the attribution of the discrimination to the existing prejudices may be a way to protect one-self from the negativeimpact on self-esteem. In this theoretical scope, the "rejection-identification" model (Branscombe, Schmitt & Harvey, 1999) has beenhighly mobilized. It emphasizes the importance of ingroup identification in the causal relationship between perceived discriminationsituation and well-being. Previous studies which did test this model show that the identification to a certain group can counteract thenegative effects on well-being. Following this theoretical frame, the presented study examines the impact of different types of causalattributions on self-esteem: internal causes (e.g. lack of skills), external causes (e.g. economic crisis), and gender identity relatedissues. For that purpose, an online survey has been created and fulfilled by 110 transgender people. Different scales were used to testthe model: the Rosenberg self-esteem scale, a causal attribution scale, the perceived discrimination of the transgender population inthe workplace scale and a group identification scale. The results show that transgender people feel still highly stigmatized today andattribute, significantly, the causes of their situation to the prejudices they are victim of. Also, in accordance with the “rejectionidentification”model, three links are observed: (1) a negative link between perceived discrimination and self-esteem; (2) a positivelink between perceived discrimination and ingroup identification; and (3) a positive link between ingroup identification and selfesteem.This situation reflects a lack in diversity considerations. Nevertheless, the attribution made to group stigmatization seems toplay a protective role towards transgender people self-esteem.

The Voyage of Impressionism in Three Violin Recitals: To See the World in Different Colors

Impressionism serves as the transition between romantic and modern music. This dissertation examines the varying characteristics and colors of Impressionism in the works of late-romantic French composers, French Impressionistic composers, and composers with Impressionistic influence from countries other than France. Violin Sonata in g minor, L. 140 (1917) is the last work composed by Claude Debussy. The impressionistic characters in this work includes the ambiguous yet innovative and variant sonority and form. As a work also written in 1917, Ottorino Respighi's Violin Sonata in b minor is deeply rooted in Italian Romanticism. Some of the Impressionistic characters can be found in the second movement where the harmonies are in parallel motion. César Franck, a forerunner of impressionism, heavily influenced Debussy with the use of cyclic form. The Violin Sonata in A major (1886) is rich in harmonic language. Ernest Chausson's works mark the transition between Franck and Debussy. The Poème portrays a love story, Song of Love Triumphant by Turgenev. The work is a symphonic poem for violin and orchestra. The Mythes, Op. 30 (1915) by Karol Szymanowski is based on Greek mythology. Ravel's Sonata for Violin and Cello (1922), dedicated to Debussy, points to the future with a sophisticated harmonic language extending into atonality, spare texture, and expanded palate of impressionistic colors and techniques. Ernest Bloch's Violin Sonata No. 1 (1920) portrays the feeling of torment. Beneath the soaring cries of the violin, the harmonic sonority of Impressionism are present. Gabriel Fauré's Violin Sonata No. 1 in A major, op. 13 (1876) is the earliest work of this project. The scherzo movement became a prototype for future scherzo movements for Ravel and Debussy. Ravel's Tzigane (1924), at once a paragon of French impressionism, a delightful gypsy-style dance-fantasy, and a breathtaking virtuoso piece, is the perfect conclusion to my dissertation project. The pieces discussed above were presented in three recitals. Compact disc recordings of these recitals are available in the Michelle Smith Performing Arts Library of the Clarice Smith Performing Arts Center at the University of Maryland.

Reducing Electronic Information Overload

College students receive a wealth of information through electronic communications that they are unable to process efficiently. This information overload negatively impacts their affect, which is officially defined in the field of psychology as the experience of feeling or emotion. To address this problem, we postulated that we could create an application that organizes and presents incoming content in a manner that optimizes users’ ability to process information. First, we conducted surveys that quantitatively measured each participant’s psychological affect while handling electronic communications, which was used to tailor the features of the application to what the user’s desire. After designing and implementing the application, we again measured the user's affect using this product. Our goal was to find that the program promoted a positive change in affect. Our application, Brevitus, was able to match Gmail on affect reduction profiles, while succeeding in implementing certain user interface specifications.

The Experience of Security in Mathematics

In this paper, we report some findings from an investigation of a topic related to affect and mathematics which is not well-represented in the literature. For some mathematicians, mathematics itself is a source of security in an uncertain world, and we investigated this feeling and experience in the case of 19 adult mathematicians working in universities and schools in Greece. The focus reported here is on ways that a relationship with mathematics offers a sense of permanence and stability on the one hand, and an assurance of novelty and progress on the other.

