The invisible elderly : lesbian, gay, bisexual, and transgender older adults

More than 2 million older adults identify as lesbian, gay, bisexual, or transgender (LGBT). The purpose of this article is to present an overview of the physical and mental health needs of LGBT older adults to sensitize nurses to the specific needs of this group. Nurses are in a prominent position to create health care environments that will meet the needs of this invisible, and often misunderstood, group of people.

Disability, public space performance & spectatorship : Unconscious performers

Why would disabled people want to re-engage, re-enact and re-envisage the everyday encounters in public spaces and places that cast them as ugly, strange, stare-worthy? In Disability, Public Space Performance and Spectatorship: Unconscious Performers, Bree Hadley examines the performance practices of disabled artists in the US, UK, Europe and Australasia who do exactly this. Operating in a live or performance art paradigm, artists like James Cunningham (Australia), Noemi Lakmaier (UK/Austria), Alison Jones (UK), Aaron Williamson (UK), Katherine Araniello (UK), Bill Shannon (US), Back to Back Theatre (Australia), Rita Marcalo (UK), Liz Crow (UK) and Mat Fraser (UK) all use installation and public space performance practices to re-stage their disabled identities in risky, guerilla-style works that remind passersby of their own complicity in the daily social drama of disability. In doing so, they draw spectators' attention to their own role in constructing Western concepts of disability. This book investigates the way each of us can become unconscious performers in a daily social drama that positions disability people as figures of tragedy, stigma or pity, and the aesthetics, politics and ethics of performance practices that intervene very directly in this drama. It constructs a framework for understanding the way spectators are positioned in these practices, and how they contribute to public sphere debates about disability today.

Building resilience in transcultural adults (BRiTA) : developing a novel preventative intervention

There is a dearth of preventative programs that enhance the Australian culturally and linguistically diverse (CALD) adults’ resilience to cope with the acculturation process. This article introduces the reader to the BRiTA Futures for Adults and Parents, a culture and language sensitive program for the CALD. The conceptual framework and the development process are described. The manualised program consisting of one introductory and eight intervention modules is presented. A training program is also developed to train facilitators, who can deliver the program in English or other languages. Preliminary trials indicated that the program was received well by the consumers. A block mode, instead of the traditional weekly sessions, appeared to be more practical for the small population for which it was trialled. Implications and future directions are discussed.

Business continuity management in airports : securing continuity in the face of crisis

This thesis investigated both the potential for Business Continuity Management to enhance organisational reliability, and appropriate levels of Business Continuity Management capability resident in a number of Australian international and regional airports. Findings indicated that a host of regulatory and business processes including Business Continuity Management can assist in creating reliability in aviation infrastructure systems in Australia. Further, the thesis developed a multi-level maturity assessment framework for defining the depth of implementation of Business Continuity Management capabilities in airports, along with other recommendations to improve functional reliability of airport operations.

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010

BACKGROUND Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

Founder p.Arg 446* mutation in the PDHX gene explains over half of cases with congenital lactic acidosis in Roma children

Investigation of 31 of Roma patients with congenital lactic acidosis (CLA) from Bulgaria identified homozygosity for the R446* mutation in the PDHX gene as the most common cause of the disorder in this ethnic group. It accounted for around 60% of patients in the study and over 25% of all CLA cases referred to the National Genetic Laboratory in Bulgaria. The detection of a homozygous patient from Hungary and carriers among population controls from Romania and Slovakia suggests a wide spread of the mutation in the European Roma population. The clinical phenotype of the twenty R446* homozygotes was relatively homogeneous, with lactic acidosis crisis in the first days or months of life as the most common initial presentation (15/20 patients) and delayed psychomotor development and/or seizures in infancy as the leading manifestations in a smaller group (5/20 patients). The subsequent clinical picture was dominated by impaired physical growth and a very consistent pattern of static cerebral palsy-like encephalopathy with spasticity and severe to profound mental retardation seen in over 80% of cases. Most patients had a positive family history. We propose testing for the R446* mutation in PDHX as a rapid first screening in Roma infants with metabolic acidosis. It will facilitate and accelerate diagnosis in a large proportion of cases, allow early rehabilitation to alleviate the chronic clinical course, and prevent further affected births in high-risk families.

Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture

Bone mineral density (BMD) is the most widely used predictor of fracture risk. We performed the largest meta-analysis to date on lumbar spine and femoral neck BMD, including 17 genome-wide association studies and 32,961 individuals of European and east Asian ancestry. We tested the top BMD-associated markers for replication in 50,933 independent subjects and for association with risk of low-trauma fracture in 31,016 individuals with a history of fracture (cases) and 102,444 controls. We identified 56 loci (32 new) associated with BMD at genome-wide significance (P < 5 × 10−8). Several of these factors cluster within the RANK-RANKL-OPG, mesenchymal stem cell differentiation, endochondral ossification and Wnt signaling pathways. However, we also discovered loci that were localized to genes not known to have a role in bone biology. Fourteen BMD-associated loci were also associated with fracture risk (P < 5 × 10−4, Bonferroni corrected), of which six reached P < 5 × 10−8, including at 18p11.21 (FAM210A), 7q21.3 (SLC25A13), 11q13.2 (LRP5), 4q22.1 (MEPE), 2p16.2 (SPTBN1) and 10q21.1 (DKK1). These findings shed light on the genetic architecture and pathophysiological mechanisms underlying BMD variation and fracture susceptibility.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Simulated systems optimization through response surface techniques [Optimización de sistemas simulados a través de técnicas de superficie de respuesta]

The purpose of this article is to show the applicability and benefits of the techniques of design of experiments as an optimization tool for discrete simulation models. The simulated systems are computational representations of real-life systems; its characteristics include a constant evolution that follows the occurrence of discrete events along the time. In this study, a production system, designed with the business philosophy JIT (Just in Time) is used, which seeks to achieve excellence in organizations through waste reduction in all the operational aspects. The most typical tool of JIT systems is the KANBAN production control that seeks to synchronize demand with flow of materials, minimize work in process, and define production metrics. Using experimental design techniques for stochastic optimization, the impact of the operational factors on the efficiency of the KANBAN / CONWIP simulation model is analyzed. The results show the effectiveness of the integration of experimental design techniques and discrete simulation models in the calculation of the operational parameters. Furthermore, the reliability of the methodologies found was improved with a new statistical consideration.

Principles of Pitch Organization in Béla Bartók's 'Duke Bluebeard's Castle'

The topic of my doctoral thesis is to demonstrate the usefulness of incorporating tonal and modal elements into a pitch-web square analysis of Béla Bartók's (1881-1945) opera, 'A kékszakállú herceg vára' ('Duke Bluebeard's Castle'). My specific goal is to demonstrate that different musical materials, which exist as foreground melodies or long-term key progressions, are unified by the unordered pitch set {0,1,4}, which becomes prominent in different sections of Bartók's opera. In Bluebeard's Castle, the set {0,1,4} is also found as a subset of several tetrachords: {0,1,4,7}, {0,1,4,8}, and {0,3,4,7}. My claim is that {0,1,4} serves to link music materials between themes, between sections, and also between scenes. This study develops an analytical method, drawn from various theoretical perspectives, for conceiving superposed diatonic spaces within a hybrid pitch-space comprised of diatonic and chromatic features. The integrity of diatonic melodic lines is retained, which allows for a non-reductive understanding of diatonic superposition, without appealing to pitch centers or specifying complete diatonic collections. Through combining various theoretical insights of the Hungarian scholar Ernő Lendvai, and the American theorists Elliott Antokoletz, Paul Wilson and Allen Forte, as well as the composer himself, this study gives a detailed analysis of the opera's pitch material in a way that combines, complements, and expands upon the studies of those scholars. The analyzed pitch sets are represented on Aarre Joutsenvirta's note-web square, which adds a new aspect to the field of Bartók analysis. Keywords: Bartók, Duke Bluebeard's Castle (Op. 11), Ernő Lendvai, axis system, Elliott Antokoletz, intervallic cycles, intervallic cells, Allen Forte, set theory, interval classes, interval vectors, Aarre Joutsenvirta, pitch-web square, pitch-web analysis.

Visual ecology of Indian carpenter bees II: adaptations of eyes and ocelli to nocturnal and diurnal lifestyles

Most bees are diurnal, with behaviour that is largely visually mediated, but several groups have made evolutionary shifts to nocturnality, despite having apposition compound eyes unsuited to vision in dim light. We compared the anatomy and optics of the apposition eyes and the ocelli of the nocturnal carpenter bee, Xylocopa tranquebarica, with two sympatric species, the strictly diurnal X. leucothorax and the occasionally crepuscular X. tenuiscapa. The ocelli of the nocturnal X. tranquebarica are unusually large (diameter ca. 1 mm) and poorly focussed. Moreover, their apposition eyes show specific visual adaptations for vision in dim light, including large size, large facets and very wide rhabdoms, which together make these eyes 9 times more sensitive than those of X. tenuiscapa and 27 times more sensitive than those of X. leucothorax. These differences in optical sensitivity are surprisingly small considering that X. tranquebarica can fly on moonless nights when background luminance is as low as 10(-5) cd m(-2), implying that this bee must employ additional visual strategies to forage and find its way back to the nest. These strategies may include photoreceptors with longer integration times and higher contrast gains as well as higher neural summation mechanisms for increasing visual reliability in dim light.

