Hunter, Wynn G; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A
Nearly one in three Americans are financially burdened by their medical expenses. To mitigate financial distress, experts recommend routine physician-patient cost conversations. However, the content and incidence of these conversations are unclear, and rigorous definitions are lacking. We sought to develop a novel set of cost conversation definitions, and determine the impact of definitional variation on cost conversation incidence in three clinical settings. Retrospective, mixed-methods analysis of transcribed dialogue from 1,755 outpatient encounters for routine clinical management of breast cancer, rheumatoid arthritis, and depression, occurring between 2010-2014. We developed cost conversation definitions using summative content analysis. Transcripts were evaluated independently by at least two members of our multi-disciplinary team to determine cost conversation incidence using each definition. Incidence estimates were compared using Pearson's Chi-Square Tests. Three cost conversation definitions emerged from our analysis: (a) Out-of-Pocket (OoP) Cost--discussion of the patient's OoP costs for a healthcare service; (b) Cost/Coverage--discussion of the patient's OoP costs or insurance coverage; (c) Cost of Illness- discussion of financial costs or insurance coverage related to health or healthcare. These definitions were hierarchical; OoP Cost was a subset of Cost/Coverage, which was a subset of Cost of Illness. In each clinical setting, we observed significant variation in the incidence of cost conversations when using different definitions; breast oncology: 16, 22, 24% of clinic visits contained cost conversation (OOP Cost, Cost/Coverage, Cost of Illness, respectively; P cost conversation varied significantly depending on the definition used. Our findings and proposed definitions may assist in retrospective interpretation and prospective design of investigations on this topic.
Hansen, Eric D; Mitchell, Mary M; Smith, Tom; Hutton, Nancy; Keruly, Jeanne; Knowlton, Amy R
In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV into a serious chronic illness, warranting patient-provider discussion about advanced care planning (ACP). Evidence is needed to inform physicians on how to approach ACP for these patients. Chronic pain is common in PLWHA, particularly in those who have substance use disorders; although it is known that this population is at risk for poorer patient-physician engagement, the effects on ACP are unknown. To further characterize factors associated with successful ACP in PLWHA, we examined associations between patient-physician relationship, chronic pain, family communication and problem-solving skills, and rates of patients discussing ACP with their physicians. Data were from the Affirm Care study (N = 325), which examined social and environmental factors associated with health outcomes among PLWHA and their informal caregivers. In multivariate analysis, higher odds of patient reports of discussing ACP with their physicians were associated with their higher rating of their relationship with their physician (adjusted odds ratio [AOR] 1.73; P family arguments about end-of-life medical decisions (AOR 2.43; P family members about problems (AOR 1.33; P family communication and family problem-solving skills. The findings also suggest that PLWHA with chronic pain and prior family discord over end-of-life medical decisions may be primed for ACP. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Full Text Available Abstract Background Older patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients’ communication with physicians. This study examines older patients’ attitudes towards, and experiences of, patient-physician end-of-life (EoL communication in three European countries. Methods A secondary analysis of interviews from British, Dutch and Belgian patients over the age of 60 with a progressive terminal illness was conducted. Cross-cutting themes were identified using a thematic approach. Results Themes from 30 interviews (Male n = 20, Median age 78.5 included: confidence and trust; disclosure and awareness; and participation in decision-making. Confidence and trust were reinforced by physicians’ availability, time and genuine attention and hindered by misdiagnoses and poor communication style. Most participants preferred full disclosure, though some remained deliberately ill-informed to avoid distress. Patients expressed a variety of preferences for and experiences of involvement in medical EoL decision-making and a few complained that information was only provided about the physician's preferred treatment. Conclusions A variety of experiences and attitudes regarding disclosure and participation in decision-making were reported from each country, suggesting that communication preferences are highly individual. It is important that physicians are sensitive to this diversity and avoid stereotyping. In regard to communication style, physicians are advised to provide clear explanations, avoid jargon, and continually check understanding. Both the ‘informed’ and the ‘shared’ patient-physician decision-making models assume patients make rational choices based on a clear understanding of treatment options. This idealized situation was often not reflected in
Background Older patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients’ communication with physicians. This study examines older patients’ attitudes towards, and experiences of, patient-physician end-of-life (EoL) communication in three European countries. Methods A secondary analysis of interviews from British, Dutch and Belgian patients over the age of 60 with a progressive terminal illness was conducted. Cross-cutting themes were identified using a thematic approach. Results Themes from 30 interviews (Male n = 20, Median age 78.5) included: confidence and trust; disclosure and awareness; and participation in decision-making. Confidence and trust were reinforced by physicians’ availability, time and genuine attention and hindered by misdiagnoses and poor communication style. Most participants preferred full disclosure, though some remained deliberately ill-informed to avoid distress. Patients expressed a variety of preferences for and experiences of involvement in medical EoL decision-making and a few complained that information was only provided about the physician's preferred treatment. Conclusions A variety of experiences and attitudes regarding disclosure and participation in decision-making were reported from each country, suggesting that communication preferences are highly individual. It is important that physicians are sensitive to this diversity and avoid stereotyping. In regard to communication style, physicians are advised to provide clear explanations, avoid jargon, and continually check understanding. Both the ‘informed’ and the ‘shared’ patient-physician decision-making models assume patients make rational choices based on a clear understanding of treatment options. This idealized situation was often not reflected in patients’ experiences. PMID
Evans, N.C.; Pasman, H.R.W.; Payne, S.A.; Seymour, J.; Pleschberger, S.; Deschepper, R.; Onwuteaka-Philipsen, B.D.
Background: Older patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients' communication with physicians. This
Full Text Available No abstract available. Article truncated at 150 words. “Life is like a boomerang. Our thoughts, deeds and words return to us sooner or later, with astounding accuracy.”-Brant M. Bright, former project leader with IBM A recent sounding board in the New England Journal of Medicine discussed legislative interference with the patient-physician relationship (1. The authors, the executive staff leadership of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Surgeons believe that legislators should abide by principles that put patients’ best interests first. Critical to achieving this goal is respect for the importance of scientific evidence, patient autonomy, and the patient-physician relationship. According to the authors, lawmakers are increasingly intruding into the realm of medical practice, often to satisfy political agendas without regard to established, evidence-based guidelines for care. The article goes on to cite examples including: The Florida ….
Larkin, Jacqui; Neumann, Ruth
The academic workforce is among the oldest (Commonwealth of Australia, 2005) and arguably has the most highly qualified professionals within Australia. Yet career management for this group is seldom discussed. This paper considers Australia's ageing academic work-force and the human resource management challenges and implications this poses for…
This is an edited transcript of the recorded discussions that followed the presentation of each paper and on the general comments at the conclusion of the session. No attempt was made to identity those who offered comments or asked questions
Downing, Kimberly; Jones, Linda L
Older adults (50-70 years old) have lower organ donor registration rates than younger adults. Older adults have different informational needs and donor registration behavior than younger age groups. The objective of this qualitative study was to understand insights of older adults about organ donation to effectively address the barriers to becoming an organ donor. This study identified turning points as "Aha!" moments that occurred during a dialogue intervention where older adults discussed benefits, barriers, and process to organ donation. Dialogues were held with small groups of older adults in 11 communities in a Midwestern organ procurement organization service area. Participants were positive to organ donation, but not registered as an organ donor. Methods/Approach: Qualitative analysis of verbatim comments from the dialogue and a follow-up survey were used to examine turning points or "Aha!" moments of participants' decision-making about organ donation and organ donor registration. Twenty-one separate in-depth dialogues were conducted with 198 participants, with mean age of 60.57 years. There were 2757 separate comments coded with 465 of the comments (17%) identified as providing Aha! moments during the dialogue. Three themes include benefits of organ donation (30%), barriers about organ donation (39%), and organ donation process (31%). The research identified moments in the dialogue where possible learning about organ donation may have occurred. After participation in the dialogue process, there was an increase in intent to register to be an organ donor, organ donation discussion with family and friends, and organ donor registration.
Mercedes Bern-Klug PhD
Full Text Available Adults are encouraged to discuss their end-of-life health care preferences so that their wishes will be known and hopefully honored. The purpose of this study was to determine with whom older adults had communicated their future health care wishes and the extent to which respondents themselves were serving as a surrogate decision maker. Results from the cross-sectional online survey with 294 persons aged 50 and older reveal that among the married, over 80% had a discussion with their spouse and among those with an adult child, close to two thirds (64% had. Over a third had discussed preferences with an attorney and 23% with a physician. Close to half were currently serving as a surrogate decision maker or had been asked to and had signed papers to formalize their role. 18% did not think that they were a surrogate but were not sure. More education is needed to emphasize the importance of advance care planning with a medical professional, especially for patients with advanced chronic illness. More education and research about the role of surrogate medical decision makers is called for.
Northridge, Mary E; Shedlin, Michele; Schrimshaw, Eric W; Estrada, Ivette; De La Cruz, Leydis; Peralta, Rogelina; Birdsall, Stacia; Metcalf, Sara S; Chakraborty, Bibhas; Kunzel, Carol
Despite a body of evidence on racial/ethnic minority enrollment and retention in research, literature specifically focused on recruiting racially/ethnically diverse older adults for social science studies is limited. There is a need for more rigorous research on methodological issues and the efficacy of recruitment methods. Cultural obstacles to recruitment of racial/ethnic minority older adults include language barriers, lack of cultural sensitivity of target communities on the part of researchers, and culturally inappropriate assessment tools. Guided by the Consolidated Framework for Implementation Research (CFIR), this study critically appraised the recruitment of racial/ethnic minority older adults for focus groups. The initial approach involved using the physical and social infrastructure of the ElderSmile network, a community-based initiative to promote oral and general health and conduct health screenings in places where older adults gather, to recruit racial/ethnic minority adults for a social science component of an interdisciplinary initiative. The process involved planning a recruitment strategy, engaging the individuals involved in its implementation (opinion leaders in senior centers, program staff as implementation leaders, senior community-based colleagues as champions, and motivated center directors as change agents), executing the recruitment plan, and reflecting on the process of implementation. While the recruitment phase of the study was delayed by 6 months to allow for ongoing recruitment and filling of focus group slots, the flexibility of the recruitment plan, the expertise of the research team members, the perseverance of the recruitment staff, and the cultivation of change agents ultimately resulted in meeting the study targets for enrollment in terms of both numbers of focus group discussions (n = 24) and numbers of participants (n = 194). This study adds to the literature in two important ways. First, we leveraged the social and
Mary E. Northridge
Full Text Available Abstract Background Despite a body of evidence on racial/ethnic minority enrollment and retention in research, literature specifically focused on recruiting racially/ethnically diverse older adults for social science studies is limited. There is a need for more rigorous research on methodological issues and the efficacy of recruitment methods. Cultural obstacles to recruitment of racial/ethnic minority older adults include language barriers, lack of cultural sensitivity of target communities on the part of researchers, and culturally inappropriate assessment tools. Methods Guided by the Consolidated Framework for Implementation Research (CFIR, this study critically appraised the recruitment of racial/ethnic minority older adults for focus groups. The initial approach involved using the physical and social infrastructure of the ElderSmile network, a community-based initiative to promote oral and general health and conduct health screenings in places where older adults gather, to recruit racial/ethnic minority adults for a social science component of an interdisciplinary initiative. The process involved planning a recruitment strategy, engaging the individuals involved in its implementation (opinion leaders in senior centers, program staff as implementation leaders, senior community-based colleagues as champions, and motivated center directors as change agents, executing the recruitment plan, and reflecting on the process of implementation. Results While the recruitment phase of the study was delayed by 6 months to allow for ongoing recruitment and filling of focus group slots, the flexibility of the recruitment plan, the expertise of the research team members, the perseverance of the recruitment staff, and the cultivation of change agents ultimately resulted in meeting the study targets for enrollment in terms of both numbers of focus group discussions (n = 24 and numbers of participants (n = 194. Conclusions This study adds to the
Thom, D H; Campbell, B
Patients' trust in their physicians has recently become a focus of concern, largely owing to the rise of managed care, yet the subject remains largely unstudied. We undertook a qualitative research study of patients' self-reported experiences with trust in a physician to gain further understanding of the components of trust in the context of the patient-physician relationship. Twenty-nine patients participants, aged 26 to 72, were recruited from three diverse practice sites. Four focus groups, each lasting 1.5 to 2 hours, were conducted to explore patients' experiences with trust. Focus groups were audio-recorded, transcribed, and coded by four readers, using principles of grounded theory. The resulting consensus codes were grouped into seven categories of physician behavior, two of which related primarily to technical competence (thoroughness in evaluation and providing appropriate and effective treatment) and five of which were interpersonal (understanding patient's individual experience, expressing caring, communicating clearly and completely, building partnership/sharing power and honesty/respect for patient). Two additional categories were predisposing factors and structural/staffing factors. Each major category had multiple subcategories. Specific examples from each major category are provided. These nine categories of physician behavior encompassed the trust experiences related by the 29 patients. These categories and the specific examples provided by patients provide insights into the process of trust formation and suggest ways in which physicians could be more effective in building and maintaining trust.
Chi, Han-Lin; Cataldo, Janine; Ho, Evelyn Y; Rehm, Roberta S
Health-care providers (HCPs) find facilitating end-of-life (EOL) care discussions challenging, especially with patients whose ethnicities differ from their own. Currently, there is little guidance on how to initiate and facilitate such discussions with older Chinese Americans (≥55 years) and their families. To explore communication strategies for HCPs to initiate EOL care discussions with older Chinese Americans in the San Francisco Bay Area. This qualitative (focused) ethnographic study included field observations and individual semistructured interviews with 14 community-dwelling older Chinese Americans who lived independently at home, 9 adult children, and 7 HCPs. Responses were analyzed using open coding, memos, and comparison across participants. The study participants emphasized the importance of assessing readiness for early EOL care discussions. All recommended using indirect communication approaches to determine older Chinese Americans' readiness. Indirect communication can be culturally targeted and applied at both system-wide (ie, health-care system) and individual (ie, HCP) levels. To institutionalize the practice, health-care facilities should implement EOL care discussion inquiries as part of routine during check-in or intake questionnaires. In individual practice, using depersonalized communication strategies to initiate the discussion was recommended to determine older Chinese Americans' readiness. Assessing readiness should be an essential and necessary action for early EOL care discussions. Culturally targeted assessment of older Chinese Americans includes using indirect communication approaches to initiate an EOL care discussion to determine their readiness. In addition to health-care system integration, providers should implement and evaluate proposed EOL discussion initiation prompts with their older Chinese American patients.
Physicians' ability to effectively and compassionately communicate information is key to a successful patient-physician relationship. The current health care environment demands increasing clinical productivity and affords less time with each patient, which can impede effective patient-physician communication. The use of patient-centered interviewing, caring communication skills, and shared decision making improves patient-physician communication. Involving advanced practice nurses or physician assistants may improve the patient's experience and understanding of her visit. Electronic communication with established patients also can enhance the patient experience in select situations.
Background With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients’ Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship. Objective Our objective was to systematically review existing research on patients’ Internet health information seeking and its influence on the patient-physician relationship. Methods We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients’ discussion of online findings during consultations and implications for the patient-physician relationship. Results We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients’ disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients’ relationship with their physicians. Conclusions Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be
Brocklehurst, Paul R; McKenna, Gerald; Schimmel, Martin; Kossioni, Anastassia; Jerković-Ćosić, Katarina; Hayes, Martina; da Mata, Cristiane; Müller, Frauke
Across the European Union costs for the treatment of oral disease is expected to rise to €93 Billion by 2020 and be higher than those for stroke and dementia combined. A significant proportion of these costs will relate to the provision of care for older people. Dental caries severity and experience is now a major public health issue in older people and periodontal disease disproportionately affects older adults. Poor oral health impacts on older people's quality of life, their self-esteem, general health and diet. Oral health care service provision for older people is often unavailable or poor, as is the standard of knowledge amongst formal and informal carers. The aim of this discussion paper is to explore some of the approaches that could be taken to improve the level of co-production in the design of healthcare services for older people. People's emotional and practical response to challenges in health and well-being and the responsiveness of systems to their needs is crucial to improve the quality of service provision. This is a particularly important aspect of care for older people as felt, expressed and normative needs may be fundamentally different and vary as they become increasingly dependent. Co-production shifts the design process away from the traditional 'top-down' medical model, where needs assessments are undertaken by someone external to a community and strategies are devised that encourage these communities to become passive recipients of services. Instead, an inductive paradigm of partnership working and shared leadership is actively encouraged to set priorities and ultimately helps improve the translational gap between research, health policy and health-service provision. The four methodological approaches discussed in this paper (Priority Setting Partnerships, Discrete Choice Experiments, Core Outcome Sets and Experience Based Co-Design) represent an approach that seeks to better engage with older people and ensure an inductive, co
Ge Jin; Fishman, Jessica; Vapiwala, Neha; Li, Susan Q.; Desai, Krupali; Xie, Sharon X.; Mao, Jun J.
Purpose: Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials: We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients’ discussion of CAM with radiation oncologists. Results: Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions: Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm.
Elizabeth R. Burns
Full Text Available Falls are the leading cause of fatal and non-fatal injuries among older adults. The American and British Geriatric Societies recommend a fall risk assessment to identify risk factors and guide interventions to prevent these falls. This study describes the self-reported discussion of fall prevention approaches used by primary care providers (PCPs—family practitioners, internists and nurse practitioners—who treat older adults. Results are described overall and by PCP type.We analyzed a sample of 1210 U.S. PCPs who participated in the 2014 DocStyles survey. PCPs reported on their recommendation of fall prevention approaches including general exercise, Tai Chi, medication adjustments, home safety modifications, vitamin D supplements, assistive devices, alarm systems, and referral to physical therapy, foot specialist, or vision specialist. Frequencies and adjusted odds ratios for fall prevention approaches were assessed by provider and practice characteristics.Self-reported discussion of any fall prevention approaches was 89.3%. Controlling for provider and practice characteristics, there were significant differences for some approaches by provider type. Family practitioners were more likely to suggest home modification [adjusted Odds Ratio: 1.8 (1.3–2.4], exercise [aOR: 2.0 (1.5–2.5], and Tai Chi [aOR: 1.5 (1.0–2.2] than internists. Nurse practitioners were more likely to suggest home modification [aOR: 2.1 (1.3–3.4] and less likely to suggest vitamin D [aOR: 0.6 (0.4–1.0] than internists.Fall prevention suggestions vary by type of PCP. Dissemination of geriatric guidelines should include all PCPs who routinely see older adults. Keywords: Primary care providers, Falls, Prevention, Older adults, Geriatrics
Ishikawa, Hirono; Hashimoto, Hideki; Kiuchi, Takahiro
Over the past few decades, the concept of "patient-centeredness" has been intensively studied in health communication research on patient-physician interaction. Despite its popularity, this concept has often been criticized for lacking a unified definition and operationalized measurement. This article reviews how health communication research on patient-physician interaction has conceptualized and operationalized patient-centered communication based on four major theoretical perspectives in sociology (i.e., functionalism, conflict theory, utilitarianism, and social constructionism), and discusses the agenda for future research in this field. Each theory addresses different aspects of the patient-physician relationship and communication from different theoretical viewpoints. Patient-centeredness is a multifaceted construct with no single theory that can sufficiently define the whole concept. Different theoretical perspectives of patient-centered communication can be selectively adopted according to the context and nature of problems in the patient-physician relationship that a particular study aims to explore. The present study may provide a useful framework: it offers an overview of the differing models of patient-centered communication and the expected roles and goals in each model; it does so toward identifying a communication model that fits the patient and the context and toward theoretically reconstructing existing measures of patient-centered communication. Furthermore, although patient-centered communication has been defined mainly from the viewpoint of physician's behaviors aimed at achieving patient-centered care, patient competence is also required for patient-centered communication. This needs to be examined in current medical practice. Copyright © 2013 Elsevier Ltd. All rights reserved.
Burns, Elizabeth R; Haddad, Yara K; Parker, Erin M
Falls are the leading cause of fatal and non-fatal injuries among older adults. The American and British Geriatric Societies recommend a fall risk assessment to identify risk factors and guide interventions to prevent these falls. This study describes the self-reported discussion of fall prevention approaches used by primary care providers (PCPs)-family practitioners, internists and nurse practitioners-who treat older adults. Results are described overall and by PCP type. We analyzed a sample of 1210 U.S. PCPs who participated in the 2014 DocStyles survey. PCPs reported on their recommendation of fall prevention approaches including general exercise, Tai Chi, medication adjustments, home safety modifications, vitamin D supplements, assistive devices, alarm systems, and referral to physical therapy, foot specialist, or vision specialist. Frequencies and adjusted odds ratios for fall prevention approaches were assessed by provider and practice characteristics. Self-reported discussion of any fall prevention approaches was 89.3%. Controlling for provider and practice characteristics, there were significant differences for some approaches by provider type. Family practitioners were more likely to suggest home modification [adjusted Odds Ratio: 1.8 (1.3-2.4)], exercise [aOR: 2.0 (1.5-2.5)], and Tai Chi [aOR: 1.5 (1.0-2.2)] than internists. Nurse practitioners were more likely to suggest home modification [aOR: 2.1 (1.3-3.4)] and less likely to suggest vitamin D [aOR: 0.6 (0.4-1.0)] than internists. Fall prevention suggestions vary by type of PCP. Dissemination of geriatric guidelines should include all PCPs who routinely see older adults.
Butler, R N; Lewis, M I; Hoffman, E; Whitehead, E D
In the medical evaluation of older men with erectile dysfunction, obtain a detailed history to determine whether the dysfunction is organic or psychogenic. Determine if there are underlying pathologic processes--most notably vascular diseases--or other factors responsible for the dysfunction, such as medications or nerve or arterial damage from surgery. Lifestyle changes in mid-life (regular exercise, a low-fat diet, and smoking cessation) increase a man's chances of remaining potent as he grows older. Treatments for impotence include injection therapy, vacuum devices, and implants. Each therapy has advantages and disadvantages, and the informed patient plays an important role in choosing the therapy that is right for him.
Tai-Seale, Ming; Bramson, Rachel; Bao, Xiaoming
A clearly stated clinical decision can induce a cognitive closure in patients and is an important investment in the end of patient-physician communications. Little is known about how often explicit decisions are made in primary care visits. To use an innovative videotape analysis approach to assess physicians' propensity to state decisions explicitly, and to examine the factors influencing decision patterns. We coded topics discussed in 395 videotapes of primary care visits, noting the number of instances and the length of discussions on each topic, and how discussions ended. A regression analysis tested the relationship between explicit decisions and visit factors such as the nature of topics under discussion, instances of discussion, the amount of time the patient spoke, and competing demands from other topics. About 77% of topics ended with explicit decisions. Patients spoke for an average of 58 seconds total per topic. Patients spoke more during topics that ended with an explicit decision, (67 seconds), compared with 36 seconds otherwise. The number of instances of a topic was associated with higher odds of having an explicit decision (OR = 1.73, p decisions. Although discussions often ended with explicit decisions, there were variations related to the content and dynamics of interactions. We recommend strengthening patients' voice and developing clinical tools, e.g., an "exit prescription," to improving decision making.
Henry, Stephen G; Czarnecki, Danielle; Kahn, Valerie C; Chou, Wen-Ying Sylvia; Fagerlin, Angela; Ubel, Peter A; Rovner, David R; Alexander, Stewart C; Knight, Sara J; Holmes-Rovner, Margaret
We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer. To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses. Forty veterans and 18 urologists at one VA medical centre. We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities. We identified five communication activities that occurred in the following typical sequence: 'diagnosis delivery', 'risk classification', 'options talk', 'decision talk' and 'next steps'. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions. Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options. © 2013 John Wiley & Sons Ltd.
Full Text Available Georgia Giannakarou University of Cambridge, UK ABSTRACT Whether Constructivism is considered a solid paradigm or just an approach in International Relations (IR Domain – a verdict which is quite too soon to be reached, I suppose, it is undoubtedly a well-promising school of thought in IR. And whether Constructivism has failed to shift the IR agenda from that which older dominant schools determined or not, it is more than evident that this constitutes a still open question in both research and academic areas. In the first part of this essay, I refer to the rise and evolution of Constructivism from the 1980s up to date highlighting its origins and its core principles, while in the second part, more attention is been given to its dynamic dialogue with other dominant schools of IR and Political Science. The scope of this essay is to illuminate a great number of arguments already made both against and in favor of Constructivism, as presented in a certain variety of papers and works in the wider field of IR. Furthermore, this illumination is being held under the light of a dual source, provided by the prominent IR Theory and the International Security sub-field. A third part of this essay is devoted to the latter. I conclude that Constructivism’s power lies in its ‘weaknesses’, namely its interpretation of world politics through culture and identity, especially in the currently world instability caused by the global identity crisis and spreading ISIS radical fanaticism.
Wuthrich, V M; Rapee, R M; Kangas, M; Perini, S
Co-morbid anxiety and depression in older adults is associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments in older adults. However, there is a paucity of research focused on testing the efficacy of the co-morbid treatment of anxiety and depression in older adults using psychological interventions. Accordingly, the primary objective of the current study was to test the effects of a group cognitive behavior therapy (CBT) program in treating co-morbid anxiety and depression in a sample of older age adults. A total of 133 community-dwelling participants aged ⩾60 years (mean age = 67.35, s.d. = 5.44, male = 59) with both an anxiety disorder and unipolar mood disorder, as assessed on the Anxiety Disorder Interview Schedule (ADIS), were randomly allocated to an 11-week CBT group or discussion group. Participants with Mini-Mental State Examination scores <26 were excluded. Participants were assessed pre-treatment, post-treatment and at 6 months follow-up on the ADIS, a brief measure of well-being, Geriatric Anxiety Inventory and Geriatric Depression Scale. Both conditions resulted in significant improvements over time on all diagnostic, symptom and wellbeing measures. Significant group × time interaction effects emerged at post-treatment only for diagnostic severity of the primary disorder, mean severity of all anxiety disorders, mood disorders, and all disorders, and recovery rates on primary disorder. Group CBT produced faster and sustained improvements in anxiety and depression on diagnostic severity and recovery rates compared to an active control in older adults.
Depczynski Julie C
Full Text Available Abstract Background The health workforce in Australia is ageing, particularly in rural areas, where this change will have the most immediate implications for health care delivery and workforce needs. In rural areas, the sustainability of health services will be dependent upon nurses and allied health workers being willing to work beyond middle age, yet the particular challenges for older health workers in rural Australia are not well known. The purpose of this research was to identify aspects of work that have become more difficult for rural health workers as they have become older; and the age-related changes and exacerbating factors that contribute to these difficulties. Findings will support efforts to make workplaces more 'user-friendly' for older health workers. Methods Nurses and allied health workers aged 50 years and over were invited to attend one of six local workshops held in the Hunter New England region of NSW, Australia. This qualitative action research project used a focus group methodology and thematic content analysis to identify and interpret issues arising from workshop discussions. Results Eighty older health workers from a range of disciplines attended the workshops. Tasks and aspects of work that have become more difficult for older health workers in hospital settings, include reading labels and administering medications; hearing patients and colleagues; manual handling; particular movements and postures; shift work; delivery of babies; patient exercises and suturing. In community settings, difficulties relate to vehicle use and home visiting. Significant issues across settings include ongoing education, work with computers and general fatigue. Wider personal challenges include coping with change, balancing work-life commitments, dealing with attachments and meeting goals and expectations. Work and age-related factors that exacerbate difficulties include vision and hearing deficits, increasing tiredness, more complex
Fragar, Lyn J; Depczynski, Julie C
The health workforce in Australia is ageing, particularly in rural areas, where this change will have the most immediate implications for health care delivery and workforce needs. In rural areas, the sustainability of health services will be dependent upon nurses and allied health workers being willing to work beyond middle age, yet the particular challenges for older health workers in rural Australia are not well known. The purpose of this research was to identify aspects of work that have become more difficult for rural health workers as they have become older; and the age-related changes and exacerbating factors that contribute to these difficulties. Findings will support efforts to make workplaces more 'user-friendly' for older health workers. Nurses and allied health workers aged 50 years and over were invited to attend one of six local workshops held in the Hunter New England region of NSW, Australia. This qualitative action research project used a focus group methodology and thematic content analysis to identify and interpret issues arising from workshop discussions. Eighty older health workers from a range of disciplines attended the workshops. Tasks and aspects of work that have become more difficult for older health workers in hospital settings, include reading labels and administering medications; hearing patients and colleagues; manual handling; particular movements and postures; shift work; delivery of babies; patient exercises and suturing. In community settings, difficulties relate to vehicle use and home visiting. Significant issues across settings include ongoing education, work with computers and general fatigue. Wider personal challenges include coping with change, balancing work-life commitments, dealing with attachments and meeting goals and expectations. Work and age-related factors that exacerbate difficulties include vision and hearing deficits, increasing tiredness, more complex professional roles and a sense of not being valued in the
Full Text Available Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls.A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively.Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts.The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.
Full Text Available This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.
Skriabikova, Olga; Pavlova, Milena; Groot, Wim
This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.
Epstein, R M; Borrell i Carrió, F
The expression of emotion and the sharing of information are determined by cultural factors, consultation time, and the structure of the health care system. Two emblematic situations in Spain - the expression of aggression in the patient-physician encounter, and the withholding of diagnostic information from the patient - have not been well-described in their sociocultural context. To explore these, the authors observed and participated in clinical practice and teaching in several settings throughout Spain and analyzed field notes using qualitative methods. In this paper, we explore three central constructs - modesty (pudor), dignity (honor), and authority (autoridad) - and their expressions in patient-physician encounters. We define two types of emotions in clinical settings - public, extroverted expressions of anger and exuberance; and private, deeply held feelings of fear and grief that tend to be expressed through the arts and religion. Premature reassurance and withholding of information are interpreted as attempts to reconstruct the honor and pudor of the patient. Physician authority and perceived loyalty to the government-run health care system generate conflict and aggression in the patient-physician relationship. These clinical behaviors are contextualized within cultural definitions of effective communication, an ideal patient-physician relationship, the role of the family, and ethical behavior. Despite agreement on the goals of medicine, the behavioral manifestations of empathy and caring in Spain contrast substantially with northern European and North American cultures.
The overall aim of this thesis was to characterize patient-physician communication in oncology care with focus on the content and quality of the consultations from the perspectives of patients, oncologists and observer. Further, the aim was to explore oncologists’ perceived barriers against psychosocial communication in out-patient consultations. Finally, the aim was to evaluate different methods for evaluating communication in this setting. Routine oncology out-patient consultations from two...
Cassel, C K
personal behavior. As advocates for the promotion of health and support of the sick, we are called upon to discuss, defend, and promulgate medical care by every ethical means available. Only by caring and advocating for the patient can the integrity of our profession be affirmed. Thus we honor our covenant of trust with patients.
Nussbaum, Abraham M; Boyer, Jonathan A; Kondrad, Elin C
As the use of medical marijuana expands, it is important to consider its implications for the patient-physician relationship. In Colorado, a small cohort of physicians is recommending marijuana, with 15 physicians registering 49% of all medical marijuana patients and a single physician registering 10% of all patients. Together, they have registered more than 2% of the state to use medical marijuana in the last three years. We are concerned that this dramatic expansion is occurring in a setting rife with conflicts of interest despite insufficient scientific knowledge about marijuana. This system diminishes the patient-physician relationship to the recommendation of a single substance while unburdening physicians of their usual responsibilities to the welfare of their patients.
Baidya, M; Gopichandran, V; Kosalram, K
Trust is the acceptance of a vulnerable situation in which the truster believes that the trustee will act in the truster's best interests. The cornerstone of the patient-physician relationship is "trust". Despite the intensity and importance of trust relationship of patients toward their physician, the phenomenon is rarely studied in developing countries. Our study aimed to explore the concept of patient-physician trust among adults of rural Tamil Nadu to assess the factors affecting patient-physician trust relationship and patient satisfaction. A cross-sectional descriptive household survey was carried out on 112 individuals selected by a multistage random sampling method. Men and women aged above 40 years who have visited a health care service at least once during the last 5 years were included in the study. Thom et al's modification of the Anderson and Dedrick Physician Trust scale was used to measure patient trust in physician. Trust is a one-dimensional construct in the surveyed population as revealed by an exploratory factor analysis which extracted one component explaining 50% of the overall variance. Trust influences patient's self-reported satisfaction (β coefficient of 0.048; P Trust in physicians seems to not depend on any of the assessed factors and largely seems to be implicit in the physician-patient relationship. Trust in physician is associated with patient satisfaction. Further studies are needed to assess trust in physicians in developing country settings.
Smith, Matthew Lee; Goltz, Heather Honoré; Motlagh, Audry S; Ahn, SangNam; Bergeron, Caroline D; Ory, Marcia G
This study aims to identify socio-demographic and health behavior factors associated with cardiovascular disease (CVD) diagnosis and patient-physician communication concerning sexual issues among older Veterans. Cross-sectional data were collected from 635 male Veterans over age 55 years as part of the 2010 National Social Life, Health and Aging Project, a nationally-representative, population-based study of community-dwelling older Americans. Two independent logistic regression analyses were performed. Over 33% of Veterans were aged 75 years or older. Over one-half of participants reported having a CVD diagnosis (58%) and sexual intercourse within the previous year (58%); over one-third (37%) reported having one or more sexual dysfunctions and discussing sexual issues with their physician (42%). Veterans diagnosed with CVD were significantly more likely to self-identify as racial/ethnic minorities (OR=1.89, P=0.021), have more chronic disease comorbidities (OR=1.23, P=0.041), and have more sexual dysfunctions (OR=1.19, P=0.028). Veterans diagnosed with CVD were significantly less likely to report having sex within the previous year (OR=0.53, P=0.005). Veterans who reported discussing sexual issues with a physician were significantly more likely to be ≥75 years (OR=1.79, P=0.010), and report more than a high school education (OR=1.62, P=0.016), CVD diagnosis (OR=1.59, P=0.015), sex within the previous year (OR=1.69, P=0.033), and trouble achieving/maintaining an erection (OR=3.39, Paging and sexual health/counseling services. These services should promote increased patient-physician communication as well as referrals between physicians and sex health/counseling specialists. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Full Text Available PURPOSE: The aim of the study was to assess levels of health literacy and computer skills in Chinese patients with cataract, and their impact on the doctor-patient relationship. METHODS: We undertook a cross-sectional study of cataract patients scheduled for cataract extraction procedures in Guangdong Province, China. Generic health literacy was assessed using 3 established screening questions. Adequate computer skills was determined if patients had used a computer and routinely used search engines on the Internet. Socio-demographic measures (e.g., age, sex, education were obtained from a standardized interview. Participants who indicated that they could not understand what their doctors mean were considered to have had poor patient-physician communications. RESULTS: Of the 211 participants, 92 (43.6% had inadequate health literacy and 204 (96.7% inadequate computer skills. In multivariate analysis, females were more likely to have inadequate health literacy (odds ratio = 2.5, 95% confidence intervals [CI]: 1.3 to 4.7. People with inadequately health literacy were more likely to have a poor patient-physician communication (odds ratio = 3.5, 95% CIs: 1.3 to 9.0. Similar associations were found for inadequate computer skills. CONCLUSION: Chinese elderly patients with cataract have inadequate health literacy and very limited computer skills, which place them at high risk of misunderstanding and mismanaging their ocular conditions. Patient education information other than online materials may improve the eye care and outcomes of these patients.
Lee, Ling-Ling; Arthur, Antony; Avis, Mark
Only a fifth of older people undertake a level of physical activity sufficient to lead to health benefit. Misconceptions about the ageing process and beliefs about the costs and benefits of exercise in late life may result in unnecessary self-imposed activity restriction. Thus, adhering to a physical activity can be difficult particularly when the benefits of exercise are often not immediate. Many of the barriers to engaging in physical activity among older people are attitudinal. It is therefore important to take account of the non-physical aspects of physical activity intervention programmes, such as increasing confidence. Self-efficacy is a widely applied theory used to understand health behaviour and facilitate behavioural modification, such as the increase of physical activity. This paper aims to examine the ways in which self-efficacy theory might be used in intervention programmes designed to overcome psychological barriers for increasing physical activity among older people. A number of studies have demonstrated that exercise self-efficacy is strongly associated with the amount of physical activity undertaken. Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of a physical activity intervention is beneficial. Physical activity interventions aimed at improving the self perception of exercise self-efficacy can have positive effects on confidence and the ability to initiate and maintain physical activity behaviour. There are a number of ways for nurses to facilitate older people to draw on the four information sources of self-efficacy: performance accomplishments, vicarious learning, verbal encouragement, and physiological and affective states. Research challenges that future studies need to address include the generalisability of exercise setting, the role of age as an effect modifier, and the need for more explicit reporting of how self-efficacy is operationalised in interventions.
Pulciani, Simonetta; Taruscio, Domenica
Patients need clinical competence, appropriate diagnosis and therapies in overcoming their disease. Yet this is insufficient. The illness experience tends to frighten people and the resulting emotional aspects could become relevant factors in coping with a sickness and disability. Hippocrates was the first to urge physicians to look beyond the physical features of diseases and to consider the patient as a unique psychosomatic entity. Additionally, the scientist spurred physicians to make the patient an active participant in combating the disease. According to Hippocrates, "the Medical Art has three actors: the physician, the patients and the disease. The physician and the patient must be allied against the disease in order to fight it". In the "Post-Genomic Era", an effective therapeutic approach merits a patient-physician participation, based on scientific understandings and human considerations. These recommendations are even more urgent for Rare Diseases.
Full Text Available Abstract Background and purpose:Now-a-days, patient satisfaction is increasingly receiving the attention of health-service providers, which is a necessary step to enhance the quality of health services. The present study aimed at exploring patient-physician communicative patterns, physicians’ job satisfaction, and patients’ satisfaction at Isfahan, Iran. Materials and Methods:This study was a descriptive analytical and cross-sectional survey in the summer of 2010. Simple random sampling was used to select participants. Data were collected through using three self-designed questionnaires on physicians’ job satisfaction, patient-physician relationship patterns (based on Hollander and Szase’ ideas, and patients’ satisfaction. Validity of the questionnaire was checked by a panel of experts. Furthermore, internal consistency reliability of the questionnaires was confirmed by Cronbach’s alpha (α = 0.80. Different dimensions of the job satisfaction questionnaire were salary, supervision, setting, promotion, fringe benefits, and working conditions. Data were analyzed by using SPSS for Windows 13.0 software. Results:The mean score of patient-physician relationship was 63. Therefore, the most frequent patient-physician communication pattern was guidance-cooperation. The mean score of physician’ job satisfaction was 50.2. The mean score of patients’ satisfaction was 86.5. Physicians’ job satisfaction was found to be related to patient-physician communication pattern (P < 0.05. Conclusion:Although patient-physician communication patterns are important, different variable such as patients’ and physicians’ satisfaction influence the patterns. Furthermore, improvement communication process between health care providers can be useful in the increasing patient satisfaction and patient quality of care.
Clark, Paul Alexander; Wolosin, Robert J; Gavran, Goran
This article explores the interrelationships between three categories of service quality in healthcare delivery organizations: patient, employee, and physician satisfaction. Using the largest and most representative national databases available, the study compares the evaluations of hospital care by more than 2 million patients, 150,000 employees, and 40,000 physicians. The results confirm the relationship connecting employees' satisfaction and loyalty to their patients' satisfaction and loyalty. Patients' satisfaction and loyalty were also strongly associated with medical staff physicians' evaluations of overall satisfaction and loyalty to the hospital. Similarly, hospital employees' satisfaction and loyalty were related to the medical staff physicians' satisfaction with and loyalty to the hospital. Based upon the strength of the interrelationships, individual measures and subscales can serve as leverage points for improving linked outcomes. Patients, physicians, and employees, the three co-creators of health, agree on the evaluation of the quality of that service experience. The results demonstrate that promoting patient-centeredness, enhancing medical staff relations, and improving the satisfaction and loyalty of employees are not necessarily three separate activities in competition for hospital resources and marketing leadership attention.
Piccoli, G; Rossetti, M; Dell'Olio, R; Perrotta, L; Mezza, E; Burdese, M; Maddalena, E; Bonetto, A; Jeantet, A; Segoloni, G P
The aim of this study was to report on the validation of a role-playing approach, using play-back and theatre laboratory in the context of a continuing medical education (CME) course on predialysis and transplantation, to discuss the patient-physician relationship. The course was developed with the help of a theatre director. The role-playing 2-day course was designed to be highly interactive for a small group (15-20 participants), based on a core of case reports (dialysis, transplantation, and return to dialysis after graft failure). Two stages were included: play-back theatre in which experiences told by the participants were mimed by a group of actors, and theatre laboratory in which different aspects of voice and touch were explored. Opinions were gathered by an anonymous semistructured questionnaire completed by all participants. The course obtained a high score from The Ministry of Health (14 credits, 1 per teaching hour). The opinions of the 18 participants were highly positive; all liked the courses. Sixteen of 18 asked to repeat the experience. The strong emotional involvement was an advantage for 15 of 18, sharing emotional aspects of the profession for 10 of 18, and usefulness in clarifying opinions on "dark sides" of our profession for 10 of 18. The positive opinions recorded during this experience, the first experiment with a "psycho-theatrical approach" developed in a CME course in our country, suggest the benefit of implementing nonconventional, educational approaches in a multidisciplinary discussion of the patient-physician relationship in transplantation medicine.
Maryam Yaghoubi; Fatemeh Rahmati-Najarkolaei
Abstract Background and purpose:Now-a-days, patient satisfaction is increasingly receiving the attention of health-service providers, which is a necessary step to enhance the quality of health services. The present study aimed at exploring patient-physician communicative patterns, physicians’ job satisfaction, and patients’ satisfaction at Isfahan, Iran. Materials and Methods:This study was a descriptive analytical and cross-sectional survey in the summer of 2010. Simple random sa...
