Franz Matthiesen outdoors with his second wife Katherina Früh outside of Franz's Carton Hill home; London.

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Discursive Matrixes of Motherhood : Cultivating Decency and Emotion in Finnish and French Mother-talk

Discursive Matrixes of Motherhood examines women's discourse on their experiences of new motherhood in Finland and France. It sets out from two culturally prevalent turns of speech observed in different social forums: in conversations amongst mothers with tertiary education and in the print media. The pool of data includes: 30 interviews, 8 autobiographically inspired novels and 80 items from women's magazines. With instruments loaned from the toolbox of rhetorical analysis, the recurrence of certain expressions or clichés is analyzed with regard to the national, cultural, biographical, political and daily contexts and settings in which the speaking subjects are immersed. "Staying at home is such a short and special time", the first expression under scrutiny, caught the sociological eye because of its salience in Finland and because it appeared as contradictory with a core characteristic of the Finnish context:long family leave. The cliché was found to function as a discursive micromechanism which swept mothers' 'complaints' under the proverbial carpet. Proper emotions and decency in mother-talk thereby appear as collective achievements. An opposite phenomenon - that of the scaling up of rewards procured by children - was also discerned in the data. Indeed, the French expression "Profiter de mon enfant" ["making the most of my child"/"enjoying my child"] is interpreted as a crystallization of a hedonist ethos of motherhood in everyday language. Secondly, the recurrence of this utterance is analyzed in the light of a requisite located in child-rearing expert literature: that of pleasure that women should take in mothering. Hence, one of the rules found to structure the discursive matrixes of motherhood is the laudability and audibility of enjoyment and conversely the discretion and discouragement of 'complaints'. The cultivation of decent matches between certain categories of emotions and certain categories of individuals also appears as a characteristic of discursive matrixes. One of the methodological findings relates to the fact that such matches may be constituted as sociological objects through the identification of recurrent discursive crystallizations in a given culture. Ideal matches may crystallize in turns of speech and mismatches can be managed through clichés. Becoming a mother entails an immersion in such a particular economy of speech. Key words: mothers, motherhood, transition to parenthood, family, emotions, morality, bonds, rhetorical analysis, discourse analysis, media analysis, France, Finland, comparative sociology

Aaishah’s choice: Choosing home education in the Muslim community

In Australia, the decision to home educate is becoming increasingly popular (cf. Townsend, 2012). In spite of its increasing popularity, the reasons home education is chosen by Australian families is under-researched (cf. Jackson & Allan, 2010). In addition, the decision to home educate among minority groups, such as Australian Muslim families, is absent from the literature. This paper reports on an interview with one Muslim mother who chose to home educate her children. An in-depth, qualitative interview was conducted with Aaishah (pseudonym), a mother who lived in one of Australia’s most populated cities. Data were analysed using the Discourse Historical Approach to Critical Discourse Analysis. The analysis revealed that there were similarities between the discourses of Christian parents described in the literature, in terms of the reasons Aaishah had given for her decision to home educate. In particular, analysis reveals Aaishah’s fears about schools, their negative experiences on her children and her hopes for her children’s futures.

Moving to stay in place: behavioral mechanisms for coexistence of African large carnivores