Fernando Pessoan ortonyymi ja heteronyymit modernistis-romanttisena myyttinä

Tutkimuksessani selvitän portugalilaisrunoilija Fernando Pessoan (1888-1935) heteronyymejä ja ortonyymiä modernistis-romanttisena myyttinä. Myytin piirteet paljastuivat Pessoan omia kirjoituksia ja runoja tutkimalla ja käyttämällä apuna Pessoa-tutkimusta. Tutkimusaineistonani ovat Pessoa-ortonyymin Mensagem-runoelma ja ”Autopsykografia”-runo, Álvaro de Campoksen vuonna 1917 Portugal Futurista –lehdessä julkaistu ”Ultimatum”-runomanifesti, Alberto Caeiron ”Guardador de Rebanhos”-runosikermä sekä Ricardo Reisin ”Oodit”-kokonaisuuteen kuuluvat runot: n:ro 59 ”Acima da verdade estão os deuses” (”Totuuden yläpuolella ovat jumalat”, 1914), n:ro 66 ”Olho os campos, Neera” (”Katson peltoja, Neera”, 1917), n:ro 181 ”Amo o que vejo” (”Rakastan sitä mitä näen”, 1934), n:ro 175 ”Estas só. Ninguem o sabe.” (”Olet yksin. Kukaan ei tiedä sitä”, 1933). Tutkimuksessani romanttisen runouden keskeisinä piirteinä pidetään uskoa taiteilijaneroon (geniukseen), mimeettiseen illuusioon (taide tavoittelee ulkoisen todellisuuden toisintamista mahdollisimman autenttisena) ja tekijän ja kokijan eli subjektin ja objektin erottamiseen toisistaan. Käsitänkin modernin runon tutkimuksessani hylänneen monia entisiä käsityksiä ja vastakkainasetteluja muun muassa tekijän ja ulkopuolisen maailman, mielen ja kielen välillä. Näitä moderneja ”rikkomuksia” identifioin ja määrittelen Pessoan heteronyymien runoudessa. Tutkimukseni apukäsitteitä ovat vilpittömyys ja autenttisuus, jotka kuvaavat runoilijan suhdetta itseensä ja muihin ja joita on pohtinut mm. Lionel Trilling teoksessaan Sincerity and authencity. Romanttisessa runoudessa suhde yhteisöön muodostui ensisijaisesti suhteessa omaan itseen, yhtenäiseen minuuteen nojaavan vilpittömyyden kautta, modernissa runoudessa hajanaisuutta ja yksilön suhdetta myös yhteisöön korostavan autenttisuuden avulla. Tutkimuksessani havaitsin, että Pessoa on jo tuotantonsa alusta lähtien kehittänyt tietoisesti modernistis-romanttista myyttiä – päätelmää tukivat niin Pessoan omat kirjoitukset kuin runoanalyysini. Pessoa ennusti ensimmäisen kerran romanttiseen nerotaiteilijaan vertautuvaa ”supra-Camõesia” ”A nova poesia Portuguesa Sociologicamente considerada” –esseessään vuonna 1912. Campoksen ”Ultimatum”-manifestissa puhuja uskoi muutaman useita kymmeniä persoonallisuuksia hallitsevan ”Synteesi-Ihmisen” tai ”supra-Camõesin” ilmestymiseen. ”Synteesi-Ihmisen” oli määrä palauttaa kukoistukseensa lamaantuneessa tilassa ollut Portugalin kirjallisuus uuteen kukoistukseensa. Eräänlaisen perustan koko myytille loi vuotta ennen Pessoan kuolemaa julkaistu Mensagem (suom. Viesti), jossa runoilija esittää saudosistisen ja sebastianistisen perustan. Teixeira de Pascoaesin kehittämä saudosismi näkyy Mensagemissa uskona Portugalin valtion perustajien ja laajentajien – löytöretkeilijöiden – edustamaan voittoisaan lusofoniseen mentaliteettiin, jonka Pessoa asettaa niin kansakunnan, runoilijan kuin ihmisen ihanteeksi. Toinen Mensagemissa esiintyvä myytin rakennusaine on sebastianismi eli usko kuningas Sebastianin (1554-1578) paluuseen. ”Synteesi-Ihminen”/”supra-Camões” oli reinkarnoitunut Sebastian, jonka piti palauttaa kansa ja kulttuuri kukoistukseensa lusofonisen valloittajamentaliteetin avulla. ”Autopsykografia”-runossaan Pessoa esittää puolestaan runoilijaa koskevan modernin poetiikan ongelmineen: esittävyyteen perustuva taide etäännyttää kokijan – taiteilijan – aina väistämättä ensimmäisestä, spontaanista ja luonnollisesta kokemuksesta ja tekee hänestä teeskentelijän ja simulakrumien (Baudrillard), toisen tason merkityksen tuottajan. ”Autopsykografian” moderni poetiikka koskee myös lukijaa, joka ei tavoita runoilijan välittämää merkitystä vaan kolmannen tason merkityksen. ”Autopsykografian” runous- ja ihmiskäsitys on moderni: runoilija on ammattimainen teeskentelijä, lähtökohtaisesti vilpillinen ja epäautenttinen. Pessoa ja Campos edustavat Pessoan objektiivisia heteronyymejä ja myytin modernia puolta. Pessoan subjektiiviset heteronyymit Reis ja Caeiro täydentävät objektiviisia, modernin ihmisen ahdistusta ja levottomuutta ilmaisseita Pessoaa ja Camposta ollen luonteeltaan romanttisia vilpittömyyden kannattajia. Caeiro arvosti näköaistia yli muiden aistien. Hänen tavoitteenaan oli katsoa aina kuin ensimmäistä kertaa, spontaanisti ja välittömästi kuin lapsi. Reis puolestaan korosti harmoniaa jumalten, ihmisten ja luonnon välillä ja uskoi kohtuullisiin aistinautintoihin. Molemmat muodostivat Pessoan myytin romanttisen puolen yhteisessä halussaan hylätä sosiaaliset roolit ja opetukset ja palata kohti yksilöllistä minää. Vilpittömyys ja autenttisuus ovat Caeiron ja Reisin ohjeita runoilijalle ja ihmiselle. Objektiiviset ja subjektiiviset heteronyymit yhdessä muodostavat modernistis-romanttisen myytin, joka kokonaisuudessaan on looginen: objektiiviset heteronyymit esittivät teeskentelyn, vilpillisyyden ja moderniuden ongelmat; subjektiiviset tarjosivat ratkaisua niihin, poisopettelua sosiaalisista rooleista ja rohkeutta mennä kohti omaa yksilöllistä minuutta.