Remarks intended to highlight topics of importance for future research were made by three of the participants at the conclusion of the Seminar. A brief listing is given of topics discussed by each of these rapporteurs
Smith, Lizette J; Mulhall, John P; Deveci, Serkan; Monaghan, Niall; Reid, M C
Limited information is available regarding sexual functioning among adults aged 70 years and older. To assess sexual functioning among older men and women, and ascertain patient-physician communication patterns about sexual functioning. Prospective participants were approached prior to scheduled appointments with their primary care physician. In-depth sexual histories were obtained along with data on their demographic, medical, psychological, and cognitive status. Sexual functioning was assessed using standardized questionnaires, and simple yes/no questions were administered to ascertain information regarding patient-physician communication practices about sex. Of the 74 eligible patients approached, 50 (68%) participated. The participants had a mean age +/- standard deviation (SD) of 81 +/- 6 years and most (56%) were women. Eighteen percent of the women and 41% of the men were sexually active. The most commonly reported sexual activity was intercourse for men and masturbation for women. Among the women, the most commonly cited reason for being sexually inactive was "no desire," whereas for most men, it was "erectile dysfunction." Sexual function scores for women were low across each category (lubrication, desire, orgasm, arousal, pain, and satisfaction.) For men, low sexual function scores were found in the domains of erectile function, orgasm, and overall satisfaction, but not desire. Only 4% of the women (vs. 36% of men) reported initiating a discussion about sexual function with their physician in the past year, whereas 7% of the women (vs. 32% of men) reported that their physician inquired about the topic in the preceding year. Finally, 32% of the women (vs. 86% of men) felt that physicians should initiate discussions about sexual function. In this study of older adults, a minority reported current sexual activity. Among sexually inactive women, most did not wish to resume activity, whereas desire for sexual activity remained high among men, despite
Alders, Irèn; Smits, Carolien; Brand, Paul; van Dulmen, Sandra
To systematically review the literature on the effectiveness of a patient coach intervention on patient - physician communication in specialists consultations. PubMed, Cochrane, PsycInfo, Cinahl and Embase were searched until November 2015. Included were papers describing interventions directed at adult outpatients in secondary care with a variety of somatic diseases. Outcomes had to be measured in communication effectivity from a patient's perspective. Seventeen publications met the inclusion criteria (involving 3787 patients), describing 13 unique interventions. Most interventions were single one-on-one sessions taking between 20 and 40min before consultation. Research quality in ten studies was high. These studies showed significant improvement on immediate, intermediate and long term patient - physician communication. We found limited evidence suggesting an improvement of patient - physician communication by having multiple patient coaching encounters during which questions are prepared and rehearsed and consultations are evaluated and reflected upon, sometimes supported by audio recording the consultation. The results of this review contribute to the (re-)design of an effective model for patient coaching, a profile and training approach of patient coaches. Future research should aim at determining which patients will benefit most from coaching interventions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
The panel discussion at the 10th Allianz Forum on 'Technology and Insurance' dealt with the following topics: New technologies: energy conversion (coal, petroleum, natural gas, nuclear energy, solar energy); infrastructure (transport, data processing); basic products (metallic materials, chemical products, pharmaceutical products); integrated products (microprocessors, production line machines) as well as new risks: political; general economic (financing, market structure); insurance-related, dangers to persons and property; reduction of risks. (orig.) [de
Much of the literature pertinent to management indicates that service providers with high emotional intelligence (EI) receive higher customer satisfaction scores. Previous studies offer limited evidence regarding the impact of physician's EI on patient-physician relationship. Using a multilevel and multisource data approach, the current study aimed to build a model that demonstrated the impact of a physician's EI on the patient's trust and the patient-physician relationship. The survey sample included 983 outpatients and 39 physicians representing 11 specialties. Results of path analyses demonstrated that the ratio of patient's follow-up visits (p impact of patient's trust on patient's satisfaction was mediated by the patient-physician relationship at a significant level (p relationship had a significantly positive effect on patient's satisfaction (p relationship; however, mutual trust and professional respect between nurses and physicians play a critical role in reinforcing the patient-physician relationship to effect improvements in the provision of patient-centered care.
Kiciman, Emre; Counts, Scott; Gamon, Michael
, time and other confounding factors, few of the studies that attempt to extract information from social media actually condition on such factors due to the difficulty in extracting these factors from naturalistic data and the added complexity of including them in analyses. In this paper, we present......Much research has focused on studying complex phenomena through their reflection in social media, from drawing neighborhood boundaries to inferring relationships between medicines and diseases. While it is generally recognized in the social sciences that such studies should be conditioned on gender...... a simple framework for specifying and implementing common social media analyses that makes it trivial to inspect and condition on contextual information. Our data model—discussion graphs—captures both the structural features of relationships inferred from social media as well as the context...
McLaughlin, Megan M; Simonson, Louis; Zou, Xia; Ling, Li; Tucker, Joseph D
Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust. We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians. These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.
Megan M McLaughlin
Full Text Available Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust.We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians.These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.
There seems to be a strong cultural expectation among patients for effective pain relief. As a result, physicians often find themselves trying to bridge the gap between the chronic pain patient's expectations and harsh biomedical reality. The typology of Emanuel and Emanuel of four models for the patient-physician relationship is used in this article as a conceptual tool to examine the possible roles of physicians in the context of chronic noncancer pain. Their typology is reconceptualized as a "pathway" along which the physician is able to walk more or less far, starting from the "information" end of the path. The other end of the pathway is "caring deliberation." I then propose that, in pain medicine today, consumerism is a powerful incentive for physicians to stay at the information end of the spectrum. Against this background, I discuss the current opioid epidemic in the United States and the need for what has been called a new medical professionalism. I conclude by challenging educators involved in pain medicine continuing professional development to not only design adequate biomedical-educational programs, but also consider issues like professionalism, personal development, critical self-reflection, and the ethics of engaging in caring deliberation with chronic pain patients.
Dave, Pujan; Villarreal, Guadalupe; Friedman, David S; Kahook, Malik Y; Ramulu, Pradeep Y
To determine the accuracy of patient-physician communication regarding topical ophthalmic medication use based on bottle cap color, particularly among individuals who may have acquired color vision deficiency from glaucoma. Cross-sectional, clinical study. Patients aged ≥18 years with primary open-angle, primary angle-closure, pseudoexfoliation, or pigment dispersion glaucoma, bilateral visual acuity of ≥20/400, and no concurrent conditions that may affect color vision. A total of 100 patients provided color descriptions of 11 distinct medication bottle caps. Color descriptors were then presented to 3 physicians. Physicians matched each color descriptor to the medication they thought the descriptor was describing. Frequency of patient-physician agreement, occurring when all 3 physicians accurately matched the color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field (VF) damage, color descriptor heterogeneity, or color vision deficiency, as determined by the Hardy-Rand-Rittler (HRR) score and Lanthony D15 color confusion index (D15 CCI). Subjects had a mean age of 69 (±11) years, with VF mean deviation of -4.7 (±6.0) and -10.9 (±8.4) decibels (dB) in the better- and worse-seeing eyes, respectively. Patients produced 102 unique color descriptors to describe the colors of the 11 bottle caps. Among individual patients, the mean number of medications demonstrating agreement was 6.1/11 (55.5%). Agreement was less than 15% for 4 medications (prednisolone acetate [generic], betaxolol HCl [Betoptic; Alcon Laboratories Inc., Fort Worth, TX], brinzolamide/brimonidine [Simbrinza; Alcon Laboratories Inc.], and latanoprost [Xalatan; Pfizer, Inc., New York, NY]). Lower HRR scores and higher D15 CCI (both indicating worse color vision) were associated with greater VF damage (P communication using bottle cap color alone may be common and could lead to confusion
Rhondali, Wadih; Perez-Cruz, Pedro; Hui, David; Chisholm, Gary B.; Dalal, Shalini; Baile, Walter; Chittenden, Eva; Bruera, Eduardo
Purpose Code status discussions are important in cancer care. The best modality for such discussions has not been established. Our objective was to determine the impact of a physician ending a code status discussion with a question (autonomy approach) versus a recommendation (beneficence approach) on patients' do-not-resuscitate (DNR) preference. Methods Patients in a supportive care clinic watched two videos showing a physician-patient discussion regarding code status. Both videos were identical except for the ending: one ended with the physician asking for the patient's code status preference and the other with the physician recommending DNR. Patients were randomly assigned to watch the videos in different sequences. The main outcome was the proportion of patients choosing DNR for the video patient. Results 78 patients completed the study. 74% chose DNR after the question video, 73% after the recommendation video. Median physician compassion score was very high and not different for both videos. 30/30 patients who had chosen DNR for themselves and 30/48 patients who had not chosen DNR for themselves chose DNR for the video patient (100% v/s 62%). Age (OR=1.1/year) and white ethnicity (OR=9.43) predicted DNR choice for the video patient. Conclusion Ending DNR discussions with a question or a recommendation did not impact DNR choice or perception of physician compassion. Therefore, both approaches are clinically appropriate. All patients who chose DNR for themselves and most patients who did not choose DNR for themselves chose DNR for the video patient. Age and race predicted DNR choice. PMID:23564395
Menger, Richard P; Storey, Christopher M; Guthikonda, Bharat; Missios, Symeon; Nanda, Anil; Cooper, John M
World War I catapulted the United States from traditional isolationism to international involvement in a major European conflict. Woodrow Wilson envisaged a permanent American imprint on democracy in world affairs through participation in the League of Nations. Amid these defining events, Wilson suffered a major ischemic stroke on October 2, 1919, which left him incapacitated. What was probably his fourth and most devastating stroke was diagnosed and treated by his friend and personal physician, Admiral Cary Grayson. Grayson, who had tremendous personal and professional loyalty to Wilson, kept the severity of the stroke hidden from Congress, the American people, and even the president himself. During a cabinet briefing, Grayson formally refused to sign a document of disability and was reluctant to address the subject of presidential succession. Wilson was essentially incapacitated and hemiplegic, yet he remained an active president and all messages were relayed directly through his wife, Edith. Patient-physician confidentiality superseded national security amid the backdrop of friendship and political power on the eve of a pivotal juncture in the history of American foreign policy. It was in part because of the absence of Woodrow Wilson's vocal and unwavering support that the United States did not join the League of Nations and distanced itself from the international stage. The League of Nations would later prove powerless without American support and was unable to thwart the rise and advance of Adolf Hitler. Only after World War II did the United States assume its global leadership role and realize Wilson's visionary, yet contentious, groundwork for a Pax Americana. The authors describe Woodrow Wilson's stroke, the historical implications of his health decline, and its impact on United States foreign policy.
Verella, J Tipan; Patek, Stephen D
Health care is a major component of the U.S. economy, and tremendous research and development efforts are directed toward new technologies in this arena. Unfortunately few tools exist for predicting outcomes associated with new medical products, including whether new technologies will find widespread use within the target population. Questions of technology adoption are rife within the diabetes technology community, and we particularly consider the long-term prognosis for continuous glucose monitoring (CGM) technology. We present an approach to the design and analysis of an agent model that describes the process of CGM adoption among patients with type 1 diabetes mellitus (T1DM), their physicians, and related stakeholders. We particularly focus on patient-physician interactions, with patients discovering CGM technology through word-of-mouth communication and through advertising, applying pressure to their physicians in the context of CGM device adoption, and physicians, concerned about liability, looking to peers for a general level of acceptance of the technology before recommending CGM to their patients. Repeated simulation trials of the agent-based model show that the adoption process reflects the heterogeneity of the adopting community. We also find that the effect of the interaction between patients and physicians is agents. Each physician, say colored by the nature of the environment as defined by the model parameters. We find that, by being able to represent the diverse perspectives of different types of stakeholders, agent-based models can offer useful insights into the adoption process. Models of this sort may eventually prove to be useful in helping physicians, other health care providers, patient advocacy groups, third party payers, and device manufacturers understand the impact of their decisions about new technologies. (c) 2009 Diabetes Technology Society.
Desthieux, Carole; Molto, Anna; Granger, Benjamin; Saraux, Alain; Fautrel, Bruno; Gossec, Laure
To assess patient-physician discordance in global assessment of disease activity in early axial spondyloarthritis (axSpA) over time and determinants of discordance. DESIR (Devenir des Spondyloarthropathies Indifférenciées Récentes) is a French, multicentre, longitudinal cohort of patients with early inflammatory back pain suggestive of axSpA. Patient global assessment (PGA) and physician global assessment (PhGA) were rated with a 0-10 numerical rating scale, every 6 months during 2 years then at 3 years. Discordance was defined by the absolute difference |PGA-PhGA|≥3 (range 0-10) and was analysed at each visit. Determinants of (PGA-PhGA) were assessed at the visit level by a generalised linear mixed model. A total of 702 patients were analysed at baseline (401 with complete data over 3 years): mean age 33.8±8.6 years, 379 (54.0%) female, mean symptom duration 18.1±10.5 months. Mean PGA values were always higher than mean PhGA values with a mean absolute difference of 1.8 points. At baseline, 202 (28.8%) patients had discordance mainly by PGA>PhGA; over 3 years the frequency of discordance was stable (range 25.5-28.8%). Discordance was not stable at the patient level, 118 (29.4%) patients were discordant once and 88 (22.0%) twice, and only 92 (22.9%) more than twice. Determinants of (PGA-PhGA) were spine pain (β=0.24, ppatient characteristic. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
reluctance to make use of medical support, as well as a higher personal disposition of being well-informed as a patient. Men may be more open toward the virtual patient-physician relationship. Conclusions Women have a stronger social motive for and experience greater enjoyment in health-related information searches, explained by social role interpretations, suggesting these needs should be met when offering health-related information on the Internet. This may be interesting for governmental bodies as well as for the insurance and the pharmaceutical industries. Furthermore, women may be more easily convinced by health awareness campaigns and are, therefore, the primary target group for them. Men are more open to engaging in a virtual relationship with the GP; therefore, they could be the primary target group for additional online services offered by GPs. There were several areas for GPs to reinforce the virtual patient-physician relationship: the fixing of personal appointments, referral to other doctors, writing prescriptions, and discussions of normal test results and doctor’s notes/certificates of health. PMID:26099325
Nie, Jing-Bao; Cheng, Yu; Zou, Xiang; Gong, Ni; Tucker, Joseph D; Wong, Bonnie; Kleinman, Arthur
To investigate the phenomenon of patient-physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust (particularly physicians' distrust of patients and their relatives) leads to increased levels of fear and self-protection by doctors which exacerbate difficulties in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism-the primacy of patient welfare-as well as the traditional Chinese ideal of "medicine as the art of humanity". Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures. © 2017 John Wiley & Sons Ltd.
Karmel, Tom; Woods, Davinia
Discussion about Australia's ageing population has focused on the importance of increasing labour force participation rates of older people. This paper examines the influence of education and training on the participation of older people in the labour market, and the pay-off of undertaking education and training as an older-person compared to…
The purpose of this study was to see whether differences emerge between older whites, older blacks, and older Mexican Americans in 12 measures of prayer. These measures assess four dimensions of prayer: The social context of prayer, interpersonal aspects of prayer, beliefs about how prayer operates, and the content or focus of prayers. Data from two nationwide surveys of older adults suggest that with respect to all four dimensions, the prayer lives of older whites appear be less developed than the prayer lives of older blacks and older Mexican Americans. In contrast, relatively few differences were found in the prayer lives of older African Americans and older Mexican Americans. The theoretical implications of these findings are discussed. PMID:22523464
This paper introduces parts of Jürgen Habermas' theory of communication in an attempt to understand how meaning is coded in patient-physician communication. By having a closer look at how patients and physicians make assertions with their utterances, light will be shed on difficult aspects of reaching understanding in the clinical encounter. Habermas' theory will be used to differentiate assertions into validity claims referring to truth, truthfulness and rightness. An analysis of hypothetical physician-replies to a patient suffering from back pains will substantiate the necessity for such a theory.
Ng, Brendan J; Le Couteur, David G; Hilmer, Sarah N
Benzodiazepines (BZDs; including the related Z-drugs) are frequently targets for deprescribing; long-term use in older people is harmful and often not beneficial. BZDs can result in significant harms, including falls, fractures, cognitive impairment, car crashes and a significant financial and legal burden to society. Deprescribing BZDs is problematic due to a complex interaction of drug, patient, physician and systematic barriers, including concern about a potentially distressing but rarely fatal withdrawal syndrome. Multiple studies have trialled interventions to deprescribe BZDs in older people and are discussed in this narrative review. Reported success rates of deprescribing BZD interventions range between 27 and 80%, and this variability can be attributed to heterogeneity of methodological approaches and limited generalisability to cognitively impaired patients. Interventions targeting the patient and/or carer include raising awareness (direct-to-consumer education, minimal interventions, and 'one-off' geriatrician counselling) and resourcing the patient (gradual dose reduction [GDR] with or without cognitive behavioural therapy, teaching relaxation techniques, and sleep hygiene). These are effective if the patient is motivated to cease and is not significantly cognitively impaired. Interventions targeted to physicians include prescribing interventions by audit, algorithm or medication review, and providing supervised GDR in combination with medication substitution. Pharmacists have less frequently been the targets for studies, but have key roles in several multifaceted interventions. Interventions are evaluated according to the Behaviour Change Wheel. Research supports trialling a stepwise approach in the cognitively intact older person, but having a low threshold to use less-consultative methods in patients with dementia. Several resources are available to support deprescribing of BZDs in clinical practice, including online protocols.
Ragnhild J. DAVIDSE
Next, based on the available literature, relevant ADAS are discussed in terms of their availability, their effects on safety and the willingness of older drivers to use and buy them. One of the conclusions is that only very few of the types of support that are thought to be most beneficial to the safety of older drivers are provided by the ADAS that are currently available.
Full Text Available A partir de uma revisão da literatura, busca-se discutir a relação médico-paciente, apresentando abordagens antropológicas e comunicacionais, vivências de médicos enquanto pacientes, concepções fundamentais da medicina que indicam a necessidade de humanização e algumas reflexões teórico-filosóficas, principalmente relacionadas a hermenêutica. Este panorama possibilita afirmar que já se observa uma série de possibilidades para execução das propostas de humanização da medicina a partir de bases teórico-filosóficas. Faz-se necessário sistematizá-las, publicá-las e avaliá-las.Based on a literature review, this article discusses the physician-patient relationship by presenting anthropological and communicational approaches, physicians' experiences as patients, key concepts showing the need for humanization of the patient-physician relationship, and some theoretical-philosophical reflections relating primarily to hermeneutics. Based on this framework, one can already identify a series of possibilities for implementing humanizing proposals. The challenge now is to classify, publish, and evaluate these proposals.
Volpe, Stella Lucia; Sukumar, Deeptha; Milliron, Brandy-Joe
The number of older adults living in the USA, 65 years of age and older, has been steadily increasing. Data from the National Health and Nutrition Examination Survey (NHANES), 2007-2010, indicate that more than one-third of older adults, 65 years of age and older, were obese. With the increased rate of obesity in older adults, the purpose of this paper is to present research on different methods to prevent or manage obesity in older adults, namely dietary interventions, physical activity interventions, and a combination of dietary and physical activity interventions. In addition, research on community assistance programs in the prevention of obesity with aging will be discussed. Finally, data on federal programs for older adults will also be presented.
Mar 8, 2010 ... as vaginal dryness and thinning, increase the risk of HIV infection through tears and abrasions during unprotected sex. .... size was required to obtain a two-sided 95% confidence .... patients about safer sex and disclosure?
Engler, Jennifer; Dahlhaus, Anne; Güthlin, Corina
Cancer screening participation rates in Germany differ depending on patients' gender. International studies have found that patient-physician gender concordance fosters recommendation and conducting of cancer screening, and especially cancer screening for women. We aimed to ascertain whether gender concordance influences general practitioners' (GPs') rating of the usefulness of cancer screening, as well as their recommendations and readiness to conduct cancer screening in general practice in Germany. For an exploratory cross-sectional survey, 500 randomly selected GPs from all over Germany were asked to fill in a questionnaire on cancer screening in general practice between March and June 2015. We asked them to rate the usefulness of each cancer screening examination, how frequently they recommended and conducted them and whether they viewed GPs or specialists as responsible for carrying them out. We used multiple logistic regression to analyse gender effect size by calculating odds ratios. Our study sample consisted of 139 GPs of which 65% were male. Male and female GPs did not differ significantly in their rating of the general usefulness of any of the specified cancer screening examinations. Male GPs were 2.9 to 6.8 times as likely to consider GPs responsible for recommending and conducting PSA testing and digital rectal examinations and were 3.7 to 7.9 times as likely to recommend and conduct these examinations on a regular basis. Patient-physician gender concordance made it more likely that male-specific cancer screenings would be recommended and conducted, but not female-specific screenings. [Box: see text].
Voruganti, Teja; Husain, Amna; Grunfeld, Eva; Webster, Fiona
In the advanced cancer context, care coordination is often inadequate, leading to suboptimal continuity of care. We evaluated an electronic web-based tool which assembles the patient, their caregivers, and their healthcare providers in a virtual space for team-based communication. We sought to understand participant perceptions on electronic communication in general and the added value of the new tool in particular. We conducted a qualitative descriptive study with participants (patients, caregivers, cancer physicians) who participated in a 3-month pilot trial evaluating the tool. Interviews were thematically analyzed and the perspectives from patients, caregivers, and cancer physicians were triangulated. Interviews from six patients, five of their caregivers, and seven cancer physicians conducted alongside monthly outcome assessments were analyzed. We identified five themes relating participants' perspectives on electronic communication to their experience of care: (1) apparent gaps in care, (2) uncertainty in defining the circle of care, (3) relational aspects of communication, (4) incongruence between technology and social norms of patient-physician communication, and (5) appreciation but apprehension about the team-based communication tool for improving the experience of care. The potential of tools for electronic communication to bring together a team of healthcare providers with the patient and caregivers is significant but may pose new challenges to existing team structure and interpersonal dynamics. Patients and physicians were worried about the impact that electronic communication may have on the patient-physician relationship. Implementation approaches, which build on the relationship and integrate the team as a whole, could positively position electronic communication to enhance the team-based care.
Full Text Available Spoken language is, arguably, the primary means by which teachers teach and students learn. Much of the literature on language in classrooms has focused on discussion that is seen as both a method of instruction and a curricular outcome. While much of the research on discussion has focused on K-12 classrooms, there is also a body of research examining the efficacy of discussion in postsecondary settings. This article provides a review of this literature in order to consider the effect of discussion on student learning in college and university classrooms, the prevalence of discussion in postsecondary settings, and the quality of discussion in these settings. In general, the results of research on the efficacy of discussion in postsecondary settings are mixed. More seriously, researchers have not been explicit about the meaning of discussion and much of what is called discussion in this body of research is merely recitation with minimal levels of student participation. Although the research on discussion in college and university classrooms is inconclusive, some implications can be drawn from this review of the research including the need for future researchers to clearly define what they mean by “discussion.”
Emotional personality/proximity versus emotional authenticity in patient-physician communication in healthy study participants, and in patients with benign breast disease, and breast cancer: a prospective case-control study in Finland.
Eskelinen, Matti; Korhonen, Riika; Selander, Tuomas; Ollonen, Paula
The associations between emotional personality, proximity and authenticity in patient-physician communication during breast cancer (BC) consultations are rarely considered together in a prospective study. We, therefore, investigated emotional personality/proximity versus authenticity in patient-physician communication in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC). In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated regarding emotional personality, proximity and authenticity in their a patient-physician communication before any diagnostic procedures were carried-out. The emotional personality and the emotional proximity in patient-physician communication was highly significantly positively correlated in the BBD group. The kappa-values for emotional personality versus emotional proximity in the HSS, BBD and BC groups were statistically significant. There was also a highly significant positive correlation between emotional personality and emotional authenticity in the HSS, BBD and BC groups and the kappa values in the HSS, BBD and BC groups were statistically significant. There was a highly significant positive correlation between emotional proximity and emotional authenticity in the BBD group, and the weighted kappa-values in the BBD group were statistically significant. The results of the present study support a powerful link between emotional personality/proximity and emotional authenticity, and provides new information in patient-physician communication in the HSS, BBD and BC groups. This finding is of clinical importance, since during breast disease consultation, barriers to patient-physician communication may be associated with difficulties in early BC diagnosis in the breast cancer diagnostic unit. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
Robert Joseph McKee
Full Text Available Classroom discussion has the potential to enhance the learning environment and encourages students to become active participants in the educational process. Student participation in classroom discussion has been shown to significantly improve the student learning experience. Research suggests that classroom discussion is an effective method for encouraging student classroom participation and for motivating student learning beyond the classroom. Participation in classroom discussion encourages students to become active collaborators in the learning process, while at the same time providing instructors with a practical method of assessing student learning. Classroom discussion is an effective tool for developing higher-level cognitive skills like critical thinking. Despite the potential discussion holds for student learning, many in academia lament the lack of participation in the classroom. The lack of student participation in classroom discussion is not a recent problem; it is one that has frustrated instructors for decades. Instructors report that some of the more current methods for encouraging classroom discussion can be exasperating and at times non-productive. This two-year study of 510 college and university students provides insight into the reasons why some students do not participate in classroom discussion. This study, which also elicited input from sixteen college and university professors and two high school teachers, offers some suggestions for creating and encouraging an environment conducive to student participation in the classroom.
Mohlman, Jan; Sirota, Karen Gainer; Papp, Laszlo A.; Staples, Alison M.; King, Arlene; Gorenstein, Ethan E.
Over the next few decades the older adult population will increase dramatically, and prevalence rates of psychiatric disorders are also expected to increase in the elderly cohort. These demographic projections highlight the need for diagnostic instruments and methods that are specifically tailored to older adults. The current paper discusses the…
Ellis, Robert A.; Calvo, Rafael; Levy, David; Tan, Kelvin
Students studying a third-year e-commerce subject experienced face-to-face and online discussions as an important part of their learning experience. The quality of the students' experiences of learning through those discussions is investigated in this study. This study uses qualitative approaches to investigate the variation in the students'…
Pruett, Diane Milhan, Ed.; And Others
Dance programs for older adults that encourage exercise and socializing are described in six articles. Program guidelines of the American Alliance Committee on Aging are explained, and other articles emphasize a movement education approach that may involve intergenerational contact. A dance program held in a worship setting is also discussed. (PP)
This podcast discusses the importance of older adults quitting smoking and other tobacco products. It is primarily targeted to public health and aging services professionals. Created: 10/27/2008 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 11/20/2008.
Wells, C.; Richards, K.M.; McKerrow, J.F.
This discussion session of the Landfill Gas-Energy and Environment 90 Conference covered the landfill gas potential, the setting up of the Non-Fossil Fuel Obligation; anticipated developments in the post 1998 period, the problem of smell for those who live near a landfill, and the length of time a landfill site is productive in terms of gas evolution. Relevant regulations in California are briefly discussed. (author)
A key aspect of the workshop was the interaction and exchange of ideas and information among the 40 participants. To facilitate this activity the workshop participants were divided into five discussions groups. These groups reviewed selected subjects and reported back to the main body with summaries of their considerations. Over the 3 days the 5 discussion groups were requested to focus on the following subjects: the characteristics and capabilities of 'good' organisations; how to ensure sufficient resources; how to ensure competence within the organisation; how to demonstrate organisational suitability; the regulatory oversight processes - including their strengths and weaknesses. A list of the related questions that were provided to the discussion groups can be found in Appendix 3. Also included in Appendix 3 are copies of the slides the groups prepared that summarised their considerations
Hennink, Monique M
The Understanding Research series focuses on the process of writing up social research. The series is broken down into three categories: Understanding Statistics, Understanding Measurement, and Understanding Qualitative Research. The books provide researchers with guides to understanding, writing, and evaluating social research. Each volume demonstrates how research should be represented, including how to write up the methodology as well as the research findings. Each volume also reviews how to appropriately evaluate published research. Focus Group Discussions addresses the challenges associated with conducting and writing focus group research. It provides detailed guidance on the practical and theoretical considerations in conducting focus group discussions including: designing the discussion guide, recruiting participants, training a field team, moderating techniques and ethical considerations. Monique Hennink describes how a methodology section is read and evaluated by others, such as journal reviewers or ...
The roundtable discussion began with remarks by the chairman who pointed out the complicated nature of plutonium chemistry. Judging from the papers presented at this symposium, he noticed a pattern which indicated to him the result of diminished funding for investigation of basic plutonium chemistry and funding focused on certain problem areas. Dr. G.L. silver pointed to plutonium chemists' erroneous use of a simplified summary equation involving the disproportionation of Pu(EV) and their each of appreciation of alpha coefficients. To his appreciation of alpha coefficients. To his charges, Dr. J.T. Bell spoke in defense of the chemists. This discussion was followed by W.W. Schulz's comments on the need for experimental work to determine solubility data for plutonium in its various oxidation states under geologic repository conditions. Discussion then turned to plutonium pyrachemical process with Dana C. Christensen as the main speaker. This paper presents edited versions of participants' written version
Treatment of the radioactive waste and utilisation of the ionisation radiation. Interesting contributions to two topics appeared in conference of Slovak Nuclear Society in Casta-Papiernicka in May 2012. The members from the female section 'Women in nuclear sector; were discussing in particular of the mind-set of Europeans to radioactive waste and novelties in nuclear medicine. (author)
This document provides summaries of the discussions occurred during the second international workshop on the indemnification of nuclear damage. It concerns the second accident scenario: a fire on board of a ship transporting enriched uranium hexafluoride along the Danube River. (A.L.B.)
Dobbs, David; Murray-Rust, Peter; Hatcher, Jordan; Pollock, Rufus
David Dobbs writes on science, medicine and culture. He has contributed to a diversity of publications, including Scientific American, Slate magazine, Wired, Audubon, Atlantic Monthly, and the New York Times magazine. He has also authored a number of books. Other participants in this discussion were Peter Murray-Rust, Jordan Hatcher, and Rufus Pollock.
Hetherington, E. Mavis
Summarizes and discusses results of the longitudinal study that comprises this monograph issue. Results concern: (1) marital, parent-child, and sibling relationships in families with single and remarried mothers; (2) the relationship between parenting style and adolescent adjustment; and (3) the relationship between marital transitions and…
Jeliazkova, Margarita I.
Discussing, deliberating and debating are a core part of any democratic process. To organise these processes well, a great deal of knowledge and skill is required. It is not simple to find a good balance between a number of elements: appropriate language and terminology; paying attention to solid
Vallas, A. [Sempra Energy Trading, Toronto, ON (Canada); Vegh, G. [MacLeod Dixon, Toronto, ON (Canada); McGee, M. [Energy Profiles Ltd., Etobicoke, ON (Canada); Zaremba, T. [Direct Energy Marketing, Calgary, AB (Canada); Seshan, A. [Larson and Toubro Information Technology, Toronto, ON (Canada); Harricks, P. [Gowlings, Toronto, ON (Canada); Bertoldi, L. [Borden Ladner Gervais, Toronto, ON (Canada); Taylor, R. [Hydro One Networks Inc., Markham, ON (Canada)
This session presented highlights of the comments of 8 panelists who discussed the issue of contract design. The new electricity market in Ontario has introduced the energy trader, who enters into a contract with the consumer, based on the spot price set by the Independent Electricity Market Operator. Every contract has a fixed price payer as well as floating-price payers. If the floating price for a given amount of energy is higher than the fixed price, then the consumer gets the difference. Confusion, however, arises with the purchase of retail physical power in the market, particularly in deciding a fixed rate that the consumer will be paying. Different billing options were also discussed with emphasis on mid to large retail customers that have portfolios in the tens of MW and up to 100 MW or more. figs.
Vallas, A.; Vegh, G.; McGee, M.; Zaremba, T.; Seshan, A.; Harricks, P.; Bertoldi, L.; Taylor, R.
This session presented highlights of the comments of 8 panelists who discussed the issue of contract design. The new electricity market in Ontario has introduced the energy trader, who enters into a contract with the consumer, based on the spot price set by the Independent Electricity Market Operator. Every contract has a fixed price payer as well as floating-price payers. If the floating price for a given amount of energy is higher than the fixed price, then the consumer gets the difference. Confusion, however, arises with the purchase of retail physical power in the market, particularly in deciding a fixed rate that the consumer will be paying. Different billing options were also discussed with emphasis on mid to large retail customers that have portfolios in the tens of MW and up to 100 MW or more. figs
Please note that the Discussion with CERN Directorate will be transmitted also in the following rooms: Council Chamber - 503-1-001 IT Amphitheatre - 31-3-004 Prevessin 774-R-013 Simultaneous interpreting into French and English will be available in the Main Auditorium. Une interprétation simultanée en français et en anglais sera disponible dans l'amphithéâtre principal.
Ybema,J.F.; Giesen, F.
Due to an ageing population and global economic competition, there is a societal need for people to extend their working lives while maintaining high work productivity. This article presents an overview of the labour participation, job performance, and job characteristics of older workers in the
Full Text Available The authors and participants of the project and the expert community analyze the problems related to the realization of a big-scale concept of renovation of the historical center “Irkutsk Quarters”. They discuss preservation of wooden architecture of the city, changes in social functions of the territory, inclusion of the new facilities in the fabric of the area, as well as the problems of the territory’s tourist function and preservation of the identity of Irkutsk downtown.
The panel discussion opened with a question concerning whether true quantification of myocardial sympathetic presynaptic function or receptor density can be obtained with currently available radiopharmaceuticals. What are the relative advantages of the two general approaches that have been proposed for quantification: (1) The assessment of tracer distribution volume in tissue following bolus injection and (2) quantification based on tracer displacement kinetics following administration of excess unlabeled tracer. It was pointed out that tracer kinetics for the delineation of presynaptic and postsynaptic binding sites by radiopharmaceuticals or radiolabeled receptor antagonists are rather complex, reflecting several physiologic processes that are difficult to separate. Several approaches were examined. The possibility of regional definition of receptor density by PET was questioned and it was noted that regions of interest can be applied to calculate regional receptor kinetics. However, due to the limited spatial resolution of PET, only average transmural values can be determined. The discussion then turned to the discrepancy between the known sparse parasympathetic innervation of the heart and the high density of muscarinic receptors observed with PET. Experiences with MIBG imaging were reported, including uptake in the transplanted heart and interaction of drugs with MIBG uptake
The concept of 'empowerment' is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions are discussed in the paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one's quality of life, and empowerment as a process is to create a professional relation where the client or community takes control over the change process, determining both the goals of this process and the means to use.
Full Text Available The purpose of this study is to confront certain propositions presented in Lesław Niemczyk’s publication Rachunkowość finansowa aktywów kompetencyjnych i kapitału intelektualnego. Nowy dział rachunkowości(Accounting for Competence Assets and Intellectual Capital. A New Area in Accounting with ideas published in other studies. The authors discuss issues concerning firm value, selected definitions of intellectual capital, as well as certain methods of intellectual capital measurement and valuation. Other problems analysed include accounting for and reporting of intellectual capital and similarities and differences between the way those issues are presented in Polish and in international studies as well as in existing legal regulations and standards.
The author deals with the experimental study of sorption, desorption and vertical migration of radionuclides in Sr-85 and Cs-137 in selected soil samples from around of NPP Bohunice and NPP Mochovce and other localities of the Slovakia. The influence of different materials [concurrent ions (K + , Ca 2+ , NH 4 + , pH), organic matter (peat) and zeolite, humidity] on kinetic of sorption and desorption of strontium and cesium as well as distribution coefficient (K D ) and transfer coefficients in followed samples of soils were followed. Obtained adsorption isotherm are presented and discussed. Using the Tessiere's sequential extraction analysis a gross variability in binding of radionuclides on soils was found. The obtained results were processed with the correlation analysis and the compartment model
Miller, Hayley J
Dehydration affects 20% to 30% of older adults. It has a greater negative outcome in this population than in younger adults and increases mortality, morbidity, and disability. Dehydration is often caused by water deprivation in older adults, although excess water loss may also be a cause. Traditional markers for dehydration do not take into consideration many of the physiological differences present in older adults. Clinical assessment of dehydration in older adults poses different findings, yet is not always diagnostic. Treatment of dehydration should focus on prevention and early diagnosis before it negatively effects health and gives rise to comorbidities. The current article discusses what has most thoroughly been studied; the best strategies and assessment tools for evaluation, diagnosis, and treatment of dehydration in older adults; and what needs to be researched further. [Journal of Gerontological Nursing, 41(9), 8-13.]. Copyright 2015, SLACK Incorporated.
Rapporteur, chose to highlight other themes and issues from the seminar that appeared to be: - important for successful D and D; - worth further work in an international context; - controversial and worthy of further debate. The five main themes selected were as follows: - stakeholder involvement and communication; - strategy selection; - waste management and clearance; - funding and costs; - satisfying social demands. Various issues were identified under each one of these five themes and, in order to make best use of the time available for discussion, participants were invited to vote on the issues of most importance to them. Subsequent discussion was then focussed on the issues so identified. (author)
Pelland, Kimberly D; Baier, Rosa R; Gardner, Rebekah L
nBACKGROUND: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters. To describe hospital-based physicians' perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians' perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. The survey's response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.
Kimberly D Pelland
Full Text Available Background: Electronic health records (EHRs may reduce medical errors and improve care, but can complicate clinical encounters. Objective: To describe hospital-based physicians’ perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians’ perceptions Methods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. Results: The survey’s response rate was 68.3% and 2,236 (87.1% respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. Conclusion: In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.
In recognition of the potential benefits of ethanol and the merits of encouraging value-added agricultural development, a committee was formed to develop options for the role of the Ontario Ministry of Agriculture and Food in the further development of the ethanol industry in Ontario. A consultation with interested parties produced a discussion paper which begins with an outline of the role of ethanol as an alternative fuel. Ethanol issues which require industry consideration are presented, including the function of ethanol as a gasoline oxygenate or octane enhancer, environmental impacts, energy impacts, agricultural impacts, trade and fiscal implications, and regulation. The ethanol industry and distribution systems in Ontario are then described. The current industry consists of one ethanol plant and over 30 retail stations. The key issue for expanding the industry is the economics of producing ethanol. At present, production of ethanol in the short term depends on tax incentives amounting to 23.2 cents/l. In the longer term, a significant reduction in feedstock costs and a significant improvement in processing technology, or equally significant gasoline price increases, will be needed to create a sustainable ethanol industry that does not need incentives. Possible roles for the Ministry are identified, such as support for ethanol research and development, financial support for construction of ethanol plants, and active encouragement of market demand for ethanol-blended gasolines
The positive energy projection operators, just described by Prof. Sucher, convert the sick Hamiltonian, H/sub DC/, into a more robust one which can support bound states. They are however still a subject of some controversy. Prof. Grant pointed out that existing computer codes produce remarkable accuracy in numerical calculations which start from H/sub DC/ (with no projection operators) and so he questioned whether these operators were indeed necessary. In response, it was pointed out by several people in the audience that the codes implicitly limit the Dirac-Hartee-Fock wave functions to a normalizable sub-space and that this operation can be described as a projection operator which has the effect of eliminating the negative energy states which are not normalizable. This operation is however, not any of the three projection operators described by Sucher and so the question arises as to the sensitivity of the results (for the energy and wave functions) to the particular projection operators which are used. This appears to be an open question
Braun, Judith Venglarik; And Others
Discusses how the concept of failure to thrive can be borrowed from pediatrics and redefined for use in caring for older persons, especially institutionalized older persons. Examines issues of undernutrition, declining physical and cognitive functioning, and depression. (Author/ABL)
... here Home » Depression In Older Adults: More Facts Depression In Older Adults: More Facts Depression affects more ... combination of both.  Older Adult Attitudes Toward Depression: According to a Mental Health America survey  ...
... Home > Navigating Cancer Care > For Older Adults For Older Adults A full-text transcript is available. More than ... Advanced Cancer For Children For Teens For Young Adults For Older Adults Aging and Cancer Cancer Care Decisions for ...
... Other Psychiatric Disorders Other Substance Abuse HIV/AIDS Older Adults A national 2008 survey found that about 40 ... of adults ages 65 and older drink alcohol. Older adults can experience a variety of problems from drinking ...
Labrador Barba E
Full Text Available Elena Labrador Barba,1 Marta Rodríguez de Miguel,1 Antonio Hernández-Mijares,2,3 Francisco Javier Alonso-Moreno,4 Maria Luisa Orera Peña,1 Susana Aceituno,5 María José Faus Dader6 1Department of Medicine, Mylan, Madrid, 2Department of Endocrinology and Nutrition, Doctor Peset University Hospital, Valencia, 3Department of Medicine, University of Valencia, Valencia, 4Department for Primary Health Care, Centro de Salud Sillería, Toledo, 5Outcomes’10, Castellon, 6Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, University of Granada, Granada, Spain Objective: A good relationship between diabetes patients and their health care team is crucial to ensure patients’ medication adherence and self-management. To this end, we aimed to identify and compare the views of type 2 diabetes mellitus (T2DM patients, physicians and pharmacists concerning the factors and strategies that may be associated with, or could improve, medication adherence and persistence.Methods: An observational, cross-sectional study was conducted using an electronic self-administered questionnaire comprising 11 questions (5-point Likert scale concerning factors and strategies related to medication adherence. The survey was designed for T2DM patients and Spanish National Health System professionals.Results: A total of 963 T2DM patients, 998 physicians and 419 pharmacists participated in the study. Overall, a lower proportion of pharmacists considered the proposed factors associated with medication adherence important as compared to patients and physicians. It should be noted that a higher percentage of physicians in comparison to pharmacists perceived that “complexity of medication” (97% vs 76.6%, respectively and “adverse events” (97.5% vs 72.2%, respectively were important medication-related factors affecting adherence. In addition, both patients (80.8% and physicians (80.8% agreed on the importance of “cost and co-payment” for adherence
Taras, Loretta; Stavroulakis, Anthea M.; Ortiz, Mary T.
Describes experiences with holding discussions on cloning at a variety of levels in undergraduate biology courses. Discusses teaching methods used and student reactions to the discussions. Contains 12 references. (WRM)
Singer, Jefferson; Rexhaj, Blerim; Baddeley, Jenna
The present study compared self-defining memories in adults 50 years of age and older to the self-defining memories of college students. Findings are largely congruent with previous memory and ageing research, but shed additional light on how personal memories are employed to achieve a sense of identity and continuity in older adults. Older adults' self-defining memories, compared to those of younger adults, were more positive in emotional tone, more summarised and less detailed, and more likely to contain integrative meaning. The implications of these findings for assessing normative personal memory in older adults are discussed along with more general observations about narrative identity in older adulthood.
President's Council on Physical Fitness and Sports, Washington, DC.
Collected here are fourteen statements on the beneficial effects of physical fitness programs for older persons presented at hearings before the Subcommittee on Aging of the Committee on Labor and Public Welfare, U.S. Senate. Areas discussed include: What research tells us regarding the contribution of exercise to the health of older people;…
Institute of Lifetime Learning, Washington, DC.
This pamphlet describes some of the employment opportunities available to older adults and discusses procedures for obtaining the training for, and actually beginning, a second career. Covered in the individual sections of the brochure are the following topics: characteristics and attitudes of older workers, long-range planning, employment…
Tracy, Bridget; Sean Morrison, R
Chronic pain is prevalent among older adults but is underrecognized and undertreated. The approach to pain assessment and management in older adults requires an understanding of the physiology of aging, validated assessment tools, and common pain presentations among older adults. To identify the overall principles of pain management in older adults with a specific focus on common painful conditions and approaches to pharmacologic treatment. We searched PubMed for common pain presentations in older adults with heart failure, end-stage renal disease, dementia, frailty, and cancer. We also reviewed guidelines for pain management. Our review encompassed 2 guidelines, 10 original studies, and 22 review articles published from 2000 to the present. This review does not discuss nonpharmacologic treatments of pain. Clinical guidelines support the use of opioids in persistent nonmalignant pain. Opioids should be used in patients with moderate or severe pain or pain not otherwise controlled but with careful attention to potential toxic effects and half-life. In addition, clinical practice guidelines recommend use of oral nonsteroidal anti-inflammatory drugs with extreme caution and for defined, limited periods. An understanding of the basics of pain pathophysiology, assessment, pharmacologic management, and a familiarity with common pain presentations will allow clinicians to effectively manage pain for older adults. © 2013 Elsevier HS Journals, Inc. All rights reserved.
In this podcast, Dr. Lynda Anderson, former Director of CDCâs Healthy Aging Program, discusses the importance of improving health literacy among older adults. Created: 9/20/2011 by Office of the Associate Director for Communication (OADC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 9/20/2011.
This podcast discusses the importance of older adults maintaing good oral health habits. It is primarily targeted to public health and aging services professionals. Created: 10/27/2008 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 10/27/2008.
Sexuality is an important part of a person's life continuing into older age. Physiologic changes that occur with aging can affect sexual function and may be exacerbated by comorbid disease. To diagnose sexual dysfunction, providers must obtain a thorough history and physical examination, including psychosocial factors. The causes of sexual dysfunction along with patient preferences within the patient's social system serve as the foundation for developing person-centered strategies to address these concerns. To improve care of older adults with sexual concerns, providers should initiate discussions with, listen to, and work with patients to create a comprehensive management plan. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available The discussion is focused on various aspects of interrelations between East and West. Its participants discuss the problems of the increasing tourist flows from China and the specific characteristics of Chinese tourists. The future development of tourism in the Baikal region is formulated, and the peculiarities of ethno tourism and its prospects are discussed.
Møller, Margrethe Hansen
Based on experience from the research project “User Manuals for Older Adults”, this paper discusses whether there are special ethical concerns with older adults as test persons in a usability test involving the think-aloud method. In this context, older adults are defined as individuals with normal...
