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Sample records for patient-physician encounters influence

  1. The third person in the room: frequency, role, and influence of companions during primary care medical encounters.

    Science.gov (United States)

    Schilling, Lisa M; Scatena, Lisa; Steiner, John F; Albertson, Gail A; Lin, C T; Cyran, Lisa; Ware, Lindsay; Anderson, Robert J

    2002-08-01

    We wanted to characterize patient accompaniment to medical encounters and to explore the rationale and influence of the companion on the primary care medical encounter. This was a descriptive study. Academic general internal medicine physicians, patients, and patient companions participated. We measured the frequency of waiting and examination room companions, the reasons for accompaniment, the influence on the encounter, and the overall helpfulness of the companion as assessed by patients and companions. We also determined the physicianamprsquos assessment of the companionamprsquos influence, helpfulness, and behavior during the encounter. Companions were in the examination room for 16% of visits; 93% were family members. The rationales for waiting and examination room companions were to help with transportation, provide emotional support, and provide company. Examination room companions helped communicate concerns to the physician, remember the physicianamprsquos advice, make decisions, and communicate their own concerns to the physician. Patients believed that examination room companions influenced 75% of medical encounters, mainly by improving communication between physician and patient. Physicians agreed that examination room companions favorably influenced physician and patient understanding (60% and 46% of encounters, respectively). Patients indicated that waiting and examination room companions were very helpful for 71% and 83% of visits, respectively. Companions frequently accompany patients to their primary care medical encounters. They are often family members, and they assume important roles in enhancing patient and physician understanding.

  2. Encounter times of chromatin loci influenced by polymer decondensation

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    Amitai, A.; Holcman, D.

    2018-03-01

    The time for a DNA sequence to find its homologous counterpart depends on a long random search inside the cell nucleus. Using polymer models, we compute here the mean first encounter time (MFET) between two sites located on two different polymer chains and confined locally by potential wells. We find that reducing tethering forces acting on the polymers results in local decondensation, and numerical simulations of the polymer model show that these changes are associated with a reduction of the MFET by several orders of magnitude. We derive here new asymptotic formula for the MFET, confirmed by Brownian simulations. We conclude from the present modeling approach that the fast search for homology is mediated by a local chromatin decondensation due to the release of multiple chromatin tethering forces. The present scenario could explain how the homologous recombination pathway for double-stranded DNA repair is controlled by its random search step.

  3. The way we encounter reading material influences how frequently we mind wander

    OpenAIRE

    Trish L Varao Sousa; Jonathan S A Carriere; Dan eSmilek

    2013-01-01

    We examined whether different encounters of reading material influence the likelihood of mind wandering, memory for the material, and the ratings of interest in the material. In a within-subjects design participants experienced three different reading encounters: (1) reading a passage aloud, (2) listening to a passage being read to them, and (3) reading a passage silently. Throughout each reading encounter probes were given in order to identify mind wandering. After finishing the passage part...

  4. Pudor, honor, and autoridad: the evolving patient-physician relationship in Spain.

    Science.gov (United States)

    Epstein, R M; Borrell i Carrió, F

    2001-10-01

    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.

  5. Research on the influence that communication in psychiatric encounters has on treatment.

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    Cruz, Mario; Pincus, Harold Alan

    2002-10-01

    The purpose of this article is to inform mental health professionals about the empirical literature on medical and psychiatric encounters and the influence of communicative behaviors on specific encounter outputs and treatment outcomes. A comprehensive review of the health communications literature from 1950 to 2001, using MEDLINE and PsycINFO, was conducted to identify relevant articles on the communication skills of psychiatrists and other physicians. These searches were augmented by personal correspondence with experts on changes in practice patterns in psychiatry and on medical and psychiatric communications research. A review of references within each article and information from the experts identified other relevant articles. Selection was then narrowed to include reports of studies that used structured written instruments that captured relevant physician and patient perceptions of the physician-patient relationship, content analysis of audio- or videotapes of communication in medical or psychiatric encounters, or interaction analysis systems used to categorize audio- or videotaped communicative behaviors in medical or psychiatric encounters. Twenty-five articles in medicine and 34 articles in psychiatry were selected. Medical communication researchers have observed associations between physicians' communicative skills and patients' satisfaction, patients' adherence to treatment recommendations, treatment outputs, and patients' willingness to file malpractice claims. The research has also shown that primary care physicians can be more responsive to patients' concerns without lengthening visits. In psychiatry, the literature can be organized into four discrete categories of research: negotiated treatment and the customer approach, therapeutic alliance, Gottschalk-Gleser content analysis of patients' speech, and content analysis of psychiatric interviews.

  6. Cultural influences on the physician-patient encounter: The case of shared treatment decision-making.

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    Charles, Cathy; Gafni, Amiram; Whelan, Tim; O'Brien, Mary Ann

    2006-11-01

    In this paper we discuss the influence of culture on the process of treatment decision-making, and in particular, shared treatment decision-making in the physician-patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect treatment decision-making; (2) cultural issues and assumptions underlying the development and use of treatment decision aids. This is a conceptual paper. Based on our knowledge and reading of the key literature in the treatment decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician-patient encounter and when designing instruments (decision aids) to help patients participate in making decisions. Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared decision-making as well as on the applicability across cultural groups of decision aids developed to facilitate patient participation in treatment decision-making with physicians. Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.

  7. Modifiable influences on female HPV vaccine uptake at the clinic encounter level: a literature review.

    Science.gov (United States)

    Small, Stephanie L; Sampselle, Carolyn M; Martyn, Kristy K; Dempsey, Amanda F

    2014-09-01

    A review of the literature to identify modifiable influences on female human papillomavirus (HPV) vaccine uptake relevant to clinical practice in order to support nurse practitioners (NPs) in the prevention of cervical cancer. PubMed, CINAHL, reference lists of publications that surfaced in the electronic search. Six influences are modifiable and potentially amenable to being addressed at the clinic encounter level: (a) cost and insurance coverage, (b) provider recommendation, (c) vaccination opportunity, (d) HPV and HPV vaccine knowledge, (e) vaccine safety concerns, and (f) HPV risk. NPs have an important role in improving HPV vaccine uptake and research suggests several areas they can address to increase vaccination during clinic visits. ©2013 American Association of Nurse Practitioners.

  8. Interference with the patient-physician relationship

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-11-01

    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 ….

  9. Early-Life Social Isolation Influences Mouse Ultrasonic Vocalizations during Male-Male Social Encounters.

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    Keesom, Sarah M; Finton, Caitlyn J; Sell, Gabrielle L; Hurley, Laura M

    2017-01-01

    Early-life social isolation has profound effects on adult social competence. This is often expressed as increased aggression or inappropriate displays of courtship-related behaviors. The social incompetence exhibited by isolated animals could be in part due to an altered ability to participate in communicatory exchanges. House mice (Mus musculus) present an excellent model for exploring this idea, because social isolation has a well-established influence on their social behavior, and mice engage in communication via multiple sensory modalities. Here, we tested the prediction that social isolation during early life would influence ultrasonic vocalizations (USVs) emitted by adult male mice during same-sex social encounters. Starting at three weeks of age, male mice were housed individually or in social groups of four males for five weeks, after which they were placed in one of three types of paired social encounters. Pair types consisted of: two individually housed males, two socially housed males, or an individually housed and a socially housed male ("mixed" pairs). Vocal behavior (USVs) and non-vocal behaviors were recorded from these 15-minute social interactions. Pairs of mice consisting of at least one individually housed male emitted more and longer USVs, with a greater proportional use of USVs containing frequency jumps and 50-kHz components. Individually housed males in the mixed social pairs exhibited increased levels of mounting behavior towards the socially housed males. Mounting in these pairs was positively correlated with increased number and duration of USVs as well as increased proportional use of spectrally more complex USVs. These findings demonstrate that USVs are part of the suite of social behaviors influenced by early-life social isolation, and suggest that altered vocal communication following isolation reflects reduced social competence.