Most ecosystems have multiple predator species that not only compete for shared prey, but also pose direct threats to each other. These intraguild interactions are key drivers of carnivore community structure, with ecosystem-wide cascading effects. Yet, behavioral mechanisms for coexistence of multiple carnivore species remain poorly understood. The challenges of studying large, free-ranging carnivores have resulted in mainly coarse-scale examination of behavioral strategies without information about all interacting competitors. We overcame some of these challenges by examining the concurrent fine-scale movement decisions of almost all individuals of four large mammalian carnivore species in a closed terrestrial system. We found that the intensity of intraguild interactions did not follow a simple hierarchical allometric pattern, because spatial and behavioral tactics of subordinate species changed with threat and resource levels across seasons. Lions (Panthera leo) were generally unrestricted and anchored themselves in areas rich in not only their principal prey, but also, during periods of resource limitation (dry season), rich in the main prey for other carnivores. Because of this, the greatest cost (potential intraguild predation) for subordinate carnivores was spatially coupled with the highest potential benefit of resource acquisition (prey-rich areas), especially in the dry season. Leopard (P. pardus) and cheetah (Acinonyx jubatus) overlapped with the home range of lions but minimized their risk using fine-scaled avoidance behaviors and restricted resource acquisition tactics. The cost of intraguild competition was most apparent for cheetahs, especially during the wet season, as areas with energetically rewarding large prey (wildebeest) were avoided when they overlapped highly with the activity areas of lions. Contrary to expectation, the smallest species (African wild dog, Lycaon pictus) did not avoid only lions, but also used multiple tactics to minimize encountering all other competitors. Intraguild competition thus forced wild dogs into areas with the lowest resource availability year round. Coexistence of multiple carnivore species has typically been explained by dietary niche separation, but our multi-scaled movement results suggest that differences in resource acquisition may instead be a consequence of avoiding intraguild competition. We generate a more realistic representation of hierarchical behavioral interactions that may ultimately drive spatially explicit trophic structures of multi-predator communities.

Home, family and society: women of the Irish landed class, 1860-1914. A Munster case study

The thesis analyses the roles and experiences of female members of the Irish landed class (wives, sisters and daughters of gentry and aristocratic landlords with estates over 1,000 acres) using primary personal material generated by twelve sample families over an important period of decline for the class, and growing rights for women. Notably, it analyses the experiences of relatively unknown married and unmarried women, something previously untried in Irish historiography. It demonstrates that women’s roles were more significant than has been assumed in the existing literature, and leads to a more rounded understanding of the entire class. Four chapters focus on themes which emerge from the sources used and which deal with their roles both inside and outside the home. These chapters argue that: Married and unmarried women were more closely bound to the priorities of their class than their sex, and prioritised male-centred values of family and estate. Male and female duties on the property overlapped, as marriage relationships were more equal than the legislation of the time would suggest. London was the cultural centre for this class. Due to close familial links with Britain (60% of sample daughters married English men) their self-perception was British or English, as well as Irish. With the self-confidence of their class, these women enjoyed cultural and political activities and movements outside the home (sport, travel, fashion, art, writing, philanthropy, (anti-)suffrage, and politics). Far from being pawns in arranged marriages, women were deeply conscious of their marriage decisions and chose socially, financially and personally compatible husbands; they also looked for sexual satisfaction. Childbirth sometimes caused lasting health problems, but pregnancy did not confine wealthy women to an invalid state. In opposition to the stereotypical distant aristocratic mother, these women breastfed their children, and were involved mothers. However, motherhood was not permitted to impinge on the more pressing role of wife

Study protocol: home-based telehealth stroke care: a randomized trial for veterans.

BACKGROUND: Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. METHODS: We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. DISCUSSION: For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00384748.

Natal emigration by both sexes in the La Pacifica population of mantled howlers: when do some stay?

We have reported previously that all male and female mantled howlers emigrate from natal groups at Hacienda La Pacifica, Costa Rica. In the years since that report, a small number of juveniles have stayed in the natal group without experiencing a solitary phase. Here, we present a post hoc analysis on juvenile emigration in six groups of howlers under observation for varying amounts of time between 1972 and 2005. Our records revealed 139 juveniles for whom emigration status was certain, and 125 of these did emigrate. There was a significant association between presence of mother and emigration: juveniles without mothers were more likely to remain in their natal group (chi(1)(2) = 53.1, P<.0001). The mean age of emigration for all juveniles (n = 125) was 2.47 years (SD = 0.9, range = 1.5-6.5). There was no difference in age of emigration by adult male composition (one-male, multi-male, both), but juveniles of unknown sex emigrated younger than either known males or females (F(2,116) = 4.4, P<.02). For emigrating juveniles of known sex (n = 99), both males and females without mothers left at a later age than those with mothers (F(1,95) = 6.5, P<.02). Although philopatry or delayed emigration occurs in a few motherless animals, most males and females do emigrate from their natal groups at ages consistent with those reported for other species of howlers.