Chesser, Amy K.; Keene Woods, Nikki; Smothers, Kyle; Rogers, Nicole
Objective: The objective of this review was to assess published literature relating to health literacy and older adults. Method: The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Results: Eight articles met inclusion criteria. All studies were conducted in urban settings in the United States. Study sample size ranged from 33 to 3,000 participants. Two studies evaluated health-related outcomes and reported significant associations between low health literacy and poorer health outcomes. Two other studies investigated the impact of health literacy on medication management, reporting mixed findings. Discussion: The findings of this review highlight the importance of working to improve health care strategies for older adults with low health literacy and highlight the need for a standardized and validated clinical health literacy screening tool for older adults. PMID:28138488
Haws, E.; Matthews, M.E.; Wilson, E.M.; Charles-Jones, S.; Allen, R.F.; Young, R.M.; O'Connor, B.
The discussion covered the following topics: the nature of boulder clay for foundations; navigation through the barrage; the construction of sluice caissons; government subsidies for construction costs; the effect of wave action on river banks; allowances for reflected energy in hydrodynamic models; water quality in impounded pools; sediment deposition. Separate abstracts have been prepared for the three papers under discussion. (UK)
Soleti, Emanuela; Wright, Daniel B; Curci, Antonietta
People often discuss events they have seen and these discussions can influence later recollections. We investigated the effects of factual, emotional, and free retelling discussion on memory recollections of individuals who have witnessed an event. Participants were shown a video, made an initial individual recall, participated in one of the three retelling conditions (emotional versus factual versus free) or a control condition, and then recalled the event individually again. Participants in the factual and free retelling conditions reported more items not previously recalled than participants in the control condition did, while the emotional condition did not show the same advantage. Participants in all three retelling conditions failed to report more previously recalled items as compared with the control condition. Finally, a memory conformity effect was observed for all three retelling conditions. These findings suggest that eyewitnesses' discussions may influence the accuracy of subsequent memory reports, especially when these discussions are focused on emotional details and thoughts.
Research has demonstrated that older drivers pose a higher risk of involvement in fatal crashes at intersections than : younger drivers. Age-triggered restrictions are problematic as research shows that the majority of older people : have unimpaired ...
Full Text Available The article analyzes the phenomenon of the demographic ageing of the population and educational opportunities for older adults in Lithuania. Ageing population is a natural outcome of demographic evolution of society. However, a growing number of older people in Lithuania as well as in other European countries requires continuous revision of societal resources in social security, economics, education, health care areas and their adjustment to the new demands. Though current discussion in Lithuania highlights the inclusion of older adults into active social life through educational activities, the studies in diverse areas show that a small number of older people take part in lifelong learning. For this reason and in the attempt to make older people feel satisfaction with life it is necessary to encourage their activity, to promote their social roles, to give them opportunities to take up voluntary tasks, educational and cultural functions and study new subjects.
Presents activities with 10- and 4-straw flexigons, an object created by stringing together lengths of plastic drinking straws with nylon fishing line. Discusses several geometric theorems that can be demonstrated with flexigons. (MKR)
Page 1. Description: Lunch to discuss IDRC's programming. Date: 2017-02-10. Attendees: 2 (IDRC 1). Location: Ottawa. Total: $79.92. Comments: 2016-2017 Hospitality Expense. Reports for Jean Lebel, President.
The LGBT+ Physicists group welcomes those who identify as gender sexual minorities, as LGBTQQIAAP+, or as allies to participate in a round-table discussion on mentoring physicists. The session will provide an opportunity to learn and discuss successful mentoring strategies at different career stages for physicists in all environments, including academia, industry, etc. Attendees are encouraged to attend a social event to follow the panel to continue to network. Allies are especially welcome at this event to learn how to support and mentor LGBT+ physicists.
Strongman, C.P.; Jones, R.; Moorhead, H.
The topics raised in discussion included: the performance of the generator sets; the movement of sediments and the effect on beach levels; monitoring near-bed sediments; the erosion of barrage materials by suspended solids; sediment transport models; the accuracy of hydrographic and other surveys; the relative ornithological importance of the estuary with respect to others in the United Kingdom. Separate abstracts were prepared for each of the three papers under discussion. (UK)
Doolittle, Peter; Hart, Heath; Hartman, Greg; Seyam, Mohammed; Walz, Anita R.
Introduction by Julie Speer, Associate Dean for Research & Informatics. Open remarks by Anita Walz, Assessment, Open Education & Online Learning Environments Librarian. Mohammed Seyam discusses the value of openly licensed material as a student, research, and graduate assistant. Heath Hart reflects on his adoption of an open educational resource and a (subscribed) online textbook in, “A Rousing Success and an Unmitigated Disaster.” Greg Hartman discusses his experiences authoring open-source ...
Walker, R.; Wilson, E.A.; Gibson, P.
Questions raised in the discussion are reported. These concerned: the Treasury discount rate for the construction of such a project; the CO 2 benefits of tidal schemes in developing countries; the criteria for deciding the total installed capacity of the scheme; the Government review of the cost-benefit analysis; the benefit arising from the elimination of nitrogen and sulphur oxides; security of supply; carbon tax projections. The only response reported is on the question of criteria for deciding the total installed capacity. Separate abstracts have been prepared on the three papers under discussion. (UK)
Wennberg, Alexandra M.; Canham, Sarah L.; Smith, Michael T.; Spira, Adam P.
As the world’s population ages, the elevated prevalence of insomnia in older adults is a growing concern. Insomnia is characterized by difficulty falling or remaining asleep, or by non-restorative sleep, and resultant daytime dysfunction. In addition to being at elevated risk for primary insomnia, older adults are at greater risk for comorbid insomnia, which results from, or occurs in conjunction with another medical or psychiatric condition. In this review, we discuss normal changes in sleep...
A A Abbasova
Full Text Available The article is devoted to the importance of selecting the optimal methods of stimulation and motivation for learning. In modern conditions it is very important that the teacher did not give the students ready knowledge, but pointed out the way for the acquisition of knowledge, taught them to gain knowledge. This demands from the philologist the choice of effective forms of working with texts of different types and styles of speech, listening, speaking. In this connection a special attention should be paid to the lessons of speech development. There is a special group of methods to stimulate the development of communicative competence. Among them, the method of discussion, which is increasingly being used during the Russian language lessons. The specificity of using this method in class for teaching Russian as a foreign language, its basic functions (teaching, developing, educating are considered. The key rules for conducting a discussion at the Russian language classes, the main and additional functions-roles of the teacher, the participants, the minute-taker are analyzed. The advantages of the discussion in Russian in comparison to the discussion in the students’ native language are summarized.
Fundamentals, objectives and parameters of feasibility studies in the field of nuclear power project planning are discussed in a general way. Technical and economic problems to be considered are pointed out. In special cases, IAEA offers its aid and support. (UA) [de
One way teachers can disrupt inequities is by doing the work to foster discussions in which students talk about race--and racism--honestly together. Teachers also need to be ready to talk with students sensitively when the subject of race comes up spontaneously--in a student's work, connected to events outside school, or in response to a…
Academic corruption is a commonplace matter about which all people are clearly aware. However, people often overlook many hidden or latent manifestations of academic corruption. This article discusses eight of these manifestations: indiscriminate use of the academic team spirit, the proliferation of "word games," deliberate attacks on…
Kanselaar, G.; Veerman, A.L.; Andriessen, J.E.B.
This article reports a study examining university student pairs carrying out an electronic discussion task in a synchronous computer mediated communication (CMC) system (NetMeeting). The purpose of the assignment was to raise students' awareness concerning conceptions that characterise effective
Raywid, Mary Anne
Examining the contemporary school choice debate yields arguments that are education, economics, governance, and policy driven. To "break the exclusive franchise," school districts are increasingly sponsoring school operation and education services supplied by multiple sources, and states are discussing sponsorship of schools by entities…
Prieler, Michael; Ivanov, Alex; Hagiwara, Shigeru
In this study, 432 television advertisements from Hong Kong, Japan, and South Korea were analyzed to determine their representations of older people. Findings demonstrate that in East Asian advertisements, older people are highly underrepresented, appear in major roles, mostly alongside younger people, and older men clearly outnumber older women. The other variables investigated (i.e., setting and product categories) led to no conclusive findings for the three societies. In short, our study, employing ethnolinguistic vitality theory to analyze television advertisements, demonstrates how East Asian societies greatly marginalize older people. Potential effects of such representations are discussed using social cognitive theory and cultivation theory.
Charles-Jones, S.; Muirhead, S.; Wilson, E.A.; Jefferson, M.; Binnie, C.J.A.; O'Connor, B.A.; Rothwell, P.; Cowie, D.
Further observations were made on the great potential for tidal power developments in NW Australia. Discussion on the Severn Barrage paper and environmental effects of tidal power plants centred mainly around the impact on bird populations. The topics covered were: the adaptability of birds to changes in their environment with particular reference to the importance of inter-tidal areas for wildfowl and wading birds in the United Kingdom; the creation of mudflats as replacement feeding areas for wading birds; whether there is a danger that pressure from the construction industry might result in a barrage being built before the uncertainties in the environmental impact assessment are removed. Separate abstracts have been prepared for the three papers under discussion. (UK)
In December 2007, the Forum on Stakeholder Confidence discussed its theme entitled 'Link between research, development and demonstration (RD and D) and stakeholder confidence'. It was remarked that regulators need a technical demonstration to aid in evaluating the safety case. Local stakeholders appreciate the opportunity to visualise technological arrangements. In both cases, demonstration adds to confidence in the feasibility of solutions. Some believe there is an important role for analogues in communication with stakeholders, if handled with integrity. To explore and benchmark current practices, it was decided to hold a topical session at the 9. regular meeting of the FSC on 4 June 2008 regarding the use of analogues for confidence building. The session opened with an introductory presentation by the session rapporteur. This incorporated input provided for the purpose by FSC members in cooperation with their country's representative to the NEA RWMC 'Integration Group on the Safety Case'. Three speakers then presented the various uses of analogues by implementers, regulators and scientists to build their own confidence; a fourth speaker dealt with the experience of using natural analogues in public information. The presentations addressed the use of analogues in the field of geological disposal of high-level waste (HLW) and long-lived intermediate level (ILW-LL) radioactive waste. Then the FSC participants split into two working groups for discussion. The outcome of these discussions was reported in plenary on 6 June 2008 and it was agreed to publish proceedings of the session. The present summary, prepared by the session rapporteur with input from the NEA Secretariat, captures the main points heard in the course of the event. It combines data from the formal presentations and remarks made in discussion. The latter represent viewpoints expressed by a group whose primary focus is not natural analogues but rather stakeholder interests. The summary and viewpoints
Berger, H.; Motz, J.W.
Since radiography yields an image that can be easily related to the tested object, it is superior to many nondestructive testing techniques in revealing the size, shape, and location of certain types of discontinuities. The discussion is limited to a description of the radiographic process, examination of some of the quantitative aspects of radiography, and an outline of some of the new ideas emerging in radiography. The advantages of monoenergetic x-ray radiography and neutron radiography are noted
Leath, Audrey T.
The United Nations Conference on Environment and Development, the “Earth Summit,” convenes in Rio de Janeiro on June 3. President Bush has pledged to attend part of the 2-week conference. The highlight of the summit will be the signing of an international framework convention to reduce emissions of greenhouse gases. The final elements of the agreement were negotiated in New York last week by representative of 143 countries. In anticipation of the Rio conference, the Senate Committee on Energy and Natural Resources held two standing-roomonly hearings, reviewing the scientific basis for global warming due to greenhouse gases and discussing the details of the proposed convention.
Dybiec, Bartlomiej; Mitarai, Namiko; Sneppen, Kim
Agents building social systems are characterized by complex states, and interactions among individuals can align their opinions. The Axelrod model describes how local interactions can result in emergence of cultural domains. We propose two variants of the Axelrod model where local consensus is reached either by listening and accepting one of neighbors' opinion or two agents discuss their opinion and achieve an agreement with mixed opinions. We show that the local agreement rule affects the character of the transition between the single culture and the multiculture regimes.
Full Text Available This article is about how to the importance of selecting the optimal methods of stimulation and motivation to learn. In modern conditions it is very important that the teacher gave the students ready knowledge, and pointed the way for the acquisition of knowledge, taught to acquire knowledge. This requires the selection of effective forms of language and literature work with texts of different types and styles of speech, listening, speaking. In this regard, special attention should be given lessons of speech development. There is a special group of methods to stimulate the development of communicative competence. Among them, and the method of discussion, which is increasingly being used in the classroom in the Russian language
In the first part, economic prospects in the world and in the European Community and their repercussions on energy demand are examined. Supply structure and growth scenari are outlined. Present and potential contribution of nuclear energy to energy supply is developed. The pros and cons are given. In the second part is examined how the production and use of various form of energy including nuclear energy, can affect health and the environment, with special reference to waste of all kinds. Safety problems and risk of accidents are examined in both non nuclear and nuclear sectors. Prospects for a low energy society and economic and social implications of the use of new forms of energy are also discussed
With the goal of discussing how epigenetic control and chromatin remodeling contribute to the various processes that lead to cellular plasticity and disease, this symposium marks the collaboration between the Institut National de la Santé et de la Recherche Médicale (INSERM) in France and the University of California, Irvine (UCI). Organized by Paolo Sassone-Corsi (UCI) and held at the Beckman Center of the National Academy of Sciences at the UCI campus December 15–16, 2011, this was the first of a series of international conferences on epigenetics dedicated to the scientific community in Southern California. The meeting also served as the official kick off for the newly formed Center for Epigenetics and Metabolism at the School of Medicine, UCI (http://cem.igb.uci.edu). PMID:22414797
Jespersen, Per Homann; Jensen, Anne; Stroschein, Christoph
The regions and cities in the COINCO-corridor Oslo-Göteborg-Malmö-Copenhagen-Berlin have worked out a strategy proposal which is presented in this discussion paper. Behind the strategy is a political will to utilize mutual strengths and together become a leading player in a globalized world, based...... on matters essential to development - ‘hard' issues such as transport infrastructure and ‘soft' issues on improving cooperation within business, administration and knowledge production. The synergy of COINCO will have to come from collaboration among businesses. Supporting cooperation between existing...... to be institutionally supported. Therefore a number of knowledge institutions have to be formed organized around the ‘triple helix'-principle - a tight collaboration between business, administration and knowledge producers, especially universities. Also new ways of collaboration have to be explored - ‘network...
Yancura, Loriena A; Aldwin, Carolyn M
Although coping has been shown to influence physical health in younger populations, whether coping affects health in older adults appears to depend upon how coping and health are conceptualized. This article reviews recent literature on coping and health in older adults in three areas. First, we discuss coping's distinct relevance to health in older adults. Second, we describe ways in which coping may differ between older and younger populations. Third, we detail recent and notable findings of coping's specific effects on biomedical health and health in general. The recent literature suggests that coping may be a developmental and multifaceted process. Positive coping strategies may have positive and even protective effects on health, whereas negative strategies may have negative effects.
Hakamies-Blomqvist, L. Sirén, A. & Davidse, R.J.
The proportion of senior citizens (aged 65+) will grow from about 15 per cent in the year 2000 to about 30 per cent in the year 2050. The share of older drivers in the driver population will grow even faster because of increasing licensing rates among the ageing population. Older drivers do not have
Nielsen, Dorthe Susanne; Minet, Lisbeth; Zeraiq, Lina
, Lost in language barriers and Having a national sense of belonging. The main findings emphasise the vulnerability of older migrants in a resettlement country. With an unclear national identity and without the local language, older migrants struggle to develop a clear vision of their role in a minority...
Council of Europe, Strasbourg (France).
The following papers were prepared for a seminar on sport for older people: (1) "Gerontological Aspects of Physical Exercise" (Eino Heikkinen); (2) "Sporting Activities in the Individual Life from the View of Older Persons" (Henning Allmer); (3) "Reasons Why Decision-Makers Should Urge Old People to Practise Physical and Sporting Activities"…
Balatsky, Galya I [Los Alamos National Laboratory; Severe, William R [Los Alamos National Laboratory; Wallace, Richard K [Los Alamos National Laboratory
The Illicit nuclear trafficking panel was conducted at the 4th Annual INMM workshop on Reducing the Risk from Radioactive and Nuclear Materials on February 2-3, 2010 in Washington DC. While the workshop occurred prior to the Nuclear Security Summit, April 12-13 2010 in Washington DC, some of the summit issues were raised during the workshop. The Communique of the Washington Nuclear Security Summit stated that 'Nuclear terrorism is one of the most challenging threats to international security, and strong nuclear security measures are the most effective means to prevent terrorists, criminals, or other unauthorized actors from acquiring nuclear materials.' The Illicit Trafficking panel is one means to strengthen nuclear security and cooperation at bilateral, regional and multilateral levels. Such a panel promotes nuclear security culture through technology development, human resources development, education and training. It is a tool which stresses the importance of international cooperation and coordination of assistance to improve efforts to prevent and respond to incidents of illicit nuclear trafficking. Illicit trafficking panel included representatives from US government, an international organization (IAEA), private industry and a non-governmental organization to discuss illicit nuclear trafficking issues. The focus of discussions was on best practices and challenges for addressing illicit nuclear trafficking. Terrorism connection. Workshop discussions pointed out the identification of terrorist connections with several trafficking incidents. Several trafficking cases involved real buyers (as opposed to undercover law enforcement agents) and there have been reports identifying individuals associated with terrorist organizations as prospective plutonium buyers. Some specific groups have been identified that consistently search for materials to buy on the black market, but no criminal groups were identified that specialize in nuclear materials or isotope
Older motorcyclists are under-recognised as vulnerable road users. Using Irish data from the Central Statistics Office, the Road Safety Authority and the Healthcare Pricing Office, we explored the trend of ageing riders and factors in older motorcyclist collisions and injuries. In 2005, 17 motorcyclists ≥55 were injured compared to 31 in 2012. Motorcyclists aged between 30 and 49 years and ≥50 have longer lengths of stay compared to riders <30. The percentage of motorcycles with an engine capacity of ≥750cc increased from 39.6% in 2007 to 46.7% in 2015. Older motorcyclists are less likely to be fatally injured in single vehicle collisions. Older motorcyclists are generally safer than younger riders but the proportion of older motorcyclist injury is rising. Irish road safety strategies and trauma services need to incorporate these findings into planning and development of preventive and treatment approaches
Hogg, Peter; Hogg, Dianne; Henwood, Suzanne
Effective leadership can be defined in many ways and is an essential element of successful organisations; poor leadership can result in problems such as low staff morale, high staff turnover and reduced productivity. Effective leadership behaviours are well documented in the literature and various leadership models have been proposed that illustrate these behaviours. This discussion paper does not focus on any particular model. Instead it considers the 'Leadership Qualities Framework' which was developed specifically for use within the UK National Health Service. This framework draws upon a range of leadership models and as such it gives a broad indication of leadership behaviours. The framework comprises three components - 'personal qualities', 'setting direction' and 'delivering the service'. This paper commences with an argument as to why effective leadership is important in organisations generally, and specifically within healthcare organisations. Various examples of leadership are illustrated from within and outside the NHS in order to demonstrate effective leadership behaviours. The Leadership Qualities Framework is then examined, along with scenarios to illustrate effective leadership behaviours in context (i.e. within a healthcare organisation). Subsequent reflections on the scenarios aim to identify leadership behaviours that are explained within the framework. The final element of this paper draws on [limited] published evidence of where consultant radiographers have demonstrated effective leadership behaviours. In this section the published evidence is examined and reflected upon. At the end of the article we indicate additional reading for those who wish to further develop their theoretical and practical leadership skills
The metal failure cases discussed by P. Gupton (Monsanto Chem. Co.) at a joint meeting of the American Society of Metals (ASM) and the National Association of Corrosion Engineers Calgary Section (Calgary 1978) include a high-temperature (1775/sup 0/-1800/sup 0/F) failure in an HK 40 outside heater tube in a synthesis gas steam-methane reformer, resulting in two major fissures caused by carbonization and oxide deposits with high carbon and lead contents due to the use of remelt scrap material with high lead content; separation of a support pad from a 30 in. pipeline due to corrosion caused by molybdenum-peroxide action; oxidation of a section of 180/sup 0/ U-bend in a thermal ethylene cracking furnace due to fluxing reaction of a high sodium and calcium feed which collected in the return bed; stress corrosion cracking of an austenitic stainless cracker tube from high temperature and electrolytic attack; and other cases of metal failure caused by weld quality problems, use of contaminated material and inadequate designs, processing, and fabrication.
Emission trading is a market-based incentive program designed to control air emissions in which a cap is placed on the total quantity of pollutants allowed to be emitted in an airshed. Appropriate shares of this amount are allocated among participating emission sources, and participants can buy or sell their shares. Advantages of emission trading include its potential to achieve air emission targets at a lower cost than the traditional command and control approach, and its ability to accommodate economic growth without compromising environmental quality. A study was conducted to evaluate the potential use of emission trading programs to achieve emission reduction goals set for nitrogen oxides, volatile organic compounds (VOC), and sulfur oxides. Emission trading programs in the USA are reviewed and a set of factors important for the success of emission trading are identified. Key policy and design issues related to an emission trading program are identified, explained, and discussed. Administrative issues are then analyzed, such as legislative authority, monitoring and enforcement requirements, and trading between jurisdictions. A preliminary assessment of emission trading for control of NOx and VOC in the Lower Fraser Valley indicates that emission trading would be feasible, but legislative authority to implement such a program would have to be introduced
Hogg, Peter [Directorate of Radiography, University of Salford, Allerton Building, Frederick Road, Salford, Greater Manchester M6 6PU (United Kingdom)], E-mail: email@example.com; Hogg, Dianne [Henwood Associates (South East) Ltd, Company Number: 513796, Registered Office: 2 Lakeview Stables, Lower St Clere, Kemsing, Kent, TN15 6NL (United Kingdom); Henwood, Suzanne [East Lancashire Primary Care Trust, Linden Business Centre, Linden Road, Colne. BB8 9BA (United Kingdom)
Effective leadership can be defined in many ways and is an essential element of successful organisations; poor leadership can result in problems such as low staff morale, high staff turnover and reduced productivity. Effective leadership behaviours are well documented in the literature and various leadership models have been proposed that illustrate these behaviours. This discussion paper does not focus on any particular model. Instead it considers the 'Leadership Qualities Framework' which was developed specifically for use within the UK National Health Service. This framework draws upon a range of leadership models and as such it gives a broad indication of leadership behaviours. The framework comprises three components - 'personal qualities', 'setting direction' and 'delivering the service'. This paper commences with an argument as to why effective leadership is important in organisations generally, and specifically within healthcare organisations. Various examples of leadership are illustrated from within and outside the NHS in order to demonstrate effective leadership behaviours. The Leadership Qualities Framework is then examined, along with scenarios to illustrate effective leadership behaviours in context (i.e. within a healthcare organisation). Subsequent reflections on the scenarios aim to identify leadership behaviours that are explained within the framework. The final element of this paper draws on [limited] published evidence of where consultant radiographers have demonstrated effective leadership behaviours. In this section the published evidence is examined and reflected upon. At the end of the article we indicate additional reading for those who wish to further develop their theoretical and practical leadership skills.
Olatayo, Adeoti Adekunle; Kubwa, Ojo Osaze; Adekunle, Ajayi Ebenezer
Introduction Oftentimes the older adults are assumed to be asexual as few studies explore into the sexuality of this age group worldwide and even in Nigeria. It is an important aspect of quality of life which is often neglected by people in this age group, attending physicians and the society as a whole. The study was aimed at determining the perception of older adults about sexuality, identify the factors that could militate against sexuality and fill any void in information in this regard. Methods Descriptive study conducted in one hundred older adults. A semi-structured questionnaire was administered to consenting participants between 1st of September 2013 and 31st of March 2014. Results Mean age of respondents was 66.42± 5.77 years. Seventy-eight percent of the male respondents considered engaging in sexual activity as safe compared to 45.8% of the female respondents. More of the women (33.3%) regarded sexuality in the older adults as a taboo when compared to the men (5.4%). However, the men were more favourably disposed to discussing sexual problems than the women with their spouses (42% vs 20%) and Physicians (23.2% vs 0.0%). Major factors responsible for sexual inactivity were participants’ medical ailments (65%), partners’ failing health (15%) as well as anxiety about sexual performance (25%) in the men and dyspareunia (25%) in women. Conclusion There is an urgent need to correct the misconception about sexuality in this age group especially among the women and for the physicians to explore the sexual history of every patient. PMID:26977224
Olatayo, Adeoti Adekunle; Kubwa, Ojo Osaze; Adekunle, Ajayi Ebenezer
Oftentimes the older adults are assumed to be asexual as few studies explore into the sexuality of this age group worldwide and even in Nigeria. It is an important aspect of quality of life which is often neglected by people in this age group, attending physicians and the society as a whole. The study was aimed at determining the perception of older adults about sexuality, identify the factors that could militate against sexuality and fill any void in information in this regard. Descriptive study conducted in one hundred older adults. A semi-structured questionnaire was administered to consenting participants between 1(st) of September 2013 and 31(st) of March 2014. Mean age of respondents was 66.42 ± 5.77 years. Seventy-eight percent of the male respondents considered engaging in sexual activity as safe compared to 45.8% of the female respondents. More of the women (33.3%) regarded sexuality in the older adults as a taboo when compared to the men (5.4%). However, the men were more favourably disposed to discussing sexual problems than the women with their spouses (42% vs 20%) and Physicians (23.2% vs 0.0%). Major factors responsible for sexual inactivity were participants' medical ailments (65%), partners' failing health (15%) as well as anxiety about sexual performance (25%) in the men and dyspareunia (25%) in women. There is an urgent need to correct the misconception about sexuality in this age group especially among the women and for the physicians to explore the sexual history of every patient.
Steinberg, Michael B; Giovenco, Daniel P; Delnevo, Cristine D
Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician-patient communication regarding e-cigarettes. A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient-provider e-cigarette communication, and attitudes towards tobacco harm reduction. Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.
Verdezoto, Nervo; Grönvall, Erik
Sustaining daily, unsupervised healthcare activities in a private home setting can challenge, among others, older adults. In this paper, we discuss experiences from designing a tablet mobile application, MediFrame, to support older adults’ medication management at home. In relation to Medi...
As we grow older, our vision sometimes isnât as clear as it used to be. As a result, older adults are at increased risk for falling. In this podcast, Dr. John Crews discusses the importance of regular eye exams. Created: 5/5/2016 by MMWR. Date Released: 5/5/2016.
As we grow older, our vision sometimes isnât as clear as it used to be. As a result, older adults are at increased risk for falling. In this podcast, Dr. John Crews discusses the importance of regular eye exams.
Saniotis, Arthur; Irvine, Rod
Climate change is an important issue for Australia. Climate change research forecasts that Australia will experience accelerated warming due to anthrogenic activities. Australia's aging society will face special challenges that demand current attention. This paper discusses two issues in relation to climate change and older Australians: first, pharmacology and autoregulation; and second, mental health among older Australians.
A limited amount of literature has discussed older adults in formal education, especially their motivations to learn in higher education. This study aims to understand older adults' learning in the context of higher education. Specifically, this study argues that higher education can function as a stimulating learning environment that helps older…
This study investigated older adults' peer teaching experiences at a Lifelong Learning Institute through interviews with eight teachers and observations of their classes. Thematic analysis revealed themes of peer-to-peer teaching, volunteer teaching, and explorative teaching. Discussion of the themes examines the meaning of older adults' peer…
This podcast discusses the special concerns many older adults face during a disaster. It is primarily targeted to public health and aging services professionals. Created: 1/26/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) and Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER). Date Released: 1/26/2009.
Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Older housing can impact the quality of the occupant's health in a number of ways, including lead exposure, housing quality, and factors that may exacerbate...
... find more information? Reprints Share Older Adults and Depression Download PDF Download ePub Order a free hardcopy ... depression need treatment to feel better. Types of Depression There are several types of depression. The most ...
Chan, Teresita; Fowles, Donald G.
Trends in the labor force participation and unemployment of older workers were reviewed in a study. A declining rate of labor force participation by older men and a growth in participation by older women were noticed. Examination of labor force participation rates by race revealed a higher participation rate for minority women than for older white…
Kaplan, Celia P; Livaudais-Toman, Jennifer; Tice, Jeffrey A; Kerlikowske, Karla; Gregorich, Steven E; Pérez-Stable, Eliseo J; Pasick, Rena J; Chen, Alice; Quinn, Jessica; Karliner, Leah S
Assessment and discussion of individual risk for breast cancer within the primary care setting are crucial to discussion of risk reduction and timely referral. We conducted a randomized controlled trial of a multiethnic, multilingual sample of women ages 40 to 74 years from two primary care practices (one academic, one safety net) to test a breast cancer risk assessment and education intervention. Patients were randomly assigned to control or intervention group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room before visit for intervention). Intervention (BreastCARE) patients and their physicians received an individualized risk report to discuss during the visit. One-week follow-up telephone surveys with all patients assessed patient-physician discussion of family cancer history, personal breast cancer risk, high-risk clinics, and genetic counseling/testing. A total of 655 control and 580 intervention women completed the risk assessment and follow-up interview; 25% were high-risk by family history, Gail, or Breast Cancer Surveillance Consortium risk models. BreastCARE increased discussions of family cancer history [OR, 1.54; 95% confidence interval (CI), 1.25-1.91], personal breast cancer risk (OR, 4.15; 95% CI, 3.02-5.70), high-risk clinics (OR, 3.84; 95% CI, 2.13-6.95), and genetic counseling/testing (OR, 2.22; 95% CI, 1.34-3.68). Among high-risk women, all intervention effects were stronger. An intervention combining an easy-to-use, quick risk assessment tool with patient-centered risk reports at the point of care can successfully promote discussion of breast cancer risk reduction between patients and primary care physicians, particularly for high-risk women. Next steps include scaling and dissemination of BreastCARE with integration into electronic medical record systems. ©2014 American Association for Cancer Research.
Molton, Ivan R; Terrill, Alexandra L
With the shifting age demographics of the U.S. population, more psychologists will be asked to provide clinical services to older adults. Given the high prevalence of persistent pain in aging, in many cases this will mean providing empirically supported interventions for pain and the interference it creates. The purpose of this review is to provide a broad overview of the scope and impact of persistent pain in older people and to discuss mechanisms by which persistent geriatric pain can lead to suffering and disability. We consider the unique context of pain in older adulthood and review differences between older and younger people in terms of pain perception, the social network, beliefs about pain, pain-related coping, and adherence to pain medication. Finally, we discuss special issues affecting pain management in older adults, including dementia, polypharmacy, and barriers to accessing adequate pain care. This review also highlights a need for greater provider training in pain management to meet the needs of a changing U.S. population. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Dougherty Paul E
Full Text Available Abstract There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.
Itai, Goro; McRae, Cynthia
Discusses important aspects of providing counseling to older Japanese American clients, including ethical issues based on cultural differences and nontraditional approaches to counseling. Examines unique historical and cultural characteristics of these clients. Includes 26 citations. (Author/CRR)
Mola, Joanna R
Erectile dysfunction (ED) in the older adult male is a significant problem affecting more than 75% of men over 70 years of age in the United States. Older men have an increased likelihood of developing ED due to chronic disease, comorbid conditions, and age-related changes. Research has demonstrated that while the prevalence and severity of ED increases with age, sexual desire often remains unchanged. This article discusses the clinical picture of ED, including relevant pathophysiology, clinical presentation, and evaluation and treatment options.
Barry, Maree; Nugent, Linda
Pressure ulcers are painful and cause discomfort, have a negative effect on quality of life, and are costly to treat. The incidence and severity of preventable pressure ulcers is an important indicator of quality of care; it is essential that healthcare providers monitor prevalence and incidence rates to ensure that care strategies implemented are effective. Frail older people are at increased risk of developing pressure ulcers. This article discusses the complexities of preventing pressure ulcers in frail older people and emphasises the importance of structured educational programmes that incorporate effective clinical leadership and multidisciplinary teamwork.
Bergeron, Caroline D; Goltz, Heather Honoré; Szucs, Leigh E; Reyes, Jovanni V; Wilson, Kelly L; Ory, Marcia G; Smith, Matthew Lee
Older women around the globe are generally depicted as asexual beings, which may impact patient-provider discussions about sex. We examined data on 703 aging women in the United States to compare factors associated with women perceiving sex as important and women discussing sex with their physicians since turning 50. While 65.1% of participants perceived sex to be important, only 23.8% discussed sex with their providers since turning 50. Factors related to discussing sex included age, education, having a chronic condition, and consuming alcohol. Provider training and tools about sexual health communication could help launch those discussions about sex and increase advocacy for older women's sexual health.
The concept of "participation" and the use of "participatory methods" in human, healthcare, nursing, and gerontological research, as well as the corresponding fields of practice, represent an expanding field of interest. However, the objectives and organization of "participation" are not always sufficiently explicated. The Critical Gerontology Working Group of the German Society of Gerontology and Geriatrics presents a statement on this phenomenon, and proposes a catalogue of criteria for reflection upon and assessment of participation by older people in research and practice, which can also be considered a stimulus for further discussions.
In the context of population aging and related policy aims to prolong working lives, it is highly important to get a better understanding of factors that may stimulate or rather inhibit prolonged employment. Dropkin and colleagues (Dropkin, J., Moline, J., Kim, H., & Gold, J. E. (2016). Blended work
Melenhorst, Anne-Sophie; Rogers, Wendy A.; Bouwhuis, Don G.
This study examined older adults' motivation to adopt technological innovation. Sixty-eight older e-mail users and nonusers discussed the use of e-mail and of traditional communication methods in 18 focus groups. The results show older adults' benefit-driven approach to new communication technology.
Melenhorst, A.S.; Rogers, W.A.; Bouwhuis, D.G.
This study examined older adults' motivation to adopt technological innovation. Sixty-eight older e-mail users and nonusers discussed the use of e-mail and of traditional communication methods in 18 focus groups. The results show older adults' benefit-driven approach to new communication technology.
Marcus-Varwijk, Anne Esther; Koopmans, Marg; Visscher, Tommy L. S.; Seidell, Jacob C.; Slaets, Joris P. J.; Smits, Carolien H. M.
Objective: This study explores older adults’ perspectives on healthy living, and their interactions with professionals regarding healthy living. This perspective is necessary for health professionals when they engage in tailored health promotion in their daily work routines. Method: In a qualitative study, 18 semi-structured interviews were carried out with older adults (aged 55-98) living in the Netherlands. The framework analysis method was used to analyze the transcripts. Results: Three themes emerged from the data—(a) healthy living: daily routines and staying active, (b) enacting healthy living: accepting and adapting, (c) interaction with health professionals with regard to healthy living: autonomy and reciprocity. Discussion: Older adults experience healthy living in a holistic way in which they prefer to live active and independent lives. Health professionals should focus on building an equal relationship of trust and focus on positive health outcomes, such as autonomy and self-sufficiency when communicating about healthy living. PMID:28138485
Franke, Thea; Tong, Catherine; Ashe, Maureen C; McKay, Heather; Sims-Gould, Joanie
Although physical activity is a recognized component in the management of many chronic diseases associated with aging, activity levels tend to progressively decline with increasing age (Manini & Pahor, 2009; Schutzer & Graves, 2004). In this article we examine the key factors that facilitate physical activity in highly active community-dwelling older adults. Using a strengths based approach, we examined the factors that facilitated physical activity in our sample of highly active older adults. Twenty-seven older adults participated in face-to face interviews. We extracted a sub-sample of 10 highly active older adults to be included in the analyses. Based on a framework analysis of our transcripts we identified three factors that facilitate physical activity in our sample, these include: 1) resourcefulness: engagement in self-help strategies such as self-efficacy, self-control and adaptability; 2) social connections: the presence of relationships (friend, neighborhood, institutions) and social activities that support or facilitate high levels of physical activity; and 3) the role of the built and natural environments: features of places and spaces that support and facilitate high levels of physical activity. Findings provide insight into, and factors that facilitate older adults' physical activity. We discuss implications for programs (e.g., accessible community centers, with appropriate programming throughout the lifecourse) and policies geared towards the promotion of physical activity (e.g., the development of spaces that facilitate both physical and social activities). © 2013.
Full Text Available Falls, a common cause of injury among older adults, have become increasingly prevalent. As the world’s population ages, the increase in – and the prevalence of – falls among older people makes this a serious and compelling societal and healthcare issue. Physical weakness is a critical predictor in falling. While considerable research has examined this relationship, comprehensive reviews of neuropsychological predictors of falls have been lacking. In this paper, we examine and discuss current studies of the neuropsychological predictors of falls in older adults, as related to sporting and non-sporting contexts. By integrating the existing evidence, we propose that brain aging is an important precursor of the increased risk of falls in older adults. Brain aging disrupts the neural integrity of motor outputs and reduces neuropsychological abilities. Older adults may shift from unconscious movement control to more conscious or attentive motor control. Increased understanding of the causes of falls will afford opportunities to reduce their incidence, reduce consequent injuries, improve overall well-being and quality of life, and possibly to prolong life.
catheter placement, intubation with mechanical ventilation, and CPR in both cancer and noncancer patients. It tended to increase the rate of opioid use. Code status discussion on admission was the only factor associated with the decreased use of CPR (P<0.001, odds ratio =0.03, 95% CI =0.004−0.21, which was found by using multivariate logistic regression analysis. Conclusion: Code status discussion on admission is associated with a decrease in invasive procedures and CPR in cancer and noncancer patients. Physicians should be educated about code status discussion to improve end-of-life care. Keywords: noncancer, end-of-life discussion, palliative care, cardiopulmonary resuscitation, DNR, quality of death
Fujioka, Yuki; Stewart, Erin
A survey of 104 physicians examined the role of physicians' evaluation of the quality of e-health and beliefs about the influence of patients' use of e-health in how physicians discuss e-health materials with patients. Physicians' lower (poor) evaluation of the quality of e-health content predicted more negative mediation (counter-reinforcement of e-health content). Perceived benefits of patients' e-health use predicted more positive (endorsement of e-health content). Physician's perceived concerns (negative influence) regarding patients' e-health use were not a significant predictor for their mediation styles. Results, challenging the utility of restrictive mediation, suggested reconceptualizing it as redirective mediation in a medical interaction. The study suggested that patient-generated e-health-related inquiries invite physician mediation in medical consultations. Findings and implications are discussed in light of the literature of physician-patient interaction, incorporating the theory of parental mediation of media into a medical context.
... 한국어 Español ภาษาไทย Tiếng Việt Text Size: Decrease Font Increase Font Contact CPSC Consumers: Businesses: Report an Unsafe Product ... can become entrapped and suffocate in older, latch-type freezers, refrigerators, dryers and coolers. GFCI Fact Sheet ...
Rehabilitation is concerned with lessening the impact of disabling conditions. These are particularly common in older people and considerable health gain can be achieved by successful rehabilitation. Hospital doctors and general practitioners should be aware of the core principles of rehabilitation, be able to recognise rehabilitation need in their patients, and have sufficient knowledge of their local rehabilitation services to trigger the referral process.
Calnan, Michael; Woolhead, Gillian; Dieppe, Paul
A study of 72 people, with an average age of 72, showed that dignity--and lack of it--were key issues in their estimation of care. Concerns about lack of dignity centred on lack of privacy, mixed sex wards, forms of address and loss of independence. The study suggested that older people do not complain about care for fear of retaliation.
van Dieën, Jaap H.; Pijnappels, Mirjam
Falls are common incidents, which can have major con-sequences. For example, falls and the interrelated category of accidents being struck by or against objects account for more than 40% of injuries and 30% of injury costs in the USA (Corso et al., 2006). Especially among older adults, falls occur
Bodner, Michael E.; Dolor, Rowena J.; Óstbye, Truls; Lyna, Pauline; Alexander, Stewart C.; Tulsky, James A.; Pollak, Kathryn I.
Objective Primary care providers should counsel overweight patients to lose weight. Rates of self-reported weight-related counseling vary, perhaps due to self-report bias. We assessed accuracy and congruence of weight-related discussions among patients, physicians, and audio-recorded encounters. Methods We audio recorded encounters between physicians (n=40) and their overweight/obese patients (n=461) at five community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. Results Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters contained weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%) but when weight was not discussed patients and physicians were more inaccurate and incongruent (patient 36%; physician 44%; 28% congruence). Physicians less comfortable discussing weight were more likely to misreport that weight was discussed [OR = 4.5 (95% CI=1.88–10.75, p<0.001)]. White physicians with African-American patients were more likely to report accurately no discussion about weight than White physicians with White patients OR=0.30 (95% CI=0.13–0.69, p<0.01). Conclusion Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed, but not when recordings indicated no weight discussions. Physician overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions. PMID:24390888
... A to Z › Cancer › Unique to Older Adults Font size A A A Print Share Glossary Unique ... group with other older people with the same type of cancer. Researchers have found that support groups ...
Researchers have examined the effects of alcohol consumption : on older adults functioning, and some have : addressed alcohols effects on older drivers crash risk. : Generally, the findings have shown that alcohol is less : likely to be a fa...
Zwetchkenbaum, Samuel R; Overbeck, Kevin J; Pomerantz, Sherry C
Gastrointestinal complications from antibiotic use, including Clostridium difficile infection (CDI), can have significant morbidity, especially among older patients. This descriptive study surveyed dentists to find out how they would respond to a patient with signs indicating potential CDI. A survey on prescribing medications for older patients was mailed to 1,000 dentists in New Jersey. Questions were asked regarding antibiotic selection, probiotic use, and approach to a patient scenario of diarrhea after antibiotic use. Respondents chose amoxicillin most frequently as an antibiotic, and clindamycin if penicillin allergy. When informed their patients had diarrhea, 64.5% advised them to stop the antibiotic. If the patient continued to have diarrhea on follow-up, 75.5% contacted the patient's physician. Most (61.6%) do not prescribe probiotics prophylactically. Most dentists respond appropriately to antibiotic-associated diarrhea in advising to stop the antibiotic, and seeking physician involvement if no improvement, but there are still many who make recommendations that could delay appropriate care. Dentists may wish to learn more about benefits of probiotics. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.
Dean, Moira; Raats, Monique M.; Grunert, Klaus G.
This chapter discusses food-related satisfaction with life of older people, identifying some of the determinants and barriers to satisfaction with food-related quality of life, and discusses possible ways of enhancing older people's quality of life in the domain of food. Despite being strongly...... associated with life, and heavily contributing to the quality of life, food has so far been neglected and not much research has been conducted into people's satisfaction with their food-related life and its relationship to overall life satisfaction. As people age, their goals and available resources in terms...... of health, social networks, income and skills change. Changes in resources can be expected to have an impact on satisfaction with life....
Five presumptions have to be considered when addressing future education for older drivers: 1. Driving a car will continue to be one element of mobility in the future; 2. Older people want to be able to keep driving; 3. Safety will be an even more important factor in mobility in the future; 4. Ecological values will be more important in the future; and 5. Innovative technological applications will be more important in the future. Hierarchical models of driving are suitable in increasing understanding of older drivers' needs and abilities. The highest levels of the driving hierarchy in the Goals for Driver Education (GDE model are especially important for the safety of both young and elderly drivers. In these highest levels goals for life, skills for living, and social environment affect everyday decision making in general but also driving, which has an impact on driver safety. Giving up driving is very much a social decision and should be taken as such. However, the highest levels of the driving hierarchy are by nature inaccessible to teacher-centered instruction These levels require more coaching-like education methods where the learner takes the central role and the teacher helps the drivers understand their own abilities and limitations in traffic. Testing and selecting older drivers to enhance safety is not, according to research findings, working in a proper way. Older drivers do not so much need more information concerning traffic rules, etc., but rather better understanding of themselves, their health restrictions, their skills, and their abilities to ensure daily mobility. Their closest companions also need tools to help them in discussions of traffic safety issues affecting older drivers.
