BackgroundDementia care is essential to promote the well-being of patients but remains a difficult task prone to ethical issues. These issues include questions like whether manipulating a person with dementia is ethically permissible if it promotes her best interest or how to engage with a person who is unwilling to recognize that she has dementia. To help people living with dementia and their carers manage ethical issues in dementia care, we developed the CARE intervention. This is an intervention focused on (...) promoting the ethical self-efficacy of people living with dementia and carers, i.e., their confidence that they can manage ethical issues when they occur. The purpose of this paper is to explain and discuss how we have developed the CARE intervention to promote the ethical self-efficacy of people living with dementia, their family, and professional carers through a specific and, we believe, new use of literary texts.MethodsThe CARE intervention has been developed in two phases: First, we conducted a needs assessment of the occurrence of ethical issues in dementia care and the need for an intervention to support people living with dementia and their carers in managing such issues. Second, in a design phase, we developed the CARE intervention to meet identified needs.ResultsTo address identified ethical issues in dementia care we designed the CARE intervention as a workshop format where people living with dementia and carers can meet, discuss literary texts, and deliberate on how to solve such issues. The workshop is structured by the following elements: An agenda of ethical issues, a collection of literary cases exemplifying ethical issues, a moderator with an understanding of dementia care, and an overview of the ethical principles relevant to the discussion of ethical issues. >This workshop concept is operationalized in three applications tailored to meet the specific ethical issues of each of the study´s three target groups: people living with dementia and family carers, professional and family carers, and professional carers.ConclusionWe conclude the paper by stating that it is possible to develop an intervention that promotes the ethical self-efficacy of people living with dementia and family and professional carers. (shrink)

For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) (...) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

IntroductionA symptom cluster is very common among oncological patients: cancer-related fatigue, emotional distress, sleep difficulties, pain, and cognitive difficulties. Clinical applications of interventions based on non-ordinary states of consciousness, mostly hypnosis and meditation, are starting to be investigated in oncology settings. They revealed encouraging results in terms of improvements of these symptoms. However, these studies often focused on breast cancer patients, with methodological limitations. Another non-ordinary state of consciousness may also have therapeutic applications in oncology: self-induced cognitive trance. It seems (...) to differ from hypnosis and meditation, as it involves the body more directly. Thus, investigating its clinical applications, along with hypnosis and meditation interventions, could improve available therapeutic options in oncology. This article details the study protocol of a preference-based longitudinal controlled superiority trial aiming to assess the effectiveness of 3 group interventions to improve oncological patients’ quality of life, and more specifically CRF, emotional distress, sleep, pain, and cognitive difficulties.Methods and analysisA power analysis required a total sample of 160 patients. Main inclusion criteria are: cancer diagnosis, active treatments completed for less than a year, no practice of hypnosis, meditation, or SICT, and presence of at least one of these four symptoms: fatigue, sleep difficulties, depression, or anxiety. Each participant will choose the intervention in which they want to participate. To test the effectiveness of the interventions, data will be collected by questionnaires and neurobiological measures and directly from the medical record at four time points: before inclusion in the study ; immediately after the intervention; and at 3- and 12-month follow-up. The longitudinal data in each group will then be measured.DiscussionIn addition to standard cancer therapies, there is a growing interest from patients in complementary approaches, such as hypnosis, meditation, and SICT. The results of this study will be useful to increase knowledge about short- and long-term effectiveness of 3 group interventions for CRF, emotional distress, sleep, pain, and cognitive difficulties in patients with different cancers.Clinical Trial RegistrationClinicalTrials.gov/. Retrospectively registered on the 29th of April 2021. url: https://clinicaltrials.gov/ct2/show/NCT04873661. (shrink)

Easeful Death sets out straightforwardly the arguments for and against the legalization of assisted suicide and euthanasia. Exploring the philosophical and legal debates as well as the medical practicalities of this sensitive issue, the authors ultimately conclude that the law should embrace a more compassionate approach to assisted dying.