  10. Influence of temporal context on value in the multiple-chains and successive-encounters procedures.

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    O'Daly, Matthew; Angulo, Samuel; Gipson, Cassandra; Fantino, Edmund

    2006-05-01

    This set of studies explored the influence of temporal context across multiple-chain and multiple-successive-encounters procedures. Following training with different temporal contexts, the value of stimuli sharing similar reinforcement schedules was assessed by presenting these stimuli in concurrent probes. The results for the multiple-chain schedule indicate that temporal context does impact the value of a conditioned reinforcer consistent with delay-reduction theory, such that a stimulus signaling a greater reduction in delay until reinforcement has greater value. Further, nonreinforced stimuli that are concurrently presented with the preferred terminal link also have greater value, consistent with value transfer. The effects of context on value for conditions with the multiple-successive-encounters procedure, however, appear to depend on whether the search schedule or alternate handling schedule was manipulated, as well as on whether the tested stimuli were the rich or lean schedules in their components. Overall, the results help delineate the conditions under which temporal context affects conditioned-reinforcement value (acting as a learning variable) and the conditions under which it does not (acting as a performance variable), an issue of relevance to theories of choice.

  11. The Influence of Physician Communication Style on Overweight Patients’ Perceptions of Length of Encounter and Physician Being Rushed

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    Gulbrandsen, Pål; Østbye, Truls; Lyna, Pauline; Dolor, Rowena J.; Tulsky, James A.; Alexander, Stewart C.; Pollak, Kathryn I.

    2012-01-01

    BACKGROUND AND OBJECTIVES Little is known about how patients and physicians perceive time and the extent to which they perceive the physician being rushed during encounters. One aim of this paper is to examine whether patient and physician characteristics and physician communication influence patient perception of the duration of the encounter and their perception of physicians being rushed. Another aim is to examine the relationship between patient and physician perceptions of physicians feeling rushed. METHODS We audiorecorded 461 encounters of overweight or obese patients with 40 primary care physicians and included 320 encounters in which weight was discussed. We calculated time spent with physician and coded all communication about weight using the Motivational Interview Treatment Integrity scale (MITI). Patients completed post-visit questionnaires in which they reported the estimated duration of the encounter and how rushed they thought the physician was during the encounter. Physicians reported how rushed they felt. RESULTS Patients estimated encounters to be longer than they actually were by an average of 2.6 minutes (SD=11.0). When physicians used reflective statements when discussing weight, patients estimated the encounter to be shorter than when physicians did not use reflective statements (1.17 versus 4.56 minutes more than actual duration). Whites perceived the encounter as shorter than African Americans (1.45 versus 4.28 minutes more than actual duration). Physicians felt rushed in 66% of visits; however, most patients did not perceive this. Internists were perceived to be more rushed than family physicians. CONCLUSIONS There is wide variation in patients’ ability to estimate the length of time they spend with their physician. Some physician and patient characteristics were related to patient perceptions of the length of the encounter. Reflective statements might lead patients to perceive encounters as shorter. Physicians, especially family

  12. Patient-physician trust: an exploratory study.

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    Thom, D H; Campbell, B

    1997-02-01

    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.

  13. Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review

    Science.gov (United States)

    2017-01-01

    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

  14. ACOG Committee Opinion No. 587: Effective patient-physician communication.

    Science.gov (United States)

    2014-02-01

    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.

  15. Influence of alcohol on condom use pattern during non-spousal sexual encounter in male migrant workers in north India.

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    Rizwan, S A; Kant, S; Goswami, K; Rai, S K; Misra, P

    2014-01-01

    Migrant workers constitute an important risk group for Human Immunodeficiency Virus/Acquired Immuno-Deficiency Syndrome transmission in India. Alcohol consumption before sexual intercourse has been postulated to influence condom use practices. This study aimed to assess this association with regard to non-spousal sexual encounters among male migrant workers in northern India. A cross-sectional facility-based survey was conducted in 2011. Male migrant workers aged ≥18 years, who were born outside Haryana, who had moved to the current location after 15 years of age,had worked in the current factory for at least 1 year, who were willing to participate and were able to give written, informed consent were included in the study. A consecutive sampling was performed. Descriptive, bivariate and multiple logistic regression analyses were carried out. A total of 162 participants reported having experienced non-spousal sexual encounters in the last 1 year. The proportion of men who reported not having used a condom at their last non-spousal sexual encounter was 59.3%, and 78.4% of the men reported having consumed alcohol in the last 1 year. About 48.1% of men reported having consumed alcohol before their last non-spousal sexual encounter. Men who consumed alcohol were three times more likely to not use a condom at their last non-spousal sexual encounter (OR = 3.1, 95% CI: 1.5-6.4). This association persisted even after adjusting for relevant confounders. Alcohol consumption had a negative influence on condom use during non-spousal sexual encounter among male migrant workers. An integrated approach to promote condom use and reduce alcohol consumption among migrant men needs to be undertaken through targeted intervention strategies.

  16. Encounters with Pinyon-Juniper influence riskier movements in Greater Sage-Grouse across the Great Basin

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    Prochazka, Brian; Coates, Peter S.; Ricca, Mark; Casazza, Michael L.; Gustafson, K. Ben; Hull, Josh M.

    2016-01-01

    Fine-scale spatiotemporal studies can better identify relationships between individual survival and habitat fragmentation so that mechanistic interpretations can be made at the population level. Recent advances in Global Positioning System (GPS) technology and statistical models capable of deconstructing high-frequency location data have facilitated interpretation of animal movement within a behaviorally mechanistic framework. Habitat fragmentation due to singleleaf pinyon (Pinus monophylla; hereafter pinyon) and Utah juniper (Juniperus osteosperma; hereafter juniper) encroachment into sagebrush (Artemisia spp.) communities is a commonly implicated perturbation that can adversely influence greater sage-grouse (Centrocercus urophasianus; hereafter sage-grouse) demographic rates. Using an extensive GPS data set (233 birds and 282,954 locations) across 12 study sites within the Great Basin, we conducted a behavioral change point analysis and subsequently constructed Brownian bridge movement models from each behaviorally homogenous section. We found a positive relationship between modeled movement rate and probability of encountering pinyon-juniper with significant variation among age classes. The probability of encountering pinyon-juniper among adults was two and three times greater than that of yearlings and juveniles, respectively. However, the movement rate in response to the probability of encountering pinyon-juniper trees was 1.5 times greater for juveniles. We then assessed the risk of mortality associated with an interaction between movement rate and the probability of encountering pinyon-juniper using shared frailty models. During pinyon-juniper encounters, on average, juvenile, yearling, and adult birds experienced a 10.4%, 0.2%, and 0.3% reduction in annual survival probabilities. Populations that used pinyon-juniper habitats with a frequency ≥ 3.8 times the overall mean experienced decreases in annual survival probabilities of 71.1%, 0.9%, and 0.9%. This

  17. Patient-physician trust among adults of rural Tamil Nadu: a community-based survey.

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    Baidya, M; Gopichandran, V; Kosalram, K

    2014-01-01

    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.

  18. Patient-Physician Communicative Patterns, Physicians’ Job Satisfaction, and Patients’ Satisfaction: The Case of a Hospital in Isfahan

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    Maryam Yaghoubi

    2014-04-01

    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.