Worz, Chad; Martin, Caren McHenry; Travis, Catherine
Several vaccine-preventable diseases-influenza, pneumonia, herpes zoster, and pertussis-threaten the health of older adults in the United States. Both the costs associated with treating these diseases and the potential to increase morbidity and mortality are high for this patient population. Pharmacists and other health care professionals play a significant role in ensuring the elderly patient receives the recommended vaccines at the recommended intervals.
David R. Phillips; Fon Sim Ong
The main objective of this study was to understand the concerns and problems faced by older people in an industrializing middle-income country, Malaysia, in their process of acquiring products to meet their everyday needs. Respondents aged 55 and over were interviewed in eight states throughout Peninsular Malaysia providing 1356 usable questionnaires; two-thirds from urban and one-third from rural areas. Education, health status, and life satisfaction were recorded. Service patronage behaviou...
... The Science of Drug Use: Discussion Points The Science of Drug Use: Discussion Points Email Facebook Twitter ... was last updated February 2017 Related Topics Addiction Science Adolescent Brain Comorbidity College-Age & Young Adults Criminal ...
Organization Search Go Search the CPC Go Expert Assessments ENSO Diagnostic Discussion Archive About Us Our Assessments > ENSO Diagnostic Discussion El NiÃ±o/Southern Oscillation (ENSO) Diagnostic Discussion PDF : English Version Spanish Version Adobe PDF Reader (Click icon for Adobe PDF Reader) Word: English Version
This article discusses the author's use of reflexivity in trying to gain a better understanding of ageing in older people with learning disabilities. In the general population ageing is viewed in rather negative terms and as a significant life transition. However, for some older people with learning disabilities this transition may go unnoticed because of their past negative life experiences and lack of opportunities. Reflexivity has the potential to provide nurses with greater understanding of the personal perspectives of older people with learning disabilities.
Undernutrition - of both macronutrients and micronutrients - is still a surprisingly common problem among older people in the UK. There is a variety of nutritional supplements that community nurses need to be aware of in managing their patients' nutritional requirements. Different supplements are taken for different disease states. This article looks at the various nutrient and energy requirements that relate directly to clients on the district nurse's caseload. Some of the negative consequences of malnutrition of the older adult are discussed, as are the NICE guidelines for nutrition. Factors affecting dietary intake in older people are considered.
Cataldo, JK; Petersen, AB; Hunter, M; Wang, J; Sheon, N
© 2015, PNG Publications. All rights reserved. Objectives: To describe older smokers' perceptions of risks and use of e-cigarettes, and their responses to marketing and knowledge of, and opinions about, regulation of e-cigarettes. Methods: Eight 90-minute focus groups with 8 to 9 participants met in urban and suburban California to discuss topics related to cigarettes and alternative tobacco products. Results: Older adults are using e-cigarettes for cessation and as a way to circumvent no-smo...
Watson, J. Mark
Discusses child molestation cases in which accused is older person, basing discussion on author's experience over five years on professional review panel advising social services agencies and courts in disposition of child abuse cases. Examines principle of diminished responsibility and considers such treatment alternatives as prisons, psychiatry…
Verweij, Lisanne Marlieke; Wehrens, Rik; Oldenhof, Lieke; Bal, Roland; Francke, Anneke L
The perspectives of nursing professionals might differ from those of older adults when it comes to care for older people. This cross-sectional study compares the views of older adults with the views of nursing professionals on the quality of care after a nationwide improvement program for care for older people was implemented (2008-2016) in the Netherlands. Questionnaire data were used from 385 nursing professionals (response rate 51%) that were part of the Nursing Staff Panel, a nationwide representative group of nursing staff, and working in home care, hospitals or general practices. Additionally, questionnaire data were used from 73 older adults (response rate 81%) who were involved in regional networks to discuss project proposals and to represent the voice of older adults in the nationwide improvement program. Participants were asked to evaluate care for older people with regard to collaboration between healthcare organizations and with regard to the tailored service, accessibility, and quality of care within their organizations and in the region in which they lived. A majority of older adults (54%) and nursing professionals (61%) felt that collaboration with others had improved over the last few years. Approximately one third of the older adults stated that care for older people was tailored to fit individual needs and was accessible most of the time or always, as opposed to approximately two thirds of the professionals. Moreover, 17% older adults thought that the quality of care was good, compared with 54% of the nursing professionals. 77% of the nursing professionals and 94% of the older adults thought that improvements were still needed in care for older people, for example better integration of the different aspects of care and a more patient-centered approach. Older adults who were involved in networks of the improvement program generally gave a less positive evaluation of aspects of care for older people and its development than nursing professionals
Chang, Shu-Fang; Lin, Hsiang-Chun; Cheng, Chih-Ling
This research explored the relationship between the stages of frailty and risk for hospitalization in older adults and evaluated the risk for hospitalization among the elderly in relation to various frailty assessment indexes. A systematic literature review and meta-analysis were carried out. A total of 32,998 older people, 8,666 of whom were hospitalized, were included in this study. Two of the researchers independently collected and reviewed the literature. The key search terms used were "frailty" or "frail," "hospitalization," and "older people" or "older" or "geriatric" or "senior." Data were recorded from January 2001 to July 2016. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted for quality assessment. A systematic search was carried out using Embase and Scopus to analyze the collected literature. A meta-analysis was conducted on eight studies that discussed the relationship between frailty and hospitalization risk in older adults 65 years of age or older. The results showed that frail older people exhibited the highest risk for hospitalization, following by prefrail and robust older people. Next, different frailty assessment indicators were used to predict the risk for hospitalization among older people. All of these indexes also showed that older persons with frailty had the highest risk for hospitalization, followed by prefrail older people. Frailty is a vital issue in geriatric care and is a crucial factor in the hospitalization of older people. Frail older people were at the highest risk for hospitalization, following by prefrail and robust older people. Assessing frailty as early as possible can reduce the hospitalization risk among older people. Professional nursing staff should use frailty indicators in a timely fashion to assess the status of frailty in older people and should effectively develop frailty prevention strategies to decrease the risk for hospitalization and to enhance quality of life
David R. Phillips
Full Text Available The main objective of this study was to understand the concerns and problems faced by older people in an industrializing middle-income country, Malaysia, in their process of acquiring products to meet their everyday needs. Respondents aged 55 and over were interviewed in eight states throughout Peninsular Malaysia providing 1356 usable questionnaires; two-thirds from urban and one-third from rural areas. Education, health status, and life satisfaction were recorded. Service patronage behaviour was examined for four main categories of commonly-sought consumer goods: groceries, health supplements, apparel, eating outlets, plus selected services (public transport, vacation packages and financial services. The findings showed that older adults in Malaysia are rather discerning consumers. Many respondents are price conscious and have developed consumer attitudes with regard to attitude of staff and assistance rendered. Many display a good ability to discriminate and to select, especially on the basis of price and durability of products and many appear to be acting as effectively as consumers in any other age group.
Sharma, Rashmi K.; Prigerson, Holly G.; Penedo, Frank J.; Maciejewski, Paul K.
Background Patient gender plays a significant role in patient-physician communication, patient illness understanding and aggressiveness of end of life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The present study aims to determine if gender differences exist in receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and receipt of ICU EoL care. Methods Multi-site, prospective, cohort study of patients (N=353) with metastatic cancers, identified as terminally ill at study enrollment and interviewed a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life. Results Patients who received ICU care at the EoL were more likely to be male than those who did not (73% male vs. 52% male, p=0.02). Adjusting for potential confounds, male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than male patients with no EoL discussion (AOR=0.26, 95% CI 0.07–0.91; p=0.04). There was no association between EoL discussions and ICU stays near death among female patients. Conclusions Men with advanced cancers are more likely than women to receive aggressive, non-beneficial, ICU care near death. Gender differences in effects of EoL discussions on EoL care likely contribute to, and may even explain, gender differences in receipt of ICU care in the last week of life. PMID:25975179
Miller, Mark J.; And Others
Reviews the historical underpinnings of dream theories and suggests that discussions of dreams in counseling can aid in setting up and maintaining therapeutic contact with clients. A number of theoretical positions on the function of dreams are discussed. Specific dream counseling techniques are also delineated. (JAC)
Public Energy Education Task Force.
This paper was intended to stimulate discussion of energy education issues at a conference on energy issues. The discussion ranges through numerous topics at issue in energy education including public energy awareness, definition of public education, the distinction between public education and public relations, and the presentation of a model…
Rathakrishnan, Mohan; Ahmad, Rahayu; Suan, Choo Ling
Online discussion has become one of the important strategies for the teacher to teach the students to think critically when conveying their ideas and become more proactive and creative. In this paper, padlet online discussion communication was conducted to examine its effectiveness in enhancing critical thinking. In this study, there are two types of critical thinking: macro and micro critical thinking. A total of 70 Universiti Utara Malaysia Management Foundation Programme students involved in this experimental research design. The students in treatment class are divided to few groups. Every group uses padlet online discussion to discuss the topic given. All the group members discuss and write their ideas in padlet. Ideas that are posted in padlet will be displayed in front of the class so that the entire group in the treatment class could see the given ideas. Paul's (1993) model was used to analyze student's macro and micro critical thinking in padlet online discussion and communication. The finding shows that students who used padlet online discussion backchannel communication have greater macro and micro critical thinking level than students who do not use online discussion.
... CREDIT FOR FLOOD CONTROL § 240.5 Discussion. Discussion of this legislation is contained in the Conference Report, H.R. Rpt. No. 99-1013, which accompanies H.R. 6. The House passed version of the bill... compatible work completed by local interests. The Senate passed version authorized crediting of compatible...
Schwartzbach, Michael Ignatieff; Palsberg, Jens
This paper summarizes three discussions conducted at the ECOOP'91 W5 Workshop on "Types, Inheritance, and Assignments" Tuesday July 16, 1991 in Geneva, Switzerland, organized by the authors.......This paper summarizes three discussions conducted at the ECOOP'91 W5 Workshop on "Types, Inheritance, and Assignments" Tuesday July 16, 1991 in Geneva, Switzerland, organized by the authors....
The information in this report must support a discussion on policy starting points for the structure of natural gas tariffs in the Netherlands. The discussion will be held within EnergieNed (the association for energy distribution companies in the Netherlands) in the light of recent developments in the energy distribution sector in Europe
The Beam Instrumentation Workshop registrants selected the following topics for group discussions: Commercial technology and beam instrumentation, 4th generation light source instrumentation, feedback systems, beam loss monitors, calibration methods, high resolution and highly stable BPM methods, challenges in beam profiling. Summaries of these discussion sessions are listed in the article that follows
Ruan, D.; Wal, A.J. van der
This is a report on the discussion about soft computing (SC) during FLINS'96. The discussion is based on the five questions formulated by X. Li, viz. (1) What is SC? (2) What are the characteristics of SC? (3) What are the principal achievements of SC? (4) What are the typical problems of SC and
Ismail, Hamidah Mohd; Majid, Faizah Abd
One of the main issues often discussed among academics is how to encourage active participation by students during classroom discussions. This applies particularly to students at the tertiary level who are expected to possess creative and critical thinking skills. Hence, this paper reports on a study that examined how these skills were…
Mittal, Rohit; Ford, Mandy L; Coopersmith, Craig M
Sepsis is a disease that affects primarily the aged. Although mortality is higher in both older septic patients and aged septic mice, the mechanisms underlying decreased survival in older hosts are incompletely understood. New work by Inoue and colleagues demonstrates persistent inflammation and T-cell exhaustion in older septic patients and aged septic mice. The clinical significance of these findings is manifested not only in increased mortality but also in a marked difference in secondary infections in older patients as long as a month following ICU admission.
Datti, Balaji; Carter, Mary W
Although older adults are frequent consumers of prescription drugs and increasingly the intended audience of direct-to-consumer advertising (DTCA) marketing efforts, little is known about the effect of DTCA on older adults' prescription drug-seeking behaviour. In response, the objective of this study is to examine factors associated with requesting a prescription drug from a physician following exposure to DTCA among older adults, and whether the drug or other medical treatment was prescribed during the encounter. A secondary data analysis of the "Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs", a data set publicly available through the Inter-university Consortium for Political and Social Research (ICPSR 3687), was conducted. For the purposes of this study, only those respondents who indicated that they had been exposed to DTCA (n = 2601) were included in the study sample. Using a two-step weighted logistic regression approach, separate models were estimated to examine first, whether a request for the advertised drug was made following exposure to DTCA and secondly, the outcomes of any patient-physician encounters that occurred following exposure to DTCA. Descriptive analysis of the outcome variables revealed that, among respondents exposed to DTCA, 31% (n = 801) requested a prescription drug from their physician. Approximately 5% of those who made a request were > or =75 years of age. Among respondents requesting a prescription drug, 69% (n = 556) received a prescription in response to their request, of whom, approximately 5% were > or =75 years of age. Multivariate findings suggest that although adults > or =75 years of age are less likely to request a prescription drug following exposure to DTCA (odds ratio [OR] = 0.58; p = 0.032), when they do approach their physicians, they are more likely to receive recommendations for further treatment, with ORs indicating a 250% (OR = 3.507; p = 0.002) increase in the odds of further referral
The first goal of this study is to see if social relationships in the church influence feelings of gratitude toward God. The second goal is to assess the impact of race and ethnicity on this relationship. The data support the following hypotheses: (1) older people who go to church more often tend to receive more spiritual support from fellow church members; (2) older adults who receive more spiritual support at church will derive a deeper understanding of themselves and others; (3) older people who develop greater insight into themselves and others will derive a greater sense of religious meaning in life; and (4) older adults who develop a deeper sense of religious meaning in life will feel more grateful to God. The results also indicate that the study model explains how feelings of gratitude toward God arise among older blacks and whites, but not older Mexican Americans.
The first goal of this study is to see if social relationships in the church influence feelings of gratitude toward God. The second goal is to assess the impact of race and ethnicity on this relationship. The data support the following hypotheses: (1) older people who go to church more often tend to receive more spiritual support from fellow church members; (2) older adults who receive more spiritual support at church will derive a deeper understanding of themselves and others; (3) older people who develop greater insight into themselves and others will derive a greater sense of religious meaning in life; and (4) older adults who develop a deeper sense of religious meaning in life will feel more grateful to God. The results also indicate that the study model explains how feelings of gratitude toward God arise among older blacks and whites, but not older Mexican Americans. PMID:23543840
Popeo, Dennis M.
Delirium is a common neuropsychiatric syndrome in the elderly that can occur in several different settings caused by several different processes. It is common and causes increased morbidity and mortality to those affected. This clinical review discusses the prediction, prevention, diagnosis and treatment of delirium in the elderly population. Several strategies to predict delirium are noted with the discussion of pharmacological and non-pharmacological trials of prevention and treatment. Diagnosis of delirium, specifically with the use of objective instruments, is discussed, as is the evidence for pharmacological and non-pharmacological treatment strategies. Discussion of the neurobiology and genetic markers for delirium may elucidate further areas for future research. PMID:21748745
Kim, Jibum; Lee, Yun-Suk; Lee, Jinkook
This study examines how living arrangements are associated with suicidal ideation for older adults in South Korea, which has the highest suicide rate among OECD countries, and a particularly high suicide rate for older persons. Analyzing a sample of 5795 women and 3758 men aged 65 and older from a nationwide representative cross-sectional data-set, we examined how many older adults think about suicide over a one-year period, why they think about suicide, and whether living arrangements are associated with suicidal ideation. About 1 out of 12 respondents in our sample reported suicidal ideation. While women and men did not differ in the prevalence of suicidal ideation, women attributed their suicidal feelings to health problems, while men attributed theirs to economic difficulties. Logistic regression results indicated that living arrangements are associated with suicidal ideation for men but not women. Older men living with a spouse were less likely to have suicidal ideation than older men with other living arrangements (i.e., living alone, living with children without spouse, living with spouse, and others). Our results highlight the importance of living arrangements to older men's suicidal ideation. We discuss gender differences in the implications of living arrangements to suicidal ideation within the context of Confucian culture.
In an attempt to better understand the process through which the family planning (FP) programs and socioeconomic developments in China affect fertility, women's participation in fertility discussions with their husbands are examined as an intermediate factor in a study based on results of a random survey of 6654 ever-married women of reproductive age from 7 cities and 30 counties of Guangdong. First, it must be noted that Chinese couples do have individual choices (albeit quite limited ones) about their fertility; they can choose to follow or ignore government policy or they can choose to remain childless. The present study has 3 major hypotheses: 1) the more a woman is involved in fertility discussions with her husband, the fewer children she will have; 2) urban women with a higher educational status will be more likely to have such discussions; and 3) women who are contacted individually by FP personnel are more likely to be involved in fertility discussions. After a discussion of data collection and variables (number of living children, education of wife and husband, age at marriage, residence, living with parents, contacted by FP personnel, and discussion with husband), the results are presented in terms of zero-order correlation coefficients indicating their relationships. The bivariate analysis supported the hypotheses. Multiple regression analysis showed that age at marriage, education of wives and husbands, FP contacts, and participation in discussions remain significant fertility determinants (but the correlation between fertility and residence becomes trivial). A further regression model indicated that a woman's educational attainment is the most significant positive indication of their participation in fertility discussions. These results imply that as women's status continues to improve in China and the deeply-rooted patriarchal tradition loses hold, increased gender equity and education will influence a fertility decline. FP personnel could also
Full Text Available Just as the body and its functions undergo changes with age, in the same way sexuality shares this aging process. However, remember a golden rule that we are sexual since we are born until we die; only possibilities are modified with the passage of the years. This article intends to show the changes that occur in the sexual response of the elderly. If sexual life during youth was pleasant and satisfactory this will condition sexuality in the socalled third age and the elderly seek to maintain it, this is not the case for those who had a dysfunctional past. This article briefly describes the andropause and the SIM, vicissitudes, changes and differences in sexual response and chances to maintain eroticism in the older adult.
Full Text Available The purpose of this case study was to investigate online discussion as a means to promote critical reflection. The study was conducted during a semester-long graduate course on issues related to literacy instructional strategies. The participants in the study were four reading education candidates. During the semester they participated in online discussion about course readings and reflected on their own teaching experiences. The data sources were the online discussion postings, responses to questionnaires, and interviews. The results suggest that technology-mediated discussion strengthens the learning community, facilitates sharing of professional experience among participants, and enhances teacher reflection. The results also point to the multi-faceted nature of teacher reflection.
Academy supports discussion meetings of small groups of scientists from within India and outside organized by a ... Conference on Physics and Chemistry of Spintronic Materials ... Recent advances in operator theory and operator algebras
Oct 10, 2000 ... Objectives: To test the recommended consensus conference methods in Tanzania by discussing the management ... “wrong”, based on recommendations advocated in western ..... future scenarios sponsored the conference.
Nov 2, 2010 ... As discussed later, the variance from budget relates to accounting ... projects or programs (see Note 10 of the Notes to the Financial Statements, page 76). ... is based on generally accepted management accounting principles ...
AISLINN FELICITY LALOR
Sleep is essential to everyone's health and wellbeing. Between 30-40% of people experience impaired sleep and is most common in older adults. Older adults also experience a higher number of hospitalisations in comparison to any other age group. This thesis aimed to investigate the causes and consequences of impaired sleep quality for older adults during and following hospital admission. Over 80% of older adults with self-reported poor sleep do not discuss it with any health professionals. Thi...
Savage, Brittany; Foli, Karen J; Edwards, Nancy E; Abrahamson, Kathleen
The Hispanic older adult population's rapid growth calls for an awareness of values that can affect the rendering and receipt of care. Familism, or familismo, a traditional Hispanic value, places importance of family over the self and can potentially affect health care perceptions and practices for Hispanic older adults. The current article discusses familism, which is upheld by some Hispanic older adults, and the potential for underuse of health care services. The traditional feminine role, marianismo, and masculine role, machismo, are considered, as well as implications for how decision making may be made by family members rather than the patient. Clinical implications for the provision of health care to Hispanic older adults are provided, along with the importance of considering acculturation and ethnic heterogeneity. Health care management strategies that reflect recognition and respect of familism, yet emphasize optimization of adherence and self-care, are described. Copyright 2016, SLACK Incorporated.
Kasckow, John; Montross, Lori; Prunty, Laurie; Fox, Lauren; Zisook, Sidney
Little is known about treating elderly suicidal patients with schizophrenia. The purpose of this article is to review the literature dealing with this population and to discuss what is required to advance this field. Most available studies from middle-aged and older individuals suggest that risk factors include hopelessness, lower quality of life, past traumatic events, depressive symptoms, lifetime suicidal ideation and past attempts; it is not clear whether these findings are generalizable to geriatric populations. Although little treatment research has been performed in older suicidal patients with schizophrenia, an integrated psychosocial and pharmacologic approach is recommended. In addition, one recent study augmented antipsychotic treatment with an SSRI (i.e., citalopram) in a sample of middle-aged and older individuals with schizophrenia with subsyndromal depression; in that study, serotonin selective reuptake inhibitor augmentation reduced depressive symptoms and suicidal ideation. More research is required to better understand suicidal behavior in older patients with schizophrenia. PMID:22028735
Mitchell, H.; Haigh, G.W.R.; Jenkins, E.
The topics raised in the discussion covered: the accuracy of the cost estimates for the project; the number of sluices to be used; factors controlling the selection of steel or concrete for caisson construction and the design life of the caissons; the type of gates and lock mechanism; shipping traffic forecasts; and the effect of the barrage on port operations. Separate abstracts have been prepared for the two papers under discussion. (UK)
Till, J E
Interactive communication on the Internet, as illustrated by the e-mail-based breast cancer discussion group, provides an alternative to the telephone, the fax machine and regular mail, and is a resource for communications research, the potential of which is only beginning to be appreciated. At least some of the messages posted to such discussion groups could be regarded as a form of "journaling". Such messages are eminently suitable for qualitative data analysis.
Lu, Nan; Peng, Changmin; Jiang, Nan; Lou, Vivian W Q
This study examined the moderating effect of gender on the relationship between cognitive social capital and formal volunteering among older adults in urban China. Cognitive social capital refers to individuals' perceptions of their social relationships in local communities. We used quota sampling to recruit 456 older adults aged 60 years and older from 16 communities of Gusu district, Suzhou city, in late 2015. Multiple group analysis was used to examine the proposed model. Gender had a moderating effect on the relationship between cognitive social capital and volunteering. The associations between cognitive social capital and volunteering were higher among older men than older women. The findings highlight the important role of cognitive social capital in influencing formal volunteering among older adults in urban Chinese contexts. The findings are particularly important for enhancing volunteering among older adults across different social and economic backgrounds. Policy and intervention implications are discussed.
Mertz, Barbara; Stephens, Nancy
Examined older adults as a potential market for American businesses. Data indicate that in terms of size and income, senior citizens comprise a substantial buying group. Their buying styles, product and service needs, and shopping behavior vary from younger adults and within the older adult population. Strategies for successful marketing are…
Young, John; Meagher, David; MacLullich, Alasdair J
peer-reviewed Cognitive assessment involves examination of higher cortical functions, particularly memory, attention, orientation, language, executive function (planning activities), and praxis (sequencing of activities). This article will focus on cognitive assessment of older people (those aged over about 65 years) in the context of possible dementia, delirium, and depression. These are common and serious clinical syndromes affecting older people, and accurate cognit...
Allers, Christopher T.
Older adults are finding themselves the neighbors of Acquired Immunodeficiency Syndrome (AIDS) patients as well as the primary caregivers of infected adult children. Focuses on roles, issues, and conflicts older adults face in dealing with relatives or neighbors with AIDS. Case management and educational intervention strategies are also offered.…
Communication is an essential aspect of life, yet it can be taken for granted. Its centrality to being in the world and in professional practice often becomes evident when nurses and older adults encounter communication difficulties. The factors that can affect nurses' communication with older adults relate to the older adult, the nurse, sociocultural considerations and the environment, and the interactions between these factors. In adopting a person-centred approach to communicating with older adults, it is necessary to get to know the person as an individual and ensure communication meets their needs and abilities. Effective communication is essential in nursing practice and requires professional competence and engagement. This article can be used by nurses to support effective communication with older adults across the continuum of care.
Klein, Andrew; Lee, John C.; Peterson, Per; Simard, Ron; Gates, W. Gary
Full text of publication follows: University nuclear science and engineering programs in the United States currently operate in a business climate that involves serious and dramatic change. The number of degree-granting nuclear engineering programs within the nation's universities has declined over the past two decades to approximately 25. More than two-thirds of the faculty in these programs are 45 yr or older. Recruiting and retaining the best faculty and students continue to be vital to the continued success and existence of these programs. Many universities are also experiencing difficulty in finding support for their research and training reactors. There are currently only 28 university research reactors remaining across the United States. Many of these reactors were initially established with 30- to 40-yr operating licenses and will require re-licensing in the next several years. Combined, the university nuclear engineering educational programs and the university research reactors form a fundamental and vital component in a broad spectrum of our national research and education infrastructure and are critical to many national priorities such as energy, health care, education, environment, and technology transfer. Speakers have been selected from various universities, the Nuclear Energy Institute, and industry to address problems related to workforce forecasting, student recruiting and retention, research reactor operation and financing, academic accreditation, and other current issues relevant to nuclear engineering education and research. (authors)
Shiraishi, Takashi; Endo, Kimihisa; Yoshida, Fujio
This study examined the hypothesis that computer mediated discussions lead to more extreme decisions than face-to-face (FTF) meeting. Kiesler, Siegel, & McGuire (1984) claimed that computer mediated communication (CMC) tended to be relatively uninhibited, as seen in 'flaming', and that group decisions under CMC using Choice Dilemma Questionnaire tended to be more extreme and riskier than FTF meetings. However, for the same reason, CMC discussions on controversial social issues for which participants initially hold strongly opposing views, might be less likely to reach a consensus, and no polarization should occur. Fifteen 4-member groups discussed a controversial social issue under one of three conditions: FTF, CMC, and partition. After discussion, participants rated their position as a group on a 9-point bipolar scale ranging from strong disagreement to strong agreement. A stronger polarization effect was observed for FTF groups than those where members were separated with partitions. However, no extreme shift from their original, individual positions was found for CMC participants. There results were discussed in terms of 'expertise and status equalization' and 'absence of social context cues' under CMC.
Potter, Jane F
People older than 65 years are more likely to need elective and emergent orthopaedic surgery compared with younger persons. They also experience significant benefits. Although age-related changes increase the risk of perioperative complications, understanding those changes allows prevention or at least early recognition and treatment when problems arise. Because of comorbidities, older persons take more medications that need to be managed in the perioperative period. Care could be simplified if patients were to bring their medications to the preoperative evaluation. Central nervous system sensitivity to certain pain medications (meperidine and propoxyphene) means that these drugs are best avoided as good alternatives exist (morphine and oxycodone). Adverse reactions to drugs are an important cause of acute confusion (delirium) that often complicates orthopaedic care. Early mobilization after surgery, avoiding certain drugs, avoiding restraints (including Foley catheters), attending to hydration, promoting normal sleep, compensating for sensory disorders, and stimulating daytime activities can prevent delirium. Patients with dementia are more likely to have delirium develop and, like many older people, will present special challenges in communication and decision making. Including family members in discussions may be helpful in ensuring truly informed consent.
Older people can be regarded as a marginalised group within society from a number of perspectives including that of health. When it comes to the use of medication older people have suffered from a double whammy. Not only are they more at risk from the adverse effects of drugs but also their involvement in clinical trials has been limited so that rational prescribing both to maximise benefit and to reduce risk has been problematic. Their special problems have been recognised formerly by the Department of Health in its NSF for Older People [National Service Framework for Older People. Department of Health, London (2001a)], [Medicines and Older People. Implementing medicines-related aspects of the NSF for Older People. Department of Health (2001b)]. Early studies focussed on compliance, the avoidance of poly-pharmacy and the high prevalence of adverse effects of drugs and the reasons for this. Studies in long-stay patients showed dramatic differences in pharmacokinetics between such older people and young healthy volunteers. Initially such differences were ascribed to age alone and the overall message became "start low and go slow". Studies in healthy older people then revealed that age differences in drug metabolism were, as a rule, not so marked although clearance of renally excreted drugs was reduced in line with the age associated decline in renal function. Including older people in clinical trials poses challenges. Many traditional trialists do not have ready access to older people, co-morbidity and poly-pharmacy are common and most people feel reluctant to ask older people to take part in complex and potentially hazardous trials. Concern about compliance is unwarranted. Adverse events may be more serious. Thus in a younger patient postural hypotension may make a subject unsteady but in an older subject the unsteadiness may lead to a fall, the fall to a fracture, and the fracture to poor recovery. The choice of end-points is crucial. Although reduction of
The MINOS (mine operating system), which is used in the majority of British collieries, provides central control at the surface for the machinery and environmental equipment distributed throughout the mine. Installed equipment, including face machinery, conveyors, pumps, fans and sensors are connected to local outstations which all communicate with the control system via a single run of signal cable. The article discusses the system particularly its use in the Automated Control System of Underground Mining Locomotives (ACSUML). The discussion includes the use of MINOS to improve wagon identification, the operating principle of ACSUML and the possibilities of a driverless locomotive. 2 figs.
The tokamak concept improvement workshop addressed a wide range of issues involved in the development of a more attractive tokamak. The agenda for the workshop progressed from a general discussion of the long-range energy context (with the objective being the identification of a set of criteria and ''figures of merit'' for measuring the attractiveness of a tokamak concept) to particular opportunities for the improvement of the tokamak concept. The discussions concluded with a compilation of research program elements leading to an improved tokamak concept
Cohen, Jamie M; Blustein, Jan; Weinstein, Barbara E; Dischinger, Hannah; Sherman, Scott; Grudzen, Corita; Chodosh, Joshua
Hearing loss is remarkably prevalent in the geriatric population: one-quarter of adults aged 60-69 and 80% of adults aged 80 years and older have bilateral disabling loss. Only about one in five adults with hearing loss wears a hearing aid, leaving many vulnerable to poor communication with healthcare providers. We quantified the extent to which hearing loss is mentioned in studies of physician-patient communication with older patients, and the degree to which hearing loss is incorporated into analyses and findings. We conducted a structured literature search within PubMed for original studies of physician-patient communication with older patients that were published since 2000, using the natural language phrase "older patient physician communication." We identified 409 papers in the initial search, and included 67 in this systematic review. Of the 67 papers, only 16 studies (23.9%) included any mention of hearing loss. In six of the 16 studies, hearing loss was mentioned only; in four studies, hearing loss was used as an exclusion criterion; and in two studies, the extent of hearing loss was measured and reported for the sample, with no further analysis. Three studies examined or reported on an association between hearing loss and the quality of physician-patient communication. One study included an intervention to temporarily mitigate hearing loss to improve communication. Less than one-quarter of studies of physician-elderly patient communication even mention that hearing loss may affect communication. Methodologically, this means that many studies may have omitted an important potential confounder. Perhaps more importantly, research in this field has largely overlooked a highly prevalent, important, and remediable influence on the quality of communication. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
... providing emergency supplies of clean drinking water. Sewage treatment and disposal, and other sanitary... with contamination of water used in its process is not eligible. The drinking water used by the people... SUPPLIES OF DRINKING WATER § 214.6 Discussion. (a) The amendment provides for furnishing emergency supplies...
automatically filter cyber discussions from Stack Exchange, Reddit, and Twitter posts written in English. Criminal hackers often use social media...monitoring hackers on Facebook and in private chat rooms. As a result, system administrators were prepared to counter distributed denial-of-service
Bouas, Kelly S.; Komorita, S. S.
Face-to-face discussion has been shown to increase cooperation behavior in social dilemmas. Two general explanations of this effect were tested: group identity and perception of consensus. Female undergraduate students (N=160) participated in four-person groups in one of four experimental conditions. Findings indicate the most plausible…
Levinsen, Klaus; Yndigegn, Carsten
Young people's engagement in political discussions with parents and friends represents a significant component of the political socialization process and can be seen as an activity where they learn some very basic democratic skills. Based on data from qualitative interviews and a questionnaire su...
Nodoushan, Mohammad Ali Salmani; Khakbaz, Nafiseh
The current study aimed at finding the probable differences between the move structure of Iranian MA graduates' thesis discussion subgenres and those of their non-Iranian counterparts, on the one hand, and those of journal paper authors, on the other. It also aimed at identifying the moves that are considered obligatory, conventional, or optional…
Perrin, E.V.; Hunt, V.R.; Murray, F.J.; Krekel, S.; Allan, R.R.
The following topics are discussed: problems of women in the workplace; public policy concerning human reproduction; toxic effects of lead in human populations; health hazards of occupational radiation exposure; reproductive hazards on the job; considerations for protecting the unborn; and legal implications
Yang, Yang; Medaglia, Rony
Social networking platforms in China provide a hugely interesting and relevant source for understanding dynamics of online discussions in a unique socio-cultural and institutional environment. This paper investigates the evolution of patterns of similar-minded and different-minded interactions ov...
This document outlines the measures the government of Canada proposes to take in order to make Canada the world's most environmentally friendly country. The reflection and discussion that this document generates will influence the order of priority in the final action plan
For the recent exhibition "Greater New York: New Art in New York Now," the Education Department at P.S.1 Contemporary Art Center, a large museum located in the Long Island City section of Queens, New York, organized a unique email-based discussion. The museum set up an e-mail address for most participating artists using the free…
Heller, Jan C
Discussing the theological beliefs that ground Catholic moral principles can make some people uncomfortable, even while others will appreciate it. But these reactions will sometimes be revealed not as the emotions they are, but as objections to the relative independence or dependence of morality on foundational beliefs. In the end, context should dictate whether one displays the theological beliefs that ground Catholic moral principles.
Baum, Rudy M.
Discusses a National Academy of Science forum at which a group of outstanding young researchers in astronomy, molecular and developmental biology, physics, chemistry, mathematics, atmospheric science, and materials science met for three days of formal presentations and informal conversations. Provides a short synopsis of major speakers. (MVL)
We present an informal discussion of some aspects of strong interactions un- der extreme conditions of temperature and density at an elementary level. This summarizes lectures delivered at the 2013 and 2015 CERN – Latin-American Schools of High-Energy Physics and is aimed at students working in experi- mental high-energy physics.
Krabbe, Erik C. W.
In many contexts a retraction of commitment is frowned upon. For instance, it is not appreciated, generally, if one withdraws a promise or denies an earlier statement. Critical discussion, too, can easily be disrupted by retractions, if these occur too frequently and at critical points. But on the
Lindahl, Mats; Bruun, Jesper; Linder, Cedric
We use a combination of network analysis (NA), text-mining (TM) techniques, and thematic discourse analysis (TDA) to characterise and compare student discussions about sustainable development. Three student groups at three different times were analysed. The analysis entails an iterative design...
McInerney, Dennis M.
A growing area of research in educational psychology is future time perspective and its relationship to desired educational outcomes. This article discusses and critiques five reviews of current research on future time perspective. Key questions addressed are when do individuals begin to articulate a future, how far into the future does this…
Facilitation of online discussions presents a challenge to online learning instructors. Unlike in face-to-face courses, students in online learning do not have physical contacts with instructors. They might view instructors as authoritarian figures and perceive instructor's comments as impersonal. This article details the author's personal…
Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.
Cunningham, A; Cid, A; Buma, AGJ
In this paper the potencial of flow cytometry as applied to the aquatic life sciences is discussed. The use of flow cytometry for studying the ecotoxicology of phytoplankton was introduced. On the other hand, the new flow cytometer EUROPA was presented. This is a multilaser machine which has been
Utting, Ian; Cooper, Stephen; Kolling, Michael; Maloney, John; Resnick, Mitchel
This article distills a discussion about the goals, mechanisms, and effects of three environments which aim to support the acquisition and development of computing concepts (problem solving and programming) in pre-University and non-technical students: Alice, Greenfoot, and Scratch. The conversation started in a special session on the topic at the…
Wang, Yu-mei; Chen, Der-Thanq
This article reports a holistic approach to assessing online discussions. This holistic approach integrates three assessment methods: assessment of learning, assessment for learning, and assessment as learning. Assessment of learning directly examines students' learning products to decide whether they have achieved the expected learning through…
Vergeer, M.R.M.; Hermans, E.A.H.M.
Online political discussions are thought to lead to more political engagement and empowerment of peripheral groups in society and thereby contributing to deliberative citizenship. Because people have increased opportunities to voice their political opinions and publish these for a potentially large
Hecker, Thomas E.
Workplace mobbing occurs in libraries but is usually unrecognized and unchecked because the phenomenon has not been described and given a name. This discussion provides the library profession with an overview but also with specific background details to assist with recognizing mobbing and preventing severe harm to employees and organizations.
The examination of doctoral theses controls an important academic threshold, yet practices are often private, codes non-specific, and individuals isolated. This article adds to recent investigation of the examination culture by reporting informal panel discussion amongst a total of 23 University of Auckland (New Zealand) faculty members as to…
Dreef, M.R.M.; Borm, P.E.M.; van der Genugten, B.B.
An aspect of casino games that in general leads to discussions among both participants and spectators, is the relative extent to which a player can positively influence his results by making appropriate strategic choices.This question is closely related to the issue of how to distinguish between
Deng, Sutong; Wang, Miao; Jiang, Xiali
Management of medical consumables is an important part of modern hospital management. In modern medical behavior, drugs and medical devices act directly on the patient, and are important factors affecting the quality of medical practice. With the increasing use of medical materials, based on practical application, this article proposes the management model of medical consumables, and discusses the essence of medical materials logistics management.
Some of the highlights from the Symposium on Coal Economics and Taxation Symposium, Regina Saskatchewan May 7-9, 1978, sponsored by the Coal Association of Canada are presented. Investment, provincial policy, sources of funds, uncertainty, tax policies, and operating costs are discussed.
Broadbear, James T.; Broadbear, Barbara C.
Sexuality education in schools continues to be a controversial issue although public debate has seemingly calmed in recent years. Dialogue about the value and purpose of sexuality education for adolescents can provide health education specialists a better understanding of public opinion and online discussion may be a potentially ideal way to…
Clark, Christopher H.
Political division in the United States is the subject of much analysis in the fields of political science and psychology. While political partisanship looms large over discussions of the national political climate's influence on schools and classrooms, very little work exists that directly examines the effects of high school students' political…
Keating, Joseph P.
In preparation for the 1987 demise of the current community college funding mechanism in California, this discussion paper reviews the current fiscal situation in the state and considers the needs that should be addressed in the finance mechanism that would become effective in July 1987. Background information is presented on the history of the…
Tremayne, Penny; Norton, Wendy
Sexual health is a key public health issue. The older woman faces a number of changes to her sexual health, wellbeing and sexuality. These changes result in many older women having to adapt to a series of complex transitions that can be challenging. This article aims to identify and explore some of these changes and how they can have a significant impact on women's quality of life. Nurses play an important role in assessing and helping women to manage normal and pathological age-related changes in order to improve the sexual health of older women and ensure they receive the advice and support needed at this stage of their life.
McArdle, John R; Trow, Terence K; Lerz, Kathryn
Pulmonary hypertension is a frequently encountered problem in older patients. True idiopathic pulmonary arterial hypertension can also be seen and requires careful exclusion in older patients. Institution of therapies must be tempered with an appreciation of individual comorbidities and functional limitations that may affect patients' ability to comply and benefit from the complex treatments available for pulmonary arterial hypertension. This article reviews the existing data on the various forms of pulmonary hypertension presenting in older patients and on appropriate therapy in this challenging population.
Betz, Marian E; Lowenstein, Steven R; Schwartz, Robert
Discussions about driving cessation are difficult. "Advance driving directives" (ADDs), like advance directives for end-of-life care, would allow drivers to designate someone to help make driving decisions for them in the future. It is not known if older drivers support the concept of ADDs. Cross-sectional study of a convenience sample of English-speaking drivers (55+ years) at 2 independent living facilities and 2 community centers who completed anonymous surveys. Of 168 participants, 80% were female; the median age was 76.5 years (range = 56-93 years). Most (74%) drove daily or almost daily, and 7% reported a crash in the past year. Few had spoken with someone about driving safety (5%) or their wishes when driving skills decline (21%). Of the few who had discussed this topic, 83% had spoken with a family member; only 17% had spoken with a health care provider. However, participants were open to driving discussions, and 54% said they would be willing to complete an ADD if recommended. Of these, 79% said it was "likely" or "very likely" they would comply with the directive in the future. Most (73%) supported mandatory, age-based retesting; the median recommended testing age suggested was 80 years. More participants thought the driver (71%), a family member (61%), or a physician (59%) should determine license revocation for an unsafe driver, rather than the department of motor vehicles (32%). Many older drivers may be open to discussing their driving plans with physicians and family members. ADDs may facilitate these discussions in the present and help define driving-related wishes in the future.
Villar, Feliciano; Celdran, Montserrat
This paper discusses the ways in which university programs for older people should change to cater to the interests and concerns of generative older people. We describe university programs offered at present, underlining their emphasis on personal growth and on learning for the sake of learning. We argue that these programs are not entirely…
At observation planes away from the image plane, an imaging lens is a nonimaging optic. We examine the variation of axial irradiance with distance in image space and highlight the following little-known observation for discussion: On a per-unit-area basis, the position of the highest concentration in image space is generally not at the focal plane. This characteristic is contrary to common experience, and it offers an additional degree of freedom for the design of detection systems. Additionally, it would also apply to lenses with negative refractive index. The position of peak concentration and its irradiance is dependent upon the location and irradiance of the image. As such, this discussion also includes a close examination of expressions for image irradiance and explains how they are related to irradiance calculations beyond the image plane. This study is restricted to rotationally symmetric refractive imaging systems with incoherent extended Lambertian sources.
CERN recently invited local partners, elected representatives, and representatives of local administrations and associations to an information and discussion evening, giving those invited an opportunity to raise various topics linked to CERN’s presence in the local area. On Tuesday, 20 October the Globe of Science and Innovation took on a distinctly regional flavour when some 60 representatives of local administrations and public bodies in Switzerland and France as well as teachers, heads of local schools and chairs of local associations attended an information and discussion evening at the invitation of the Director-General. In his opening address, the Director-General underlined CERN’s commitment to transparency and the desire to enhance its communication with the local community. This address was followed by four presentations. Philippe Bloch, head of the Physics Department, explained the scientific goals of the LHC and the L...
A group of physicists at TRIUMF have been meeting regularly to discuss options for involvement in experiments that relate closely to the physics that would be undertaken at the KAON Factory. At a meeting held to discuss possibilities for work at KEK in the light of the new facilities that are under construction or proposed as part of the JHP, the topics considered ranged from the ion source to kaon beams. They included measurements of kaon-nucleon elastic and inelastic scattering in the 1600 to 2000 MeV range; transport of polarized proton beams through synchrotrons; the development of laser pumped polarized ion sources and volume cusp H - sources; studies of the problems that high intensity beams will present for the maintenance of H - stripping foils; collaboration on radioactive beam facilities; production of hypernuclei; low energy kaon scattering; and new types of detectors
in general, sub-matter experts, experts on peace and conflict studies, and practitioners in crisis management. A total of eighteen speakers explored the effectiveness of international assistance to the four African examples from different perspectives, drawing a rather pessimistic picture of the current......One round-table event was organised within the framework of Work Package III, part of the IECEU project. The events focused on the WP3’s four case studies: Libya, CAR, South Sudan and DRC. This report provides information on the round-table event and presents the main points of discussion...... that emerged during it. The round-table discussion and the subsequent seminar on the Effectiveness of International Assistance and Local Ownership in the four case studies was organised by the Royal Danish Defence College on 31 October-1. November 2016. The round-table participants included experts on Africa...