C’est à partir de deux exemples concrets, celui des employés de banque et des chauffeurs de taxi collectif à Beyrouth que nous nous proposons d’interroger l’« absence » de la question du temps de travail dans les revendications sociales au Liban. Une absence qui serait l’indice de la prégnance d’un autre rapport au temps : on serait en présence de régimes de temporalités hétérogènes les uns aux autres, à la mesure de la fragmentation de la société entre des mondes sociaux (...) où le travail est soumis à des contraintes radicalement opposées. (shrink)

C’est à partir de deux exemples concrets, celui des employés de banque et des chauffeurs de taxi collectif à Beyrouth que nous nous proposons d’interroger l’« absence » de la question du temps de travail dans les revendications sociales au Liban. Une absence qui serait l’indice de la prégnance d’un autre rapport au temps : on serait en présence de régimes de temporalités hétérogènes les uns aux autres, à la mesure de la fragmentation de la société entre des mondes sociaux (...) où le travail est soumis à des contraintes radicalement opposées. (shrink)

Packed with ideas designed to help children learn to sing, this booklet offers criteria for selecting songs, strategies to bring out the best in children's voices, and suggestions for games, ideas, and resources.

To explore literary silence is to explore the relationships between literary texts and the silence of the ineffable. Philosophical and critical accounts tend to operate with a dualistic understanding of silence as the negative other of text. This study, however, seeks to place silence within the literary text. Central to this theoretical endeavour are thinkers like Blanchot, Derrida, Gadamer and Vattimo, and the result is a fundamental challenge to our ideas of silence and text. The study continues to draw on (...) the ideas of Kierkegaard and Bataille to develop an effective methodology for reading such literary silences. (shrink)

Recent studies have shown that schizophrenia may be a disease affecting the states of consciousness. The present study is aimed at investigating metamemory, i.e., the knowledge about one's own memory capabilities, in patients with schizophrenia. The accuracy of the Confidence level (CL) in the correctness of the answers provided during a recall phase, and the predictability of the Feeling of Knowing (FOK) when recall fails were measured using a task consisting of general information questions and assessing semantic memory. Nineteen outpatients (...) were paired with 19 control subjects with respect to age, sex, and education. Results showed that patients with schizophrenia exhibited an impaired semantic memory. CL ratings as well as CL and FOK accuracy were not significantly different in the schizophrenic and the control groups. However, FOK ratings were significantly reduced for the patient group, and discordant FOK judgments were also observed more frequently. Such results suggest that FOK judgments are impaired in patients with schizophrenia, which confirms that schizophrenia is an illness characterized by an impaired conscious awareness of one's own knowledge. (shrink)

To explore literary silence is to explore the relationships between literary texts and the silence of the ineffable. It is to enquire what dynamics texts develop as they strive to 'say the unsayable', and it is to think literature as a silence that speaks itself. This study describes these literary and silent dynamics through readings of Pascal's Pensées, Rousseau's Rêveries, and Beckett's trilogy Molloy, Malone meurt, and L'Innommable. It contributes to our understanding of three major writers and challenges our idea (...) of what silence is. The subject of silence and of the ineffable has a long philosophical and critical tradition. A careful study of this tradition reveals the dominance of a limiting dualistic understanding of silence and its relationship to noise or language: silence becomes the negative other, the beyond, about which there remains nothing to say. The study of literary silence seeks rather to trace a language that becomes its own silence. It compromises the attempt to think a silence that moves within and through texts, that is inherent to the literary expression. Central to this theoretical endeavour are thinkers like Derrida, Deleuze, Gadamer, and Vattimo. The theoretical understanding of silence permits an effective methodology for reading literary silence. Notions of repetition, the aporia and the implosion, which are developed in reference to Kierkegaard and Bataille, describe textual strategies of literary silence and structure the readings. Finally, the reading of literary silence has its point of reference in writers like Mallarmé, Blanchot, and Beckett. It is their texts that have taught us to become topological readers, to move in and out of texts' movements; they have shown us how the literary expression is irreducible to linear, meaning oriented language. As readers of such texts we have been prepared to read the dynamics of the unsayable, and finally to start discerning the silences of the literary. (shrink)