  19. Influence of metformin and insulin on myocardial substrate oxidation under conditions encountered during cardiac surgery.

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    Holmes, Cyonna; Powell, LaShondra; Clarke, Nicholas S; Jessen, Michael E; Peltz, Matthias

    2018-02-01

    The influence of diabetic therapies on myocardial substrate selection during cardiac surgery is unknown but may be important to ensure optimal surgical outcomes. We hypothesized that metformin and insulin alter myocardial substrate selection during cardiac surgery and may affect reperfusion cardiac function. Rat hearts (n = 8 per group) were evaluated under 3 metabolic conditions: normokalemia, cardioplegia, or bypass. Groups were perfused with Krebs-Henseleit buffer in the presence of no additives, metformin, insulin, or both insulin and metformin. Perfusion buffer containing physiologic concentrations of energetic substrates with different carbon-13 ( 13 C) labeling patterns were used to determine substrate oxidation preferences using 13 C magnetic resonance spectroscopy and glutamate isotopomer analysis. Rate pressure product and oxygen consumption were measured. Myocardial function was not different between groups. For normokalemia, ketone oxidation was reduced in the presence of insulin and the combination of metformin and insulin reduced fatty acid oxidation. Metformin reduced fatty acid and ketone oxidation during cardioplegia. Fatty acid oxidation was increased in the bypass group compared with all other conditions. Metformin and insulin affect substrate utilization and reduce fatty acid oxidation before reperfusion. These alterations in substrate oxidation did not affect myocardial function in otherwise normal hearts. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Mobile encounters

    DEFF Research Database (Denmark)

    Koefoed, Lasse Martin; Christensen, Mathilde Dissing; Simonsen, Kirsten

    2017-01-01

    The paper explores modes of encounters in the everyday practice of bus travel. Particularly, it addresses cross-cultural encounters located in the tension between familiarity and difference, between inclusion and exclusion. The paper is located in contemporary thoughts, approaching public transport...... not only as a moving device but also as a social arena. Furthermore, the bus is simultaneously perceived as a public space, at once composite, contradictory and heterogeneous, and as a meeting place involving ‘Throwntogetherness’. The encounters analysed are bodily, emotional charged and outspoken meetings...

  1. What influences the quality of educational encounters between trainer and trainee in vocational training for general practice?

    NARCIS (Netherlands)

    Boendermaker, PM; Ket, P; Dusman, H; Schuling, J; Van der Vleuten, CPM; Tan, LHC

    This study of educational encounters between a trainer and a trainee in vocational training for general practice investigates the quality of the encounter. The study focuses on the relation between the quality of the encounter and elements such as presence of feedback, duration, use of media, etc. A

  2. Encountering Materiality

    DEFF Research Database (Denmark)

    Svabo, Connie

    2016-01-01

    DHT researcher Connie Svabo and artist Charlotte Grum did a joint performance presentation titled Becoming Sheep, Becoming Animal at the international conference Encountering Materiality – Transdisciplinary Conversations, held in Geneve, Schwitzerland, June 23-25 2016.......DHT researcher Connie Svabo and artist Charlotte Grum did a joint performance presentation titled Becoming Sheep, Becoming Animal at the international conference Encountering Materiality – Transdisciplinary Conversations, held in Geneve, Schwitzerland, June 23-25 2016....

  3. Does patient coaching make a difference in patient-physician communication during specialist consultations? A systematic review.

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    Alders, Irèn; Smits, Carolien; Brand, Paul; van Dulmen, Sandra

    2017-05-01

    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.

  4. Cosmopolitan encounters

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    Plage, Stefanie; Willing, Indigo; Woodward, Ian

    2017-01-01

    This study contributes to the growing research on everyday cosmopolitanism in diverse societies. We employ a cosmopolitan encounters framework to explore the reflexive openness people perform and the ethical reasoning they draw on to get along with each other. In particular, we look beyond....... The ethical framework we propose is grounded in reflexive acts of sharing going beyond notions of giving and performing hospitality within a host/guest dyad....

  5. Moving Encounters

    Directory of Open Access Journals (Sweden)

    Ann Deslandes

    2011-04-01

    Full Text Available This essay explores my experience of losing an authoritative speaking position – that is, ‘falling on my face’ in a research encounter with the Brazilian Landless Worker’s Movement (O Movimento dos Trabalhadores Rurais sem Terra, or MST.  My specific movements through this locale invoke Gayatri Chakravorty Spivak’s concept of ‘unlearning one’s privilege as a loss’; and Sara Ahmed’s theory of ‘stranger fetishism’.  In writing my brief loss, I also; of course, recover my speaking position, meaning that I can always efface the loss by re-writing it as a source of ethnographic authority.  This essay is written in two voices in order to reflect this paradox: one which describes the encounter, and one that critically ruminates upon it.  I note, for example, that the MST as a variegated conglomerate of people takes the form of particular ‘Others’ when they are represented in the scholarship and polemic of ‘first world’ activists in the so called ‘global justice movement’.  ‘Falling on my face in the street’ of these Others locates particular processes of fetishization within the global justice movement and the relationships across power and difference that are contained herein; processes that impact on the idea of a ‘global’ solidarity against systemic ‘global’ oppressions.

  6. A reflection of the coding of meaning in patient-physician interaction: Jürgen Habermas' theory of communication applied to sequence analysis.

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    Skirbekk, Helge

    2004-08-01

    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.

  7. African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

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    McLaughlin, Megan M; Simonson, Louis; Zou, Xia; Ling, Li; Tucker, Joseph D

    2015-01-01

    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.

  8. African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

    Directory of Open Access Journals (Sweden)

    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.

  9. Decision or no decision: how do patient-physician interactions end and what matters?

    Science.gov (United States)

    Tai-Seale, Ming; Bramson, Rachel; Bao, Xiaoming

    2007-03-01

    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.

  10. Patient-Physician Communication in Oncology Care : The character of, barriers against, and ways to evaluate patient-physician communication, with focus on the psychosocial dimensions

    OpenAIRE

    Fagerlind, Hanna

    2012-01-01

    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...

  11. Jazz and the ‘Art’ of Medicine: Improvisation in the Medical Encounter

    Science.gov (United States)

    Haidet, Paul

    2007-01-01

    Improvisation is an important aspect of patient-physician communication. It is also a defining feature of jazz music performance. This essay uses examples from jazz to illustrate principles of improvisation that relate to an individual communication act (ie, building space into one’s communication), a physician’s communicative style (ie, developing one’s voice), and the communicative process of the medical encounter (ie, achieving ensemble). At all 3 levels, the traditions of jazz improvisation can inform efforts to research and teach medical interviewing by fostering a contextualized view of patient-physician communication. PMID:17389542

  12. Jazz and the 'art' of medicine: improvisation in the medical encounter.

    Science.gov (United States)

    Haidet, Paul

    2007-01-01

    Improvisation is an important aspect of patient-physician communication. It is also a defining feature of jazz music performance. This essay uses examples from jazz to illustrate principles of improvisation that relate to an individual communication act (ie, building space into one's communication), a physician's communicative style (ie, developing one's voice), and the communicative process of the medical encounter (ie, achieving ensemble). At all 3 levels, the traditions of jazz improvisation can inform efforts to research and teach medical interviewing by fostering a contextualized view of patient-physician communication.