The reporting behaviours of student nurses who have experienced verbal abuse

Background: There is evidence that student nurses are vulnerable to experiencing verbal abuse from a variety of sources and under-reporting of verbal abuse is prevalent throughout the nursing profession. The objective of the study is to explore the reporting behaviours of student nurses who have experienced verbal abuse. Method: For this study a definition of verbal abuse was adopted from current Department of Health (England) guidelines. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving an overall response rate of 73.0%. Results: Fifty one students (44.7% of responses) reported verbal abuse; all of these completed the section exploring reporting behaviours. The incidents involved patients in thirty three cases (64.7%); eight cases (15.7%) involved visitors or relatives and ten cases (19.6%) involved other healthcare workers. Thirty two students (62.7%) stated that they did report the incident of verbal abuse they experienced and nineteen (37.3%) of respondents reported that they did not. Only four incidents developed from an oral report to being formally documented. There was a statistically significant association (P = 0.003) between the focus of verbal abuse (patient/visitor or colleague) and the respondents reporting practices with respondents experiencing verbal abuse from colleagues less likely to report incidents. Most frequent feelings following experiences of verbal abuse from colleagues were feelings of embarrassment and hurt/shock. Most frequent consequences of experiencing verbal abuse from patients or relatives were feeling embarrassed and feeling sorry for the abuser. When comparing non reporters with reporters, the most frequent feelings of non reporters were embarrassment and hurt and reporters, embarrassment and feeling sorry for the abuser. When considering levels of support after the incident the mean rating score of respondents who reported the incident was 5.40 (standard deviation 2.89) and of those that did not, 4.36 (standard deviation 2.87) which was not statistically significant (p = 0.220). Conclusions: 1. Not documenting experiences of verbal abuse formally in writing is a prevalent phenomenon within the sample studied and reporting practices are inconsistent. 2. Both Higher Education Institutions and health care providers should consider emphasising formal reporting and documenting of incidents of verbal abuse during student nurse training and access to formal supportive services should be promoted. 3. Effective incident reporting processes and analysis of these reports can lead to an increased awareness of how to avoid negative interactions in the workplace and how to deal with incidents effectively.

The emotional costs of caring incurred by men and women in the British labour market

This study investigates whether men and women in caring occupations experience more negative job-related feelings at the end of the day compared to the rest of the working population. The data are from Wave Nine of the British Household Panel Survey (1999) where respondents were asked whether, at the end of the working day, they tended to keep worrying or have trouble unwinding, and the extent to which work left them feeling exhausted or “used up.” Their responses to these questions were used to develop ordinal dependent variables. Control variables in the models include: number of children, age, hours worked per week, managerial responsibilities and job satisfaction, all of which have been shown in previous research to be significantly related to “job burnout.” The results are that those in caring occupations are more likely to feel worried, tense, drained and exhausted at the end of the working day. Women in particular appear to pay a high emotional cost for working in caring occupations. Men do not emerge unscathed, but report significantly lower levels of worry and exhaustion at the end of the day than do women.

Evaluation of extended training for general practice in Northern Ireland: qualitative study.

Objective To evaluate participants' perceptions of the impact on them of an additional six months' training beyond the standard 12 month general practice vocational training scheme. Design Qualitative study using focus groups. Setting General practice vocational training in Northern Ireland. Participants 13 general practitioner registrars, six of whom participated in the additional six months' training, and four trainers involved in the additional six months' training. Main outcome measures: Participants' views about their experiences in 18 month and 12 month courses. Results Participants reported that the 12 month course was generally positive but was too pressurised and focused on examinations, and also that it had a negative impact on self care. The nature of the learning and assessment was reported to have left participants feeling averse to further continuing education and lacking in confidence. In contrast, the extended six month component was reported to have restimulated learning by focusing more on patient care and promoting self directed learning. It developed confidence, promoted teamwork, and gave experience of two practice contexts, and was reported as valuable by both ex-registrars and trainers. However, both the 12 and 18 month courses left participants feeling underprepared for practice management and self care. Conclusions 12 months' training in general practice does not provide doctors with the necessary competencies and confidence to enter independent practice. The extended period was reported to promote greater professional development, critical evaluation skills, and orientation to lifelong learning but does not fill all the gaps.