To explore literary silence is to explore the relationships between literary texts and the silence of the ineffable. It is to enquire what dynamics texts develop as they strive to 'say the unsayable', and it is to think literature as a silence that speaks itself. This study describes these literary and silent dynamics through readings of Pascal's Pensées, Rousseau's Rêveries, and Beckett's trilogy Molloy, Malone meurt, and L'Innommable. It contributes to our understanding of three major writers and challenges our idea (...) of what silence is. The subject of silence and of the ineffable has a long philosophical and critical tradition. A careful study of this tradition reveals the dominance of a limiting dualistic understanding of silence and its relationship to noise or language: silence becomes the negative other, the beyond, about which there remains nothing to say. The study of literary silence seeks rather to trace a language that becomes its own silence. It compromises the attempt to think a silence that moves within and through texts, that is inherent to the literary expression. Central to this theoretical endeavour are thinkers like Derrida, Deleuze, Gadamer, and Vattimo. The theoretical understanding of silence permits an effective methodology for reading literary silence. Notions of repetition, the aporia and the implosion, which are developed in reference to Kierkegaard and Bataille, describe textual strategies of literary silence and structure the readings. Finally, the reading of literary silence has its point of reference in writers like Mallarmé, Blanchot, and Beckett. It is their texts that have taught us to become topological readers, to move in and out of texts' movements; they have shown us how the literary expression is irreducible to linear, meaning oriented language. As readers of such texts we have been prepared to read the dynamics of the unsayable, and finally to start discerning the silences of the literary. (shrink)

Sustainable development (SD) has contested meanings, and perspectives vary within and across societies. Emphases can range dramatically from recycling advocacy to eradication of poverty. Assumptions and approaches to sustainable development inherently contain many ethical considerations, yet U.S. students often have a limited understanding of ethical considerations in non-Western and global contexts. This paper describes an academic program on sustainable development we ran to Morocco and Spain. We describe the program’s pedagogy and assess learning related to ethics. The largest impact on (...) students’ awareness of ethics resulted from their observations and experiences with socioeconomic inequities and unequal access to infrastructure. However, without explicitly teaching ethical frameworks to sustainability students, they tend to equate sustainability with morality, imputing their own normative presuppositions of right versus wrong onto the concept of sustainable development. Therefore, we conclude with a discussion on how ethics could be more systematically integrated into education for sustainable development abroad. (shrink)

Sustainable development (SD) has contested meanings, and perspectives vary within and across societies. Emphases can range dramatically from recycling advocacy to eradication of poverty. Assumptions and approaches to sustainable development inherently contain many ethical considerations, yet U.S. students often have a limited understanding of ethical considerations in non-Western and global contexts. This paper describes an academic program on sustainable development we ran to Morocco and Spain. We describe the program’s pedagogy and assess learning related to ethics. The largest impact on (...) students’ awareness of ethics resulted from their observations and experiences with socioeconomic inequities and unequal access to infrastructure. However, without explicitly teaching ethical frameworks to sustainability students, they tend to equate sustainability with morality, imputing their own normative presuppositions of right versus wrong onto the concept of sustainable development. Therefore, we conclude with a discussion on how ethics could be more systematically integrated into education for sustainable development abroad. (shrink)

Collaboration for nursing is a core competence and therefore educational interventions are essentials for collaborative skills. To identify such interventions, we carried out a study to understand nursing students' collaborative process. A narrative inquiry method was used to explore the collaborative process of first‐year undergraduate nursing students. The analysis was conducted on field notes from 70 h of observation of 87 nursing students' collaboration during skills lab activities. It also included transcriptions of four focus group discussions with 11 students. The (...) results are presented as a sequential process of (1) navigating in unfamiliar territory, (2) navigating together to cope, and (3) navigating together towards independency and the future nursing profession. We identified a transition from teacher‐led assistance and guidance to student interdependency and reciprocal learning, ending with student‐led assistance supporting independency. In line with Vygotsky's theory of zone of proximal development, different scaffolding interventions are needed depending on where the students are in the collaborative process. (shrink)