  13. Organised Cultural Encounters

    DEFF Research Database (Denmark)

    Christiansen, Lene Bull; Galal, Lise Paulsen; Hvenegård-Lassen, Kirsten

    2017-01-01

    The article introduces the special issue by presenting the concept of organised cultural encounters that are encounters organised to manage and/or transform problems perceived to originate in or include cultural differences. Inspired by Pratt’s conceptualisation of the contact zone, a critical...... perspective on the particular historical and spatial context of any encounter and how this context frames and mediates what takes place during an encounter is applied. While the articles of the issue present different varieties of organised cultural encounters, it is argued that they are not only of the same...

  14. Cultural geography. Different encounters, encountering difference

    OpenAIRE

    Longhurst, Robyn

    2007-01-01

    In the first half of this paper it is argued that cultural geography is a dynamic and diverse field that extends well beyond a single branch of human geography. The boundaries between it and other sub-disciplines are often blurred. People have «different» encounters with cultural geography depending on their sub-disciplinary convergences. People also have different encounters with cultural geography depending on where they live and work. «Place matters» in the construction, production and rep...

  15. "But my doctor recommended pot": medical marijuana and the patient-physician relationship.

    Science.gov (United States)

    Nussbaum, Abraham M; Boyer, Jonathan A; Kondrad, Elin C

    2011-11-01

    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.

  16. The evolving concept of "patient-centeredness" in patient-physician communication research.

    Science.gov (United States)

    Ishikawa, Hirono; Hashimoto, Hideki; Kiuchi, Takahiro

    2013-11-01

    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.

  17. Encounters with immigrant customers

    DEFF Research Database (Denmark)

    Mygind, Anna; Espersen, Sacha; Nørgaard, Lotte Stig

    2013-01-01

    were not sufficiently assessed at the counter (n = 55, 65%), and that their latest encounter with an immigrant customer was less satisfactory than a similar encounter with an ethnic Danish customer (n = 48, 57%) (significantly more pharmacists than assistants: odds ratio, OR, 3.19; 95% confidence...

  18. Dental Encounter System (DES)

    Data.gov (United States)

    Department of Veterans Affairs — Dental Encounter System (DES) is an automated health care application designed to capture critical data about the operations of VA Dental Services. Information on...

  19. Encounter with comet Halley

    International Nuclear Information System (INIS)

    Sagdeev, R.Z.

    1989-01-01

    This paper reports on an international armada of six spacecraft which encountered the comet Halley and performed in-situ measurements. These encounters led to the discovery of a number of cometary plasma physics phenomena. Another important result was that a value for the average density of the cometary nucleus could be estimated, which is found to be compatible with snow ball models for the nucleus

  20. Patient-Physician Communication About Complementary and Alternative Medicine in a Radiation Oncology Setting

    International Nuclear Information System (INIS)

    Ge Jin; Fishman, Jessica; Vapiwala, Neha; Li, Susan Q.; Desai, Krupali; Xie, Sharon X.; Mao, Jun J.

    2013-01-01

    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.

  1. Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior.

    Science.gov (United States)

    Tang, Yan; Chang, Chung-Chou H; Lave, Judith R; Gellad, Walid F; Huskamp, Haiden A; Donohue, Julie M

    2016-03-01

    Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes. To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing. Using 2011 data from Pennsylvania's Medicaid program, IMS Health's HCOSTM database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to 10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing. There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average. Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians' prescribing behavior and indicate that even among specialties regularly prescribing a therapeutic category, some physicians rely heavily on a small number of agents. Health systems may need to offer educational interventions to clinicians in order to improve their ability to tailor treatment decisions to the needs of individual patients. Future studies should examine the impact of the diversity of antipsychotic prescribing to determine whether more diversified prescribing improves patient adherence and outcomes.

  2. Privacy encounters in Teledialogue

    DEFF Research Database (Denmark)

    Andersen, Lars Bo; Bøge, Ask Risom; Danholt, Peter

    2017-01-01

    Privacy is a major concern when new technologies are introduced between public authorities and private citizens. What is meant by privacy, however, is often unclear and contested. Accordingly, this article utilises grounded theory to study privacy empirically in the research and design project...... Teledialogue aimed at introducing new ways for public case managers and placed children to communicate through IT. The resulting argument is that privacy can be understood as an encounter, that is, as something that arises between implicated actors and entails some degree of friction and negotiation....... An argument which is further qualified through the philosophy of Gilles Deleuze. The article opens with a review of privacy literature before continuing to present privacy as an encounter with five different foci: what technologies bring into the encounter; who is related to privacy by implication; what...

  3. The Idealized Cultural Encounter

    DEFF Research Database (Denmark)

    Christiansen, Lene Bull

    Studies into cultural encounters have predominantly taken point of departure in ‘problematic encounters’, in which researchers and participants see cultural difference as an obstacle on the road to harmonious relationships (e.g. in ‘the clash of civilisations,’ or in migration/integration studies......). This paper proposes to study cultural encounters which are organised around ideals of cultural difference as a positive social and political force. The Danish People to People NGO Mellemfolkeligt Samvirke (MS) is build around ideals of equality, co-operation, mutuality and solidarity between people...... and cultures. A prominent feature of the organisation is organised cultural encounters between Northern (predominantly Danish) volunteers and Africans, which takes place at ‘training centres’ both in Denmark and in African countries, such as Kenya or Tanzania. In this paper I will outline the theoretical...

  4. Health literacy, computer skills and quality of patient-physician communication in Chinese patients with cataract.

    Directory of Open Access Journals (Sweden)

    Xianchai Lin

    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.

  5. Encounters in cancer treatment

    DEFF Research Database (Denmark)

    Høybye, Mette Terp; Tjørnhøj-Thomsen, Tine

    2014-01-01

    Based on extensive ethnographic material from in-depth interviews with Danish cancer patients after treatment, this study analyzes their stories to explore how interactions with the physician configures and situates a need for rehabilitation. We identify three themes in the illness stories: (1...... by this encounter. The significance of the social encounters in cancer treatment is elucidated through this analysis, and we demonstrate how the need for recognition of the complex effects of cancer on one's life is central to counter experiences of objectification and dehumanization....

  6. Awkward Encounters and Ethnography

    DEFF Research Database (Denmark)

    Koning, Juliette; Ooi, Can-Seng

    2013-01-01

    from these encounters. Un-paralyzing reflexivity means to include the awkward, the emotional, and admit the non-rational aspects of our ethnographic experiences; such inclusive reflexivity is incredibly insightful. Research limitations/implications – Inclusive reflexivity not only allows room...

  7. Global Diabetes Encounters

    DEFF Research Database (Denmark)

    Juul Nielsen, Annegrete; Langstrup, Henriette

    2014-01-01

    As already recognized, though little theorized within International Relations, the capacity of technology to ensure the achievement of preset policy goals is often grossly overrated. Drawing on Science and Technology Studies, this chapter proposes a lens to investigate global encounters, which ta...

  8. A Lakatosian Encounter

    Science.gov (United States)

    Chick, Helen

    2010-01-01

    There is much to be learned and pondered by reading "Proofs and Refutations," by Imre Lakatos. It highlights the importance of mathematical definitions, and how definitions evolve to capture the essence of the object they are defining. It also provides an exhilarating encounter with the ups and downs of the mathematical reasoning process, where…

  9. Festival as embodied encounters

    DEFF Research Database (Denmark)

    Simonsen, Kirsten; Koefoed, Lasse Martin; Neergaard, Maja de

    2017-01-01

    This article is part of a project on Paradoxical Spaces: Encountering the Other in public space which explores how cultural difference is experienced, practiced and negotiated in public space. Specifically, it explores the ‘multicultural’ festival Kulturhavn taking place yearly along the harbour...... of Copenhagen. Multicultural festivals are seen as places for on-going identity negotiations, where individuals and groups define meaningful concepts of identity along with notions of exclusion. In the paper, we adopt a performative approach abandoning the distinction between bodies and space and embracing...... ideas of ‘embodiment’ and ‘rhythm’. We explore participant engagement emphasizing bodily practices as well as sensuous experiences, but also differential processes and orientalist images produced in, and through, encounters. Among the range of activities at the festival, we focus on three: food; dance...