Preoperative predictors of extended hospital length of stay following total knee arthroplasty.

The purpose of this study was to identify the preoperative predictors of hospital length of stay after primary total knee arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A single-center, multi-surgeon retrospective chart review of two hundred and sixty consecutive patients who underwent primary total knee arthroplasty was performed. The mean length of stay was 3.0 days. Among the different variables studied, increasing comorbidities, lack of adequate assistance at home, and bilateral surgery were the only multivariable significant predictors of longer length of stay. The study was adequately powered for statistical analyses and the concordance index of the multivariable logistic regression model was 0.815.

A Home from Hospital service for older people.

Current policy and practice emphasises much more than ever before a need for purchasers and providers to reduce appropriately the length of hospital stay. Consequently, a number of early discharge “schemes” have been developed. This paper presents the findings from an evaluation of a “home from hospital” (HFH) scheme. The HFH service provides a maximum of six weeks intensive domiciliary care for older people on their discharge from hospital. The aim of the service is to facilitate early discharge from hospital and to assist patients to regain independence. The study reported here elicited the views and perceptions of clients and professionals involved in the HFH scheme about the quality, efficiency and effectiveness of the service. Seventy-five clients were discharged from hospital to the HFH scheme during a two month period and those who consented to participate in the study were interviewed after discharge from the HFH service (n = 40). Participants had attended hospital for various conditions but the largest group were fracture patients. Hospital staff and community based professionals completed a questionnaire about the service. Overall, clients and professionals perceived the HFH scheme as a beneficial service, though some minor problems existed at an individual level. Clients’ dependency levels generally decreased during their time on the scheme. Research using a controlled design is necessary in order to draw firm conclusions about the cost-effectiveness of a HFH service. Overall, home-from-hospital appears to be an effective model of an early discharge scheme worthy of further attention.

Addressing Bed Costs for the Elderly: A New Methodology for Modelling Patient Outcomes and Length of Stay

The proportion of elderly in the population has dramatically increased and will continue to do so for at least the next 50 years. Medical resources throughout the world are feeling the added strain of the increasing proportion of elderly in the population. The effective care of elderly patients in hospitals may be enhanced by accurately modelling the length of stay of the patients in hospital and the associated costs involved. This paper examines previously developed models for patient length of stay in hospital and describes the recently developed conditional phase-type distribution (C-Ph) to model patient duration of stay in relation to explanatory patient variables. The Clinics data set was used to demonstrate the C-Ph methodology. The resulting model highlighted a strong relationship between Barthel grade, patient outcome and length of stay showing various groups of patient behaviour. The patients who stay in hospital for a very long time are usually those that consume the largest amount of hospital resources. These have been identified as the patients whose resulting outcome is transfer. Overall, the majority of transfer patients spend a considerably longer period of time in hospital compared to patients who die or are discharged home. The C-Ph model has the potential for considering costs where different costs are attached to the various phases or subgroups of patients and the anticipated cost of care estimated in advance. It is hoped that such a method will lead to the successful identification of the most cost effective case-mix management of the hospital ward.

Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia:A randomized controlled trial

Context: Nursing home residents with pneumonia are frequently hospitalized. Such transfers may be associated with multiple hazards of hospitalization as well as economic costs. Objective: To assess whether using a clinical pathway for on-site treatment of pneumonia and other lower respiratory tract infections in nursing homes could reduce hospital admissions, related complications, and costs. Design, Setting, and Participants: A cluster randomized controlled trial of 680 residents aged 65 years or older in 22 nursing homes in Hamilton, Ontario, Canada. Nursing homes began enrollment between January 2, 2001, and April 18, 2002, with the last resident follow-up occurring July 4, 2005. Residents were eligible if they met a standardized definition of lower respiratory tract infection. Interventions: Treatment in nursing homes according to a clinical pathway, which included use of oral antimicrobials, portable chest radiographs, oxygen saturation monitoring, rehydration, and close monitoring by a research nurse, or usual care. Main Outcome Measures: Hospital admissions, length of hospital stay, mortality, health-related quality of life, functional status, and cost. Results: Thirty-four (10%) of 327 residents in the clinical pathway group were hospitalized compared with 76 (22%) of 353 residents in the usual care group. Adjusting for clustering of residents in nursing homes, the weighted mean reduction in hospitalizations was 12% (95% confidence interval [CI], 5%-18%; P=.001). The mean number of hospital days per resident was 0.79 in the clinical pathway group vs 1.74 in the usual care group, with a weighted mean difference of 0.95 days per resident (95% CI, 0.34-1.55 days; P=.004). The mortality rate was 8% (24 deaths) in the clinical pathway group vs 9% (32 deaths) in the usual care group, with a weighted mean difference of 2.9% (95% CI, -2.0% to 7.9%; P=.23). There were no significant differences between the groups in health-related quality of life or functional status. The clinical pathway resulted in an overall cost savings of US $1016 per resident (95% CI, $207-$1824) treated. Conclusion: Treating residents of nursing homes with pneumonia and other lower respiratory tract infections with a clinical pathway can result in comparable clinical outcomes, while reducing hospitalizations and health care costs. ©2006 American Medical Association. All rights reserved.

Should I stay or should I go? Sibling effects in household formation

This paper analyzes peer effects among siblings in the decision to leave parental home. Estimating peer effects is challenging because of problems of refection, endogenous group formation, and correlated unobservables. We overcome these issues using the exogenous variation in siblings' household formation implied by the eligibility rules for a Spanish rental subsidy. Our results show that sibling effects are negative and that these effects can be explained by the presence of old or ill parents. Sibling effects turn positive from older to younger close-in-age siblings, when imitation is more likely to prevail. Our findings indicate that policy makers who aim at fostering household formation should target the household rather than the individual and combine policies for young adults with policies for the elderly.

Nursing Home-Acquired Pneumonia Presenting at the Emergency Department

Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old (IQR 77-90). Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age ≥ 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillin-resistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