Subjective reports and theories about memory may have an influence on other beliefs and behaviours. Patients with schizophrenia suffer a wide range of deficits affecting their awareness of daily life, including memory. With the Metamemory Inventory in Adulthood we ascertained patients’ memory knowledge and thoughts about their own cognitive capacities and about several aspects of cognitive functioning: personal capacities, knowledge of processes, use of strategies, perceived change with ageing, anxiety, motivation and mastery. The participants’ ratings were correlated with their intellectual, (...) cognitive and psychiatric data. Patients felt they had a lower capacity and marginally lower mastery over their memory than comparison subjects. They reported less recourse to strategies, and higher levels of memory-related anxiety. However, their knowledge of basic memory processes, motivation to succeed, and perception of ageing effects were similar. So patients with schizophrenia do not suffer a general and non specific impairment of their metacognitive knowledge. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wonder, Imagination, and the Matter of Theatre in The TempestMary MooreAriel occurs. Recounting his performance of "the tempest" in Act I, scene 1 of The Tempest, he presents himself as being and action, fracturing grammar, spatial and temporal logic in ways that amaze and confound:I boarded the King's ship; now on the beak, Now in the waist, the deck, in every cabin, I flamed amazement. Sometime I'd divide, And (...) burn in many places; on the topmast, The yards, and bowsprit would I flame distinctly, Then meet and join...(1.2.195–201) 1"I flamed" means that Ariel emits or is flames, which in the normal order of things would consume him. His very narration, however, proves his survival, evoking wonder through the utterance itself. Forceful and compacted syntax, a recognized source of wonder in Classical and Renaissance accounts of style (Biester, pp. 14; 35–40), magnifies this effect. 2 Shakespeare's transitive use of the usually intransitive verb flame reflects a not uncommon practice, as E. A. Abbott shows; 3 but this syntactic device also reflects The Tempest's own logic. Ariel crosses boundaries between [End Page 496] deed and being, verb and noun, subject and object, matter and spirit: he both is and does flames. What could be more jarring to syntax and semantics than a singular subject whose utterance claims that he can flame, divide, meet and join? Just as "a" fire consists of many flames yet functions grammatically as a singular substance in English, just as the Christian Trinity is both singular and multiple, Ariel burns in many places at once. Meanwhile, this extraordinary language seems belied by the actor's very embodiment. Ariel cannot have done what he claims; yet the prior scene has represented the very storm in which Ariel flamed. In that sense, the actor's embodiment represents what we imagine to be matter's intractability, while Ariel's claims, coupled with the storm we have just witnessed, reveal matter's fluidity and permeability to imagination. Fluidity and intractability co-exist, another source of wonder. Sound mimics these paradoxes: the assonance and consonance in flame and amazement create a near rhyme that echoes the near identity of fire and human amazement. If, as Gurr and Ichikawa observe, a Renaissance audience expected to hear more than see a play, this echo calls attention to Ariel's marvelous powers. 4 Lest the noises and pleasures of the Renaissance theatre, which recent scholarship deems to be considerable, distract audience members from this bit of language, similar moments reinforce Ariel's play in and with language and matter throughout the play. Marvelous poetic language is of a piece with a "fever" that is of "the mind," with music that "creeps," actors who vanish, new found goddesses who speak the discoverers' own language.Amazement provides our cue: it and its cognates name the appropriate response to Ariel, his language, and to The Tempest itself. Attention to Ariel's poetic language reveals that it, like the plot, conforms to the marvels of the play and to the period's well documented love for marvels in several ways. Wonder, an aesthetic "'object of desire'" in itself, and a response to the inexplicable in classical and early modern views, may be evoked by the unexpected in style (and through other strategies that the era's handbooks taught). 5 The clause "I flamed amazement" epitomizes the unexpected in syntax as well as differing from one of the few sources found for The Tempest, William Strachey's 1610 letter, which describes just such a storm. 