Jacelon, Cynthia S; Connelly, Thomas W; Brown, Rana; Proulx, Kathy; Vo, Thuy
Human dignity is an essential value of professional nursing education as well as a component of the American Nurses Association Code of Ethics. Nurses are exhorted to treat patients with dignity, and older adults want to be treated with dignity and die with dignity. Although dignity, particularly the dignity of older adults, is often discussed in the health care literature, its meaning is not always clear. The aim of this paper is to describe a concept analysis to develop a definition of dignity in older adults. Data were collected using a literature review and five focus groups composed of older adults. The literature provided data about professionals' ideas of dignity and the focus groups provided qualitative data about the nature of dignity in older people. The literature review and focus groups were carried out concurrently, followed by synthesis of the findings. Dignity is an inherent characteristic of being human, it can be subjectively felt as an attribute of the self, and is made manifest through behaviour that demonstrates respect for self and others. Dignity must be learned, and an individual's dignity is affected by the treatment received from others. A behavioural definition of dignity was constructed and this could provide the theoretical basis for nurses to develop interventions that foster dignity for older people.
Chotirmall, Sanjay Haresh
Despite comprehensive guidelines established by the European Global Initiative for Asthma and the U.S. National Asthma Education and Prevention Program on the diagnosis and management of asthma, its mortality in older adults continues to rise. Diagnostic and therapeutic problems contribute to older patients being inadequately treated. The diagnosis of asthma rests on the history and characteristic pulmonary function testing (PFT) with the demonstration of reversible airway obstruction, but there are unique problems in performing this test in older patients and in its interpretation. This review aims to address the difficulties in performing and interpreting PFT in older patients because of the effects of age-related changes in lung function on respiratory physiology. The concept of "airway remodeling" resulting in "fixed obstructive" PFT and the relevance of atopy in older people with asthma are assessed. There are certain therapeutic issues unique to older patients with asthma, including the increased probability of adverse effects in the setting of multiple comorbidities and issues surrounding effective drug delivery. The use of beta 2-agonist, anticholinergic, corticosteroid, and anti-immunoglobulin E treatments are discussed in the context of these therapeutic issues.
Li Bing; Chen Yingying; Xiao Jun; Yang Duanjie; Cui Hao
The discussion on control room envelope integrity, source term analysis in habitability assessments and other impact factors for dose consequence is provided combined with regulatory requirements and the current status of domestic NPPs. Considering that the infiltration is an important factor for control room habitability assessment, CRE integrity test should be performed to demonstrate the CRE's infiltration characteristics. The consequence assessment should be performed based on different DBAs and different pathways, such as pathways internal to the plant. (authors)
Liu Aigui; Wang Lu; Wu Wenjing; Chen Gang
Traditional storage system has been unable to meet the demand of computing. WAN storage systems face many problems since the complexity of WAN. This paper in-depth discusses on data interoperability, data prediction, active data service and semantic-based data access according to the characteristics of high energy physics applications. To eliminate isolated island, improve performance and simplify usage, it will be better to meet the demands of high energy physics applications. (authors)
Michelle Donizeth Euzébio; Anderson Jair Goulart; Angelita Darela Mendes
This study focuses on the characterization of graphocentrism in microculture. We aim to describe, based on literacy studies, the presence of written language in the life of socially and historically situated subjects, thematizing the axiological capital of less favored socioeconomic contexts. Subjects are children undergoing schooling process, living in a district of Florianópolis, Santa Catarina, Brazil. Discussions on the theme are based on Barton (1994), Barton, Hamilton and Ivanic (2000),...
reverse engineering, security, malware , blackhat) were labeled as cyber and posts on non- cyber topics (e.g., astronomy, electronics, beer, biology, mu...firewall, hash, infect, inject, install, key, malicious, malware , network, obfuscate, overflow, packet, password, payload, request, risk, scan, script...cyber vulnerabilities (e.g., malware , overflow, attack). The keyword system lacked the keywords used in Heartbleed discussions, and thus suffered from
De Vos, M.
The CNSC (Canadian AECB) is ready to regulate Small Modular Reactors (SMR) facilities in Canada. The CNSC is well situated to engage with proponents of SMR reactors in design reviews or licensing discussions. A risk-informed (graded) approach is possible in many instances for reactors but it is not a relaxation of requirements. The vendor design review process helps reduce regulatory risks by encouraging early engagement.
The round table discussions of the first session of the Belgium Workshop addressed the following questions: - Accepting or refusing a person, an institution or a grouping as a legitimate Stakeholder who makes the decision and how? - How are the local partnerships built and organised? - How to obtain community support for the partnership's legitimate decisions/findings? - Experience teaches that no decision is reached solely by formal and legal processes. What role do informal processes play? - How can the informal procedures be accepted? Do they need to be made explicit? Discussion took place after the plenary presentations, at tables grouping Belgian stakeholders and FSC delegates. After the discussion, each table's findings were reported to the plenary. Most of the discussion concerned the local partnerships. Important findings were that the statutes for the partnerships were developed by the partnerships themselves and there were no legally binding rules handed down by the federal level. The partnerships are part of an informal process. A legally binding participation (i.e. within the EIA) will be initiated at a later stage. As the partnerships function outside of the formal legal procedure, they can function in a more flexible way. It was noted that the partnerships make recommendations, but it is not clear what the government will do with these recommendations. It was also argued that the process may cause conflicts between neighboring communities. As in other contexts visited by the FSC, the importance of the right of veto of the community was stressed, although this may cause a conflict between technical suitability and social acceptance. Access of the community to the local partnership is necessary. Finally it was accepted that time is needed to explain the recommendations to the broader community before any decisions are taken. (author)
This paper aims to find out the strategies, applied by students in classroom interaction particularly in discussion, to maintain their interpersonal rapport as well as to enhance their rapport management with their fellow students. There are five strategies based on Spencer-Oatey (2008) that the interactants apply in social interactions. The strategies are request, compliments, apologies, gratitude and disagreement. The research is done to see whether the students realize the management of ra...
Full Text Available In the past gender specific problems were mainly discussed in a female perspective. In the meantime there is a rising attentiveness in the living conditions of men and their coping strategies within critical life events. In this paper an appropriate frame of reference is outlined which can be used in those areas of social work where men are already discovered as a target group with special difficulties and needs.
Speaking is one of important parts in teaching language because it includes one of four basic language skills. Nevertheless, in MA NU BANAT Kudus, the writer found that most of students there still get the difficulties in studying speaking. It may be caused by the method used in teaching English, especially speaking. Classroom Discussion is a method that can be applied in teaching English, especially to improve the ability of speaking. In this method, hopefully, the students get a big opportu...
Baldermann, C.; Bernhardt, J.H.; Brueggemeyer, H.; Leitgeb, N.; Reichardt, R.; Steinmetz, M.
The actual state of knowledge on health risks of non-ionizing radiation is discussed on an international as well as a national basis. Emphasis is given to EMF risks when using mobile phones on the one hand, and to the dangers from natural and artificial UV radiation on the other. Furthermore, a comprehensive compilation is given of national laws and regulations for telecommunication and mobile phones in Germany. (Orig.)
Andrei STĂNCULESCU; Eugen MITRICĂ
This paper is a meaningful attempt to critically analyze the cohesion and relationship between three fundamental pillars of the corporate governance system: the shareholders, the board of directors and the employees. We present the characteristics of each pillar and discuss its relevance in corporate governance. A couple of world-renowned corporate governance models are considered. A synthetic conclusion is drawn based on information presented.
Chou, Chih-Yueh; Lin, Pin-Hsun
Peer instruction (PI) involves students answering questions and peer discussion learning activities. PI can enhance student performance and engagement in classroom instruction. However, some students do not engage in the discussions. This study proposes two mechanisms, discussion partner assignment and accountability scoring mechanisms, to form…
The purpose of the study is to examine positions of students and a teacher in dialogic discussion. In this study, dialogic discussion was defined with Bakhtin's (1981) dialogism, Nystrand's (1997) explanation of dialogically organized instruction, and Mercer's (1995) explanation of Exploratory Talk. Studies about literature discussion in…
The round table discussions of the second session of the FSC Belgium Workshop addressed the following questions: - Do local stakeholders have, internally or externally, all the expertise they need in order to address the issues raised by radioactive waste management projects? - Do institutional stakeholders have all the expertise they need to take local impacts into account? - What kinds of expert input are sought and attained by the different stakeholders? - Were any formal methods used to aid local partnerships perform technology assessments? Or other types of assessment? - How to maintain the knowledge and expertise achieved by the stakeholders? Discussion took place after the plenary presentations, at tables grouping Belgian stakeholders and FSC delegates. As in Session I, most of the round table discussion focussed specifically on the experience of the local partnerships. Many insights were shared about the nature and role of expertise in complex decision making. They are summarised below, on the basis of the feedback provided to the plenary by each round table. Some of these insights can be generalised to other contexts. All in all, a profile emerged of the local partnerships as a unique and effective tool to deal with knowledge issues in managing risk. (author)
Business files compilation for an enterprise is a distillation and recreation of its spiritual wealth, from which the applicable information can be available to those who want to use it in a fast, extensive and precise way. Proceeding from the effects of business files compilation on scientific researches, productive constructions and developments, this paper in five points discusses the way how to define topics, analyze historical materials, search or select data and process it to an enterprise archives collection. Firstly, to expound the importance and necessity of business files compilation in production, operation and development of an company; secondly, to present processing methods from topic definition, material searching and data selection to final examination and correction; thirdly, to define principle and classification in order to make different categories and levels of processing methods available to business files compilation; fourthly, to discuss the specific method how to implement a file compilation through a documentation collection upon principle of topic definition gearing with demand; fifthly, to address application of information technology to business files compilation in view point of widely needs for business files so as to level up enterprise archives management. The present discussion focuses on the examination and correction principle of enterprise historical material compilation and the basic classifications as well as the major forms of business files compilation achievements. (author)
Full Text Available In this concise review we discuss some of the complex edges of the concept of death that arose after the notorious advances in science and medicine over the last 50 years, in which the classical cardio-pulmonary criteria have led to the neurological criteria of death. New complicated questions like the definition of death and the operational criteria for diagnosing it have arisen and we think that they are far from being adequately and satisfactorily solved. A number of important issues -like the reliability and differences between cardio-pulmonary versus brain based criteria of death, if death is an event or a process, the meaning of integration and irreversibility- have not yet received sufficient attention. Here we have approached the death problem from two (biological complex system perspectives: the organism level and the cellular-molecular level. We also discuss issues from a third systemic approach, that is, the entire society, thus involving legal, religious, bioethical and political aspects of death. Our aim is to integrate new perspectives in order to promote further discussion on these critical yet frequently neglected issues
O'Keefe, J. A.; Barkatt, A.; Glass, B. P.; Alterescu, S.
J. J. Crovisier and J. Honnorez  discuss an article by W. W. Maggs, “Mg May Protect Waste Under Glass” [Maggs, 1988] summarizing work by A. Barkatt (Catholic University, Washington, D.C.), B. P. Glass (University of Delaware, Newark), and S. Alterescu and J. A. O'Keefe (NASA/GSFC, Greenbelt, Md.). We found that seawater is orders of magnitude less corrosive t h an fresh water in attacking tektite glass; traced the protective effect to the presence of magnesium, at a level of about 1.3 g/L in seawater; and suggested that the effect might be useful in protecting nuclear waste glasses from corrosion.Crovisier and Honnorez first make the point that the rate of corrosion of glass is, in principle, a function of the ratio of surface area 5 to the effective volume V. This concept, which is usually discussed in American literature under the name of S/V effects, is discussed by Crovisier and Honnorez in terms of the “permeability of the environment.” These effects have been carefully considered throughout our work (see, for example, Barkatt et al. [19867rsqb;). It turns out that in the sea the effective S/V is so small that the effects referred to by Crovisier and Honnorez can be ignored.
Ellianawati; Rudiana, D.; Sabandar, J.; Subali, B.
The Focus Group Discussion (FGD) activity in Mathematical Physics learning has helped students perform the stages of problem solving reflectively. The FGD implementation was conducted to explore the problems and find the right strategy to improve the students' ability to solve the problem accurately which is one of reflective thinking component that has been difficult to improve. The research method used is descriptive qualitative by using single subject response in Physics student. During the FGD process, one student was observed of her reflective thinking development in solving the physics problem. The strategy chosen in the discussion activity was the Cognitive Apprenticeship-Instruction (CA-I) syntax. Based on the results of this study, it is obtained the information that after going through a series of stages of discussion, the students' reflective thinking skills is increased significantly. The scaffolding stage in the CA-I model plays an important role in the process of solving physics problems accurately. Students are able to recognize and formulate problems by describing problem sketches, identifying the variables involved, applying mathematical equations that accord to physics concepts, executing accurately, and applying evaluation by explaining the solution to various contexts.
Hanks, Roma Stovall
In eight focus groups in five cities, older adults identified their concerns about safety on elevators and escalators, often related to misunderstanding of the equipment. Their preferences for delivery of safety information included video/television, pamphlets, discussions, and posters. Educational interventions and modifications for disabilities…
Kristensen, Maartje; van Lier, Alies; Eilers, Renske; McDonald, Scott A.; Opstelten, Wim; van der Maas, Nicoline; van der Hoek, Wim; Kretzschmar, Mirjam E.; Nielen, Mark M.; de Melker, Hester E.
Background: Implementation of additional targeted vaccinations to prevent infectious diseases in the older adults is under discussion in different countries. When considering the added value of such preventive measures, insight into the current disease burden will assist in prioritization. The aim
... all older Americans (10.2 percent). *Income and poverty estimates are based on redesigned income questions from the Current Population Survey, Annual Social and Economic Supplement. SELF-RATED ...
Træen, Bente; Carvalheira, Ana; Kvalem, Ingela Lundin
with their bodies than men, particularly in sexual contexts, older women appear to be less vulnerable to body-related dissatisfaction than younger women. Despite the age-specific dynamics of sexual satisfaction and sexual well-being, which parallel age-related decrease in the frequency of sexual activity, research...... findings from different countries show that substantial proportions of aging men and women are satisfied with their sex life. There is some limited evidence that this proportion may be increasing across cohorts. Gender differences in factors that influence sexual satisfaction among older adults appear...... marginal. Conclusion: Older age can affect sexual satisfaction on individual, interpersonal, and culture-related levels. Future research in older adults' sexuality should focus on sexual well-being in women who are without partners, sexual satisfaction among aging lesbian, gay, bisexual, and transgender...
... a bone. Common fractures are those of the hip, wrist, or a bone in the back (vertebra). ... leading cause for dehydration among older adults is water pills (diuretics). In addition to not feeling thirsty, ...
... Stroke Urinary Incontinence Related Documents PDF Choosing Wisely: Diabetes Tests and Treatments Download Related Video Join our e-newsletter! Aging & Health A to Z Diabetes Unique to Older Adults This section provides information ...
Payne, S; Doyal, L
Older women make up an increasingly important sector in the labour market. However, we know little about their health-the various influences on their health and the ways in which paid and unpaid work impact on both physical and mental well being. This paper reviews the available literature on older women's health in the workplace, focussing on work-specific and more general risks for older women, including stress, discrimination, physical hazards and the 'double burden' of paid work and caring responsibilities. Databases searched included Web of Science, CAS, CINAHL, Medline and ASSIA, together with UK and European statistical sources. We conclude with a three-point research agenda, calling for more empirical work on the risks faced by older women, studies that take a life-course perspective of women's occupational health and work that explores the interactions between unpaid and paid work in later life.
... out some of our online STEADI resources for older adults. These resources include: Stay Independent brochure What You Can Do to Prevent Falls brochure Check for Safety brochure Postural Hypotension brochure Chair Rise Exercise Related Pages Important ...
Jessup, Denise; Greenberg, Barbara
Describes program innovations to keep older workers employed: retraining, job sharing, flexible working hours, job redesign, and phased retirement. Addresses costs and savings, disincentives for workers and employers, and future trends. (SK)
Sep 14, 2007 ... Sebastiana Kalula is Head of Geriatric Medicine and Acting Director of The Albertina and Walter .... performance of cognitive and physical .... Older persons may need multiple drug therapy for an increased number of chronic.
... Extreme Heat Older Adults (Aged 65+) Infants and Children Chronic Medical Conditions Low Income Athletes Outdoor Workers Pets Hot Weather Tips Warning Signs and Symptoms FAQs Social Media How to Stay Cool Missouri Cooling Centers Extreme ...
Wallace, Steven; Pourat,, Nadereh; Durazo, Eva; Leos, Rosana
This policy brief examines the growing rate of repeated falls among senior citizens, comparing data from the 2003 and 2007 California Health Interview Survey (CHIS). The authors found that over half million older Californians (565,000) fell more than once in 2007—about 100,00 more seniors with repeated falls than in 2003. National guidelines by the American Geriatrics Society (AGS) and a recent synthesis of the scientific literature recommend reducing the risk of falling by older adu...
Full Text Available This paper analyzes how older people, living in Spain, use smartphones and smartphone applications. Using a mixed methods approach, we compare quantitative results obtained by tracking mobile app usage amongst different generational samples with qualitative, focus-group discussions with active smartphone users. A sample of Spanish smartphone users were tracked during one month in the winter of 2014 (238 individuals, aged 20 to 76 years-old. This was followed by three focus group sessions conducted in the spring of 2015, with 24 individuals aged 55 to 81. As we learned, WhatsApp is currently the most popular application used by people of all ages, including older adults. Smartphones increasingly are playing a central role in the life of older participants, although the frequency of app access is negatively correlated with age. On the other hand, as our data indicates, older adults also use a number of different types of apps that are distinct from that of younger users. Older participants access personal information manager apps (calendar, address book and notes more often than other age groups. And comparatively, older participants use the smartphone less often in stable locations (home, office, relatives’ home with Wifi than somewhere else and with mobile data. As we argue, differences in age seem to reflect the evolution in personal interests and communication patterns that change as we grow older. Our study captures new trends in smartphone usage amongst this cohort. It also indicates how a combination of methods may help to assess the validity of the log and qualitative data. We highlight the relevance of conducting careful generational studies in smartphone use and some of the potentials and limitations of making predictive studies of ICT use as we change throughout the life course. Finally, we assert the value of the inclusion of older representatives within research, which ultimately may influence public decisions and the design of new
Understanding consumer psychological characteristics and their impact on consumer behavior is an important foundation for business marketing strategies. Self-perceived age has a great impact on older consumers’ behavior. This article defines the gray market in China, investigates the factors that affect the differences between older consumers’ self-perceived age and life age, and analyzes the influence of self-perceived age on older Chinese consumers’ behavior. In this study, 1,120 older consumers were randomly selected from six cities in China. Findings show that over half of the respondents feel younger than their actual life age. Related marketing strategies are discussed. PMID:20835378
Sciuk, J.; Peters, P.E.
A total of 2,878 unselected subsequent CT examinations carried out in 1984 were analyzed retrospectively. All studies were performed in a university hospital with a centralized department of diagnostic radiology. Most of the patients investigated were hospitalized; there were only 12% outpatients. Of the patients studied 12.6% were older than 65 years and 20.5% older than 60; 17.7% were emergency cases and patients between 16 and 25 years of age represented the largest fraction. In all other age groups the relative distribution between emergency cases and regular studies revealed no significant differences. There was no statistically significant difference between the older age group (patients older than 65 years) and the total population of this study in almost all items investigated, i.e., no differences in CT examination time and no differences in preparation time (time between two CT studies). The rate of abdominal CT examinations was 7% higher in the older age group, while the relative distribution of all other CT examinations was again comparable to the total population under study. Thus, the expected increase in patients in the older age group does not measurably prolong the CT examination time. This statement applies to a major referral center with a high percentage of inpatients. (orig.) [de
Cotterell, Natalie; Buffel, Tine; Phillipson, Christopher
The extent of social isolation amongst older people has emerged as a major concern for health and social policy. Although the social and health outcomes of social isolation are well documented, evidence regarding the prevention of isolation in later life remains scarce. This article addresses this by presenting the findings from a literature review focusing on the identification, assessment, prevention, and intervention strategies relevant to social isolation in older age. The paper first addresses the issues of identification and assessment, using an ecological framework to identify the risk factors for social isolation at four levels: individual, relationship, community, and societal. It then reviews different types of interventions to reduce or prevent social isolation in later life, including one-to-one, group, service provision, technology-based, neighbourhood, and structural interventions. The paper discusses both the opportunities and the constraints associated with these different approaches. The discussion highlights future directions for research, emphasising the need for a cultural change from 'cure' to 'prevention' of social isolation across the life-course, and the importance of acknowledging greater diversity within the ageing population. Copyright © 2018 Elsevier B.V. All rights reserved.
Qu Jingyuan; Liu Yuanzhong
The concept of risk, the methods for assessing risk and the acceptability of risk are discussed. The emphasis was laid on the three components for complete description of a risk: scenario, probability and consequence of an event. The disadvantages of the concept and presentation of risk used in some risk analysis were pointed out. The paper emphasized that it is necessary to explicitly consider the multi-dimensionality of risk in the assessment and management of risk. Several important factors influencing the acceptability of risk and the methodology for evaluating the acceptability of risk were also described
The experts' discussion on reactor safety research deals with risk analysis, political realization, man and technics, as well as with the international state of affairs. Inspite of a controversy on individual issues and on the proportion of governmental and industrial involvment in reactor safety research, the continuation and intensification of corresponding research work is said to be necessary. Several participants demanded to consider possible 'conventional accidents' as well as a stronger financial commitment by the industry in this sector. The ratio 'man and technics' being an interface decisive for the proper functioning or failure of complex technical systems requires even more research work to be done. (GL) [de
Ma Xinhua; Xiao Wuyun; Ai Xianyun; Shi Zhilan; Liu Ying
This article describes the development of luminescence dose data measurement and processing technology. General design planning of luminescence dose data measurement and processing technology is put forward with the diverse demands. The emphasis is focused on dose data processing method, luminescence curve analysis method, using of network, mechanics of communication among computers, data base management system of individual dose in this paper. The main methods and skills used in this technology as well as their advantages are also discussed. And it offers general design references for development luminescence dose data processing software. (authors)
Eight conference papers are presented which discussed the following topics: 1. Energy and environment - conflict or harmony; 2. A common electricity market within the European Community - from the point of view of the German electricity industry; 3. Radioactive waste in nuclear engineering; 4. Effects of electric and magnetic fields on humans; 5. Classroom ventilation; 6. The polluted atmosphere - potential effects on the global climate; 7. Environment-centered marketing, a challenge to a household appliances supplier; 8. High-temperature superconductors - perspectives for application. (UA) [de
Cynthia E. Milton.
Full Text Available In theaftermath of civil conflict and a truth commission into twenty years of violence (19802000, Peru is presently engaged in the difficult task of establishing overarching narratives that provide frameworks for organizing personal and collective memories in the few public spaces available for the discussion of this recent past. This article looks at two public spaces, a series of performative events in Ayacucho duringthe submission of the truth commission's Final Report, and Lima's memorysite, The Eye that Cries. One contentious memory is over who are appropriate victims and heroes to remember.
Full Text Available In November 2013, the Institute of Advanced Studies (University of Warwick hosted a meeting of interdisciplinary colleagues interested in Creative Research Methods. The aspirations were to kick-start the debate at Warwick and create a platform from which researchers can develop projects that embrace new forms of intellectual enquiry and knowledge production. Following the meeting, several of the attendees agreed to develop some of the discussion points and briefly responded to a number of questions in an online document over a period of a few weeks. This paper is the result of that real space and online collaboration.
Youngblood, Robert; Bier, Vicki M.; Bukowski, Richard W.; Prasad Kadambi, N.; Koonce, James F.
Full text of publication follows: Performance-based regulation is a part of the NRC's Strategic Plan and is realizing steady progress in conceptual development for actual applications. For example, high-level, conceptual guidelines have been proposed that would apply to reactors, materials, and waste areas. Performance-based approaches are also being applied in other regulated industries such as FAA and OSHA. The discussion will include comments from speakers from different parts of the nuclear industry and other industries regarding benefits and weaknesses of performance-based regulation. (authors)
This article is devoted to the issues of educational activity of the elderly in Poland. Defining the term “old age” and drawing attention to the issue of human adaptation to old age were the starting points of the discussion. Next, the most important issues concerning the activity of seniors were raised. Further discussed were the conditions and objectives of the educational activity of older people. An attention was also drawn to the role of institutions, promoting education and culture, in ...
This executive summary addresses the activities associated with the National Transuranic (TRU) Program managed by the Carlsbad Area Office (CAO). The CAO programmatically reports to the Assistant Secretary for Environmental Management and receives administrative support through the Albuquerque Operations Office. The mission of the Carlsbad Area Office (CAO) is to protect human health and the environment by opening and operating the Waste Isolation Pilot Plant for site disposal of TRU waste and by establishing an effective system for management of TRU waste from generation to disposal. It includes personnel assigned to the CAO, the Waste Isolation Pilot Plant (WIPP) site operations, and other activities associated with the National TRU Program. The CAO develops and directs implementation of the program, while the DOE Headquarters establishes policy and guidelines. The CAO assesses compliance with the program guidance, as well as the commonality of activities and assumptions among all the sites. Since the development of the February 28, 1997, database used to develop this Discussion Draft, the opening of the WIPP facility for receipt of Contact Handled waste has been delayed from November 1997 to May 1998. This slippage is significant enough to require a change in the milestones and volumes included in the documents to be reviewed by our stakeholders. Changes have been incorporated into this Discussion Draft and its supporting Project Baseline Summaries (PBSs)
Bennett, E.L.; Rosenzweig, M.R.
It is generally assumed that memory faculties decline with age. A discussion of the relationship of memory and aging and the possibility of retarding the potential decline is hampered by the fact that no satisfactory explanation of memory is available in either molecular or anatomical terms. However, this lack of description of memory does not mean that there is a lack of suggested mechanisms for long-term memory storage. Present theories of memory usually include first, neurophysiological or electrical events, followed by a series of chemical events which ultimately lead to long-lasting anatomical changes in the brain. Evidence is increasing for the biochemical and anatomical plasticity of the nervous system and its importance in the normal functioning of the brain. Modification of this plasticity may be an important factor in senescence. This discussion reports experiments which indicate that protein synthesis and anatomical changes may be involved in long-term memory storage. Environmental influences can produce quantitative differences in brain anatomy and in behavior. In experimental animals, enriched environments lead to more complex anatomical patterns than do colony or impoverished environments. This raises fundamental questions about the adequacy of the isolated animal which is frequently being used as a model for aging research. A more important applied question is the role of social and intellectual stimulation in influencing aging of the human brain.
Kustusch, Mary Bridget; Ptak, Corey; Sayre, Eleanor C.; Franklin, Scott V.
It is increasingly common in physics classes for students to work together to solve problems and perform laboratory experiments. When students work together, they need to negotiate the roles and decision making within the group. We examine how a large group of students negotiates authority as part of their two week summer College Readiness Program at Rochester Institute of Technology. The program is designed to develop metacognitive skills in first generation and Deaf and hard-of-hearing (DHH) STEM undergraduates through cooperative group work, laboratory experimentation, and explicit reflection exercises. On the first full day of the program, the students collaboratively developed a sign for the word ``metacognition'' for which there is not a sign in American Sign Language. This presentation will focus on three aspects of the ensuing discussion: (1) how the instructor communicated expectations about decision making; (2) how the instructor promoted student-driven decision making rather than instructor-driven policy; and (3) one student's shifts in decision making behavior. We conclude by discussing implications of this research for activity-based physics instruction.
McDonald, Kristina L.; Malti, Tina; Killen, Melanie; Rubin, Kenneth H.
Peer relationships, particularly friendships, have been theorized to contribute to how children and adolescents think about social and moral issues. The current study examined how young adolescent best friends (191 dyads; 53.4% female) reason together about multifaceted social dilemmas and how their reasoning is related to friendship quality. Mutually-recognized friendship dyads were videotaped discussing dilemmas entailing moral, social-conventional and prudential/pragmatic issues. Both dyad members completed a self-report measure of friendship quality. Dyadic data analyses guided by the Actor-Partner Interdependence Model indicated that adolescent and friend's reports of friendship qualities were related to the forms of reasoning used during discussion. Friends who both reported that they could resolve conflicts in a constructive way were more likely to use moral reasoning than friends who reported that their conflict resolution was poor or disagreed on the quality of their conflict resolution. The findings provide evidence for the important role that friendship interaction may play in adolescents’ social and moral development. PMID:23666555
McDonald, Kristina L; Malti, Tina; Killen, Melanie; Rubin, Kenneth H
Peer relationships, particularly friendships, have been theorized to contribute to how children and adolescents think about social and moral issues. The current study examined how young adolescent best friends (191 dyads; 53.4% female) reason together about multifaceted social dilemmas and how their reasoning is related to friendship quality. Mutually-recognized friendship dyads were videotaped discussing dilemmas entailing moral, social-conventional and prudential/pragmatic issues. Both dyad members completed a self-report measure of friendship quality. Dyadic data analyses guided by the Actor-Partner Interdependence Model indicated that adolescent and friend reports of friendship qualities were related to the forms of reasoning used during discussion. Friends who both reported that they could resolve conflicts in a constructive way were more likely to use moral reasoning than friends who reported that their conflict resolution was poor or disagreed on the quality of their conflict resolution. The findings provide evidence for the important role that friendship interaction may play in adolescents' social and moral development.
The author introduces a special section of Psychological Bulletin devoted to the study of disgust. After discussing conflicts between its supposed role as a basic emotion and its more recently understood involvement in responding to moral transgressions, the author summarizes 3 articles contained in the special section. Widen and Russell (2013) present a developmental account of disgust highlighting the ages at which children experience, express, understand, verbalize, and recognize disgust. The article shows that disgust is present early but that recognition of disgust in others is considerably delayed. Chapman and Anderson (2013) review evidence pertaining to the question of whether genuine disgust is elicited by moral transgressions. Their review covers data from self-report, brain imaging, facial behavior, and implicit measures gathered from both experimental and correlational studies. They conclude that moral transgressions elicit genuine disgust. Russell and Giner-Sorolla (2013) ask what types of moral transgressions are most likely to elicit pure disgust. They find that moral transgressions involving body violations are more likely than others to elicit such disgust. Moreover, they suggest that disgust elicited by body violations is likely to be more resistant to modification by context, situation, and efforts at rationalization. Taken together, the reviews support the view that rudiments of disgust to physical objects are present early in life but later become adapted to social influence and new moral purposes. Social implications are discussed. © 2013 American Psychological Association
A panel discussion on the radiotracer development process opened with a question regarding the role of toxicological studies in the process of obtaining a physician-sponsored Investigational New Drug (IND) for a new radiopharmaceutical. Panel members were uniformly supportive of new radiotracer development, expressing their opinions that the regulatory hurdles were there but could be overcome. Several institutions are actively working with regulatory agencies to determine just what toxicology data are relevant to new radiopharmaceutical development in the PET field. The FDA is beginning to understand that the pharmacology of PET tracer doses may be completely different from what is usually important in drug trials. The second part of the panel discussion centered on the role, if any, of the pharmaceutical companies in new radiotracer development. It was pointed out that what the radiochemist is looking for in a radiopharmaceutical is different from what these companies are searching for in a therapeutic drug. Panel and audience members responded to the question: What would a pharmaceutical company gain from collaboration with radiopharmaceutical research laboratories? Several examples were given such as providing crucial data from humans rather than animals; determining individualized drug doses to maximize the therapeutic index of a new drug regimen; and replacing the large amounts of time and money currently invested by drug companies in the radiolabeling and evaluation of metabolites of new drugs
The first two presentations were given by specialists in human science, and focused more on the ethical aspects of the funding for decommissioning. Some new aspects or approaches were presented, which allowed to highlight the egalitarian and utilitarian approaches of inter-generational equity. The different ethical principles led to conclude on the need of a democratic debate on the subject, and the need of ethical guidance at international level. Some other key points, like the preservation of competences, funding and resources, were also considered in the light of the inter-generational community. The session was concluded by a presentation on the application of the ethical principles for the funding. Session 2: Actual experience in funding. The various mechanisms for funding have been analyses on their principle, current practice and merits. Three main aspects were analysed: How funds are raised? How are the funds managed? How to disburse when needed? The actual experience in different countries showed different mechanisms and return of experience. Session 3: Uncertainties. In most large industrial projects (construction, civil works, aerospace...), the return of experience shows that overrun (in time and cost) is a rather general tendency. But it depends on the type of project, on the degree of innovation, etc. Some means to avoid these overrun were presented. In the case of D and D, the main uncertainties affecting funding can be found in: cost estimate, inflow of resources, management of resources, time factor: when will the costs occur? Moreover, these uncertainties sources can also be inter-linked. One of the conclusions from this analysis is that the existing uncertainties in funding are good reasons not to postpone decommissioning operations to a too distant future. Presentations on return of experience were presented by several countries. Plenary discussions: The plenary discussions allowed to tackle the different aspects presented during the day. Some
Full Text Available Purpose: The aim of the paper is to present and assess professional development opportunities for older employees in SME. Methodology: In the process of desk research, the author has discerned a number of characteristics of training activities conducted by SMEs. The management of older employees’ professional development is discussed on the basis of selected research findings, i.a. CATI and CAPI surveys conducted in the framework of the “Comprehensive program of activation of people aged 50+” project carried out by the Department of Human Resource Management at Kozminski University in 2010–2012. Findings: The first part of the paper discusses the specificity of training measures undertaken in SMEs. According to a large body research results available, these include: informality, reactivity, short-term perspective, focus on solving current problems, “learning by doing”, focus on the development of specific skills and organizational knowledge, lack of professional organization of trainings. The core part of the paper focuses on the management of professional development of older employees in SMEs. The majority of surveyed firms have declared providing their older and younger employees with the same access to training. However, it does not always mean training is organised, or that employees aged 50+ participate in it. Moreover, the survey has proven the existence of significant differences in assessments and opinions among entrepreneurs and employees. Originality/value: This paper discusses professional development of older SME employees, which is a relatively new problem; it is based on an extensive body of research. Managing professional development of older workers is one of the most important challenges faced by SMEs in the twentyfirst century and it shall require extensive and thorough research in the future.
Thompson, Edward H; Killgore, Leslie; Connors, Heather
Objective Few studies examine how older adults' health status affects spiritual and religious involvement. This study examined the effects of gender and poor cardiac health on older adults' ends, means, and quest religious motivations and frequency of private devotion. Method Longitudinal data (12 months between the T1 and T2 interviews) with 182 older adults sampled from a Northeast city were used to examine in a multivariate analysis of covariance whether gender and the existence of cardiac health problems at T1 affected older adults' spiritual and religious involvement at T2. Findings A gender and cardiac health condition interaction showed older men with heart trouble had more changes in religious involvement-they engaged in more religious doubt, prayed less, and were not as intrinsically oriented at T2. Discussion The findings strongly suggest that older men with heart trouble may maintain a masculine style and shun seeking divine help.
Sharit, Joseph; Czaja, Sara J; Hernandez, Mario; Yang, Yulong; Perdomo, Dolores; Lewis, John E; Lee, Chin Chin; Nair, Sankaran
Telecommuting work represents a strategy for managing the growing number of older people in the workforce. This study involved a simulated customer service telecommuting task that used e-mail to answer customer queries about media-related products and company policies. Participants included 27 "younger" older adults (50-65 years) and 25 "older" older adults (66-80 years). The participants performed the task for two 2-hr sessions a day over 4 consecutive days. Although both age groups showed significant improvement across sessions on many of the performance criteria, in general the improvements were more marked for the older age-group participants. However, the participants from both age groups had difficulty meeting some of the task performance requirements. These results are discussed in terms of training strategies for older workers.
Perpetua Lum Tanyi
Feb 6, 2018 ... ... social policy are discussed. Keywords: HIV/AIDS, older adults, African family, caregiving, Cameroon ...... and treatment that may be spread out over the full period of illness. ..... anxiety, relationships, grief, loss and addictions.
Spruiell, Phyllis R.; Jernigan, Marian
Investigated the clothing preferences and problems of older women, using personal interviews. Presents results of preferred styles in detail. Discusses implications of the research for gerontologists in higher education and for the American clothing industry. (RC)
Silbey, Robert; Beretta, Gian Paolo; Cengel, Yunus; Foley, Andrew; Gyftopoulos, Elias P.; Hatsopoulos, George N.; Keck, James C.; Lewins, Jeffery; Lior, Noam; Nieuwenhuizen, Theodorus M.; Steinfeld, Jeffrey; von Spakovsky, Michael R.; Wang, Lin-Shu; Zanchini, Enzo
This article reports an open discussion that took place during the Keenan Symposium "Meeting the Entropy Challenge" (held in Cambridge, Massachusetts, on October 5, 2007) following the short presentations—each reported as a separate article in the present volume—by Joseph Smith Jr., Howard Butler, Andrew Foley, Kimberly Hamad-Schifferli, Bernhardt Trout, Jeffery Lewins, Enzo Zanchini, and Michael von Spakovsky. All panelists and the audience were asked to address the following questions • Why is the second law taught in so many different ways? Why so many textbooks on thermodynamics? Why so many schools of thought? • Some say that thermodynamics is limited to equilibrium, others that it extends to nonequilibrium. How is entropy defined for nonequilibrium states?
Harvey, Jeffrey A.; Moore, Gregory W.
It is well known that string theory has a T-duality symmetry relating circle compactifications of large and small radius. This symmetry plays a foundational role in string theory. We note here that while T-duality is order two acting on the moduli space of compactifications, it is order four in its action on the conformal field theory state space. More generally, involutions in the Weyl group W ( G) which act at points of enhanced G symmetry have canonical lifts to order four elements of G, a phenomenon first investigated by J. Tits in the mathematical literature on Lie groups and generalized here to conformal field theory. This simple fact has a number of interesting consequences. One consequence is a reevaluation of a mod two condition appearing in asymmetric orbifold constructions. We also briefly discuss the implications for the idea that T-duality and its generalizations should be thought of as discrete gauge symmetries in spacetime.
Full Text Available Open Access (OA, like any other model or strategy for the dissemination of knowledge, carries with it clear benefits as well as costs and downsides. These vary depending on the OA strategy in question, and in order for OA to bring maximum benefit to the world of scholarship, its costs and benefits need be examined carefully and dispassionately so that the former can be maximized and the latter minimized. Unfortunately, the OA advocacy community tends to resist all attempts to examine OA in this way, to the point that those who approach OA in a spirit of critical analysis (rather than celebration and evangelism are attacked and punished. This article describes the problem, provides examples of it, and proposes strategies for promoting a more rigorous and analytical discussion of OA.
Fischer, Nico; Kondrat, Simon A; Shozi, Mzamo
Welcome to Africa was the motto when after more than 100 years the flag ship conference series of the Royal Society of Chemistry, the Faraday Discussions was hosted for the first time on the African Continent. Under the fitting topic 'Catalysis for Fuels' over 120 delegates followed the invitation by the conference chair Prof. Graham Hutchings FRS (Cardiff Catalysis Institute), his organizing committee and the co-organizing DST-NRF Centre of Excellence in Catalysis c*change (). In the presentations of 21 invited speakers and 59 posters, cutting edge research in the field of catalysis for fuels, designing new catalysts for synthetic fuels, hydrocarbon conversion in the production of synthetic fuels and novel photocatalysis was presented over the two-day meeting. The scene was set by the opening lecture of Prof. Enrique Iglesias (UC Berkeley) and wrapped-up with the concluding remarks by Philip Gibson (SASOL).
Full Text Available Before 9/11 WTC was an international landmark. The definition of the two high-rise buildings identity, their tourist, social, visual and economic significance, disappeared with the destruction of their materiality. As a result, the contemplative visual and unwritten discourse of the Lower Manhattan disappeared together with the architectural, urban, technological essence and also with the philosophy of stability and equilibrium of a prosperous society. At the social-mental level this event triggers a crisis in personal and collective consciences (of the American Nation but also of the Nations, and a crisis of humanity. The architectural - urban and ideas competition organized to select the best urban-social-architectural concept proved to be a difficult task. Not only it had to “fill” a particular place on earth, but it also needed to configure a philosophy of place that would ‘heal” the wounds of the local and international communities, namely the lack of security and prosperity brought on by a no longer hidden technology of aggression bringing cities and communities under threats never experienced before at times of peace. In its first part the article discusses the competition, proposals and the finalized urban project. The particular challenges related to the selection of design in the case of WTC are doubled by a certain complexity related to the institutional arrangements common to most large urban development projects. It is also clear that there is interdependency between the project governance and the project results. These aspects are discussed in the second part of the article.