  10. Strange culinary encounters:

    DEFF Research Database (Denmark)

    Leer, Jonatan; Kjær, Katrine Meldgaard

    2015-01-01

    In this article, we examine the ways in which the encountering of 'other' food cultures is played out in the two travelogue cooking shows Gordon's Great Escape and Jamie's Italian Escape. We investigate how the two protagonist chefs Jamie Oliver and Gordon Ramsay imagine, meet and evaluate the ‘o...... approach to meeting the other (culinary culture), ultimately, their respective culinary adventures work to re-affirm a social hierarchy in their favor....

  11. Patient-physician alliance: from Hippocrates to Post-Genomic Era. Commentary.

    Science.gov (United States)

    Pulciani, Simonetta; Taruscio, Domenica

    2017-01-01

    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.

  12. Encounters between medical specialists and patients with medically unexplained physical symptoms; influences of communication on patient outcomes and use of health care: a literature overview.

    NARCIS (Netherlands)

    Weiland, A.; Kraats, R.E. van de; Blankenstein, A.H.; Saase, J.L.C.M. van; Molen, H.T. van der; Bramer, W.M.; Dulmen, A.M. van; Arends, L.R.

    2012-01-01

    Medically unexplained physical symptoms (MUPS) burden patients and health services due to large quantities of consultations and medical interventions. The aim of this study is to determine which elements of communication in non-psychiatric specialist MUPS care influence health outcomes. Systematic

  13. Customer convergence: patients, physicians, and employees share in the experience and evaluation of healthcare quality.

    Science.gov (United States)

    Clark, Paul Alexander; Wolosin, Robert J; Gavran, Goran

    2006-01-01

    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.

  14. Patient-physician communication about early stage prostate cancer: analysis of overall visit structure.

    Science.gov (United States)

    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

    2015-10-01

    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.

  15. Encounters on a Shape-changing Bench

    DEFF Research Database (Denmark)

    Kinch, Sofie; Grönvall, Erik; Petersen, Marianne Graves

    2014-01-01

    ; a concert hall, an airport and a shopping mall. We gathered insights from more than 120 people, as they unexpectedly encountered the shape changing capabilities of the bench. By taking the user tests out of the lab and into the wild, we explored the influence of context on the users experience of a shape...

  16. Influence of Hydroponically Grown Hoyt Soybeans and Radiation Encountered on Mars Missions on the Yield and Quality of Soymilk and Tofu

    Science.gov (United States)

    Wilson, Lester A.

    2005-01-01

    Soybeans were chosen for hmar and planetary missions due to their nutritive value and ability to produce oil and protein for further food applications. However, soybeans must be processed into foods prior to crew consumption. Wilson et al. (2003) raised questions about (1) the influence of radiation (on germination and functional properties) that the soybeans would be exposed to during bulk storage for a Mars mission, and (2) the impact of using hydroponically grown versus field grown soybeans on the yield and quality of soyfoods. The influence of radiation can be broken down into two components: (A) affect of surface pasteurization to ensure the astronauts safety from food-borne illnesses (a Hazard Analysis Critical Control Point), and (B) affect of the amount of radiation the soybeans receive during a Mars mission. Decreases in the amount of natural antioxidants and free radical formation and oxidation induced changes in the soybean (lipid, protein, etc.) will influence the nutritional value, texture, quality, and safety of soyfoods made from them. The objectives of this project are to (1) evaluate the influence of gamma and electron beam radiation on bulk soybeans (HACCP, CCP) on the microbial load, germination, ease of processing, and quality of soymilk and tofu; (2) provide scale up and mass balance data for Advanced Life Support subsystems including Biomass, Solid Waste Processing, and Water Recovery Systems; and (3) to compare Hoyt field grown to hydroponically grown Hoyt soybeans for soymilk and tofu production. The soybean cultivar Hoyt, a small standing, high protein cultivar that could grow hydroponically in the AIMS facility on Mars) was evaluated for the production of soymilk and tofu. The quality and yield of the soymilk and tofu from hydroponic Hoyt, was compared to Vinton 81 (a soyfood industry standard), field Hoyt, IA 2032LS (lipoxygenase-free), and Proto (high protein and antioxidant potential). Soymilk and tofu were produced using the Japanese

  17. Determinants of customer satisfaction with service encounter

    Directory of Open Access Journals (Sweden)

    Ariana Nefat

    2008-12-01

    Full Text Available Service encounters are the focal point of a customer’s perception of a service in terms of its quality, value and customer satisfaction. The paper researches the influence of the components of a service encounter on customer satisfaction. Among several factors that determine customer satisfaction the quality of service, which is related to the characteristics of service, plays an important role. However, a direct insight into the reasons that make a service encounter satisfactory or unsatisfactory is provided by the critical incident technique, where causes of dis/satisfaction differ primarily depending on whether they derive from interpersonal contact or from contact with technology. The evidence of service, which includes people, process and the physical evidence, plays a critical role in a customer’s dis/satisfaction. The influence of these elements cannot be observed separately; it must be observed in their interaction during the delivery of service and their strongest effect is achieved during face-to-face service encounters that have the characteristics of a theatre metaphor. Even though a high level of satisfaction may be achieved after the recovery of a service, enterprises should aim to conduct excellent service encounters right from the start.

  18. The readiness of German GPs to recommend and conduct cancer screening is associated with patient-physician gender concordance. Results of a survey.

    Science.gov (United States)

    Engler, Jennifer; Dahlhaus, Anne; Güthlin, Corina

    2017-12-01

    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].

  19. Older patients’ attitudes towards and experiences of patient-physician end-of-life communication: a secondary analysis of interviews from British, Dutch and Belgian patients

    Directory of Open Access Journals (Sweden)

    Evans Natalie

    2012-11-01

    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

  20. Older patients’ attitudes towards and experiences of patient-physician end-of-life communication: a secondary analysis of interviews from British, Dutch and Belgian patients

    Science.gov (United States)

    2012-01-01

    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

  1. Encountering Rural Transformation

    DEFF Research Database (Denmark)

    Krag, Mo Michelsen Stochholm

    2017-01-01

    . The presence of “The controlled ruin at the church” in the rural village catalyzed an exchange of memories of the place among the local inhabitants. Furthermore, the subsequent decay process showed a positive influence on the local attitude towards the implemented strategy. Bringing in surveyed examples...

  2. Universalist ethics in extraterrestrial encounter

    Science.gov (United States)

    Baum, Seth D.

    2010-02-01

    If humanity encounters an extraterrestrial civilization, or if two extraterrestrial civilizations encounter each other, then the outcome may depend not only on the civilizations' relative strength to destroy each other but also on what ethics are held by one or both civilizations. This paper explores outcomes of encounter scenarios in which one or both civilizations hold a universalist ethical framework. Several outcomes are possible in such scenarios, ranging from one civilization destroying the other to both civilizations racing to be the first to commit suicide. Thus, attention to the ethics of both humanity and extraterrestrials is warranted in human planning for such an encounter. Additionally, the possibility of such an encounter raises profound questions for contemporary human ethics, even if such an encounter never occurs.