6 While St. Elmo's fire itself may elicit wonder, Shakespeare's syntax and diction reinforce that marvel. And no wonder: rhetoric and theatre alike depend upon audience attention, and wonders naturally evoke it. Jarring language also harmonizes with The Tempest's structural marvels—loose ends, disrupted actions, unforeseen futures—issues several critics explore. 7 [End Page 497]The wonders of The Tempest, however, also involve imagination—in early modern psychology, the human faculty that permits perception of the world and invention of images. 8 Wonder responds to how the perceived differs from the expected, how the imagined supplants the usual, how an... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wonder, Imagination, and the Matter of Theatre in The TempestMary MooreAriel occurs. Recounting his performance of "the tempest" in Act I, scene 1 of The Tempest, he presents himself as being and action, fracturing grammar, spatial and temporal logic in ways that amaze and confound:I boarded the King's ship; now on the beak, Now in the waist, the deck, in every cabin, I flamed amazement. Sometime I'd divide, And (...) burn in many places; on the topmast, The yards, and bowsprit would I flame distinctly, Then meet and join...(1.2.195–201) 1"I flamed" means that Ariel emits or is flames, which in the normal order of things would consume him. His very narration, however, proves his survival, evoking wonder through the utterance itself. Forceful and compacted syntax, a recognized source of wonder in Classical and Renaissance accounts of style (Biester, pp. 14; 35–40), magnifies this effect. 2 Shakespeare's transitive use of the usually intransitive verb flame reflects a not uncommon practice, as E. A. Abbott shows; 3 but this syntactic device also reflects The Tempest's own logic. Ariel crosses boundaries between [End Page 496] deed and being, verb and noun, subject and object, matter and spirit: he both is and does flames. What could be more jarring to syntax and semantics than a singular subject whose utterance claims that he can flame, divide, meet and join? Just as "a" fire consists of many flames yet functions grammatically as a singular substance in English, just as the Christian Trinity is both singular and multiple, Ariel burns in many places at once. Meanwhile, this extraordinary language seems belied by the actor's very embodiment. Ariel cannot have done what he claims; yet the prior scene has represented the very storm in which Ariel flamed. In that sense, the actor's embodiment represents what we imagine to be matter's intractability, while Ariel's claims, coupled with the storm we have just witnessed, reveal matter's fluidity and permeability to imagination. Fluidity and intractability co-exist, another source of wonder. Sound mimics these paradoxes: the assonance and consonance in flame and amazement create a near rhyme that echoes the near identity of fire and human amazement. If, as Gurr and Ichikawa observe, a Renaissance audience expected to hear more than see a play, this echo calls attention to Ariel's marvelous powers. 4 Lest the noises and pleasures of the Renaissance theatre, which recent scholarship deems to be considerable, distract audience members from this bit of language, similar moments reinforce Ariel's play in and with language and matter throughout the play. Marvelous poetic language is of a piece with a "fever" that is of "the mind," with music that "creeps," actors who vanish, new found goddesses who speak the discoverers' own language.Amazement provides our cue: it and its cognates name the appropriate response to Ariel, his language, and to The Tempest itself. Attention to Ariel's poetic language reveals that it, like the plot, conforms to the marvels of the play and to the period's well documented love for marvels in several ways. Wonder, an aesthetic "'object of desire'" in itself, and a response to the inexplicable in classical and early modern views, may be evoked by the unexpected in style (and through other strategies that the era's handbooks taught). 5 The clause "I flamed amazement" epitomizes the unexpected in syntax as well as differing from one of the few sources found for The Tempest, William Strachey's 1610 letter, which describes just such a storm. 6 While St. Elmo's fire itself may elicit wonder, Shakespeare's syntax and diction reinforce that marvel. And no wonder: rhetoric and theatre alike depend upon audience attention, and wonders naturally evoke it. Jarring language also harmonizes with The Tempest's structural marvels—loose ends, disrupted actions, unforeseen futures—issues several critics explore. 7 [End Page 497]The wonders of The Tempest, however, also involve imagination—in early modern psychology, the human faculty that permits perception of the world and invention of images. 8 Wonder responds to how the perceived differs from the expected, how the imagined supplants the usual, how an... (shrink)