Some Incidents and Circumstances

- The first part of the document traces Mr. Haile’s lineage. His father, James Haile was a farmer. His grandfather, Amos Haile was a sailor for the early part of his life. He was placed on a British man-of- war in about 1758. He escaped and settled in Putney. (p.1) - His father’s mother’s maiden name was Parker. His mother’s maiden name was Campbell. Her father was a captain in the Revolutionary Army. (p.2) - His earliest memories revolve around the death of his aunt and the funeral of General Washington (although he did not witness this). At the time, his father was a Lieutenant in a regiment militia of Light Dragoons who wore red coats. (p.3) - In 1804, an addition was added to the Haile house which necessitated that William was to stay home to help with the building. He continued to study and read on his own. He was particularly interested in Napoleon Bonaparte’s victories. In that same year he was sent to Fairfield Academy where Reverend Caleb Alexander was the principal. (p.4) - On June 1, 1812, William was appointed as an Ensign in the Infantry of the Army of the United States. He was put into the recruiting service at Nassau (20 miles east of Albany) where he remained until September. (p.4) - He was assigned to the 11th Regiment of the W.S. Infantry and directed to proceed to Plattsburgh to report to Colonel Isaac Clark. (p.7) - He was assigned to the company commanded by Captain Samuel H. Halley who was not in the best of health and often absent. For a good part of the time William was in charge of the company. (p.8) - The 11th Regiment was encamped beside the 15th Regiment commanded by Col. Zebulon Montgomery Pike [Pike’s Peak was named after him]. Col. Pike generously drilled and disciplined the 11th Regiment since their officers didn’t seem capable of doing so. (p.8) - The first brigade to which William’s regiment was attached to was commanded by Brigadier General Bloomfield of New Jersey. Brigadier Chandler of Maine commanded the second brigade. (p.9) - At the beginning of November, Major General Dearborn took command of the army. He had been a good officer in his time, but William refers to him as “old and inefficient” earning him the nickname “Granny Dearborn” (p.9) - On November 17th, 1812, General Dearborn moved north with his army. The troops ended up in Champlain. There was no fighting, only a skirmish between a party of men under Colonel Pike and a few British troops who he succeeded in capturing. (p.10) - The troops were moved to barracks for the winter. Colonel Pike’s troops were put into suitable barracks and kept healthy but another part of the army (including the 11th Regiment) were sent to a barracks of green lumber north of Burlington. Disease soon broke out in the damp barracks and the hundreds of deaths soon followed. One morning, William counted 22 bodies who had died the previous night. He puts a lot of this down to an inexperienced commanding officer, General Chandler. (p.11) - At the beginning of 1813, William was stationed as a recruiter on the shore of Shoreham across from Fort Ticonderoga. In February, he returned to Burlington with his recruits. In March he received an order from General Chandler to proceed to Whitehall and take charge of the stores and provisions. In April and May it was decided that his half of the regiment (the First Battalion) should march to Sackett’s Harbour, Lake Ontario. They arrived at Sackett’s Harbour about the 10th of June, a few days after the Battle of Sackett’s Harbour. (p.12) - He was camped near the site of Fort Oswego and got word to head back to Sackett’s Harbour. A storm overtook the schooner that he was on. (p.14) - William was involved in the Battle of Williamsburg (or Chrysler’s Farm) which he calls a “stupid and bungling affair on the part of our generals”.(p. 18) - General Covington was wounded and died a few days after the battle. (p.19) - William speaks of being ill. The troops were ordered to march to Buffalo, but he is able to go to his father’s house in Fairfield where his mother nursed him back to health (p.23) - Upon arrival at Buffalo, the “old fogy Generals” were replaced with younger, more efficient men. (p.25) - On page 27 he sums up a few facts: In 1812, the army was assembled on Lake Champlain with the intention of capturing Montreal, and then Quebec. That year, under General Dearborn the army marched as far as Champlain, then turned back and went into winter quarters. In 1813, the army was assembled at Sackett’s Harbour and that year the campaign ended at French Mills which was 70 or 80 miles from Montreal. In 1814, the army at Buffalo were some 400 miles from Montreal with still the same object in view. - He says that these facts make “a riddle – difficult to explain”. (p.27) - On the evening of July 2nd they embarked on the boats with the objective of capturing Fort Erie. The enemy were all made prisoners of war (p.27) - On July 4th they went to Street’s Creek, 2 miles above the Chippewa [Chippawa] River (p.28) - Page 29 is titled The Battle of Chippewa [Chippawa] - He speaks of 2 drummers who were fighting over the possession of a drum when a cannonball came along and took of both of their heads (p.29) - He proclaims that this was one of the “most brilliant battles of the war”. The battle was fought and won in less than an hour after they left their tents. He credits General Scott with this success and states that was due to his rapid orders and movements. (p.30) - The dead of the battle remained on the field during the night. He describes this as quite gloomy seeing friend and foe lying side by side. At daybreak they set to work digging trenches to bury the dead. (p.31) - Colonel Campbell was wounded and advised to have his leg amputated. He refused, and subsequently died. (p.32) - It is said that the British threw several of their dead into the river and they went over the Falls. (p.32) - His troops repaired the bridge over Chippawa which the enemy had partially destroyed and then pursued the British as far as Queenston Heights. (p.32) - On pages 33 and 34 he speaks about meeting an old friend of his, Philip Harter. - The account ends at Queenston Heights

Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.