  3. Patient-Physician Communicative Patterns, Physicians’ Job Satisfaction, and Patients’ Satisfaction: The Case of a Hospital in Isfahan

    OpenAIRE

    Maryam Yaghoubi; Fatemeh Rahmati-Najarkolaei

    2014-01-01

    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...

  4. Stream Lifetimes Against Planetary Encounters

    Science.gov (United States)

    Valsecchi, G. B.; Lega, E.; Froeschle, Cl.

    2011-01-01

    We study, both analytically and numerically, the perturbation induced by an encounter with a planet on a meteoroid stream. Our analytical tool is the extension of pik s theory of close encounters, that we apply to streams described by geocentric variables. The resulting formulae are used to compute the rate at which a stream is dispersed by planetary encounters into the sporadic background. We have verified the accuracy of the analytical model using a numerical test.

  5. [A tale of two encounters].

    Science.gov (United States)

    Chanel, Marie-Paule

    The moving testimony of a patient shows the impact which a successful encounter can have. Beyond the positive clinical consequences, her rediscovered motivation and pleasure are the essential drivers which have guided her along the pathway of reconstruction. A tale of two encounters which have marked her life course. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. "It's like texting at the dinner table": A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals.

    Science.gov (United States)

    Pelland, Kimberly D; Baier, Rosa R; Gardner, Rebekah L

    2017-06-30

    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.

  7. “It’s like texting at the dinner table”: A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals

    Directory of Open Access Journals (Sweden)

    Kimberly D Pelland

    2017-06-01

    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.

  8. Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction.

    Science.gov (United States)

    Weng, Hui-Ching

    2008-01-01

    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.

  9. Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study.

    Science.gov (United States)

    Ofstad, Eirik H; Frich, Jan C; Schei, Edvin; Frankel, Richard M; Gulbrandsen, Pål

    2014-11-01

    To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. The Art of the Encounter

    Directory of Open Access Journals (Sweden)

    Éric Vautrin

    2013-03-01

    Full Text Available As the archives from the second half of Grotowski’s life were made available, this text focuses on the Polish master’s conceptions of theatre where he describes theatre as the art of the encounter. This paper simultaneously places this proposition in the context of questions of a specific time period, and reveals how this encounter is the anathema that will revert viewpoints both about the art of acting and the creation of theatrical relations. These researches on theatre as the art of the encounter continue today through the Open Program, one of the two groups of the Workcenter of Jerzy Grotowski and Thomas Richards, and, notably, their creations around American poet Allen Ginsberg, an author whose poetry intends, in a similar way, to encounter the other and the world.

  11. Personal Albums and Cultural Encounters

    DEFF Research Database (Denmark)

    Marselis, Randi Lorenz

    2018-01-01

    as discussions of representational ethics in relation to anthropological and colonial photography, this article examines the exhibition The Photo Albums at the Dutch National Maritime Museum. Typically, the photo collections of maritime museums include many photographs that represent cultural encounters...

  12. Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates.

    Science.gov (United States)

    Hunter, Wynn G; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A

    2016-03-31

    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.

  13. Service Encounter Related Process Quality, Patient Satisfaction, and Behavioral Intention

    Directory of Open Access Journals (Sweden)

    Nandakumar Mekoth

    2011-12-01

    Full Text Available This study identifies some of the critical service encounters thatthe outpatients undergo in a health care facility and investigateswhether the service encounter related process quality as perceivedby the patients leads to patient satisfaction, repeat visit, and recommendationintentions. Personal visits, observations, and enquiriesat the outpatient center have been conducted to identifythe various service encounters that outpatients undergo in thehospital. Exit interviews of the outpatients have been conductedto identify service encounter related process quality variableswhich determine patient satisfaction and behavioral intentions.A preliminary scale to measure service encounter related processquality was developed and its factor structure and internal consistencyreliability were established. The study reveals that boththe physician quality and laboratory quality have been found tobe significantly related to patient satisfaction. However, quite interestingly,courtesy shown by the registration or outpatient staff,perceived length of waiting time, or even the salient aspects of theservicescape, did not influence patient satisfaction.

  14. Ability of Bottle Cap Color to Facilitate Accurate Patient-Physician Communication Regarding Medication Identity in Patients with Glaucoma.

    Science.gov (United States)

    Dave, Pujan; Villarreal, Guadalupe; Friedman, David S; Kahook, Malik Y; Ramulu, Pradeep Y

    2015-12-01

    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

  15. A Lakatosian Encounter with Probability

    Science.gov (United States)

    Chick, Helen

    2010-01-01

    There is much to be learned and pondered by reading "Proofs and Refutations" by Imre Lakatos (Lakatos, 1976). It highlights the importance of mathematical definitions, and how definitions evolve to capture the essence of the object they are defining. It also provides an exhilarating encounter with the ups and downs of the mathematical reasoning…

  16. The Power of Citizens and Professionals in Welfare Encounters

    DEFF Research Database (Denmark)

    Mik-Meyer, Nanna

    relationships with welfare workers. However, other factors impact these interactions; factors which often pull in different directions. Welfare encounters are thus influenced by bureaucratic principles and market values as well. Consequently, this book engages with both Weberian (bureaucracy) and Foucauldian...... (market values/NPM) studies when investigating the powerful welfare encounter. The book is targeted Academics, post-graduates, and undergraduates within sociology, anthropology and political science....

  17. Encountering spiritual tourism in Kathmandu

    OpenAIRE

    Børø, Nora

    2015-01-01

    Spiritual tourism as a phenomenon is increasing worldwide. Many have conducted research looking at the intersection between religion and tourism, but few have focused on the host community within these encounters. Many Western tourists arrive in Kathmandu to go on retreats', and to participate in yoga and meditation classes. The majority of these are particularly interested in various forms of Buddhist practice and traditions. In this thesis I have studied how N...

  18. Processing changes across reading encounters.

    Science.gov (United States)

    Levy, B A; Newell, S; Snyder, J; Timmins, K

    1986-10-01

    Five experiments examined changes in the processing of a text across reading encounters. Experiment 1 showed that reading speed increased systematically across encounters, with no loss in the extensiveness of analyses of the printed text, as indicated by the ability to detect nonword errors embedded within that passage. Experiment 2 replicated this improved reading fluency with experience and showed that it occurred even with typescript changes across trials, thus indicating that a primed visual operations explanation cannot account for the effect. The third and fourth experiments then extended the study of the familiarity effect to higher level processing, as indicated by the detection of word errors. Familiarity facilitated the detection of these violations at the syntactic-semantic levels. Finally, Experiment 5 showed that these higher level violations continued to be well detected over a series of reading encounters with the same text. The results indicate that prior experience improves reading speed, with no attenuation of analysis of the printed words or of the passage's message.

  19. Interfaith dialogue as moral encounter

    DEFF Research Database (Denmark)

    Galal, Lise Paulsen

    The concept of interfaith dialogue has been introduced and developed by scholars of different religions. The aim has been to find solutions from within religion to handle and optimise encounters with religious ‘Others’. Furthermore, interfaith dialogue has increasingly become a tool to solve...... between Muslims and Christians and analyse the different moral orders involved and how – following these orders – the participants are expected to deal with differences. Main focus is on how the participants are expected to deal with a requirement of staying the same (as Christian or Muslim) while...

  20. Feminist Encounters with Evolutionary Psychology

    OpenAIRE

    O'Neill, Rachel

    2016-01-01

    This Section of Australian Feminist Studies is the product of an event that took place at King’s College London in January 2015, hosted as part of the UK-based ‘Critical Sexology’ seminar series. Participants at this event – feminist scholars working across the fields of lin- guistics, cultural studies, sociology, and psychology – were invited to reflect on their encounters with evolutionary psychology (EP). As the event organiser, I was interested to prompt a discussion about how EP shapes t...