TOT states may be viewed as a temporary and reversible microamnesia. We investigated the effects of lorazepam on TOT states in response to general knowledge questions. The lorazepam participants produced more commission errors and more TOTs following commission errors than the placebo participants . The resolution of the TOTs was unimpaired by the drug. Neither feeling-of-knowing accuracy nor recognition were affected by lorazepam. The higher level of incorrect recalls produced by lorazepam participants may be due to the fact that they (...) were more frequently temporarily unable to access a known item. For some of these items, the awareness of the retrieval failure resulted in a commission TOT . The resolution of the TOT conflict is discussed in the light of the anxiolytic and anticonflict effects of lorazepam. The data are discussed in terms of contemporary theories of TOTs and the effects that benzodiazepines have on semantic memory. (shrink)

Ή νέα αὐτή μελέτη δέχεται τήν ταύτιση τοῦ θέματος μέ τήν κρίση τοῦ Πάρι καί προτείνει τήν παρακάτω ἀποκατάσταση γιά τά τμήματα πού λείπουν : πάνω στό σφηνόλιθο, ἀνάμεσα στούς λίθους Ρ καί Q, ὐπῆρχε ἕνα φοινικόδεντρο · πάνω στή χαμένη τρίτη πλάκα, ὑπῆρχε δεύτερο φοινικόδεντρο, ὁ Πάρις καθισμένος σέ βράχο, κατόπιν ἡ Ἥρα πού ἀνεβαίνει στό ἀρμα καί κλείνοντας τή σύνθεση, ἕνας ὑπηρέτης γιά τό ζευγάρι τῶν ζώων. Ή νέα ἀποκατάσταση δείχνει σέ τί βαθμό ό σχεδιαστής φρόντισε νά ἐνσωματώσει (...) τή σύνθεση του μέ τά ἀρχιτεκτονικά μέλη τῆς πρόσοψης. (shrink)

The patient’s home is a common setting for palliative care. This means that we need to understand current palliative care philosophy and how its goals can be realized in home‐care nursing encounters (HCNEs) between the nurse, patient and patient’s relatives. The existing research on this topic describes both a negative and a positive perspective. There has, however, been a reliance on interview and descriptive methods in this context. The aim of this study was to explore planned HCNEs in palliative care. (...) The design was a multiple case study based on observations. The analysis includes a descriptive and an explanation building phase. The results show that planned palliative HCNEs can be described as a process of co‐creating possibilities for the patient to reach vital goals through shared knowledge in a warm and caring atmosphere, based on good caring relations. However, in some HCNEs, co‐creation did not occur: Wishes and needs were discouraged or made impossible and vital goals were not reached for the patients or their relatives. Further research is needed to understand why. The co‐creative process presented in this article can be seen as a concretization of the palliative care ideal of working with a person‐centered approach. (shrink)

Ethnic minority groups have been shown to obtain poorer final year degree outcomes than their majority group counterparts in countries including the US, the UK and The Netherlands. Obtaining a lower degree classification may limit future employment prospects of graduates as well as opportunities for higher level study. To further investigate this achievement gap, we analysed performance levels across three academic years of study of 3,051 Black, Asian and White students from a UK University. Analyses of covariance investigated effects of (...) ethnicity and work placement experience (internships) on first, second and final year marks, whilst statistically controlling for a number of factors thought to influence achievement, including prior academic performance. Results demonstrated superior achievement of White students consistently across all years of study. Placement experience reduced, but did not eliminate, the size of the achievement gap exhibited by final year students. Sex, parental education and socioeconomic status had no significant main effects. Female students showed a more complex pattern of results than males, with Black females not showing the same final year uplift in marks as their Asian and White counterparts. Implications and possible explanations are discussed. (shrink)

Two aspects of mothering—using drugs during pregnancy and giving up the rearing of one's children—are the focus of this analysis of 58 addicted Chicana mothers who spent their adolescent years in barrio gangs. From a traditional stance, such women were doubly deviant, since they violated gender-role prescriptions by joining a barrio gang and by becoming involved in heroin and street life. Half of these women added to this deviance by using heroin during pregnancy, and 40 percent relinquished at least one (...) of their children. This article explores what distinguishes these classically “bad mothers” from addicts who maintain some degree of conventionality in their mothering. We found that Mexican gender-role traditionalism is not the only influence on these women. Many came from cholo or underclass families with a tradition of street involvement. In addition, their involvement in gang and heroin worlds may influence their behavior as mothers. We found that women who used drugs during pregnancy were more likely than abstainers to be cholas and to reject traditional gender-role values. However, those who gave up their children were more likely than those who kept their children to be from traditional families. We discuss the implications of these findings for research on deviance and the underclass among Hispanic women. (shrink)

Lorazepam has been repeatedly shown to induce memory impairments. The effects of this benzodiazepine on the processes involved in the strategic regulation of memory accuracy have not as yet been explored. An experimental procedure that delineates the role of monitoring and control processes was used. Fifteen lorazepam and 15 placebo subjects were examined using a semantic memory task that combined both a forced- and a free-report option and a no-incentive and an incentive condition. Memory accuracy was lower in the lorazepam (...) than in the placebo group. Lorazepam impaired control sensitivity . While the absolute aspect of monitoring was impaired , both the discriminative aspect and the response criterion setting were spared. The pharmacological dissociation between monitoring effectiveness and control sensitivity indicates that these two components involve distinct processes. (shrink)