The possibilities of using radiation for food preservation as a way of alleviating the food deficiency problem in a large part of the world has been studied for some 20 years. Since the idea was recognized as a viable one, scientists had to develop it along three levels: firstly, the technological problems and economic viability had to be faced; at the same time tests had to be initiated to prove the wholesomeness of the irradiated foodstuffs, and then public acceptance and confidence in the end product had to be established. Work is proceeding along these three lines and in some cases, success has been won on all fronts. In others, it is continuing. As a FLASHBACK to the situation TWO YEARS AGO, we thought it interesting to reprint excerpts from a round-table discussion at which scientists from five countries sat down to discuss the pros and cons of food irradiation. ost at the gathering was Dr. Rocco Basson, Director of Chemistry at Pelindaba, South Africa, and the man responsible for directing radiation processing in that country. With him were Dr. Lapidot, Head of the Radiation and Engineering and Processing Section of the Israel Atomic Energy Commission at Soreq; Dr. Saint-Lebe of the Radioagronomy Service, French Atomic Energy Commission, at Cadarache; Dr. Ulmann, then Director of the Food Irradiation Pilot Plant at Wageningen in Holland; and Mr. Roy Hickman, leader of the International Project in the Field of Irradiation, sponsored by the FAO, IAEA and the OECD Nuclear Energy Agency, centred at Karlsruhe in Germany. (author)
Vic Montemayor - No one has been more passionate about improving the quality and effectiveness of the teaching of Medical Physics than Bill Hendee. It was in August of 2008 that the first AAPM Workshop on Becoming a Better Teacher of Medical Physics was held, organized and run by Bill Hendee. This was followed up in July of 2010 with a summer school on the same topic, again organized by Bill. There has been continued interest in alternate approaches to teaching medical physics since those initial gatherings. The momentum established by these workshops is made clear each year in the annual Innovation in Medical Physics Education session, which highlights work being done in all forms of medical physics education, from one-on-one residencies or classroom presentations to large-scale program revisions and on-line resources for international audiences. This symposium, presented on behalf of the Education Council, highlights the work of three finalists from past Innovation in Education sessions. Each will be presenting their approaches to and innovations in teaching medical physics. It is hoped that audience members interested in trying something new in their teaching of medical physics will find some of these ideas and approaches readily applicable to their own classrooms. Rebecca Howell - The presentation will discuss ways to maximize classroom learning, i.e., increasing the amount of material covered while also enhancing students’ understanding of the broader implications of the course topics. Specifically, the presentation will focus on two teaching methodologies, project based learning and flip learning. These teaching methods will be illustrated using an example of graduate medical physics course where both are used in conjunction with traditional lectures. Additionally, the presentation will focus on our experience implementing these methods including challenges that were overcome. Jay Burmeister - My presentation will discuss the incorporation of active
Montemayor, V. [Germantown Academy (United States)
Vic Montemayor - No one has been more passionate about improving the quality and effectiveness of the teaching of Medical Physics than Bill Hendee. It was in August of 2008 that the first AAPM Workshop on Becoming a Better Teacher of Medical Physics was held, organized and run by Bill Hendee. This was followed up in July of 2010 with a summer school on the same topic, again organized by Bill. There has been continued interest in alternate approaches to teaching medical physics since those initial gatherings. The momentum established by these workshops is made clear each year in the annual Innovation in Medical Physics Education session, which highlights work being done in all forms of medical physics education, from one-on-one residencies or classroom presentations to large-scale program revisions and on-line resources for international audiences. This symposium, presented on behalf of the Education Council, highlights the work of three finalists from past Innovation in Education sessions. Each will be presenting their approaches to and innovations in teaching medical physics. It is hoped that audience members interested in trying something new in their teaching of medical physics will find some of these ideas and approaches readily applicable to their own classrooms. Rebecca Howell - The presentation will discuss ways to maximize classroom learning, i.e., increasing the amount of material covered while also enhancing students’ understanding of the broader implications of the course topics. Specifically, the presentation will focus on two teaching methodologies, project based learning and flip learning. These teaching methods will be illustrated using an example of graduate medical physics course where both are used in conjunction with traditional lectures. Additionally, the presentation will focus on our experience implementing these methods including challenges that were overcome. Jay Burmeister - My presentation will discuss the incorporation of active
Greim, Helmut; Arand, Michael; Autrup, Herman; Bolt, Hermann M; Bridges, James; Dybing, Erik; Glomot, Rémi; Foa, Vito; Schulte-Hermann, Rolf
It is the ultimate goal of the intended REACH process (Registration, Evaluation and Authorization of Chemicals) of the European Union to identify substances of hazardous properties and to evaluate the risks of human and environmental exposure. During the last few months there has been a controversial discussion as to what extent in vitro studies and consideration of structure activity relationship provide sufficient information to waive repeated exposure studies. Industry as well as certain regulatory agencies or NGOs support this approach and propose that repeated dose studies may only be required beyond 100 t/a. From a toxicological point of view it has to be stressed that this discussion primarily considers the cost reduction and protection of animals, whereas protection of human health and the environment are secondary. In vitro studies only allow identification of specific hazardous properties which can be detected by the specific test system. Moreover, appropriate information on the dose response of adverse effects, identification of thresholds and NOELs that are essential for risk characterization cannot be obtained from these studies. Consequently, identification of all relevant hazardous properties and endpoints of adverse effects can only be determined in the intact animal by repeated dose studies such as 28-day or 90-day studies. In the absence of such information the hazard identification is incomplete and there is no basis for appropriate risk assessment of human exposure. Thus, any waiving of repeated dose studies in animals bears the probability of unforeseen effects in case of acute or continuous human exposure. From this the undersigning European Toxicologists conclude: 1. The intention of REACH is to identify hazardous properties in order that a reliable risk assessment can be made and measures taken to deal with chemicals posing a significant risk. 2. The recent debate has centered on ways in which the well established in vivo methods for risk
Silbey, Robert; Ao, Ping; Beretta, Gian Paolo; Cengel, Yunus; Foley, Andrew; Freedman, Steven; Graeff, Roderich; Keck, James C.; Lloyd, Seth; Maroney, Owen; Nieuwenhuizen, Theodorus M.; Weissman, Michael
This article reports an open discussion that took place during the Keenan Symposium "Meeting the Entropy Challenge" (held in Cambridge, Massachusetts, on October 4, 2007) following the short presentations—each reported as a separate article in the present volume—by Seth Lloyd, Owen Maroney, Silviu Guiasu, Ping Ao, Jochen Gemmer, Bernard Guy, Gian Paolo Beretta, Speranta Gheorghiu-Svirschevski, and Dorion Sagan. All panelists and the audience were asked to address the following questions • Why is the second law true? Is it an inviolable law of nature? If not, is it possible to develop a perpetual motion machine of the second kind? • Are second law limitations objective or subjective, real or apparent, due to the nature of physical states or the representation and manipulation of information? Is entropy a physical property in the same sense as energy is universally understood to be an intrinsic property of matter? • Does the second law conflict with quantum mechanics? Are the differences between mechanical and thermodynamic descriptions of physical phenomena reconcilable? Does the reversible law of motion of hamiltonian mechanics and quantum mechanics conflict with the empirical observation of irreversible phenomena?
Lloyd, Seth; Banerjee, Debjyoti; Bejan, Adrian; Beretta, Gian Paolo; Geskin, Ernest; Ghoniem, Ahmed; Gutowski, Timothy G.; Gyftopoulos, Elias P.; Keck, James C.; Lior, Noam; Miller, Sam; Nieuwenhuizen, Theodorus M.; Peterson, Richard; Salamon, Peter; Williamson, Lihong
This article reports an open discussion that took place during the Keenan Symposium "Meeting the Entropy Challenge" (held in Cambridge, Massachusetts, on October 5, 2007) following the short presentations—each reported as a separate article in the present volume—by Thomas Widmer, Ernest Geskin, James Keck, Noam Lior, Debjyoti Banerjee, Richard Peterson, Erik Ydstie, Ron Zevenhoven, Zhuomin Zhang, and Ahmed Ghoniem. All panelists and the audience were asked to address the following questions • Current state-of-the-art efficiency of combined-cycle energy conversion technology is about 60%. Based on the trend of historical data, some forecast that second-law efficiency of energy conversion will reach 80% by the end of the century. What technologies are at sight that might hold this promise? • Nanotechnologies and microtechnologies point towards the development of microscopic heat engines? How do second law limitations map down to these scales? • Combustion is the principal way of converting the chemical energy of fossil fuels to thermal energy, but it is highly irreversible. Are there promising ways to reduce combustion irreversibility? Are fuel cells the only alternative to combustion?
Lloyd, Seth; Bejan, Adrian; Bennett, Charles; Beretta, Gian Paolo; Butler, Howard; Gordon, Lyndsay; Grmela, Miroslav; Gyftopoulos, Elias P.; Hatsopoulos, George N.; Jou, David; Kjelstrup, Signe; Lior, Noam; Miller, Sam; Rubi, Miguel; Schneider, Eric D.; Sekulic, Dusan P.; Zhang, Zhuomin
This article reports an open discussion that took place during the Keenan Symposium "Meeting the Entropy Challenge" (held in Cambridge, Massachusetts, on October 4, 2007) following the short presentations—each reported as a separate article in the present volume—by Adrian Bejan, Bjarne Andresen, Miguel Rubi, Signe Kjelstrup, David Jou, Miroslav Grmela, Lyndsay Gordon, and Eric Schneider. All panelists and the audience were asked to address the following questions • Is the second law relevant when we trap single ions, prepare, manipulate and measure single photons, excite single atoms, induce spin echoes, measure quantum entanglement? Is it possible or impossible to build Maxwell demons that beat the second law by exploiting fluctuations? • Is the maximum entropy generation principle capable of unifying nonequilibrium molecular dynamics, chemical kinetics, nonlocal and nonequilibrium rheology, biological systems, natural structures, and cosmological evolution? • Research in quantum computation and quantum information has raised many fundamental questions about the foundations of quantum theory. Are any of these questions related to the second law?
Xie, Qi; Cui, Meng; Wu, Zhen-Dou; Zhao, Hong
With the rapid development of information science, the ancient Traditional Chinese Medicine is combining with it rapidly, and forming a new discipline: Traditional Chinese Medicine (TCM) Informatics. TCM information digitalization is the process of digital processing, which uses modern information technology to obtain, process, store, and analyze TCM-related data, information, and knowledge. It gathers research, application development, and service in an integrated whole. This article systematically analyzes the key research issues of TCM informatics (e.g., on data resources, data standard, data system construction). Also, the methodology and technology of TCM information digitalization research are thoroughly discussed. The starting point of the research on traditional Chinese medical information digitalization was in question. The research from the current study research was drawn from collected information that was stored, transferred, and utilized. This process helped to place an emphasis on the topic, as well as extending its research areas. In addition, an innovative TCM information virtual study center was set up to support a great deal of fundamental work.
Mutlu, Basak; Serbetcioglu, Bulent
A review of the Dizziness Handicap Inventory (DHI). NUMBER OF STUDIES: Seventy-four studies. Articles published between January 1990 and May 2012 were identified by searches in PubMed electronic database. Of the 227 articles meeting the inclusion criteria 74 were reviewed. These articles are discussed under nine topics; Reliability, validity and internal consistency of the original version of DHI, relationship between vestibular/balance tests and DHI, association between DHI and the other scales related to balance impairments, exploratory factor analysis of the DHI, screening version of DHI, translations of DHI into other languages, the role of DHI to assess the success of the treatment of balance disorder, DHI results in various vestibular disorders, general characteristics of DHI in patients with balance impairment. Self reported measures represent unique pieces of the information important for the management of dizzy patients. DHI is the most widely used self reported measurement of patients with dizziness. It has been translated into fourteen languages, so it is widely accepted.
Suzuki, Fabio F.
The radioprotection aims the protection of people against exposure to ionizing radiation or radioactive substances as well as the safety of radiation sources. As ionizing radiation is not perceived by human senses, the warning signs and labels on radiation sources and the safety posters in controlled and supervised areas have an important role to keep the doses and risks as low as reasonably achievable, to prevent radiological accidents and to mitigate their consequences. In Brazil, several technical regulations require such safety labels and posters, however, despite their importance, there is quite few guidance about their format or contents. In this paper the posting and labeling requirements for radiological control existing in Brazilian technical regulations are discussed, confronting them with national, foreign and international technical standards and by drawing up a parallel with requirements of technical regulations from other countries. Changes are suggested in some parts of the national regulations, to prevent some differences in the current guidance, allowing the optimization of posting and labeling programs of radiological facilities. (author)
Full Text Available The research programme on vicarious learning, part of which we report in this paper, has been aimed at exploring the idea that learning can be facilitated by providing learners with access to the experiences of other learners. We use Bandura's term vicarious learning to describe this (Bandura, 1986, and we believe it to be a paradigm that offers particular promise when seen as an innovative way of exploiting recent technical advances in multimedia and distance learning technologies. It offers the prospect of a real alternative to the building of intelligent tutors (which directly address the problem of allowing learners access to dialogue, but which have proved largely intractable in practice or to the direct support of live dialogues (which do not offer a solution to the problem of providing 'live' tutors - unless they are between peer learners. In the research reported here our main objectives were to develop techniques to facilitate learners' access to, especially, dialogues and discussions which have arisen when other learners were faced with similar issues or problems in understanding the material. This required us to investigate means of indexing and retrieving appropriate dialogues and build on these to create an advanced prototype system for use in educational settings.
Prue, Robert; Voss, Richard W
This essay frames an invitation to pastoral counselors and pastoral theologians to examine connections and perhaps interactions between themselves and traditional shamanic healers who use ayahuasca in their healing ceremonies. Indigenous people in South America have used ayahuasca for centuries, and the ritual has become common among the mestizo populations in urban areas of the Amazon, particularly as a curing ritual for drug addiction (Dobkin de Rios, 1970; Moir, 1998). Like peyote in the United States (Calabrese, 1997) ayahuasca use amongst the indigenous people of the Amazon is a form of cultural psychiatry. A review of the literature reveals very little commentary or discussion of shamanic practice in Pastoral Counseling (Pastoral Theology). The scant literature identifies an antithetical relationship at best. The current authors wonder about the possibility of to including shamanic practices in the context of pastoral counseling? This essay seeks to provide some basic information about the ritual use of ayahuasca and to offer a rationale for pastoral counselors to engage in a dialogue about its utility.
We study entanglement entropy in gravity theory with quantum effects. A simplest model is a two dimensional Einstein gravity theory. We use an n-sheet manifold to obtain an area term of entanglement entropy by summing over all background fields. Based on AdS/CFT correspondence, strongly coupled conformal field theory is expected to describe perturbative quantum gravity theory. An ultraviolet complete quantum gravity theory should not depend on a choice of an entangling surface. To analysis the problem explicitly, we analyze two dimensional conformal field theory. We find that a coefficient of a universal term of entanglement entropy is independent of a choice of an entangling surface in two dimensional conformal field theory for one interval to show a tentative evidence. Finally, we discuss that translational invariance in a quantum system at zero temperature, size goes to infinity and no mass scales, except for cut-off, possibly be a necessary condition in quantum gravity theory by ruing out a volume law of entanglement entropy. (copyright 2018 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)
Patterson, Karen; Newman, Claire; Doona, Katherine
There are currently no internationally recognised and approved processes relating to the care of older persons with dementia in prison. This research aimed to develop tools and procedures related to managing the care of, including the identification and assessment of, older persons with dementia who are imprisoned in New South Wales, Australia. A modified approach to the Policy Delphi method, using both surveys and facilitated discussion groups, enabled experts to come together to discuss improving the quality of care provision for older persons with dementia in prison and achieve research aims. © The Author(s) 2014.
Taylor, Abi; Gosney, Margot A
This review describes the fact that many elderly people enjoy an active sex life and examines the evidence against the general perception of an 'asexual' old age. It offers an overview of the evidence for healthcare professionals who had not previously considered the sexuality of their older patients. It also describes some of the sexual problems faced by older people, especially the difficulties experienced in disclosing such problems to healthcare professionals. It examines why healthcare professionals routinely avoid discussing sexual problems with older patients, and how this can be improved. It also offers some recommendations for future research in the area, as well as a word of caution regarding the temptation of over-sexualising the ageing process.
Ozawa, Martha N; Lum, Terry Y
The federal policy on older workers has shifted from the encouragement of early withdrawal from the labor force to the encouragement of continuous participation in the labor force. In this light, it is instructive to investigate the backgrounds of elderly people who work at age 70 or older. This article presents the findings of a study, using data from the 1993 Asset and Health Dynamics of the Oldest Old Study, that investigated the effects of health, economic conditions (net worth, employer-provided pensions, and supplemental medical insurance coverage), education, and spouse's work status on the probability of working among men aged 70 or older. The study addressed the probability of working, the probability of working fulltime and of working part-time, and the probability of being self-employed and of being employed by others. Implications for policy are discussed.
Wong, Carmen K M; Yeung, Dannii Y; Ho, Henry C Y; Tse, Kin-Po; Lam, Chun-Yiu
Technological advancement benefits Internet users with the convenience of social connection and information search. This study aimed at investigating the predictors of Internet use to search for online health information among Chinese older adults. The Technology Acceptance Model (TAM) was applied to examine the predictiveness of perceived ease of use, perceived usefulness, and attitudes toward Internet use on behavioral intention to search for health information online. Ninety-eight Chinese older adults were recruited from an academic institute for older people and community centers. Frequency of Internet use and physical and psychological health were also assessed. Results showed that perceived ease of use and attitudes significantly predicted behavioral intention of Internet use. The potential influences of traditional Chinese values and beliefs in health were also discussed.
Cukrowicz, Kelly C; Franzese, Alexis T; Thorp, Steven R; Cheavens, Jennifer S; Lynch, Thomas R
The contribution of personality traits and social support to mental health is well established, but to our knowledge there have been no longitudinal investigations of the relation between personality and social support in depressed older adults. In the current study, we examined a repeated measures multi-level mixed model of change in perceived social support to determine whether personality traits and depressive symptoms were associated with changes in perceived social support over the 3 year study interval in a sample of depressed older adults. Results suggest that Conscientiousness and Extraversion were personality traits that were significantly predictive of changes in perceived social support over this time interval. Based on these results it appears that, among depressed older adults, those with conscientious or extraverted personality traits are more likely to resist impulses to withdraw from relationships. In addition, these traits may lead to more satisfying interactions and greater perceived social support over time. The implications of these results are discussed.
Træen, Bente; Hald, Gert Martin; Graham, Cynthia A.
INFO. Results: The review showed that although common biological changes may adversely affect sexual function in old age, sexual experience seems to also be affected by psychological and interpersonal factors. Conclusions: Greater life expectancy and better medical care will result in older individuals......Objectives: The aim of the current article was to provide an overview of literature on sexual function and sexual difficulties in older adults. Method: The authors conducted a narrative review of papers published in English between January 2005 and July 2015 based on an extensive search in Psyc...... with chronic diseases living longer. The need for help to cope with changes in sexual health is likely to increase in older adults, as sexuality may be negatively affected through several pathways....
V. N. Poptsov
Full Text Available In the current situation of the shortage of suitable donor organs, heart transplantation from older donors is one of the ways to increase the performance of more heart transplants, particularly, in patients with urgent need of transplantation. While planning a heart transplantation from older donor one should consider increased risk of early cardiac allograft dysfunction, preexisting coronary artery disease, accelerated transplant vasculopathy which may adversely affect early and long-term survival of recipients. Subject to careful selection of donor–recipient pairs, effective prevention and treatment of early cardiac allograft dysfunction, pre-existing atherosclerosis and transplant vasculopathy the early and long-term survival of heart transplant recipients from older donors is comparable to heart transplantation from young donors.
Full Text Available Henna Wong,1,2 Nicola Lovett,3 Nicola Curry,1 Ku Shah,2 Simon J Stanworth1,2,4 1Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, 2Radcliffe Department of Medicine, University of Oxford, Oxford BRC Haematology Theme, 3Department of Geratology, Oxford University Hospitals NHS Foundation Trust, 4Department of Haematology, NHS Blood and Transplant, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK Abstract: The ageing population has resulted in a change in the demographics of trauma, and older adult trauma now accounts for a growing number of trauma admissions. The management of older adult trauma can be particularly challenging, and exhibits differences to that of the younger age groups affected by trauma. Frailty syndromes are closely related with falls, which are the leading cause of major trauma in older adults. Comorbid disease and antithrombotic use are more common in the older population. Physiological changes that occur with ageing can alter the expected clinical presentation of older persons after injury and their susceptibility to injury. Following major trauma, definitive control of hemorrhage remains essential for improving outcomes. In the initial assessment of an injured patient, it is important to consider whether the patient is taking anticoagulants or antiplatelets and if measures to promote hemostasis such as reversal are indicated. After hemostasis is achieved and bleeding has stopped, longer-term decisions to recommence antithrombotic agents can be challenging, especially in older people. In this review, we discuss one aspect of management for the older trauma patients in greater detail, that is, acute and longer-term management of antithrombotic therapy. As we consider the health needs of an ageing population, rise in elderly trauma and increasing use of antithrombotic therapy, the need for research in this area becomes more pressing to establish best
Full Text Available Kylie Johnston1, Karen Grimmer-Somers1, Michele Sutherland21International Centre for Allied Health Evidence, University of South Australia, Adelaide; 2Falls Prevention Unit, Department of Health, Government of South Australia, Adelaide, AustraliaBackground: Personal alarms are proposed as a reliable mechanism for older people to obtain assistance after falling. However, little is known about how older people feel about owning and using personal alarms.Aim: This paper reports on experiences of independently living older people, who have recently fallen, regarding alarm use and their independence.Method: Volunteers older than 65 years who had sustained a fall in the previous six months were sought via community invitations. Semistructured telephone interviews were conducted to gain information about their fall and their perspectives on personal alarm use. Interviews were content-analyzed to identify key concepts and themes.Results: Thirty-one interviews were conducted. Twenty callers owned personal alarms. Four subgroups of older fallers were identified; the first group used personal alarms effectively and were advocates for their benefits, the second group owned an alarm but did not use it effectively, the third group did not own alarms mostly because of cost, although were receptive to an alarm should one be provided, and the fourth group did not have an alarm and would not use it even if it was provided.Discussion: Personal alarms produce positive experiences when used effectively by the right people. The cost of personal alarms prohibits some older fallers from being effective alarm users. However, other elderly fallers remain unwilling to consider alarm use even if one was provided. In view of their cost, personal alarms should be targeted to people who will benefit most. Alternative strategies should be considered when alarms are unlikely to be used appropriately.Keywords: personal alarm devices, falls, older people, patient perspective
Full Text Available The task of identifying named entities from the discussion texts in Web forums faces the challenge of noisy names. As the names are often misspelled or abbreviated, the conventional techniques have failed to detect the noisy names properly. In this paper we propose a global context based framework for handling the noisy names. The framework is tested on a named entity recognition system designed to identify the names from the discussion texts in a homeopathy diagnosis discussion forum. The proposed global context-based framework is found to be effective in improving the accuracy of the named entity recognition system.
Michelle Donizeth Euzébio
Full Text Available This study focuses on the characterization of graphocentrism in microculture. We aim to describe, based on literacy studies, the presence of written language in the life of socially and historically situated subjects, thematizing the axiological capital of less favored socioeconomic contexts. Subjects are children undergoing schooling process, living in a district of Florianópolis, Santa Catarina, Brazil. Discussions on the theme are based on Barton (1994, Barton, Hamilton and Ivanic (2000, Heath (1982, and Street (1994, 2003. Looking at literacy from a sociocultural perspective implies understanding that subjects deal with written language in their daily life in different ways. It seems that school tends to teach subject matters defined beforehand, and this hampers the dialog with different social practices played by students who come from family environments with different schooling levels. This study is inserted in a project whose focus is the defense of a more sensible look of school concerning the different realities which constitute school itself, regarding the teaching of written language. The present research aims to answer the following questions: How can we configure the microculture (family, school, church, neighborhood – more or less graphocentric – where children attending 1st to 5th grade live, in an economically less privileged community of Florianópolis? How can we delineate the axiological capital regarding the mastering of written language by those children? What literacy events are more recurrent within that microculture? The data were collected by means of interviews, observations and field annotations, focusing on the visible elements of literacy events, similarly to what has been done by Hamiton (2000, such as participants, environments, artifacts, and activities. On the hand, the non-visible constituents of literacy practices, such as hidden participants, domain, resources, and routines, were observed during
The preabortion interview required by French law takes place between the medical consultation and the aspiration or administration of RU-486. The three marriage counselors at the Center for Social Gynecology in Marseilles have each undertaken a course of personal therapy to enable them to understand their own reactions and motivations as a way of improving their effectiveness with clients. The preabortion interview is an opportunity to listen to and support women who may be experiencing anguish, sadness, ambivalence, or aggressivity. Each client determines the content of the interview. Often the reason for the abortion is given, frequently in terms of economic problems, unemployment, or other justification. The women almost always state that they "cannot", not that they "do not want", to continue the pregnancy, as if external circumstances had made their decision. The decision is usually made with little discussion. Young adolescents are often astounded to find themselves pregnant. Among young girls, the pregnancy may represent an appeal to the parents for attention or understanding. Sometimes the abortion represents a repetition or a reminder of some difficult event in the past, such as a previous abortion or the death of a child. Often the abortion exacerbates problems in the couple's relationship. The mother often experiences rejection of the pregnancy by the father as rejection of herself. Repeat abortions raise questions about whether some aspect of counseling was neglected. The abortion request always occasions a great feeling of guilt, both for being pregnant and for refusing the pregnancy. The interview permits the client to express her feelings and may help her make sense of the experience.
G Michael Allan
Full Text Available BACKGROUND: Healthcare costs, particularly pharmaceutical costs, are a dominant issue for most healthcare organizations, but it is unclear if randomized controlled trials (RCTs routinely discuss costs. Our objective was to assess the frequency and factors associated with the inclusion of costs in RCTs. METHODS AND FINDINGS: We randomly sampled 188 RCTs spanning three years (2003-2005 from six high impact journals. The sample size for RCTs was based on a calculation to estimate the inclusion of actual drug costs with a precision of +/-3%. Two reviewers independently extracted cost data and study characteristics. Frequencies were calculated and potential characteristics associated with the inclusion of costs were explored. Actual drug costs were included in 4.7% (9/188 of RCTs; any actual costs were included in 7.4% (14/188 of RCTs; and any mention of costs was included in 27.7% (52/188 of RCTs. As the amount of industry funding increased across RCTs, from non-profit to mixed to fully industry funded RCTs, there was a statistically significant reduction in the number of RCTs with any actual costs (Cochran-Armitage test, p = 0.005 and any mention of costs (Cochran-Armitage test, p = 0.02. Logistic regression analysis also indicated funding was associated with the inclusion of any actual cost (OR = 0.34, p = 0.009 or any mention of costs (OR = 0.63, p = 0.02. Journal, study conclusions, study location, primary author's country and product age were not associated with inclusion of cost information. CONCLUSION: While physicians are encouraged to consider costs when prescribing drugs for their patients, actual drug costs were provided in only 5% of RCTs and were not mentioned at all in 72% of RCTs. Industry funded trials were less likely to include cost information. No other factors were associated with the inclusion of cost information.
Helfand, D.J.; Tademaru, E.
From an examination of the current sample of 12 pulsars with measured proper motions and the z-distribution of the much larger group of over 80 sources with measured period derivatives, we develop a self-consistent picture of pulsar evolution. The apparent tendency of pulsars to move parallel to the galactic plane is explained as the result of various selection effects. A method for calculating the unmeasurable radial velocity of a pulsar is presented; it is shown that the total space velocities thus obtained are consistent with the assumption of an extreme Population I origin for pulsars which subsequently move away from the plane with a large range of velocities. The time scale for pulsar magnetic field decay is derived from dynamical considerations. A strong correlation of the original pulsar field strength with the magnitude of pulsar velocity is discussed. This results in the division of pulsars into two classes: Class A sources characterized by low space velocities, a small scale height, and low values of P 0 P 0 ; and Class B sources with a large range of velocities (up to 1000 km s -1 ), a much greater scale height, and larger values of initial field strength. It is postulated that Class A sources originate in tight binaries where their impulse acceleration at birth is insufficient to remove them from the system, while the Class B sources arise from single stars or loosely bound binaries and are accelerated to high velocities by their asymmetric radiation force. The evolutionary picture which is developed is shown to be consistent with a number of constraints imposed by supernova rates, the relative frequency of massive binaries and Class A sources, theoretical field-decay times, and the overall pulsar galactic distribution
This paper summarizes a conference panel discussion among parliamentarians and researchers on water and food supplies and population growth in Asia. The Western Samoa legislator urged delegates to be aware of human development that was no more than the promotion of values associated with a market economy. Samoans increased their per capita caloric consumption. The food supply is provided locally, and 90% of exports are food products. Food security would be jeopardized by a fivefold increase in population. Samoan human development indicators were relatively good for a developing country. However, the country was still ranked as a low-income, food-deficit country. The Pakistani delegate explained that Pakistan's agriculture used the largest, continuous irrigation system in the world. However, the system operated inefficiently. There was concern that future high population growth would jeopardize food security. Another barrier was institutional mismanagement of irrigation and reliance on imports for staple items. Agricultural productivity must increase to meet the increased needs of continued population growth. All available land is currently under cultivation. Future strategies will necessitate international cooperation and innovative and environmentally sound technology. Professor Xuan remarked that increased population growth and rising demand, decreased water quality, and changing consumption patterns were a threat to water supplies. Sustainable increases in food production would entail better water management: reforestation to reduce and prevent water runoff, better technological exploitation of rain water, and more efficient use of irrigation systems. Better international financing schemes were needed for support of these policy changes. Professor Ness suggested free markets in water in order to price water at actual rates of consumption. Polluters should pay. Water management was also threatened by global warming.
Allan, G Michael; Korownyk, Christina; LaSalle, Kate; Vandermeer, Ben; Ma, Victoria; Klein, Douglas; Manca, Donna
Healthcare costs, particularly pharmaceutical costs, are a dominant issue for most healthcare organizations, but it is unclear if randomized controlled trials (RCTs) routinely discuss costs. Our objective was to assess the frequency and factors associated with the inclusion of costs in RCTs. We randomly sampled 188 RCTs spanning three years (2003-2005) from six high impact journals. The sample size for RCTs was based on a calculation to estimate the inclusion of actual drug costs with a precision of +/-3%. Two reviewers independently extracted cost data and study characteristics. Frequencies were calculated and potential characteristics associated with the inclusion of costs were explored. Actual drug costs were included in 4.7% (9/188) of RCTs; any actual costs were included in 7.4% (14/188) of RCTs; and any mention of costs was included in 27.7% (52/188) of RCTs. As the amount of industry funding increased across RCTs, from non-profit to mixed to fully industry funded RCTs, there was a statistically significant reduction in the number of RCTs with any actual costs (Cochran-Armitage test, p = 0.005) and any mention of costs (Cochran-Armitage test, p = 0.02). Logistic regression analysis also indicated funding was associated with the inclusion of any actual cost (OR = 0.34, p = 0.009) or any mention of costs (OR = 0.63, p = 0.02). Journal, study conclusions, study location, primary author's country and product age were not associated with inclusion of cost information. While physicians are encouraged to consider costs when prescribing drugs for their patients, actual drug costs were provided in only 5% of RCTs and were not mentioned at all in 72% of RCTs. Industry funded trials were less likely to include cost information. No other factors were associated with the inclusion of cost information.
In his recent analysis of multiculturalism, Tom Beauchamp has argued that those who implement multicultural reasoning in their arguments against common morality theories, such as his own, have failed to understand that multiculturalism is neither a form of moral pluralism nor ethical relativism but is rather a universalistic moral theory in its own right. Beauchamp's position is indeed on the right track in that multiculturalists do not consider themselves ethical relativists. Yet, Beauchamp tends to miss the mark when he argues that multiculturalism is in effect a school of thought that endorses a form of moral universalism that is akin to his own vision of a common morality. As a supporter of multiculturalism, I would like to discuss some aspects of Beauchamp's comments on multiculturalism and clarify what a multicultural account of public bioethics might look like. Ultimately, multiculturalism is purported as a means of managing diversity in the public arena and should not be thought of as endorsing either a version of moral relativism or a universal morality. By simultaneously refraining from the promotion of a comprehensive common moral system while it attempts to avoid a collapse into relativism, multiculturalism can serve as the ethico-political framework in which diverse moralities can be managed and in which opportunities for ethical dialogue, debate and deliberation on the prospects of common bioethical norms are made possible. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Session 1 provided the opportunity to be informed of the Japanese institutional scene on geologic disposal as well as to acquaint the Japanese dignitaries and workshop participants with the RWMC Regulators' Forum, the challenges we face and the aims of the workshop. A lecture on accomplishments and issues in long-term safety regulation prepared discussions during the workshop. Session 2 - Fundamental Concepts and Evolution of International Guidance: One important point is that the use of language in this subject is not conducive to easy understanding by the public, certainly, and perhaps even by others. We need to consider how it might be made more accessible for the purpose of public involvement and regulatory dialogue. This might open the way to creating a readily comprehensible long-term objective for geological disposal that is consistent with the objectives for protecting society from the potential consequences of other activities with long-lived implications. The goal of the following presentations was to give an overall picture on these questions. Session 3 - Establishing Regulatory Criteria that Account for the Inherent Difficulties Associated with the Long-time Frames for Protection: Even though there have been significant developments in recent years and experience feedback from a number of ongoing geological disposal projects, international guidance remains rather difficult to understand and apply. The recent work from the RWMC-RF on long-term safety criteria for geological for geological disposal also shows that there are important differences between national criteria as well as differences in regulatory approach. It has emerged that we have no common basis for setting criteria as between different NEA countries and that the process of setting criteria is not readily explicable to the general public. Furthermore we are required, for the purposes of the international Joint Convention on the Safe Management of Spent Fuel and Radioactive Waste, to protect
This paper reports a study whose aims were to introduce the theory of gerotranscendence to a group of older people; to give participants in the group an opportunity to discuss their ageing process; to study how participants described their ageing in relation to the theory; and to gather participants' opinions about discussing their ageing in a group. The theory of gerotranscendence states that human development is a process extending into old age. Guidelines had previously been derived for its practical use in the care of older people, aiming to promote their development towards gerotranscendence. A qualitative descriptive approach was taken, and older people were invited to participate in group sessions at a day centre. At the sessions, participants discussed their ageing, and a video presentation about the theory of gerotranscendence was shown at one of the sessions. They were encouraged to discuss the description of the ageing process presented in the video and to link this to their own experiences of growing old. The discussion in each session was tape-recorded and transcribed verbatim. Data were analysed and categorized using qualitative methods. The data were collected in 2002. All women had an experience of ageing that was in some way in line with the theory's description, and they more or less agreed that this description of ageing was in accordance with their own ageing. They considered that it was interesting and fruitful to discuss ageing in a group. They felt that introduction of the view of ageing offered by the theory of gerotranscendence was beneficial because it gave them a more positive view of ageing which also allowed them to be as they were. It is possible to arrange this type of group activity for older people, resulting in possibilities to use aspects of the theory of gerotranscendence as an intervention in gerontological nursing.
Gould, Lisa J; Fulton, Ana Tuya
Impaired wound healing in the elderly represents a major clinical problem that is growing as our population ages. Wound healing is affected by age and by co-morbid conditions, particularly diabetes and obesity. This is particularly important in Rhode Island as the state has a very high percentage of vulnerable older adults. A multi- disciplinary approach that incorporates the skills of a comprehensive wound center with specialized nursing, geriatric medicine and palliative care will facilitate rapid wound healing, reduce costs and improve outcomes for our older adults that suffer from 'problem wounds'.
Nef, Tobias; Ganea, Raluca L; Müri, René M; Mosimann, Urs P
Social networking sites can be beneficial for senior citizens to promote social participation and to enhance intergenerational communication. Particularly for older adults with impaired mobility, social networking sites can help them to connect with family members and other active social networking users. The aim of this systematic review is to give an overview of existing scientific literature on social networking in older users. Computerized databases were searched and 105 articles were identified and screened using exclusion criteria. After exclusion of 87 articles, 18 articles were included, reviewed, classified, and the key findings were extracted. Common findings are identified and critically discussed and possible future research directions are outlined. The main benefit of using social networking sites for older adults is to enter in an intergenerational communication with younger family members (children and grandchildren) that is appreciated by both sides. Identified barriers are privacy concerns, technical difficulties and the fact that current Web design does not take the needs of older users into account. Under the conditions that these problems are carefully addressed, social networking sites have the potential to support today's and tomorrow's communication between older and younger family members.
Ward, Lizzie; Barnes, Marian
This article explores the relevance of deliberative practices framed by feminist care ethics to social work practice with older people. It draws on two connected projects which brought together older people: practitioners and academics. The first was a participatory research project in which the significance of care to well-being in old age emerged. The second was a knowledge exchange project which generated learning resources for social care practice based on the research findings of the first project. Here we analyse selected transcripts of recordings from meetings of both projects to consider the ways that discussions about lived experiences and everyday lives demonstrate care through this dialogue. Using this analysis, we propose that care ethics can be useful in transforming relationships between older people and those working with them through the creation of hybrid spaces in which 'care-full deliberation' can happen. We argue that such reflective spaces can enable transformative dialogue about care and its importance to older people and offer a counterbalance to the procedurally driven environments in which much social work practice takes place and can support practice more attuned to the circumstances and concerns of older people.
Jansen, Jesse; van Weert, Julia; van der Meulen, Nienke; van Dulmen, Sandra; Heeren, Thea; Bensing, Jozien
Remembering medical treatment information may be particularly taxing for older cancer patients, but to our knowledge this ability has never been assessed in this specific age group only. Our purpose in this study was to investigate older cancer patients' recall of information after patient education preceding chemotherapy. We constructed a recall questionnaire consisting of multiple-choice questions, completion items, and open-ended questions related to information about treatment and recommendations on how to handle side effects. Immediately after a nursing consultation preceding chemotherapy treatment, 69 older patients (M = 71.8 years, SD = 4.1) completed the questionnaire. We checked recall against the actual communication in video recordings of the consultations. On average, 82.2 items were discussed during the consultations. The mean percentage of information recalled correctly was 23.2% for open-ended questions, 68.0% for completion items, and 80.2% for multiple-choice questions. Older cancer patients are confronted with a lot of information. Recall of information strongly depended on question format; especially active reproduction appeared to be poor. To improve treatment outcomes, it is important that cancer patients are able to actively retrieve knowledge about how to prevent and recognize adverse side effects and that this is checked by the health professional. We make suggestions on how to make information more memorable for older cancer patients.
Gravrand, O.; Destefanis, G.; Cervera, C.; Zanatta, J.-P.; Baier, N.; Ferron, A.; Boulade, O.
Detection for space application is very demanding on the IR detector: all wavelengths, from visible-NIR (2- 3um cutoff) to LWIR (10-12.5um cutoff), even sometimes VLWIR (15um cutoff) may be of interest. Moreover, various scenarii are usually considered. Some are imaging applications where the focal plane array (FPA) is used as an optical element to sense an image. However, the FPA may also be used in spectrometric applications where light is triggered on the different pixels depending on its wavelength. In some cases, star pointing is another use of FPAs where the retina is used to sense the position of the satellite. In all those configurations, we might distinguish several categories of applications: • low flux applications where the FPA is staring at space and the detection occurs with only a few number of photons. • high flux applications where the FPA is usually staring at the earth. In this case, the black body emission of the earth and its atmosphere ensures usually a large number of photons to perform the detection. Those two different categories are highly dimensioning for the detector as it usually determines the level of dark current and quantum efficiency (QE) requirements. Indeed, high detection performance usually requires a large number of integrated photons such that high QE is needed for low flux applications, in order to limit the integration time as much as possible. Moreover, dark current requirement is also directly linked to the expected incoming flux, in order to limit as much as possible the SNR degradation due to dark charges vs photocharges. Note that in most cases, this dark current is highly depending on operating temperature which dominates detector consumption. A classical way to mitigate dark current is to cool down the detector to very low temperatures. This paper won't discuss the need for wavefront sensing where the number of detected photons is low because of a very narrow integration window. Rigorously, this kind of
Hamilton, Alison B; Grella, Christine E
This purpose of this study was to explore the following question: Are there gender differences among older individuals with a history of heroin addiction with regard to social and family relationships and health problems? Eight gender-specific focus groups were conducted with 38 (19 women, 19 men) older (50+ years) individuals with long-term histories of heroin dependence. Four groups were conducted in a methadone maintenance (MM) clinic and four groups were derived from the Los Angeles community. Modest gender differences were observed, but mainly in the focus-group dynamics. Women typically described the impact of their addiction on their families, while men typically described their surprise at still being alive. Hepatitis C was the primary health concern in all groups; mental health issues were also discussed. Remarkable gender differences were not apparent in the qualitative experiences of these participants. Instead, we found overriding similarities related to the interactive effects of drug use and aging. Longitudinal studies of this population as they age and interact with the health-care system and other social systems will help to untangle the complicated relationship between aging, drug addiction, gender, and health.
[Joint Press Release by the Government of the Republic of Chile and the European Southern Observatory. The text is issued simultaneously in Santiago de Chile (in Spanish) and at the ESO Headquarters in Garching (in English).] Today, Tuesday, 18 April 1995, at the ESO Headquarters in Garching (Germany), Mr. Roberto Cifuentes, Plenipotentiary Ambassador representing the Government of the Republic of Chile, and the Director General of the European Southern Observatory, Professor Riccardo Giacconi, have signed a Supplementary, Interpretative and Amending Agreement to the Convention of 6 November 1963 which governs the relations between Chile and this International Organisation. This Agreement which in practice signifies a widening and strengthening of the cooperative relations between the Organisation and the Chilean scientific community will hereafter be submitted for ratification by the National Congress of the Republic of Chile (the Parliament) and by the ESO Council. According to the Agreement signed today, Chilean astronomers will have privileged access within up to 10 percent observing time on all present and future ESO telescopes in Chile. Moreover, ESO accepts to incorporate into its labour regulations for Chilean personnel concepts like freedom of association and collective bargaining. This signing of the Supplementary, Interpretative and Amending Agreement to the original Convention of 1963 follows after months of constructive dialogue between the parties. It constitutes an important step towards a solution of some of the pending points on the current agenda for discussions between the Government of Chile and ESO. Among the issues still pending, ESO has informed the Government of Chile that respect for its immunities by the Chilean State is of vital importance for the continuation of the construction of the world's largest telescope at Paranal, as well as the continued presence of the Organisation in Chile. The Chilean Government, on its side, and concerning
This report is also to be published by ETUI (Euruopean Trade Unions' Institute) in a book on Active Strategies for Older Workers. It is the National report for Denmark and contains a short section on characteristics of the Danish labour market, with a special focus on the situation of the elderly...
Sunderland, Jaqueline Tippett
The potential force for the mutual enrichment of the arts on the lives of older people was investigated by an advisory committee representing the John F. Kennedy Center for Performing Arts and The National Council on the Aging. This prospectus, a report of the committee findings, includes a review of a representative spectrum of cultural programs…
Hoof, van J.; Hensen, J.L.M.
The majority of the increasing number of older adults wishes to age-in-place. Appropriate and comfortable housing is of great importance to facilitate this desire. One of the aspects of concern is thermal comfort. This is normally assessed using the model of Fanger, however, one might ask if this
Bloesch, Emily K.; Abrams, Richard A.
Action integration is the process through which actions performed on a stimulus and perceptual aspects of the stimulus become bound as a unitary object. This process appears to be controlled by the dopaminergic system in the prefrontal cortex, an area that is known to decrease in volume and dopamine functioning in older adults. Although the…
de Jong Gierveld, J.; Broese van Groenou, M.; Bookwala, Jamila
The couple relationship is a major factor in alleviating loneliness. Midlife and older adults without a couple relationship, especially after widowhood or divorce, are at serious risk of loneliness. Outcomes of empirical research, both dating back to the former century (Lopata, 1980, 1996), as well
The workshop was an important step in the establishment of a strategy to review the part of SKB's safety case that is devoted to the demonstration of the isolation function of a future spent fuel repository. The emphasis was on identification rather than resolution of issues in this workshop synthesis. Subsequent steps therefore have to be taken within the Swedish regulatory bodies to follow up on this report and suggest activities within the regulators research programmes, as well as organise more detailed issue evaluation for different experts group. Ongoing and planned activities within the SKB programme that are related to the issues identified in this report would have to be reviewed in detail. The great emphasis of isolation of spent nuclear fuel rather than, e.g., radionuclide retardation and dilution, featured in the SR97 performance assessment, suggests that the Swedish regulators have to be prepared to review this part of the coming PAs in greater detail. The specific features of the workshop that contributed to the rather comprehensive description of issues relevant for future licensing activities are: The combined consideration of the areas of the copper canister and bentonite buffer, the assessment of both chemical and mechanical aspects of EBS and canister integrity, the use of a published comprehensive performance assessment (SR-97) as a basis for discussions, the active participation by SKB providing additional information on recent developments. There is an educational value for external consultants and researchers, as well as SKI staff, in addressing the broad subject areas relevant for the EBS isolation function. However, a broad coverage to some extent necessitates rather superficial view of the various issues under consideration. It should be noted that the descriptions in this synthesis can by no means be regarded as fully comprehensive, and that additional key issues may be identified in the SKB programme as well as future regulatory
Cloyd, Elizabeth; Dyer, Carmel B
The plight of older adults during catastrophic events is a societal concern. Older persons have an increased prevalence of cognitive disorders, chronic illnesses, and mobility problems that limit their ability to cope. These disorders may result in a lack of mental capacity and the ability to discern when they should evacuate or resolve problems encountered during a catastrophe. Some older persons may have limited transportation options, and many of the elderly survivors are at increased risk for abuse, neglect, and exploitation. Recommendations for future catastrophic events include the development of a federal tracking system for elders and other vulnerable adults, the designation of separate shelter areas for elders and other vulnerable adults, and involvement of gerontological professionals in all aspects of emergency preparedness and care delivery, including training of frontline workers. Preparation through preevent planning that includes region-specific social services, medical and public health resources, volunteers, and facilities for elders and vulnerable adults is critical. Elders need to be protected from abuse and fraud during catastrophic events. A public health triage system for elders and other vulnerable populations in pre- and postdisaster situations is useful, and disaster preparedness is paramount. Communities and members of safety and rescue teams must address ethical issues before an event. When older adults are involved, consideration needs to be given to triage decision making, transporting those who are immobile, the care of older adults who receive palliative care, and the equitable distribution of resources. Nurses are perfectly equipped with the skills, knowledge, and training needed to plan and implement disaster preparedness programs. In keeping with the tradition of Florence Nightingale, nurses can assume several crucial roles in disaster preparedness for older adults. Nurses possess the ability to participate and lead community
Bradford, Judith B; Putney, Jennifer M; Shepard, Bonnie L; Sass, Samantha E; Rudicel, Sally; Ladd, Holly; Cahill, Sean
In Boston and Outer Cape, Massachusetts, we explored the expectations of lesbians 60 years and older regarding healthy aging and community importance. Focus groups were conducted with participants after completing an anonymous demographic questionnaire. Thematic analysis was used to generate themes and identify how they varied by urban versus rural settings. Group discussions focused on community, finances, housing, and healthcare. Primary concerns included continued access to supportive and lesbian communities as a source of resilience during aging. Concerns about discrimination and isolation mirror themes found in national research. The study findings suggest a need for more research into the housing and transportation needs of lesbians approaching later life, with a focus on how those needs relate to affordability, accessibility, and proximity to social support and healthcare. These findings also suggest the need for substantial investments in strengthening the LGBT-related cultural competence of providers of services for the elderly.