Kampen om Eros : Om kön och kärlek i Pahlensviten

The Struggle for Eros: On Love and Gender in the Pahlen Series The present dissertation examines how gender, sexuality and motherhood are constructed in the novel series Fröknarna von Pahlen (The Misses von Pahlen, I VII, 1930 1935) by the Swedish author Agnes von Krusenstjerna. The aim of the study is to analyze how the Pahlen series relates to the discourses on gender and sexuality circulating in the 1930s, and how the series opens a dialogue with the feminist thinking of the time especially with the book Lifslinjer I (Love and Marriage, 1903) by the Swedish author Ellen Key. Fröknarna von Pahlen holds a central position in the research on Agnes von Krusenstjerna partly due to the literary debate that the novel series triggered. The debate was connected to the development taking place in the Swedish society in the beginning of the 1930s, in the so-called second phase of the Modern Breakthrough. Sweden was at that time characterized by struggle over the definitions of gender, sexuality and parenthood, and this struggle is also visible in the Pahlen series. The literary debate took place in 1934 1935 and it began after an article by the modernist writer Karin Boye was published in Social-Demokraten on 28 January 1934. In her polemic article, Boye saw the Pahlen series as a sign that the family institution is on the verge of a breakdown and with it the whole moral system that has come to existence through it . Boye went on to state that Krusenstjerna only sees and describes and that she explores neither new literary forms nor new values. Boye wrote the article before the last two parts of the novel series were published, so obviously she could not discuss the utopian vision characterizing those parts. This study, however, strives to demonstrate that Krusenstjerna not only sees and describes, but that she like many of her contemporary female colleagues appears to take the request of Friedrich Nietzsche to revaluate all values seriously. Like the works of her contemporaries, Krusenstjerna s Pahlen series is marked by a double vision on the one hand a critique of the prevailing social order, and on the other hand a dream of a new world and a new human being. In this research the vision of the Pahlen series is characterized as queer in order to emphasize that the series not only criticizes the prevailing gender order and its morals, but is also open for new ways of doing gender, parenthood, and family.