For decades, aged care facility residents at risk of pressure ulcers have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week. Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent of residents identified as (...) being at risk of PUs and repositioned two-hourly 24/7, 34 per cent died with one or more PUs. Behaviours of concern were noted in 72 per cent of residents of whom 38 per cent were restrained. Dementia was diagnosed in 70 per cent of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia. The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

Objective: Previous research suggests a positive association between pain, depression and sleep. In this study, we investigate how sleep correlates with varying levels of pain and depression in nursing home patients with dementia.Materials and methods: Cross-sectional study with sleep-related data, derived from two multicenter studies conducted in Norway. We included NH patients with dementia according to the Mini-Mental State Examination from the COSMOS trial and the DEP.PAIN.DEM trial whose sleep was objectively measured with actigraphy. In the COSMOS trial, NH patients (...) were included if they were ≥65 years of age and with life expectancy >6 months. In the DEP.PAIN.DEM trial, patients were included if they were ≥60 years and if they had depression according to the Cornell Scale for Depression in Dementia. In both studies, pain was assessed with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale, and depression with CSDD. Sleep parameters were total sleep time, sleep efficiency, sleep onset latency, wake after sleep onset, early morning awakening, daytime total sleep time and time in bed. We registered use of sedatives, analgesics, opioids and antidepressants from patient health records and adjusted for these medications in the analyses.Results: Mean age was 86.2 years and 76.3% were female. Hierarchical regressions showed that pain was associated with higher TST and SE, less WASO and more DTS. More severe dementia was associated with more WASO and TiB. More severe depression was associated with less TST, less DTS and less TiB. Use of sedative medications was associated with less TiB.Conclusion: When sleep was measured with actigraphy, NH patients with dementia and pain slept more than patients without pain, in terms of higher total sleep time. Furthermore, their sleep efficiency was higher, indicating that the patients had more sleep within the time they spent in bed. Patients with more severe dementia spent more time awake during the time spent in bed. Furthermore, people with more severe depression slept less at daytime and had less total sleep time Controlling for concomitant medication use did not affect the obtained results. (shrink)

Background In the context of limited health care budgets in countries where Neglected Tropical Diseases are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, and (...) 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. Discussion Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

BackgroundIn the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost‐effectiveness analyses may lead to biased and insufficiently justified priorities.ObjectivesThe objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi‐criteria decision‐making matrix, and 3) discuss (...) the conditions under which this decision‐making procedure should be carried out in a real‐world decision‐making context.MethodsThis paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi‐criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases.DiscussionOur in vitro multi‐criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil‐transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision‐making process and we stress the limitations of this study exercise.ConclusionBy exploring how several criteria relevant to the multi‐facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

The recent death of Peter McHugh becomes an occasion for the remembrance and recollection of the distinctive form of reflexive or analytic social inquiry, which framed his work and that of his longtime friend and collaborator, Alan Blum. Following dual appointments at York University, Toronto, Canada in 1972, Blum and McHugh’s partnership formed the basis for a community of scholars and students throughout the 1970s, 1980s, and 1990s. A brief review of McHugh and Blum’s works shows theoretical roots in social (...) constructivism and a deep appreciation of the linguistic turn, which in turn lead to the development of a form of social analysis that meets the stringent requirements of a reflexive sociology by repudiating any claim to a privileged exemption of theoretical speech (practice) from the hermeneutical circle of speech and language. Blum and McHugh are shown to embrace and not to evade the hermeneutical circle by a form of social inquiry that subverts the inherent possibilities available within speech and social convention to make available an encounter with the (moral) authority or form of life for that self-same speech. With each example of everyday life or conventional usage, McHugh (and Blum) move from theorizing which formulates the complexity of a particular instance of social interaction through its rules, to the question of the form of life that make that particular instance of the rules possible. It is the pursuit of transparency between speech and its roots in language that informed and continues to inform the distinctive style of social theory fostered at York-Toronto under the orchestration of McHugh and Blum. (shrink)