  1. Special relativity a first encounter

    CERN Document Server

    Giulini, Domenico

    2005-01-01

    Special relativity provides the foundations of our knowledge of space and time. Without it, our understanding of the world, and its place in the universe, would be unthinkable. This book gives a concise, elementary, yet exceptionally modern, introduction to special relativity. It is a gentle yet serious 'first encounter', in that it conveys a true understanding rather than purely reports the basic facts. Only very elementary mathematical knowledge is needed to master it (basichigh-school maths), yet it will leave the reader with a sound understanding of the subject. Special Relativity: A First

  2. Empirical Models of Demand for Out-Patient Physician Services and Their Relevance to the Assessment of Patient Payment Policies: A Critical Review of the Literature

    Directory of Open Access Journals (Sweden)

    Olga Skriabikova

    2010-06-01

    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.

  3. Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature.

    Science.gov (United States)

    Skriabikova, Olga; Pavlova, Milena; Groot, Wim

    2010-06-01

    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.

  4. Focus Groups as Transformative Spiritual Encounters

    Directory of Open Access Journals (Sweden)

    Sharon Moloney PhD

    2011-03-01

    Full Text Available Focus groups are a valuable method for exploring the construction and negotiation of meanings. In her doctoral research the author explored how Australian women's experiences of menstruation, birth, and spirituality are invested with meaning and how that meaning influences and shapes those experiences. The focus group has been described as a potentially liminal space, which enables the discussion of taboo subjects by breaking the ice and giving people permission to comment. In addition, she discovered that the groups could be occasions of empowerment and transformation for both participants and researcher. In a way that far exceeded her expectations, the group format was ideally suited to feminist research and the organic inquiry methodology she used. Some groups became deeply spiritual encounters that were nourishing and transformative for all. This article explores how focus groups can be vehicles of spiritual transformation, examining one group in particular to highlight the points raised.

  5. Initial Encounters : The Lived Experiences of Buyers

    NARCIS (Netherlands)

    G. Wright; J.J. Dekker

    2012-01-01

    The initial encounter between a buyer and a seller has received much attention among practitioners. The first time a buyer interacts with a seller is thought to be highly influential. The premise is that buyers form an opinion during this first encounter, or even the first minutes of this encounter.

  6. Woodrow Wilson's hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy.

    Science.gov (United States)

    Menger, Richard P; Storey, Christopher M; Guthikonda, Bharat; Missios, Symeon; Nanda, Anil; Cooper, John M

    2015-07-01

    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.

  7. Toward an agent-based patient-physician model for the adoption of continuous glucose monitoring technology.

    Science.gov (United States)

    Verella, J Tipan; Patek, Stephen D

    2009-03-01

    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.

  8. Patient-physician discordance in global assessment in early spondyloarthritis and its change over time: the DESIR cohort.

    Science.gov (United States)

    Desthieux, Carole; Molto, Anna; Granger, Benjamin; Saraux, Alain; Fautrel, Bruno; Gossec, Laure

    2016-09-01

    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/

  9. Alien encounter a scientific novel

    CERN Document Server

    Schulze-Makuch, Dirk

    2014-01-01

    It has been nearly 100 years since the Apollo moon landings, when Jack and Vladimir, two astronauts on a mission to Venus, discover a mysterious void related to indigenous life on the planet. Subsequently more voids are detected on Earth, Mars, Titan, and, quite ominously, inside a planetoid emerging from the Kuiper belt. Jack is sent to investigate the voids in the Solar System and intercept the planetoid - which, as becomes increasingly clear, is inhabited by alien life forms. Jack and his crew will have little time to understand their alien biochemistry, abilities, behavior patterns, resilience, and technology, but also how these life forms relate to the voids. Humankind's first encounter with these exotic life forms couldn't be more fateful, becoming a race against time to save life on Earth and to reveal the true nature of the voids, which seem to be intrinsically related to life and the universe itself. In this novel, the author combines many topics related to state-of-the-art research in the field of...

  10. Innovative generativity of digital service encounters

    DEFF Research Database (Denmark)

    Henten, Anders; Sørensen, Jannick Kirk

    2018-01-01

    The research question examined in this chapter is how service encounters, based on digital interfaces, differ from face-to-face (f2f) encounters in terms of potential innovative generativity. New computer technologies facilitating big data processing and the development of advanced recommender...... systems and the recent developments of artificial intelligence with respect to cognitive and affective computing will certainly enhance the potential for innovations to be created on the basis of digital service encounters. However, the empathetic understanding of the needs and wants of the service users...... that can be part of the f2f service encounters cannot automatically result from digital service encounters. Digital tools can be developed and used to supplement the impressions that f2f encounters initiate. However, human interpretations and even human f2f encounters will also be needed to maintain...

  11. Gender Differences in Searching for Health Information on the Internet and the Virtual Patient-Physician Relationship in Germany: Exploratory Results on How Men and Women Differ and Why

    Science.gov (United States)

    Terlutter, Ralf

    2015-01-01

    Background Many studies have shown that women use the Internet more often for health-related information searches than men, but we have limited knowledge about the underlying reasons. We also do not know whether and how women and men differ in their current use of the Internet for communicating with their general practitioner (GP) and in their future intention to do so (virtual patient-physician relationship). Objective This study investigates (1) gender differences in health-related information search behavior by exploring underlying emotional, motivational, attitudinal as well as cognitive variables, situational involvement, and normative influences, and different personal involvement regarding health-related information searching and (2) gender differences in the virtual patient-physician relationship. Methods Gender differences were analyzed based on an empirical online survey of 1006 randomly selected German patients. The sample was drawn from an e-panel maintained by GfK HealthCare. A total of 958 usable questionnaires were analyzed. Principal component analyses were carried out for some variables. Differences between men (517/958) and women (441/958) were analyzed using t tests and Kendall’s tau-b tests. The survey instrument was guided by several research questions and was based on existing literature. Results Women were more engaged in using the Internet for health-related information searching. Gender differences were found for the frequency of usage of various Internet channels for health-related information searches. Women used the Internet for health-related information searches to a higher degree for social motives and enjoyment and they judged the usability of the Internet medium and of the information gained by health information searches higher than men did. Women had a more positive attitude toward Web 2.0 than men did, but perceived themselves as less digitally competent. Women had a higher health and nutrition awareness and a greater

  12. The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism.

    Science.gov (United States)

    Nie, Jing-Bao; Cheng, Yu; Zou, Xiang; Gong, Ni; Tucker, Joseph D; Wong, Bonnie; Kleinman, Arthur

    2018-03-01

    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.

  13. Understanding metropolitan patterns of daily encounters.

    Science.gov (United States)

    Sun, Lijun; Axhausen, Kay W; Lee, Der-Horng; Huang, Xianfeng

    2013-08-20

    Understanding of the mechanisms driving our daily face-to-face encounters is still limited; the field lacks large-scale datasets describing both individual behaviors and their collective interactions. However, here, with the help of travel smart card data, we uncover such encounter mechanisms and structures by constructing a time-resolved in-vehicle social encounter network on public buses in a city (about 5 million residents). Using a population scale dataset, we find physical encounters display reproducible temporal patterns, indicating that repeated encounters are regular and identical. On an individual scale, we find that collective regularities dominate distinct encounters' bounded nature. An individual's encounter capability is rooted in his/her daily behavioral regularity, explaining the emergence of "familiar strangers" in daily life. Strikingly, we find individuals with repeated encounters are not grouped into small communities, but become strongly connected over time, resulting in a large, but imperceptible, small-world contact network or "structure of co-presence" across the whole metropolitan area. Revealing the encounter pattern and identifying this large-scale contact network are crucial to understanding the dynamics in patterns of social acquaintances, collective human behaviors, and--particularly--disclosing the impact of human behavior on various diffusion/spreading processes.