Mei Ching Lee
Full Text Available The purpose of this research is to explore behavioral, normative, and control beliefs in the discussion of advance care planning (ACP among older and younger Chinese Americans. Ethnic minority groups have been identified as less engaged in ACP and this represents an ethnic and cultural gap. Older Chinese American adults often have different beliefs and values compared to the younger generation who are more acculturated to American mainstream culture. These differences may hinder the discussion of ACP with Chinese older adults. A qualitative design was used. The Theory of Planned Behavior guided the development of the interview guide. We recruited 60 Chinese Americans. Prior experience was identified as a theme that influenced attitudes about ACP. We found that older and younger Chinese participants had different beliefs in the norm and control related to ACP discussions, but not in the belief of attitudes about ACP discussions. Both younger and older Chinese American participants believed that ACP was important and necessary. Participants in both clusters expressed that they were ready and willing to engage in ACP discussions with their family members but hesitant to initiate these discussions. The reluctance in discussing ACP with Chinese older adults may be related to the expectations and obligations of Xiao (filial piety in Chinese culture. This study describes the similarities and differences of beliefs in ACP between older and younger Chinese Americans. We identified barriers and facilitators in behavioral, normative, and control beliefs that can be used to promote ACP for Chinese Americans.
This paper aims to describe menopausal women's positive experience of growing older and becoming middle-aged.......This paper aims to describe menopausal women's positive experience of growing older and becoming middle-aged....
U.S. Environmental Protection Agency — The Physiological Parameters Database for Older Adults is available for download and contains physiological parameters values for healthy older human adults (age 60...
Simpson, Douglas J.; Hull, William J., Jr.
The authors identify, examine, and clarify three kinds of hindrances (dismissive/evasive tactics, logical stoppers, and ad hominem arguments) to teaching about ethical issues in P-12 schools. In discussing these three types of obstacles, they stress that the barriers themselves provide both challenges and opportunities for teachers. Indeed, they…
Many OECD countries have, or have had, a policy that exempts older unemployed people from the requirement to search for a job. An aging population and low participation by older workers in the labor market increasingly place public finances under strain, and spur calls for policy measures that activate labor force participation by older workers. Introducing job search requirements for the older unemployed aims to increase their re-employment rates. Abolishing the exemption from job search req...
... have contributed so much to our Nation. This year's theme for Older Americans Month, ``Age Strong, Live... Senior Corps. My Administration is committed to ensuring older Americans can age strong and live long. By.... Many of our Nation's older men and women have worked tirelessly and sacrificed so their children could...
Wright, Sara L.; Canetto, Silvia Sara
This study examined stereotypes of older lesbians and gay men. Key findings are that older lesbians and gay men were perceived as similar to older heterosexual women and men with regard to aging stereotypes, such as being judicious. At the same time, sexual minorities were targets of unique stereotypes. Consistent with the implicit inversion…
Gonzales, Ernest; Morrow-Howell, Nancy; Gilbert, Pat
Given the growth in the number of older adults and the ageist attitudes many in the health care profession hold, interventions aimed at improving health professionals' attitudes toward older adults are imperative. Vital Visionaries is an intergenerational art program designed to improve medical students' attitudes toward older adults. Participants…
This brochure presents the facts about the financial situation of older women. It explains the vital role of Social Security (SS) for women and offers suggestions to improve their financial outlook. A true/false checklist tests knowledge about women growing older and remaining financially secure. These reasons for poorer older women are outlined:…
Berger, Sarah E.; Nuzzo, Katie
Evidence exists for two competing theories about the effects of having an older sibling on development. Previous research has found that having an older sibling has both advantages and disadvantages for younger siblings' development. This study examined whether and how older siblings influenced the onset of their own younger siblings' motor…
This paper uses the social cognitive theory model to review the literature on older adult gambling, and related personal and environment characteristics. Results show that lottery is the kind of gambling most frequently played by older adults, followed by casino games. Older adults take trips to casinos to socialize, find excitement, and win…
Boelens, C.; Hekman, Edsko E.G.; Verkerke, Gijsbertus Jacob
METHOD: A literature search was conducted to retrieve studies of the past 25 years. All participants from the studies lived in the community or institutions and were aged 60 or older. The following key word combinations were used, limited to the title: elderly or older people or older adults and
Tânia R. Bertoldo Benedetti
Full Text Available In old age, social groups can be a crucial component for health and well-being. In 2009-2010, a follow-up survey was carried out in Florianópolis, Brazil to understand the impact of a variety of programs established since 2002 that were designed to enhance social activities among the older adult population. This study employed two surveys within the population of older adults in Florianópolis. The first survey interviewed a total of 875 older adults in 2002, and the second survey involved 1,705 older adults between 2009 and 2010. By 2010, many new programs were offered in the community and the enrollment of older adults in social programs followed similar trends. “Convivência” groups stood out as extremely popular social groups among this population. This paper discusses some of the potential outcomes associated with participation in “convivência” groups.
Taylor, Robert Joseph; Chatters, Linda M; Bullard, Kai McKeever; Wallace, John M; Jackson, James S
This study utilizes data from the older African American sub-sample of the National Survey of American Life (n=837) to examine the sociodemographic and denominational correlates of organizational religious involvement among older African Americans. Six measures of organizational religious participation are utilized, including two measures of time allocation for organized religious pursuits. The findings indicate significant gender, region, marital status and denominational differences in organizational religiosity. Of particular note, although older black women generally displayed higher levels of religious participation, older black men spent more hours per week in other activities at their place of worship. The findings are discussed in relation to prior work in the area of religious involvement among older adults. New directions for research on religious time allocation are outlined.
Dixon, Roger A.
Among older adults, everyday competence is often expressed in the context of other participating individuals. Although this active human context may be occasionally comprised of mere acquaintances, long-term partners (such as couples) often act as a unit in engaging in everyday actions or reporting on familiar domains. This special section reflects an important movement in aging research to examine couples as an alternative but normatively common unit of analysis. My discussion focuses on 2 m...
Kasckow, John; Montross, Lori; Prunty, Laurie; Fox, Lauren; Zisook, Sidney
Little is known about treating elderly suicidal patients with schizophrenia. The purpose of this article is to review the literature dealing with this population and to discuss what is required to advance this field. Most available studies from middle-aged and older individuals suggest that risk factors include hopelessness, lower quality of life, past traumatic events, depressive symptoms, lifetime suicidal ideation and past attempts; it is not clear whether these findings are generalizable ...
Markle-Reid, Maureen; Browne, Gina
The aim of this article is to discuss the concept of frailty and its adequacy in identifying and describing older adults as frail. Despite the dramatic increase in use of the term 'frailty' over the past two decades, there is a lack of consensus in the literature about its meaning and use, and no clear conceptual guidelines for identifying and describing older adults as frail. Differences in theoretical perspectives will influence policy decisions regarding eligibility for, and allocation of, scarce health care resources among older adults. The article presents a literature review and synthesis of definitions and conceptual models of frailty in relation to older adults. The first part of the paper is a summary of the synonyms, antonyms and definitions of the term frailty. The second part is a critical evaluation of conceptual models of frailty. Six conceptual models are analysed on the basis of four main categories of assumptions about: (1) the nature of scientific knowledge; (2) the level of analysis; (3) the ageing process; (4) the stability of frailty. The implications of these are discussed in relation to clinical practice, policy and research. The review gives guidelines for a new theoretical approach to the concept of frailty in older adults: (1) it must be a multidimensional concept that considers the complex interplay of physical, psychological, social and environmental factors; (2) the concept must not be age-related, suggesting a negative and stereotypical view of ageing; (3) the concept must take into account an individual's context and incorporate subjective perceptions; (4) the concept must take into account the contribution of both individual and environmental factors.
Alessi, Cathy; Vitiello, Michael V
Up to 40% of older adults have insomnia, with difficulty getting to sleep, early waking, or feeling unrefreshed on waking. The prevalence of insomnia increases with age. Other risk factors include medical and psychiatric illnesses, psychological factors, stress, daytime napping, and hyperarousal.Primary insomnia is a chronic and relapsing condition that may increase the risks of accidents.Primary insomnia is chronic insomnia without specific underlying medical, psychiatric, or other sleep ...
Colón-Emeric, Cathleen S.; Saag, Kenneth G.
Osteoporotic fractures are emerging as a major public health problem in the aging population. Fractures result in increased morbidity, mortality and health expenditures. This article reviews current evidence for the management of common issues following osteoporotic fractures in older adults including: (1) thromboembolism prevention; (2) delirium prevention; (3) pain management; (4) rehabilitation; (5) assessing the cause of fracture; and (6) prevention of subsequent fractures. Areas for prac...
Schoenborn, Nancy L.; Lee, Kimberley; Pollack, Craig E.; Armacost, Karen; Dy, Sydney M.; Bridges, John F. P.; Xue, Qian-Li; Wolff, Antonio C.; Boyd, Cynthia
IMPORTANCE Older adults with limited life expectancy are frequently screened for cancer even though it exposes them to risks of screening with minimal benefit. Patient preferences may be an important contributor to continued screening. OBJECTIVE To examine older adults’ views on the decision to stop cancer screening when life expectancy is limited and to identify older adults’ preferences for how clinicians should communicate recommendations to cease cancer screening. DESIGN, SETTING, AND PARTICIPANTS In this semistructured interview study, we interviewed 40 community-dwelling older adults (≥ 65 years) recruited at 4 clinical programs affiliated with an urban academic medical center. MAIN OUTCOMES AND MEASURE We transcribed the audio recorded discussions and analyzed the transcripts using standard techniques of qualitative content analysis to identify major themes and subthemes. RESULTS The participants’ average age was 75.7 years. Twenty-three participants (57.5%) were female; 25 (62.5%) were white. Estimated life expectancy was less than 10 years for 19 participants (47.5%). We identified 3 key themes. First, participants were amenable to stopping cancer screening, especially in the context of a trusting relationship with their clinician. Second, although many participants supported using age and health status to individualize the screening decision, they did not often understand the role of life expectancy. All except 2 participants objected to a Choosing Wisely statement about not recommending cancer screening in those with limited life expectancy, often believing that clinicians cannot accurately predict life expectancy. Third, participants preferred that clinicians explain a recommendation to stop screening by incorporating individual health status but were divided on whether life expectancy should be mentioned. Specific wording of life expectancy was important; many felt the language of “you may not live long enough to benefit from this test” was
Sarah T. Stahl
Discussion: Several challenges in implementing our lifestyle interventions to older widow(ers who are at risk for common mental disorders have been identified. Direct outreach to hospice organizations is an effective way to identify older adults in the early months following spousal death. Results from study may advance the field of grief support and promote a healthy adaptation to widowhood.
Podfigurna-Stopa, Agnieszka; Czyzyk, Adam; Katulski, Krzysztof; Smolarczyk, Roman; Grymowicz, Monika; Maciejewska-Jeske, Marzena; Meczekalski, Blazej
Eating disorders (EDs) are disturbances that seriously endanger the physical health and often the lives of sufferers and affect their psychosocial functioning. EDs are usually thought of as problems afflicting teenagers. However, the incidence in older women has increased in recent decades. These cases may represent either late-onset disease or, more likely, a continuation of a lifelong disorder. The DSM-5 classification differentiates 4 categories of eating disorder: anorexia nervosa, bulimia nervosa, binge-eating disorders and other specified feeding and eating disorders. The weight loss and malnutrition resulting from EDs have widespread negative consequences for physical, mental and social health. The main risk factors for developing long-term consequences are the degree of weight loss and the chronicity of the illness. Most of the cardiac, neurological, pulmonary, gastric, haematological and dermatological complications of EDs are reversible with weight restoration. EDs are serious illnesses and they should never be neglected or treated only as a manifestation of the fashion for dieting or a woman's wish to achieve an imposed standard feminine figure. Additionally, EDs are associated with high risk of morbidity and mortality. The literature concerning EDs in older, postmenopausal women is very limited. The main aim of this paper is to ascertain the epidemiology and prognosis of EDs in older women, and to review their diagnosis and management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Available The aging of the labor force is observed in most developed and developing countries. The employment rate of older employees has been increasing every year and it appears to be not changed in the nearest future. The aging workforce is a serious challenge for organizations due to the prevailing stereotypical approach that older employees are less motivated, demonstrate lower labor productivity, they have more difficulties adopting new information, technologies and the lower ability to adapt to innovations. The aim of the paper is to investigate the impact of the work characteristics on the involvement in the work, the influence of employee’s characteristics on the work engagement, the influence of age and related factors on the involvement in the work and the relationship between age and achievements. The research is based on the analysis and synthesis of scientific literature, investigating to reveal the diversity of the concepts and methodologies and to systematize prevailing issues. The paper integrates the main researches in the field of older employees’ engagement and provides recommendations for future research.
Granville, G; Evandrou, M
To consider the complex interrelationships between work and health among older men, drawing out the importance of considering gender difference in approaches to occupational medicine. The method used in the literature search was to review national and international research published in English since 1990 on the health and work of older men. Journal articles were the primary source. Databases used included Web of Science, CSA Illumina Social Sciences, CINAHL, Medline and ANGINFO. The review of the evidence was structured in terms of key themes emerging from the literature into which issues of gender, ethnicity, age and socio-economic inequalities were cross cut. The current paper now focuses on two of those themes that have particular relevance to occupational medicine: work-caused and work-related ill-health, and secondly promoting workplace health. It begins by setting the scene with a profile of older men in the labour market. Two key themes emerge from the review, which are of particular significance. One is the central role that work plays in the lives and identity of men and therefore the impact this has on their health, both in and out of work. Secondly, the occupational histories of men expose them to work-related and work-caused ill-health, which has consequences for life expectancy and chronic disease in old age. These findings have implications for future research, policy formulation and implementation, and for public health practice.
Moncada, Lainie Van Voast; Mire, L Glen
The American Geriatrics Society and British Geriatrics Society recommend that all adults older than 65 years be screened annually for a history of falls or balance impairment. The U.S. Preventive Services Task Force and American Academy of Family Physicians recommend exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling older adults who are at increased risk of falls. Although the U.S. Preventive Services Task Force and American Academy of Family Physicians do not recommend routine multifactorial intervention to prevent falls in all community-dwelling older adults, they state that it may be appropriate in individual cases. The Centers for Disease Control and Prevention developed an algorithm to aid in the implementation of the American Geriatrics Society/British Geriatrics Society guideline. The algorithm suggests assessment and multifactorial intervention for those who have had two or more falls or one fall-related injury. Multifactorial interventions should include exercise, particularly balance, strength, and gait training; vitamin D supplementation with or without calcium; management of medications, especially psychoactive medications; home environment modification; and management of postural hypotension, vision problems, foot problems, and footwear. These interventions effectively decrease falls in the community, hospital, and nursing home settings. Fall prevention is reimbursed as part of the Medicare Annual Wellness Visit.
Thomson, W M
Dry mouth is more common among older people than in any other age group. Appropriate definition and accurate measurement of dry mouth is critical for better understanding, monitoring and treatment of the condition. Xerostomia is the symptom(s) of dry mouth; it can be measured using methods ranging from single questions to multi-item summated rating scales. Low salivary flow (known as salivary gland hypofunction, or SGH) must be determined by measuring that flow. The relationship between SGH and xerostomia is not straightforward, but both conditions are common among older people, and they affect sufferers' day-to-day lives in important ways. The major risk factor for dry mouth is the taking of particular medications, and older people take more of those than any other age group, not only for symptomatic relief of various age-associated chronic diseases, but also in order to reduce the likelihood of complications which may arise from those conditions. The greater the number taken, the greater the associated anticholinergic burden, and the more likely it is that the individual will suffer from dry mouth. Since treating dry mouth is such a challenge for clinicians, there is a need for dentists, doctors and pharmacists to work together to prevent it occurring. © 2015 Australian Dental Association.
Accurate Prognostic Awareness Facilitates, Whereas Better Quality of Life and More Anxiety Symptoms Hinder End-of-Life Care Discussions: A Longitudinal Survey Study in Terminally Ill Cancer Patients' Last Six Months of Life.
Tang, Siew Tzuh; Chen, Chen Hsiu; Wen, Fur-Hsing; Chen, Jen-Shi; Chang, Wen-Cheng; Hsieh, Chia-Hsun; Chou, Wen-Chi; Hou, Ming-Mo
Terminally ill cancer patients do not engage in end-of-life (EOL) care discussions or do so only when death is imminent, despite guidelines for EOL care discussions early in their disease trajectory. Most studies on patient-reported EOL care discussions are cross sectional without exploring the evolution of EOL care discussions as death approaches. Cross-sectional studies cannot determine the direction of association between EOL care discussions and patients' prognostic awareness, psychological well-being, and quality of life (QOL). We examined the evolution and associations of accurate prognostic awareness, functional dependence, physical and psychological symptom distress, and QOL with patient-physician EOL care discussions among 256 terminally ill cancer patients in their last six months by hierarchical generalized linear modeling with logistic regression and by arranging time-varying modifiable variables and EOL care discussions in a distinct time sequence. The prevalence of physician-patient EOL care discussions increased as death approached (9.2%, 11.8%, and 18.3% for 91-180, 31-90, and 1-30 days before death, respectively) but only reached significance in the last month. Accurate prognostic awareness facilitated subsequent physician-patient EOL care discussions, whereas better patient-reported QOL and more anxiety symptoms hindered such discussions. The likelihood of EOL care discussions was not associated with levels of physical symptom distress, functional dependence, or depressive symptoms. Physician-patient EOL care discussions for terminally ill Taiwanese cancer patients remain uncommon even when death approaches. Physicians should facilitate EOL care discussions by cultivating patients' accurate prognostic awareness early in their cancer trajectory when they are physically and psychologically competent, with better QOL, thus promoting informed and value-based EOL care decision making. Copyright © 2017 American Academy of Hospice and Palliative
Seferoğlu, Meral; Yıldız, Demet; Pekel, Nilüfer Büyükkoyuncu; Güneş, Aygül; Yıldız, Abdülmecit; Tufan, Fatih
Attitude of healthcare providers toward older people is very important in the aging world. Neurologists contact older adults very frequently. We aimed to investigate the attitudes of neurologists toward older adults. We recorded participants age; sex; duration of clinical practice in neurology; existence of older adult relatives; and history of geriatrics education, nursing home visits, older adult patient density in their clinical practice, and participation in voluntary public activities. UCLA Geriatrics Attitude Scale was used to evaluate participants' attitudes. A total of 100 neurologists participated in this study. Seventy-seven percent had positive, 3 % had neutral, and 20 % had negative attitudes. Twenty-seven percent of the participants had history of geriatrics education, and these participants tended to have a higher rate of positive attitudes. Neurologists with positive attitudes tended to be older than those with negative attitudes. Participants with history of living with older adult relatives had lower rates of positive attitudes. The most common diagnoses of the patients the participants encountered were stroke and dementia. Independent factors associated with positive attitudes were history of geriatrics education and older age. History of living with older relatives tended to have a negative effect. Most of the negative items of the attitude scale were associated with the natural course and behavior of the common diseases in neurology practice. Generalization of geriatrics education may translate into a better understanding and improved care for older patients. Development of instruments and implementation of qualitative studies to assess attitudes of neurologists toward older adults are needed.
Hyer, L A; Jacobsen, R; Harrison, W R
The relationship to age of irrational beliefs among psychiatric inpatients has not been explored using the rational-emotive model. This study addressed the following two questions: 1) Do older and younger psychiatric inpatients differ in irrational beliefs? 2) Do older depressives differ from older nondepressives in irrational beliefs? Upon admission to a large medical center, 58 younger (less than 45 years old) and 54 older (greater than 55 years old) subjects were assessed on a battery of psychological tests, including the Idea Inventory and the Beck Depression Inventory. Results showed that older and younger inpatients did not differ on irrational beliefs. Results also showed that older and younger groups of depressives did not differ on the irrationality scores. When a correlational analysis was used, depression was related to irrationality within the older group but not within the younger group.
Myers, Wade C; Chan, Heng Choon Oliver; Mariano, Timothy Y; Safarik, Mark E; Geberth, Vernon J
Recent research has expanded our understanding of sexual homicide offenders (SHOs). However, little exists beyond case reports for older SHOs. We characterized male SHOs ≥ 55 years, comparing them to typical adult male SHOs who are in their 20s. Analysis of 37 years (1976-2012) of US Supplementary Homicide Reports data provided a large SHO sample (N = 3453). Three case reports provide clinical context for the diverse nature and patterns of older SHOs. Only 32 older male SHOs and no older female SHOs were identified. Murders by older SHOs accounted for only 0.5% of US sexual homicides. Unlike typical SHOs that generally target young adult females, over two-thirds of older SHO victims were ≥40 years, and one-third were ≥55 years. Sexual homicides by older SHOs, like sexual homicide in general, decreased over the study period. These crimes, while exceedingly rare, do occur, warranting special consideration. © 2017 American Academy of Forensic Sciences.
Maciel, Michelle; Laganà, Luciana
Sexual desire is a major component of sexuality at any age, and inhibited desire is one of the main sexual dysfunctions reported by older women. Nonetheless, in medical settings, for a variety of reasons discussed herein, its assessment--as well as the assessment of older women's sexual health in general--is typically avoided or conducted by asking a single sex question. In this paper, we have reviewed the literature (most of which is preliminary in nature) regarding the main psychosocial and health factors that could impact older women's sexual desire, as well as potential obstacles to the assessment and treatment of this geriatric sexual issue. It is certainly advisable that medical care providers who are uncomfortable discussing older women's sexual concerns be prepared to make appropriate referrals to clinicians who possess the proper training to accurately assess and treat sexual challenges (and female sexual interest problems in particular) in this neglected patient population.
Elizabeth A. van Es
Full Text Available Video is being used widely in professional development. Yet, little is known about how to design video-based learning environments that are productive for teacher learning. One promising model is a video club (Sherin, 2000. Video clubs bring teachers together to view and analyze video segments from one another’s classrooms. The idea is that by watching and discussing video segments focused on student thinking, teachers will learn practices for identifying and analyzing noteworthy student thinking during instruction and can use what they learn to inform their instructional decisions. This paper addresses issues to consider when setting up a video club for teacher education, such as defining goals for using video, establishing norms for viewing and discussing one another’s teaching, selecting clips for analysis, and facilitating teacher discussions. Si consiglia la discussione tra osservatori. Nei Video Club gli insegnanti mettono a fuoco le modalità con cui gli studenti apprendono.Il video è stato ampiamente utilizzato per la formazione professionale. Tuttavia poche sono le conoscenze relative alla progettazione di ambienti di apprendimento basati su video che siano efficaci per la formazione degli insegnanti. Un modello promettente è il “video club” (Sherin, 2000. Video club uniscono insegnanti che guardano ed analizzano insieme segmenti video delle proprie rispettive classi. L'idea è che gli insegnanti, guardando e discutendo segmenti video centrati sul pensiero degli alunni, imparino ad adottare durante l’insegnamento pratiche d'identificazione e analisi di pensieri degli alunni degni di nota e possano poi utilizzare ciò che hanno imparato nelle decisioni didattiche. Questo articolo affronta le questioni da considerare quando si configura un video club per la formazione degli insegnanti, come ad esempio la definizione di obiettivi per l'utilizzo dei video, le norme per la visione e discussione dei rispettivi video, la selezione
Kessler, Eva-Marie; Schwender, Clemens; Bowen, Catherine E
We investigated the portrayal of older people's social participation on TV advertisements according to a set of theoretically meaningful indicators from communication science and gerontology. We examined a representative sample of 656 prime-time advertisements broadcast for a period of 2 weeks in 2005 in Germany. Five percent of the advertisements featured at least one older character. Each of the characters in the subsample was rated according to role prominence, viewer-character distance, employment status, openness to experience, social interactions, and loneliness. This portrayal was compared with the portrayal of younger characters appearing in the same commercials and with the portrayal of younger characters in commercials without an older character according to the same indicators. 4.5% of the characters were rated 60 years or older. Older characters were disproportionately featured in major roles, depicted as employed and open to new experience. Furthermore, older characters were most often depicted within intergenerational and nonfamily contexts. Older characters were kept at a greater camera distance than younger characters in "young commercials." Although rare, when older characters did appear, they were depicted as socially engaged. We compare this portrayal with real-world gerontological evidence and age stereotypes and discuss how the portrayal might affect viewers.
Fox, Siobhan; Kenny, Lorna; Day, Mary Rose; O'Connell, Cathal; Finnerty, Joe; Timmons, Suzanne
Objective: Our home can have a major impact on our physical and mental health; this is particularly true for older people who may spend more time at home. Older people in social (i.e., public) housing are particularly vulnerable. Housing options for older people in social housing include standard design dwellings or specially designed "sheltered housing." The most suitable housing model should be identified, with older people consulted in this process. Method: Survey of older people (aged ≥60) living in standard or sheltered social housing. Data were analyzed using descriptive and inferential statistics in SPSS Version 22. Results: Overall, 380 surveys were returned (response rate = 47.2%). All older people had similar housing needs. Those in sheltered housing were more satisfied with the physical home design and reported more positive outcomes. Older people in standard housing were less likely to have necessary adaptations to facilitate aging-in-place. Discussion: Older people in standard housing reported more disability/illnesses, are worried about the future, and felt less safe at home. However, few wanted to move, and very few viewed sheltered housing as an alternative, suggesting limited knowledge about their housing options. Future social housing designs should be flexible, that is, adaptable to the needs of the tenants over time.
Kluge, Annette; Krings, Franciska
This study investigated attitudes towards older employees, perceived age discrimination, and HR practices (personnel development and reward) in 240 employees. Attitudes toward older employees were largely positive, thus supporting the notion that attitudes toward older employees are becoming increasingly positive. Older employees' attitudes towards older employees were more positive, but younger employees' attitudes were still favorable. Moreover, older and younger employees reported benefiti...
McCool, Judith P; Cameron, Linda D; Petrie, Keith J
Research testifies that images of tobacco use in popular films are highly pervasive and typically glamorised. There are concerns that these images may promote motivations to smoke in adolescents, but little is known about how these images are interpreted by members of this age group. A qualitative study was conducted to explore how older teenagers interpret and decode smoking imagery in film. This study builds on earlier work with a younger age group (12 and 13 years) to explore how various interpretations of smoking imagery shape and support common understandings about smoking among older teenagers. Data were collected through focus groups. Eighty-eight 16 and 17 year old students were interviewed at school. Participants discussed their recollections of and responses to recently viewed films. Older teens were receptive to smoking imagery when it was used in a credible manner to portray an emotional state, sub-culture affiliation, and lifestyle. Experience as a smoker appeared to inflate the credibility of realistic smoking images, particularly those presented in gritty realism/drama film. Older teens perceived realistic images, as opposed to stereotypical images, as a salient reference to their own lives. Stereotypical images were also readily recalled and appeared to perform an important role in supporting misconceptions about smoking and contributing to popular ideologies about tobacco use. Stereotypical images presented in comedy and action genre also serve to present paradoxical and contradictory messages about tobacco use. In particular, participants recalled tobacco use in film as associated with stress and anxiety, drug use, and seduction. Film images of tobacco use in specific contexts appear to hold specific and significant meanings for older teens. Realistic images offered salient representations of the perceived reality of smoking for this group. Pervasive and credible smoking scenes in film may offer support and reassurance to older teens who currently
Full Text Available Smart homes are homes with technologically advanced systems to enable domestic task automation, easier communication, and higher security. As an enabler of health and well-being enhancement, smart homes have been geared to accommodate people with special needs, especially older people. This paper examines the concept of “smart home” in a technologically driven society and its multi-functional contribution to the enhancement of older people’s lives. Discussion then focuses on the challenges in the use of smart homes among older people such as accessibility and ethical issues. Finally, some implications and recommendations are provided.
Erlangsen, Annette; Nordentoft, Merete; Conwell, Yeates
BACKGROUND: The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide....... AIMS: To disseminate key considerations for interventions addressing senior suicidal behavior. METHODS: An international expert panel has reviewed and discussed key considerations for interventions against suicide in older adults based on existing evidence, where available, and expert opinion. RESULTS...
Leist, Anja K
Maintaining social relationships has been defined as a core element of aging well. With a considerable amount of older adults living alone, social media provides the possibility to engage in meaningful social contact, e.g. by joining online social networks and online discussion forums. The review encompasses current knowledge of prerequisites in social media use of older adults such as functional capacity, information and communications technology-related knowledge, and favorable attitudes towards social media. Then, the potential of social media use for clinical practice and possible negative consequences are outlined. Literature on social media use from a gerontological perspective was reviewed in July and August 2012. Online communities are suitable for providing and receiving social support when confronted with a difficult life situation, regardless of geographical location or time. From a practitioner's perspective, social media can be used to advance health-related knowledge such as information on prevention, diagnosis, and treatment of specific conditions and disorders. Further positive consequences have been shown to be overcoming loneliness, relieving stress, and raising feelings of control and self-efficacy. Possible negative consequences could be misuse of personal data as well as the distribution and uncritical adoption of potentially harmful information via online communities. The potential of social media in clinical practice is reflected in a wide range of intervention possibilities for older adults. However, with the rise of social media, new threats emerge for older adults as well. Copyright © 2013 S. Karger AG, Basel.
Owsley, Cynthia; McGwin, Gerald; Seder, Thomas
Little is known about older drivers' preferences and attitudes about instrumentation design in vehicles. Yet visual processing impairments are common among older adults and could impact their ability to interface with a vehicle's dashboard. The purpose of this study is to obtain information from them about this topic, using focus groups and content analysis methodology. A trained facilitator led 8 focus groups of older adults. Discussion was stimulated by an outline relevant to dashboard interfaces, audiotaped, and transcribed. Using multi-step content analysis, a trained coder placed comments into thematic categories and coded comments as positive, negative, or neutral in meaning. Comments were coded into these categories: gauges, knobs/switches, interior lighting, color, lettering, symbols, location, entertainment, GPS, cost, uniformity, and getting information. Comments on gauges and knobs/switches represented half the comments. Women made more comments about getting information; men made more comments about uniformity. Positive and negative comments were made in each category; individual differences in preferences were broad. The results of this study will be used to guide the design of a population-based survey of older drivers about instrument cluster format, which will also examine how their responses are related to their visual processing capabilities. Copyright © 2011 Elsevier Ltd. All rights reserved.
Ferreira, Manuela L; McLachlan, Andrew
Sciatica is a debilitating condition affecting approximately 25 % of the population. Typically, the patient will complain of lower limb pain that is more severe than pain in the lower back, usually accompanied by numbness and motor weakness. Most international guidelines recommend pharmacological management for the pain relief of sciatica, including paracetamol, non-steroidal anti-inflammatory drugs, opioid analgesics, anticonvulsants, and corticosteroids, among others. However, the evidence for most of these pharmacological options is scarce, and the majority of clinical trials exclude older patients. There is overall very limited information on the efficacy, safety, and tolerability of these medicines in older patients with sciatica. This review presents a critical appraisal of the existing evidence for the pharmacological treatment of sciatica, with a special focus on the older adult. The age-related changes in the health of older patients, as well as their impact on the response to pharmacological treatment, including polypharmacy, drug interactions, and drug-disease interactions, is also discussed.
Holzer, Katherine J; Vaughn, Michael G
Antisocial personality disorder (ASPD) has enormous negative impacts on the affected individuals, their loved ones, and society. This burden is intensified by the social and functional changes related to age. The lower prevalence of ASPD in older adults compared to younger adults is well-documented. This discrepancy, often attributed solely to antisocial "burnout," contributes to the lack of attention given to this disorder in older adults and may signify difficulty measuring ASPD in this population. These measurement issues likely stem from problems with the validity of the diagnostic criteria for older adults which may not effectively capture changes that occur with age. This review focuses on the current literature surrounding the validity of ASPD criteria with older adults and relevant concepts, including the connection between criminality and ASPD. Issues with screening tools and the measurement of ASPD caused by problems with the criteria are also discussed. Finally, recommendations for improvement, including use of dimensional models of personality disorders, a potential geriatric subclassification of criteria, and modification of the existing criteria are presented with clinical implications and suggestions for future research.
Marina Picazzio Perez Batista
Full Text Available OBJECTIVE To understand the job function of caregivers of older adults and contribute to the debate on the consolidation of this professional practice. METHODOLOGICAL PROCEDURES This is a descriptive, qualitative, and exploratory study. Four focal group sessions were performed in 2011 with 11 elderly companions, formal caregivers of older adults in the Programa Acompanhante de Idosos (Program for Caregivers of Older Adults, Sao Paulo, SP, Southeastern Brazil. These sessions, guided by a semi-structured script, were audio-recorded and fully transcribed. Data were analyzed using the Content Analysis technique, Thematic Modality. RESULTS In view of considering the caregivers of older adults as a new category of workers, it was difficult to define their duties. The elderly companions themselves as well as the care receivers, their families, and the professionals that comprised the team were unclear about their duties. The professional practice of these formal caregivers has been built on the basis of constant discussions and negotiations among them and other team members in Programa Acompanhante de Idosos during daily work. This was achieved via a recognition process of their job functions and by setting apart other workers’ exclusive responsibilities. CONCLUSIONS The delimitation of specific job functions for elderly companions is currently one of the greatest challenges faced by these workers to develop and consolidate their professional role as well as improve Programa Acompanhante de Idosos.
Delgado Silveira, Eva
Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers\\' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person\\'s Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers\\' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP\\/START criteria could become a useful screening tool to improve prescription in older people.
Chang, Po-Ju; Wray, Linda; Lin, Yeqiang
Objective Although the link between enhanced social relationships and better health has generally been well established, few studies have examined the role of leisure activity in this link. This study examined how leisure influences the link between social relationships and health in older age. Methods Using data from the 2006 and 2010 waves of the nationally representative U.S. Health and Retirement Study and structural equation modelling analyses, we examined data on 2,965 older participants to determine if leisure activities mediated the link between social relationships and health in 2010, controlling for race, education level, and health in 2006. Results The results demonstrated that leisure activities mediate the link between social relationships and health in these age groups. Perceptions of positive social relationships were associated with greater involvement in leisure activities, and greater involvement in leisure activities was associated with better health in older age. Discussion & Conclusions The contribution of leisure to health in these age groups is receiving increasing attention, and the results of this study add to the literature on this topic, by identifying the mediating effect of leisure activity on the link between social relationships and health. Future studies aimed at increasing leisure activity may contribute to improved health outcomes in older adults. PMID:24884905
Kiyak, H A
The importance of recognising psychosocial characteristics of older people that influence their oral health behaviours and the potential success of dental procedures is discussed. Three variables and instruments developed and tested by the author and colleagues are presented. A measure of perceived importance of oral health behaviours has been found to be a significant predictor of dental service utilization in three studies. Self-efficacy regarding oral health has been found to be lower than self-efficacy regarding general health and medication use among older adults, especially among non-Western ethnic minorities. The significance of self-efficacy for predicting changes in caries and periodontal disease is described. Finally, a measure of expectations regarding specific dental procedures has been used with older people undergoing implant therapy. Studies with this instrument reveal that patients have concerns about the procedure far different than those focused on by dental providers. All three instruments can be used in clinical practice as a means of understanding patients' values, perceived oral health abilities, and expectations from dental care. These instruments can enhance dentist-patient rapport and improve the chances of successful dental outcomes for older patients.
Perry, Tam E
While discussions of accessibility, mobility and activities of daily living frame relocation studies, in older adulthood, the paper explores the emotional motivation of gift giving as a rationale for moving. This ethnographic study investigates the processes of household disbandment and decision-making of older adults in the Midwestern United States relocating in post-Global Financial Crisis contexts. In this study, relationships are created and sustained through the process of moving, linking older adults (n=81), their kin (n=49), and professionals (n=46) in the Midwestern United States. Using Marcel Mauss' The Gift (1925/1990) as a theoretical lens, relocation in older adulthood is conceptualized as a gift in two ways: to one's partner, and one's kin. Partners may consider gift-giving in terms of the act of moving to appease and honor their partner. Kin who were not moving themselves were also recipients of the gift of moving. These gifts enchain others in relationships of reciprocity. However these gifts, like all gifts, are not without costs or danger, so this paper examines some of the challenges that emerge along with gift-giving. Copyright © 2014 Elsevier Inc. All rights reserved.
Dotzauer, Mandy; Caljouw, Simone R; de Waard, Dick; Brouwer, Wiebo H
Within the next few decades, the number of older drivers operating a vehicle will increase rapidly (Eurostat, 2011). As age increases so does physical vulnerability, age-related impairments, and the risk of being involved in a fatal crashes. Older drivers experience problems in driving situations that require divided attention and decision making under time pressure as reflected by their overrepresentation in at-fault crashes on intersections. Advanced Driver Assistance Systems (ADAS) especially designed to support older drivers crossing intersections might counteract these difficulties. In a longer-term driving simulator study, the effects of an intersection assistant on driving were evaluated. 18 older drivers (M=71.44 years) returned repeatedly completing a ride either with or without a support system in a driving simulator. In order to test the intersection assistance, eight intersections were depicted for further analyses. Results show that ADAS affects driving. Equipped with ADAS, drivers allocated more attention to the road center rather than the left and right, crossed intersections in shorter time, engaged in higher speeds, and crossed more often with a critical time-to-collision (TTC) value. The implications of results are discussed in terms of behavioral adaptation and safety. Copyright © 2013 Elsevier Ltd. All rights reserved.
Full Text Available Else Cathrine Rustad,1–4 Bodil Furnes,1 Berit Seiger Cronfalk,2,5,6 Elin Dysvik1 1Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway; 2Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway; 3Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway; 4Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway; 5Palliative Research Center, Ersta Sköndal University College, Stockholm, Sweden; 6Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Background: A fragmented health care system leads to an increased demand for continuity of care across health care levels. Research indicates age-related differences during care transition, with the oldest patients having experiences and needs that differ from those of other patients. To meet the older patients’ needs and preferences during care transition, professionals must understand their experiences.Objective: The purpose of the study was to explore how patients ≥80 years of age experienced the care transition from hospital to municipal health care services.Methods: The study has a descriptive, explorative design, using semistructured interviews. Fourteen patients aged ≥80 participated in the study. Qualitative content analysis was used to describe the individuals’ experiences during care transition.Results: Two complementary themes emerged during the analysis: “Participation depends on being invited to plan the care transition” and “Managing continuity of care represents a complex and challenging process”.Discussion: Lack of participation, insufficient information, and vague responsibilities among staff during care transition seemed to limit the continuity of care. The patients are the vulnerable part of the care transition process, although they possess important
Hoertner, H.; Koeberlein, K.
The report summarizes the experience of the GRS obtained within the framework of a probabilistic evaluation of older nuclear power plants and the German risk study. The applied methodology and the problems involved are explained first. After a brief summary of probabilistic analyses carried out for German nuclear power plants, reliability analyses for older systems are discussed in detail. The findings from the probabilistic safety analyses and the conclusions drawn are presented. (orig.) [de
Strong, Jessica V; Mast, Benjamin T
This study examined similarities and differences in the cognitive profiles of older adult instrumental musicians and non-musicians. We compared neuropsychological test scores among older adult non-musicians, low-activity musicians (memory. The current study supports late life cognitive benefits of early musical training, but only in select cognitive domains, including language, executive functioning, and visual spatial ability. The results are discussed in the context of cognitive reserve and aging.
The goal of palliative care is to provide the best possible quality of life for patients and their families in the process of dying as well as before, during the course of illness. Emphasis is on the role of team approach in every aspect of patient care. The moral principles of sacredness of life and the right of personal autonomy may occasionally come in conflict. The basic principle of the respect of life prohibits killing, which has been accepted in one way or another by all societies - for the reasons of survival. Similar to this, modern morality supports the principle of respecting autonomy and self-management based on informed, conscious personality of an individual. Still, if the needs of another person appear to be more important or desirable than reaching certain individual goals, then the right of an individual regarding autonomy may be legitimately limited. Decisions on not applying or terminating certain procedures must be based on thorough discussion and consideration of the nature and expected result of treatment. If the patient is not competent, then the discussion should involve a team providing care for the patient and a representative of the patient. When the physician and the team can clearly see that unfavorable effects of treatment will outweigh therapeutic benefits, then, according to medical ethics of the respecting beneficiary, the team is not obliged to provide that form of treatment. Except for palliative care, there is no medical treatment that is always obligatory. A physician that does not accept the patient's request to be killed does not limit the patient's autonomy. Autonomy is self-management and capability of the patient to kill him/herself is not limited by the physician's refusal to do so. Even in those cases when patients for various reasons say that death will be a relief, it does not mean that the physician is obliged to terminate life. The superior obligation of physicians is to alleviate pain. If euthanasia would be legal
Wouda, Jan C.; van de Wiel, Harry B. M.
Objective: Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication. Methods: We adapted the reflective impulsive model of social
Baeza, H; Bueno, G
The communication between physicians and patients is often deficient. Little time is devoted to it and the patient receives scanty information with a low emotional content. Some features of our medicine can explain this situation. The rationalist and mechanistic biological model, allows to study only those things that can be undertaken with the scientific method. Psychological, social and spiritual aspects are surpassed. It only looks at material aspects of people, limiting the communication. Patients express their symptoms in an emotional way, with multiple beliefs and fears. The physician converts them to a precise, scientific, measurable and rational medical logical type. This language is not understood by patients, generating hesitancy in the communication. The paternalism is based in the power that physicians have over patients. We give knowledge and ask the patient to subordinate and accept our power. The patient loses his moral right to be informed, to ask, to have doubts or to disagree. Our personal communication is almost always formal, unemotional and with no explanations, further limiting communication.
Shams, Junaid; Spitzer, Allison B; Kennelly, Ann M; Tosi, Laura L
Defining bone quality remains elusive. From a patient perspective bone quality can best be defined as an individual's likelihood of sustaining a fracture. Fracture risk indicators and performance measures can help clinicians better understand individual fracture risk. Educational resources such as the Web can help clinicians and patients better understand fracture risk, communicate effectively, and make decisions concerning diagnosis and treatment. We examined four questions: What tools can be used to identify individuals at high risk for fracture? What clinical performance measures are available? What strategies can help ensure that patients at risk for fracture are identified? What are some authoritative Web sites for educating providers and patients about bone quality? Using Google, PUBMED, and trademark names, we reviewed the literature using the terms "bone quality" and "osteoporosis education." Web site legitimacy was evaluated using specific criteria. Educational Web sites were limited to English-language sites sponsored by nonprofit organizations The Fracture Risk Assessment Tool® (FRAX®) and the Fracture Risk Calculator (FRC) are reliable means of assessing fracture risk. Performance measures relating to bone health were developed by the AMA convened Physician Consortium for Performance Improvement® and are included in the Physician Quality Reporting Initiative. In addition, quality measures have been developed by the Joint Commission. Strategies for identifying individuals at risk include designating responsibility for case finding and intervention, evaluating secondary causes of osteoporosis, educating patients and providers, performing cost-effectiveness evaluation, and using information technology. An abundance of authoritative educational Web sites exists for providers and patients. Effective clinical indicators, performance measures, and educational tools to better understand and identify fracture risk are now available. The next challenge is to encourage broader use of these resources so that individuals at high risk for fracture will not just be identified but will also adhere to therapy.
Ke, Li-Shan; Huang, Xiaoyan; Hu, Wen-Yu; O'Connor, Margaret; Lee, Susan
Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. To understand the experiences and perspectives of older people regarding advance care planning. A systematic review of qualitative studies and meta-synthesis was conducted. CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care. Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.
Gamliel, Eyal; Levi-Belz, Yossi
Global suicide rates among older adults are very high. Public attitudes towards older adults' suicide may affect older adults upon their contemplating such an act. Previous research has demonstrated that message framing affects persons' judgments and decision making. Thus, message framing may have particular significance in the context of attitudes towards end-of-life phenomena, such as physician-aided suicide. This study examined the possible role of ageism in moderating the effect of message framing on attitudes towards older adults' suicide. Two studies examined the association between ageism and attitudes towards older adults' suicide. Study 1 assessed both variables by self-administered questionnaires; Study 2 further examined these variables, incorporating participants' responses to a suicide-related vignette, and evaluating the possible effect of message framing, using a between-participants design. High-ageism participants expressed greater acceptance for older adults' suicide, whereas low-ageism participants expressed a less permissive approach to it (Study 1). In addition, ageism moderated the effect of message framing on attitudes towards older adults' suicide: High-ageism participants revealed a more permissive attitude towards older adults' suicide when the issue was presented in positive terms of not prolonging life, relative to a negative presentation of ending life; a similar effect was not found for low-ageism participants (Study 2). The moderating effect of ageism on attitudes towards older adults' suicide has both theoretical and practical implications. We discuss these implications with respect to suicide prevention among older adults, and suggest future research.
Cykowski, Matthew D.; Powell, Suzanne Z.; Schulz, Paul E.; Takei, Hidehiro; Rivera, Andreana L.; Jackson, Robert E.; Roman, Gustavo; Jicha, Gregory A.; Nelson, Peter T.
Context Autopsy studies of the older population (≥65 years of age), and particularly of the “oldest-old” (≥85 years of age), have identified a significant proportion (~20%) of cognitively impaired patients in which hippocampal sclerosis is the major substrate of an amnestic syndrome. Hippocampal sclerosis may also be comorbid with frontotemporal lobar degeneration, Alzheimer disease, and Lewy body disease. Until recently, the terms hippocampal sclerosis of aging or hippocampal sclerosis dementia were applied in this context. Recent discoveries have prompted a conceptual expansion of hippocampal sclerosis of aging because (1) cellular inclusions of TAR DNA-binding protein 43 kDa (TDP-43) are frequent; (2) TDP-43 pathology may be found outside hippocampus; and (3) brain arteriolosclerosis is a common, possibly pathogenic, component. Objective To aid pathologists with recent recommendations for diagnoses of common neuropathologies in older persons, particularly hippocampal sclerosis, and highlight the recent shift in diagnostic terminology from HS-aging to cerebral age-related TDP-43 with sclerosis (CARTS). Data Sources Peer-reviewed literature and 5 autopsy examples that illustrate common age-related neuropathologies, including CARTS, and emphasize the importance of distinguishing CARTS from late-onset frontotemporal lobar degeneration with TDP-43 pathology and from advanced Alzheimer disease with TDP-43 pathology. Conclusions In advanced old age, the substrates of cognitive impairment are often multifactorial. This article demonstrates common and frequently comorbid neuropathologic substrates of cognitive impairment in the older population, including CARTS, to aid those practicing in this area of pathology. PMID:28467211
Nawaz, Samia; Tulunay-Ugur, Ozlem E
Dysphagia in older adults is a challenging problem and necessitates a team approach. The key to effective management is recognition. Patients tend to dismiss their symptoms as normal aging; therefore, early diagnosis depends on the diligence of the primary care doctors. No diagnostic technique can replace the benefits of a thorough history, with a detailed understanding of nutritional status and aspiration risk. Although one of the main goals in management is to ensure safe swallowing, the impact of a nonoral diet on the quality of life of patients should not be underestimated. Copyright © 2018 Elsevier Inc. All rights reserved.
Full Text Available Older adults have long been encouraged to maintain their autonomy by expressing their wishes for health care before they become too ill to meaningfully participate in decision making. This study explored the manner in which community-dwelling adults aged 55 and older plan for serious illness. An online survey was conducted within the province of Saskatchewan, Canada, with 283 adults ranging in age from 55 to 88 years. Planning for future medical care was important for the majority (78.4% of respondents, although only 25.4% possessed a written advance care plan and 41.5% had designated a substitute decision maker. Sixty percent of respondents reported conversations about their treatment wishes; nearly half had discussed unacceptable states of health. Associations between key predictor variables and planning behaviors (discussions about treatment wishes or unacceptable states of health; designation of a substitute decision maker; preparation of a written advance care plan were assessed using binary logistic regression. After controlling for all predictor variables, self-reported knowledge about advance care planning was the key variable significantly associated with all four planning behaviors. The efforts of nurses to educate older adults regarding the process of advance care planning can play an important role in enhancing autonomy.
Full Text Available Decision-making competence in later adulthood is affected by declines in cognitive skills, and age-related changes in affect and experience can sometimes compensate. However, recent findings suggest that age-related changes in motivation also affect the extent to which adults draw from experience, affect, and deliberative skills when making decisions. To date, relatively little attention has been given to strategies for addressing age-related changes in motivation to promote better decisions in older adults. To address this limitation, we draw from diverse literatures to suggest promising intervention strategies for motivating older recipients’ motivation to make better decisions. We start by reviewing the life-span developmental literature, which suggests that older adults’ motivation to put effort into decisions depends on the perceived personal relevance of decisions as well as their self-efficacy (i.e., confidence in applying their ability and knowledge. Next, we discuss two approaches from the health intervention design literature, the mental models approach and the patient activation approach, which aim to improve motivation for decision making by improving personal relevance or by building self-efficacy or confidence to use new information and skills. Using examples from these literatures, we discuss how to construct interventions to motivate good decisions in later adulthood.
Strough, JoNell; de Bruin, Wändi Bruine; Peters, Ellen
Decision-making competence in later adulthood is affected by declines in cognitive skills, and age-related changes in affect and experience can sometimes compensate. However, recent findings suggest that age-related changes in motivation also affect the extent to which adults draw from experience, affect, and deliberative skills when making decisions. To date, relatively little attention has been given to strategies for addressing age-related changes in motivation to promote better decisions in older adults. To address this limitation, we draw from diverse literatures to suggest promising intervention strategies for motivating older recipients’ motivation to make better decisions. We start by reviewing the life-span developmental literature, which suggests that older adults’ motivation to put effort into decisions depends on the perceived personal relevance of decisions as well as their self-efficacy (i.e., confidence in applying their ability and knowledge). Next, we discuss two approaches from the health intervention design literature, the mental models approach and the patient activation approach, which aim to improve motivation for decision making by improving personal relevance or by building self-efficacy or confidence to use new information and skills. Using examples from these literatures, we discuss how to construct interventions to motivate good decisions in later adulthood. PMID:26157398
Pacientes, médicos y enfermeros: tres puntos de vista distintos sobre una misma realidad. Actitudes y percepciones ante los derechos de los pacientes Patients, physicians and nurses: three different points of view on the same issue. Attitudes to and perceptions of patient rights
Joan Guix Oliver
Full Text Available Objetivos: Analizar las actitudes y las percepciones de pacientes, médicos y enfermeros respecto a los derechos de los pacientes en el ámbito de los hospitales públicos del sector sanitario de Reus (Tarragona. Métodos: Análisis cualitativo, mediante grupos focales de profesionales sanitarios (médicos y enfermeros y usuarios dados de alta, seguido de 3 encuestas dirigidas a cada uno de estos colectivos. Se realizó un análisis descriptivo de los resultados y de las diferencias entre colectivos. Se utilizó el análisis de componentes principales categóricos para reducir el número de dimensiones y revelar las relaciones existentes entre las diversas variables. Resultados: Ex pacientes y enfermeros identifican los «derechos a la información» y «autonomía del paciente» como los más importantes, mientras que para los médicos las 2 dimensiones más importantes son «derecho a la autonomía» y «derecho a la formulación de la opinión del paciente». Una minoría de pacientes es refractaria a la toma de decisiones. Las mujeres, los más jóvenes y los niveles de educación altos son más favorables al respeto a la autonomía del paciente. Hay posiciones menos favorables a las visiones «autonomistas» por parte de los pacientes, en comparación con las visiones más favorables por parte de los médicos y radicalmente partidarias por parte de los enfermeros. Conclusiones: Los derechos de los pacientes no son suficientemente conocidos y el derecho a la información es valorado como más importante que el derecho al ejercicio de la autonomía. Ex pacientes, médicos y enfermeros tienen actitudes y percepciones diferentes frente a situaciones similares.Objectives: To analyze patients', physicians' and nurses' attitudes to and perceptions of patient rights in the public hospitals of the Reus health district in Catalonia (Spain. Methods: We performed a qualitative analysis, through focus groups composed of health professionals (physicians
Full Text Available In this paper, I address the issue of collective female identities in contemporary Russia. The Pussy Riot performance is regarded as a critical event that serves as a trigger for certain 'groupness'. Taking critical event perspectives avoids framing the respondents with the researcher's predetermined categories. The empirical data is collected via collective interviews with the diverse group of Moscovites. Analysis highlights the domination of an authoritarian/collectivistic interpretative repertoire in older participants' discussions about the performance, which has resulted in the articulation of the image of the disadvantaged female and the denial of women's agency. The younger participants, being familiar with a co-existing liberal interpretative repertoire, have continued to use a conservative repertoire to discuss Pussy Riot. This and a general lack of gender problematisation in the interviews indicate that feminist discourse is not at all widespread in the Moscovites' everyday discourse.
Anders, W.A.; Rusche, B.C.; Stello, V. Jr.; Minogue, R.B.
William A. Anders, Chairman of the Nuclear Regulatory Commission (NRC), and several senior officials spoke to the Joint Committee on Atomic Energy on the subject of nuclear safety, improvements in reactor plant safety, and quality assurance. The NRC, during its first year of organization, has developed new initiatives to improve safety and safeguards regulations. Anders stressed that NRC is not stifling internal discussion of opposing views, that it has been honest with the public, and that operating reactors are meeting rigorous safety standards. Other speakers discussed comparative safety of old and new reactors. Backfitting of older plants with new features is done when substantial safety protection can be added, but detuning an integrated system is not done indiscriminately. Officials of NRC do not agree with former General Electric employees, who testified that the regulatory procedure is inadequate. Safety improvements since August 28, 1962 and outlines of the review process are included in the Appendixes
Göransson, Carina; Eriksson, Irene; Ziegert, Kristina; Wengström, Yvonne; Langius-Eklöf, Ann; Brovall, Maria; Kihlgren, Annica; Blomberg, Karin
To explore the experiences of using an app among older people with home-based health care and their nurses. Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. Explorative qualitative design. For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care. © 2017 John Wiley & Sons Ltd.
Rina K. Kusumaratna
Full Text Available As older persons are steadily increasing in number and there are no specialized comprehensive healthcare services for older persons in Indonesia, including East Kalimantan, the aim of the present study was to determine the extent of the problems facing healthcare staff and officials in Tarakan City, East Kalimantan, in providing comprehensive healthcare services attuned to the needs of older persons.This study was a qualitative interview-based survey with focus group discussions, involving heads and healthcare officials of seven puskesmas in Tarakan City, East Kalimantan district, with the addition of a number of district health planning officials. The results revealed a difference between daily hospital referral rate of older persons by puskesmas staff and actual daily hospital admission rate for the referrals. None of the consulted healthcare staff had any speciality education in geriatrics or older persons health. The older persons most frequently presented to the hospital with hypertension, diabetes, and myocardial insufficiency. On the other hand, at the health centers the presenting conditions were hypertension, gastroenteritis, rheumatism, sleep disorders, and upper respiratory tract infections. Improved access to healthcare for older persons should be achieved by improving knowledge and skills of human resources, including communication skills, and of supporting healthcare service infrastructure at puskesmas, specifically oriented towards the needs of and designed for use by older persons, such as ramps for wheelchairs, and handrails in corridors. Local governments should strengthen the appropriate service delivery to older persons, and provide support for the maintenance, sustainability and strengthening of community-based care for older persons.
Rina K. Kusumaratna
Full Text Available As older persons are steadily increasing in number and there are no specialized comprehensive healthcare services for older persons in Indonesia, including East Kalimantan, the aim of the present study was to determine the extent of the problems facing healthcare staff and officials in Tarakan City, East Kalimantan, in providing comprehensive healthcare services attuned to the needs of older persons.This study was a qualitative interview-based survey with focus group discussions, involving heads and healthcare officials of seven puskesmas in Tarakan City, East Kalimantan district, with the addition of a number of district health planning officials. The results revealed a difference between daily hospital referral rate of older persons by puskesmas staff and actual daily hospital admission rate for the referrals. None of the consulted healthcare staff had any speciality education in geriatrics or older persons health. The older persons most frequently presented to the hospital with hypertension, diabetes, and myocardial insufficiency. On the other hand, at the health centers the presenting conditions were hypertension, gastroenteritis, rheumatism, sleep disorders, and upper respiratory tract infections. Improved access to healthcare for older persons should be achieved by improving knowledge and skills of human resources, including communication skills, and of supporting healthcare service infrastructure at puskesmas, specifically oriented towards the needs of and designed for use by older persons, such as ramps for wheelchairs, and handrails in corridors. Local governments should strengthen the appropriate service delivery to older persons, and provide support for the maintenance, sustainability and strengthening of community-based care for older persons.
Drewes, Yvonne M; Koenen, Julia M; de Ruijter, Wouter; van Dijk-van Dijk, D J Annemarie; van der Weele, Gerda M; Middelkoop, Barend J C; Reis, Ria; Assendelft, Willem J J; Gussekloo, Jacobijn
Preventive care traditionally aims to prevent diseases or injuries. For older people, different aims of prevention, such as maintenance of independence and wellbeing, are increasingly important. To explore GPs' perspectives on preventive care for older people. Qualitative study comprising six focus groups with GPs in the Netherlands. The focus-group discussions with 37 GPs were analysed using the framework analysis method. Whether or not to implement preventive care for older people depends on the patient's individual level of vitality, as perceived by the GP. For older people with a high level of vitality, GPs confine their role to standardised disease-oriented prevention on a patient's request; when the vitality levels in older people fall, the scope of preventive care shifts from prevention of disease to prevention of functional decline. For older, vulnerable people, GPs expect most benefit from a proactive, individualised approach, enabling them to live as independently as possible. Based on these perspectives, a conceptual model for preventive care was developed, which describes GPs' different perspectives toward older people who are vulnerable and those with high levels of vitality. It focuses on five main dimensions: aim of care (prevention of disease versus prevention of functional decline), concept of care (disease model versus functional model), initiator (older persons themselves versus GP), target groups (people with requests versus specified risk groups), and content of preventive care (mainly cardiovascular risk management versus functional decline). GPs' perspectives on preventive care are determined by their perception of the level of vitality of their older patients. Preventive care for older people with high levels of vitality may consist of a standardised disease-oriented approach; those who are vulnerable will need an individualised approach to prevent functional decline.
Alonso, Irene; Dellacherie, Delphine; Samson, Séverine
The emotions evoked by music can enhance recognition of excerpts. It has been suggested that memory is better for high than for low arousing music (Eschrich et al., 2005; Samson et al., 2009), but it remains unclear whether positively (Eschrich et al., 2008) or negatively valenced music (Aubé et al., 2013; Vieillard and Gilet, 2013) may be better recognized. Moreover, we still know very little about the influence of age on emotional memory for music. To address these issues, we tested emotional memory for music in young and older adults using musical excerpts varying in terms of arousal and valence. Participants completed immediate and 24 h delayed recognition tests. We predicted highly arousing excerpts to be better recognized by both groups in immediate recognition. We hypothesized that arousal may compensate consolidation deficits in aging, thus showing more prominent benefit of high over low arousing stimuli in older than younger adults on delayed recognition. We also hypothesized worst retention of negative excerpts for the older group, resulting in a recognition benefit for positive over negative excerpts specific to older adults. Our results suggest that although older adults had worse recognition than young adults overall, effects of emotion on memory do not seem to be modified by aging. Results on immediate recognition suggest that recognition of low arousing excerpts can be affected by valence, with better memory for positive relative to negative low arousing music. However, 24 h delayed recognition results demonstrate effects of emotion on memory consolidation regardless of age, with a recognition benefit for high arousal and for negatively valenced music. The present study highlights the role of emotion on memory consolidation. Findings are examined in light of the literature on emotional memory for music and for other stimuli. We finally discuss the implication of the present results for potential music interventions in aging and dementia. PMID
Alonso, Irene; Dellacherie, Delphine; Samson, Séverine
The emotions evoked by music can enhance recognition of excerpts. It has been suggested that memory is better for high than for low arousing music (Eschrich et al., 2005; Samson et al., 2009), but it remains unclear whether positively (Eschrich et al., 2008) or negatively valenced music (Aubé et al., 2013; Vieillard and Gilet, 2013) may be better recognized. Moreover, we still know very little about the influence of age on emotional memory for music. To address these issues, we tested emotional memory for music in young and older adults using musical excerpts varying in terms of arousal and valence. Participants completed immediate and 24 h delayed recognition tests. We predicted highly arousing excerpts to be better recognized by both groups in immediate recognition. We hypothesized that arousal may compensate consolidation deficits in aging, thus showing more prominent benefit of high over low arousing stimuli in older than younger adults on delayed recognition. We also hypothesized worst retention of negative excerpts for the older group, resulting in a recognition benefit for positive over negative excerpts specific to older adults. Our results suggest that although older adults had worse recognition than young adults overall, effects of emotion on memory do not seem to be modified by aging. Results on immediate recognition suggest that recognition of low arousing excerpts can be affected by valence, with better memory for positive relative to negative low arousing music. However, 24 h delayed recognition results demonstrate effects of emotion on memory consolidation regardless of age, with a recognition benefit for high arousal and for negatively valenced music. The present study highlights the role of emotion on memory consolidation. Findings are examined in light of the literature on emotional memory for music and for other stimuli. We finally discuss the implication of the present results for potential music interventions in aging and dementia.
Full Text Available The emotions evoked by music can enhance recognition of excerpts. It has been suggested that memory is better for high than for low arousing music (Eschrich et al., 2005; Samson et al., 2009, but it remains unclear whether positively (Eschrich et al., 2008 or negatively valenced music (Aubé et al., 2013; Vieillard and Gilet, 2013 may be better recognized. Moreover, we still know very little about the influence of age on emotional memory for music. To address these issues, we tested emotional memory for music in young and older adults using musical excerpts varying in terms of arousal and valence. Participants completed immediate and 24h delayed recognition tests. We predicted highly arousing excerpts to be better recognized by both groups in immediate recognition. We hypothesized that arousal may compensate consolidation deficits in aging, thus showing more prominent benefit of high over low arousing stimuli in older than younger adults on delayed recognition. We also hypothesized worst retention of negative excerpts for the older group, resulting in a recognition benefit for positive over negative excerpts specific to older adults. Our results suggest that although older adults had worse recognition than young adults overall, effects of emotion on memory do not seem to be modified by aging. Results on immediate recognition suggest that recognition of low arousing excerpts can be affected by valence, with better memory for positive relative to negative low arousing music. However, 24h delayed recognition results demonstrate effects of emotion on memory consolidation regardless of age, with a recognition benefit for high arousal and for negatively valenced music. The present study highlights the role of emotion on memory consolidation. Findings are examined in light of to the literature on emotional memory for music and for other stimuli. We finally discuss the implication of the present results for potential music interventions in aging and
Full Text Available This interpretive study explored older people's understanding of loneliness and what they considered appropriate and effective ways of dealing with it. Thirty elderly people were interviewed in-depth; 12 described themselves as “lonely” and 18 as “not lonely.” We found a striking difference in the way “lonely” and “not lonely” people talked about loneliness. The “not lonely” participants described loneliness as painful, caused by the person's negative way of behaving and a state they should pull themselves out of. The “lonely” participants also described loneliness as painful, and gave more detailed descriptions of loneliness as disconnection from others, from their former home and from today's society. The “lonely” participants were more reserved and subdued in trying to explain loneliness, attributing it partly to themselves, but mostly to the lack of social contact with important others. Some felt able to handle their loneliness, while others felt unable to cope. This study underlines the importance of subjective experiences in trying to understand a phenomenon like loneliness and of developing support for lonely older people unable to cope on their own.
H. Nahvi Z. Khorgami
Full Text Available Midgut malrotation is typically presented during the first few months of life but sometimes may encounter later in life, causing difficulties and mistakes in diagnosis. We reviewed records of eleven rare patients with midgut malrotation older than one year of age and extracted their clinical and paraclinical data. The most common presenting symptoms were bilious vomiting, recurrent abdominal pain and constipation. Five of eleven patients had presented from neonatal period. The average interval between first symptoms and surgical correction of malrotation was about 22 months. Some of the patients had been undergone false treatments. Most cases were diagnosed by contrast studies (upper gastrointestinal series and barium enema. Diagnosing midgut malrotation in older children is often delayed. This anomaly should be suspected in all children with signs and symptoms of small bowel obstruction, chronic abdominal pain and vague abdominal discomfort and in all patients of any age with abdominal discomfort who do not respond to other therapies. Contrast studies may be necessary to rule out malrotation in suspected patients.
This paper shows that training of older employees is less effective. Training effectiveness is measured with respect to key dimensions such as career development, earnings, adoption of new skills, flexibility or job security. Older employees also pursue less ambitious goals with their training participation. An important reason for these differences during the life cycle might be that firms do not offer the “right” training forms and contents. Older employees get higher returns from informal ...
Sparto, Patrick J; Jennings, J Richard; Furman, Joseph M; Redfern, Mark S
Older adults have varied postural responses during induced and voluntary lateral stepping. The purpose of the research was to quantify the occurrence of different stepping strategies during lateral step initiation in older adults and to relate the stepping responses to retrospective history of falls. Seventy community-ambulating older adults (mean age 76 y, range 70–94 y) performed voluntary lateral steps as quickly as possible to the right or left in response to a visual cue, in a blocked de...
George M Korniotis; Alok Kumar
This paper examines the investment decisions of older individual investors. We find that older and experienced investors are more likely to follow rules of thumb that reflect greater investment knowledge. However, older investors are less effective in applying their investment knowledge and exhibit worse investment skill, especially if they are less educated, earn lower income, and belong to minority racial/ethnic groups. Overall, the adverse effects of aging dominate the positive effects of ...
Kristensen, Dorte V; Sundler, Annelie J; Eide, Hilde; Hafskjold, Linda; Ruud, Iren; Holmström, Inger K
To describe the characteristics of communication practice in home care visits between older people (over 65 years old) and nurse assistants and to discuss the findings from a person-centered perspective. The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial. A descriptive design with a qualitative inductive approach was used. Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis. Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being. The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students. Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication. © 2017 John Wiley & Sons Ltd.
Toivo, Terhi; Dimitrow, Maarit; Puustinen, Juha; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Kinnunen, Sirkka; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Airaksinen, Marja
The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources
Wang, Szu-Yao; Davies, Elizabeth
The literature on the impact of nursing home placement of older parents on family caregivers is still incomplete. Family caregivers experience stress, shock, anxiety, fear, resistance, and guilt in the process of decision making. The literature has demonstrated that family caregivers continue to experience stress and problems after placing older relatives into a long term care facility. Cultural values impact on people's attitudes, values and expectations. Culture will therefore affect the care-giving experience. Relatively little information is available from Asian and multicultural societies. Identifying family caregiver experiences after nursing home placement can alert professionals to the need for family guidance prior to nursing home placement and assist in early identification of potential problems. This article reviews the literature and discusses the impact on family caregivers of making a decision for nursing home placement and dealing with the stress and challenges that persist after nursing home admission.
Cataldo, Janine K; Petersen, Anne Berit; Hunter, Mary; Wang, Julie; Sheon, Nicolas
To describe older smokers' perceptions of risks and use of e-cigarettes, and their responses to marketing and knowledge of, and opinions about, regulation of e-cigarettes. Eight 90-minute focus groups with 8 to 9 participants met in urban and suburban California to discuss topics related to cigarettes and alternative tobacco products. Older adults are using e-cigarettes for cessation and as a way to circumvent no-smoking policies; they have false perceptions about the effectiveness and safety of e-cigarettes. They perceive e-cigarette marketing as a way to renormalize smoking. To stem the current epidemic of nicotine addiction, the FDA must take immediate action because e-cigarette advertising promotes dual use and may contribute to the renormalization of smoking.
Cataldo, Janine K.; Petersen, Anne Berit; Hunter, Mary; Wang, Julie; Sheon, Nicolas
Objectives To describe older smokers’ perceptions of risks and use of e-cigarettes, and their responses to marketing and knowledge of, and opinions about, regulation of e-cigarettes. Methods Eight 90-minute focus groups with 8 to 9 participants met in urban and suburban California to discuss topics related to cigarettes and alternative tobacco products. Results Older adults are using e-cigarettes for cessation and as a way to circumvent no-smoking policies; they have false perceptions about the effectiveness and safety of e-cigarettes. They perceive e-cigarette marketing as a way to renormalize smoking. Conclusions To stem the current epidemic of nicotine addiction, the FDA must take immediate action because e-cigarette advertising promotes dual use and may contribute to the renormalization of smoking. PMID:25741681
Leh, Sandra Kundrik; Melincavage, Sharon M.
A paucity of published literature exists related to the use of panel discussion as a teaching strategy. This article describes the panel discussion, the underpinnings of constructivism and the use of panel discussion to create a constructivist classroom environment. Details of planning, evaluating, and challenges of a panel discussion are also…
Assuming that the issue of same-sex marriage should be discussed in schools, how should the discussion be framed? Michael Hand first distinguishes this question from the related but distinct question of whether discussion on this topic should be steered. He then examines three possible frames for discussion of same-sex marriage: the perfectionist…
Wu, Anise M S; Tang, Catherine S K; Yan, Elsie C W
This study examined demographic and psychosocial differences between older Chinese volunteers and non-volunteers. The influences of work-related factors on older Chinese volunteers' post-retirement psychological functioning and life satisfaction were also explored. A total of 501 older Chinese in Hong Kong were individually interviewed. About 65% of them were involved in community voluntary work since their retirement, with an average of four hours per week. Compared to those without voluntary work experiences, older Chinese volunteers had higher educational attainment and reported better physical health, higher self-efficacy, greater life satisfaction, and less psychological distress. Results from hierarchical regression analyses showed that salient correlates of a low level of psychological distress in older Chinese volunteers were high educational attainment, high self-efficacy, perceived good physical health, and high levels of perceived rewards and satisfaction from voluntary work. Self-efficacy and perceived rewards from voluntary work were also salient correlates of life satisfaction for older Chinese volunteers. As hypothesized, work-related factors of perceived rewards and work satisfaction remained significant correlates of older volunteers' psychological well-being, even after controlling for demographic and individual psychosocial factors. Limitations and implications of the study were also discussed.
Full Text Available Introduction: Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older people's influence is an important and required aspect of these practices. This study's objective was to describe and analyse older people's influence on care-planning meetings at home and in hospital. Methods: Ten care-planning meetings were audio-recorded in the older people's homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. Results: Care-planning meetings at home appeared to enable older people's involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. Conclusion: Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older people's opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service.
Full Text Available Technology has become an increasingly integral part of life. For example, technology allows individuals to stay in touch with loved ones, obtain medical services through telehealthcare, and enjoy an overall higher quality of life. Particularly for older adults, using technology increases the likelihood that they will maintain their independence and autonomy. Long-distance caregiving has recently become a feasible option where caregivers for older adults can access reports and information about their loved one’s patterns that day (e.g., food and medication intake. Technology may be able to offset age-related challenges (e.g., caregiving, accessing healthcare, decreased social networks by applying technology to the needs of older adults. Solutions for meeting such challenges, however, have been less targeted. In addition, the healthcare system is evolving to focus on providing options and services in the home. This has direct implications for older adults, as the majority of healthcare services are utilized by older adults. Research is still at the beginning stages of developing successful technology tools that are compatible with older adult users. Therefore, the design, implementation, and outcome of such computer-based communication activities will be discussed in this paper in order to guide future endeavors in technology marketed for older adults.
Loh, Kah Poh; Burhenn, Peggy; Hurria, Arti; Zachariah, Finly; Mohile, Supriya Gupta
Insomnia is common in older adults with cancer, with a reported prevalence of 19-60% in prior studies. Cancer treatments are associated with increased risk of insomnia or aggravation of pre-existing insomnia symptoms, and patients who are receiving active cancer treatments are more likely to report insomnia. Insomnia can lead to significant physical and psychological consequences with increased mortality. We discuss physiological sleep changes in older adults, and illustrated the various sleep disorders. We present a literature review on the prevalence and the effects of insomnia on the quality of life in older adults with cancer. We discuss the risk factors and presented a theoretical framework of insomnia in older adults with cancer. We present a case study to illustrate the assessment and management of insomnia in older adults with cancer, comparing and contrasting a number of tools for sleep assessment. There are currently no guidelines on the treatment of sleep disorders in older adults with cancer. We present an algorithm developed at the City of Hope Comprehensive Cancer Center by a multidisciplinary team for managing insomnia, using evidence-based pharmacologic and non-pharmacologic interventions. Copyright © 2016 Elsevier Inc. All rights reserved.
Danis, Marion; Sommers, Roseanna; Logan, Jean; Weidmer, Beverly; Chen, Shirley; Goold, Susan; Pearson, Steven; Donley, Greer; McGlynn, Elizabeth
Patients' willingness to discuss costs of treatment alternatives with their physicians is uncertain. To explore public attitudes toward doctor-patient discussions of insurer and out-of-pocket costs and to examine whether several possible communication strategies might enhance patient receptivity to discussing costs with their physicians. Focus group discussions and pre-discussion and post-discussion questionnaires. Two hundred and eleven insured individuals with mean age of 48 years, 51 % female, 34 % African American, 27 % Latino, and 50 % with incomes below 300 % of the federal poverty threshold, participated in 22 focus groups in Santa Monica, CA and in the Washington, DC metro area. Attitudes toward discussing out-of-pocket and insurer costs with physicians, and towards physicians' role in controlling costs; receptivity toward recommended communication strategies regarding costs. Participants expressed more willingness to talk to doctors about personal costs than insurer costs. Older participants and sicker participants were more willing to talk to the doctor about all costs than younger and healthier participants (OR = 1.8, p = 0.004; OR = 1.6, p = 0.027 respectively). Participants who face cost-related barriers to accessing health care were in greater agreement than others that doctors should play a role in reducing out-of-pocket costs (OR = 2.4, p = 0.011). Participants did not endorse recommended communication strategies for discussing costs in the clinical encounter. In contrast, participants stated that trust in one's physician would enhance their willingness to discuss costs. Perceived impediments to discussing costs included rushed, impersonal visits, and clinicians who are insufficiently informed about costs. This study suggests that trusting relationships may be more conducive than any particular discussion strategy to facilitating doctor-patient discussions of health care costs. Better public understanding of how medical
Full Text Available Research shows that maintaining high individual modernity level can enable the shaping of positive self-image and boost life satisfaction for older people along with better adaptation to the process of societal modernization. This study examined the factorial structure and evaluated the psychometric properties of the adapted Multidimensional Scale of Chinese Individual Modernity (MS-CIM in a sample of 445 elders (the finalized version is named “MS-CIME” and added a self-constructed nine-item behavioral modernity domain. Principal component analysis suggested a conceptually meaningful seven-factor model, which was further supported by the results of the confirmatory factor analysis (CFA. The final 25-item MS-CIME indicated an acceptable level of reliability. The convergent validity was demonstrated by its associations with socio-economic status, participation in daily activities, self-image, and life satisfaction in expected directions.
The purpose of this study was to examine the effect of participation in a music-based intergenerational music program on cross-age interactions and cross-age attitudes of elementary-age children and older adults, and older adults' psychosocial well-being. Twenty-one children in the 4th grade volunteered to participate in the experimental (n = 12) or control (n = 9) group. Twenty-six older adults from a retirement living facility also volunteered to participate in the experimental (n = 14) or control (n = 12) group. Ten 30-min music sessions occurred in which participants engaged in singing, structured conversation, moving to music, and instrument playing interventions. Data analysis of cross-age interactions revealed that the interventions "structured conversation" and "moving to music" were more effective in eliciting interaction behaviors than the interventions "singing" and "instrument playing." Standardized measures revealed that children's attitudes towards older adults improved, though not significantly so, after participation in the intergenerational program. Results of biweekly post-session questionnaires revealed a decrease in negative descriptions of older adults and an increase in positive descriptions of older adults--suggesting a more positive view towards aging. Results revealed that older adults' attitudes towards children improved significantly after their participation in the intergenerational program. While standardized measures revealed that older adults did not perceive a significant improvement in their psychosocial well-being, their bi-weekly post-session questionnaires showed they perceived increased feelings of usefulness and other personal benefits from the intergenerational interactions. Suggestions for future research, the utility of varied measurement instruments, and implications for practice are discussed.
Parker, Samantha J; Jessel, Sonal; Richardson, Joshua E; Reid, M Cary
Mobile health (mHealth) is a rapidly emerging field with the potential to assist older adults in the management of chronic pain (CP) through enhanced communication with providers, monitoring treatment-related side effects and pain levels, and increased access to pain care resources. Little is currently known, however, about older adults' attitudes and perceptions of mHealth or perceived barriers and facilitators to using mHealth tools to improve pain management. We conducted six focus groups comprised of 41 diverse older adults (≥60 years of age) with CP. Participants were recruited from one primary care practice and two multiservice senior community day-visit centers located in New York City that serve older adults in their surrounding neighborhoods. Focus group discussions were recorded and transcribed, and transcriptions were analyzed using direct content analysis to identify and quantify themes. Focus group discussions generated 38 individual themes pertaining to the use of mHealth to help manage pain and pain medications. Participants had low prior use of mHealth (5% of participants), but the vast majority (85%) were highly willing to try the devices. Participants reported that mHealth devices might help them reach their healthcare provider more expeditiously (27%), as well as help to monitor for falls and other adverse events in the home (15%). Barriers to device use included concerns about the cost (42%) and a lack of familiarity with the technology (32%). Facilitators to device use included training prior to device use (61%) and tailoring devices to the functional needs of older adults (34%). This study suggests that older adults with CP are interested and willing to use mHealth to assist in the management of pain. Participants in our study reported important barriers that medical professionals, researchers, and mHealth developers should address to help facilitate the development and evaluation of age-appropriate, and function-appropriate, m
Neil, Wendy; Curran, Stephen; Wattis, John
older people. There is a need to redress this balance to ensure that the prescribing of antipsychotics in older people is evidence based.
Dalgaard, Lea Gulstav; Grönvall, Erik; Verdezoto, Nervo
treatment or a specific condition. In this paper, we discuss experiences from designing the tablet-based application MediFrame. MediFrame is a personal medication management system to support older adults in non-clinical settings such as the home. The paper describes the user-centered design process...... and the resulting tablet application. We show how MediFrame can be used to support adherence in medical treatments through fieldwork informed use scenarios. Based on early qualitative feedback, we also discuss lessons learned and how designers can support a holistic medication experience for an older adult...
Sorrell, Jeanne M
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is targeted for publication in May 2013. Older adults and their families should be aware of the potential impact that changes in this important document may have on diagnosis and treatment of mental health concerns. Two specific changes related to a new category of Neurocognitive Disorders and a new interpretation of criteria for depression after bereavement are discussed in this article. Nurses can help older adults and their families understand the new DSM-5 terminology and encourage them to discuss risks, benefits, and likely outcomes of diagnoses, procedures, and treatments that may seem unfamiliar. Copyright 2013, SLACK Incorporated.
Melenhorst, Anne-Sophie; Rogers, Wendy A; Bouwhuis, Don G
This study examined older adults' motivation to adopt technological innovation. Sixty-eight older e-mail users and nonusers discussed the use of e-mail and of traditional communication methods in 18 focus groups. The results show older adults' benefit-driven approach to new communication technology. Regardless of whether their decision about the new technology was positive or negative and irrespective of their e-mail experience, participants focused on benefits rather than costs. For traditional media, both costs and benefits were important. Results contradict the common belief that barriers such as usability problems determine whether older people use new technology and indicate the decisive role of perceived benefits for successful innovation. ((c) 2006 APA, all rights reserved).
Ebner, Natalie C; Johnson, Marcia K
Human attention is selective, focusing on some aspects of events at the expense of others. In particular, angry faces engage attention. Most studies have used pictures of young faces, even when comparing young and older age groups. Two experiments asked (1) whether task-irrelevant faces of young and older individuals with happy, angry, and neutral expressions disrupt performance on a face-unrelated task, (2) whether interference varies for faces of different ages and different facial expressions, and (3) whether young and older adults differ in this regard. Participants gave speeded responses on a number task while irrelevant faces appeared in the background. Both age groups were more distracted by own than other-age faces. In addition, young participants' responses were slower for angry than happy faces, whereas older participants' responses were slower for happy than angry faces. Factors underlying age-group differences in interference from emotional faces of different ages are discussed.
Pizzigalli, L; Micheletti Cremasco, M; Mulasso, A; Rainoldi, A
Falls are a serious health problem for older adults. Several studies have identified the decline of postural balance as one of the main risk factors for falls. Contrary to what may be believed, the capability of force platform measurements to predict falls remains uncertain. The focus of this narrative review is the identification of postural characteristics of older adults at risk of falling using both static and dynamic postural balance assessments. The literature analysis was conducted on Medline/PubMed. The search ended in May 2015. Centre of pressure (CoP) path length, CoP velocity and sway in medial lateral and anterior-posterior are the variables that distinguish older adult fallers from non-fallers. Recommendations to medical personnel on how to provide efficient balance training for older adults are offered, discussing the relevance and limitations of postural stability on static and dynamic board in falling risk prevention. Copyright © 2015 Elsevier Ltd. All rights reserved.
Buford, Thomas W.; Anton, Stephen D.; Clark, David J.; Higgins, Torrance J.; Cooke, Matthew B.
As the number of older adults continues to rise worldwide, the prevention of physical disability among seniors is an increasingly important public health priority. Physical exercise is among the best known methods of preventing disability, but accumulating evidence indicates that considerable variability exists in the responsiveness of older adults to standard training regimens. Accordingly, a need exists to develop tailored interventions to optimize the beneficial effects of exercise on the physical function of older adults at risk for becoming disabled. The present review summarizes the available literature related to the use of adjuvant or alternative strategies intended to enhance the efficacy of exercise in improving the physical function of older adults. Within this work, we also discuss potential future research directions in this area. PMID:24361365
Buford, Thomas W; Anton, Stephen D; Clark, David J; Higgins, Torrance J; Cooke, Matthew B
As the number of older adults continues to rise worldwide, the prevention of physical disability among seniors is an increasingly important public health priority. Physical exercise is among the best known methods of preventing disability, but accumulating evidence indicates that considerable variability exists in the responsiveness of older adults to standard training regimens. Accordingly, a need exists to develop tailored interventions to optimize the beneficial effects of exercise on the physical function of older adults at risk for becoming disabled. The present review summarizes the available literature related to the use of adjuvant or alternative strategies intended to enhance the efficacy of exercise in improving the physical function of older adults. Within this work, we also discuss potential future research directions in this area. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Hughes, Anne K; Luz, Clare; Hall, Dennis; Gardner, Penny; Hennessey, Chris Walker; Lammers, Lynn
Lesbian, gay, bisexual, or transgender (LGBT) older adults are often unaware or fearful of aging services that contribute to greater vulnerability, isolation, and risk when services are needed. In addition, they may perceive or experience bias in health care encounters. Providers may not recognize their own biases or their impact on such encounters. In response, a group of LGBT community activists, aging professionals, researchers, and a theatre ensemble developed an interactive theatre experience, described herein, that portrays challenges faced by LGBT older adults needing services. Goals included raising awareness among LGBT older adults and providers about issues such as the limited legal rights of partners, limited family support, and fear of being mistreated as a result of homophobia. Evaluations and feedback reflected the potential of interactive theatre to engage people in sensitive discussions that can lead to increased awareness, reduced bias, practice change, and ultimately improved care for LGBT older adults.
Marshall, Lynette C
In discussing the potential implications of the attitudes of the registered nurse towards the work of caring for older people, it was helpful to highlight why this work is important, gain some understanding of quality care and how it can be facilitated or hindered. Patient centred care is essential as there is great diversity found amongst older people. It was found that attitudes held by registered nurses and students towards older people have a direct impact on the quality of care provided. Negative attitudes and stereotyping get in the way of quality care while positive attitudes enabled quality care. In identifying the factors that influence these attitudes, registered nurses can take on a leadership role in promoting positive attitudes and challenging negative attitudes towards the care of older people with the goal of providing patient centre care.
Chronic pain management is an important, and often under-addressed, component in the care of older adults with venous leg ulcers (VLUs). Clinicians caring for older adults with VLUs must consider and address both the physiological and psychosocial aspects of chronic pain. Traditional pharmacological approaches to pain management are only part of the solution. One strategy is to adopt a more holistic approach to chronic pain management that includes complementary and alternative medicine (CAM) therapies. Unfortunately, there is a paucity of CAM research that focuses on the pain management of older adults with VLUs. Despite these limitations, pain management that includes discussion of relevant CAM modalities must be a priority for clinicians caring for older adults living with VLUs.
This book will attempt to deconstruct communication patterns between registered nurses and older patients and propose methods for re-constructing the manner in which nurses and older patients relate to one another. The number of Americans over the age of 65 grew from 3.1 million in 1900 (about 4% of
Conejero, Ismael; Olié, Emilie; Courtet, Philippe; Calati, Raffaella
Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts. PMID:29719381
Boulton-Lewis, Gillian M.; Buys, Laurie
This paper reports on the findings of qualitative, semistructured interviews conducted with 40 older Australian participants who either did or did not engage in organized learning. Phenomenology was used to guide the interviews and analysis to explore the lived learning experiences and perspectives of these older people. Their experiences of…
Poor oral health for all older adults can result in higher risk for heart disease, stroke, diabetes, and oral cancer. Findings from this study indicated older veterans needed to improve their oral hygiene habits but barriers to oral hygiene performance prevented them from receiving and performing oral hygiene measures.
Caplan, L S; Haynes, S G
There is currently an epidemic of breast cancer in women 65 years of age and older. The purposes of this paper are to explore the breast cancer screening behaviors of older women and to identify some of the determinants of screening in these women. Data were analyzed from the 1987 National Health Interview Survey, a continuous nationwide household interview survey of the U.S. civilian, noninstitutionalized population. As in other studies, the utilization of breast cancer screening by older women was less in older women than in younger women. This was true for both mammography and clinical breast examination. A number of determinants of screening in older women were identified here. Women with a usual source of care and/or no activity limitation, as well as high school graduates, were the ones most likely to have received a screening mammogram and/or a screening clinical breast exam during the past year. The failure of older women to receive adequate breast cancer screening is an important concern which should be reevaluated, given the breast cancer epidemic in this population. This study identified a number of determinants of breast cancer screening in older women. For the most part, these determinants point to the primary care physician as the key to breast cancer screening in these women. Therefore, the primary care physician must be informed of, and encouraged to follow, the recommendations for periodic breast cancer screening in older women.
Wang, Lin; Rau, Pei-Luen Patrick; Salvendy, Gavriel
This study investigated variables contributing to older adults' information technology acceptance through a survey, which was used to find factors explaining and predicting older adults' information technology acceptance behaviors. Four factors, including needs satisfaction, perceived usability, support availability, and public acceptance, were…
Grimes, Galen A.; Hough, Michelle G.; Mazur, Elizabeth; Signorella, Margaret L.
Older adults are less likely to be using computers and less knowledgeable about Internet security than are younger users. The two groups do not differ on trust of Internet information. The younger group shows no age or gender differences. Within the older group, computer users are more trusting of Internet information, and along with those with…