  14. Protoplanetary disc response to distant tidal encounters in stellar clusters

    Science.gov (United States)

    Winter, A. J.; Clarke, C. J.; Rosotti, G.; Booth, R. A.

    2018-04-01

    The majority of stars form in a clustered environment. This has an impact on the evolution of surrounding protoplanetary discs (PPDs) due to either photoevaporation or tidal truncation. Consequently, the development of planets depends on formation environment. Here, we present the first thorough investigation of tidally induced angular momentum loss in PPDs in the distant regime, partly motivated by claims in the literature for the importance of distant encounters in disc evolution. We employ both theoretical predictions and dynamical/hydrodynamical simulations in 2D and 3D. Our theoretical analysis is based on that of Ostriker (1994) and leads us to conclude that in the limit that the closest approach distance xmin ≫ r, the radius of a particle ring, the fractional change in angular momentum scales as (xmin/r)-5. This asymptotic limit ensures that the cumulative effect of distant encounters is minor in terms of its influence on disc evolution. The angular momentum transfer is dominated by the m = 2 Lindblad resonance for closer encounters and by the m = 1, ω = 0 Lindblad resonance at large xmin/r. We contextualize these results by comparing expected angular momentum loss for the outer edge of a PPD due to distant and close encounters. Contrary to the suggestions of previous works, we do not find that distant encounters contribute significantly to angular momentum loss in PPDs. We define an upper limit for closest approach distance where interactions are significant as a function of arbitrary host to perturber mass ratio M2/M1.

  15. Aging and Osteoarthritis: An Inevitable Encounter?

    Directory of Open Access Journals (Sweden)

    Thomas Hügle

    2012-01-01

    Full Text Available Osteoarthritis (OA is a major health burden of our time. Age is the most prominent risk factor for the development and progression of OA. The mechanistic influence of aging on OA has different facets. On a molecular level, matrix proteins such as collagen or proteoglycans are modified, which alters cartilage function. Collagen cross-linking within the bone results in impaired plasticity and increased stiffness. Synovial or fat tissue, menisci but also ligaments and muscles play an important role in the pathogenesis of OA. In the elderly, sarcopenia or other causes of muscle atrophy are frequently encountered, leading to a decreased stability of the joint. Inflammation in form of cellular infiltration of synovial tissue or subchondral bone and expression of inflammatory cytokines is more and more recognized as trigger of OA. It has been demonstrated that joint movement can exhibit anti-inflammatory mechanisms. Therefore physical activity or physiotherapy in the elderly should be encouraged, also in order to increase the muscle mass. A reduced stem cell capacity in the elderly is likely associated with a decrease of repair mechanisms of the musculoskeletal system. New treatment strategies, for example with mesenchymal stem cells (MSC are investigated, despite clear evidence for their efficacy is lacking.

  16. Beyond the Embodied Digital Service Encounter

    DEFF Research Database (Denmark)

    Sørensen, Jannick Kirk

    2018-01-01

    When a digital service encounter develops differently than anticipated, the client becomes a user. This transformation reveals the ambiguous nature of digital service encounter being neither well-functioning tools, nor having the same sensitivity to and tolerance for service failures as in human ...

  17. Frontcountry encounter norms among three cultures

    Science.gov (United States)

    Jerry J. Vaske; Maureen P. Donnelly; Robert M. Doctor; James P. Petruzzi

    1995-01-01

    Existing normative studies have focused on backcountry encounter norms reported by North Americans. This study extends previous research by comparing encounter norms reported by three different cultures - North Americans, Europeans, and Japanese - in a frontcountry day use recreation area. Data were obtained from on-site surveys distributed at the Columbia Icefield in...

  18. ASRS Reports on Wake Vortex Encounters

    Science.gov (United States)

    Connell, Linda J.; Taube, Elisa Ann; Drew, Charles Robert; Barclay, Tommy Earl

    2010-01-01

    ASRS is conducting a structured callback research project of wake vortex incidents reported to the ASRS at all US airports, as well as wake encounters in the enroute environment. This study has three objectives: (1) Utilize the established ASRS supplemental data collection methodology and provide ongoing analysis of wake vortex encounter reports; (2) Document event dynamics and contributing factors underlying wake vortex encounter events; and (3) Support ongoing FAA efforts to address pre-emptive wake vortex risk reduction by utilizing ASRS reporting contributions.

  19. First-Year Principal Encounters Homophobia

    Science.gov (United States)

    Retelle, Ellen

    2011-01-01

    A 1st-year principal encounters homonegativity and an ethical dilemma when she attempts to terminate a teacher because of the teacher's inadequate and ineffective teaching. The teacher responds by threatening to "out" Ms. L. to the parents.

  20. Encounter Group Effects of Soccer Team Performance.

    Science.gov (United States)

    Magen, Zipora

    1980-01-01

    Suggests that a positive relationship exists between encounter group experience and the soccer team performance--a conclusion worthy of consideration in further research in the fields of psychology and sociology of sports. (Author)

  1. Hostile sexist male patients and female doctors: a challenging encounter.

    Science.gov (United States)

    Klöckner Cronauer, Christina; Schmid Mast, Marianne

    2014-01-01

    Patient characteristics and attitudes can affect how patients react to the physician's communication style, and this reaction can then influence consultation outcomes. The goal of the present study was to investigate whether the attitude of a sexist male patient affects how he perceives a female physician's nonverbal communication and whether this then results in expecting less positive consultation outcomes. Participants were analog patients who viewed four videotaped male and four videotaped female physicians in a consultation with one of their patients. Physician videos were preselected to represent a range of high and low patient-centered physician nonverbal behavior. Participants filled in questionnaires to assess how patient-centered they perceived the female and male physicians' nonverbal communication to be, and participants indicated how positive they expected the consultation outcomes to be. Moreover, we assessed the participants' sexist attitudes with a questionnaire measuring hostile and benevolent sexism. Students (N = 60) from a French-speaking university in Switzerland were recruited on campus. The main outcome measures were the extent to which analog patients expect the consultation outcomes to be positive (high satisfaction, increased trust in the physician, intention to adhere to treatment recommendations, and perceived physician competence) and the extent to which analog patients perceive physicians as patient-centered (judged from the physicians' nonverbal cues). Male analog patients' hostile sexism was negatively related to perceiving the physicians as patient-centered, and male analog patients' hostile sexism was also negatively related to expected positive consultation outcomes. For male patients viewing female physicians, mediation analysis revealed that perceived physician patient-centeredness mediated the negative relationship between hostile sexism and expected positive consultation outcomes. Male hostile sexist patients perceive a female

  2. Close stellar encounters in globular clusters

    International Nuclear Information System (INIS)

    Bailyn, C.D.

    1989-01-01

    Stellar encounters are expected to produce a variety of interesting objects in the cores of globular clusters, either through the formation of binaries by tidal capture, or direct collisions. Here, I describe several attempts to observe the products of stellar encounters. In particular, the use of color maps has demonstrated the existence of a color gradient in the core of M15, which seems to be caused by a population of faint blue objects concentrated towards the cluster center. (author)

  3. Termite: Emulation Testbed for Encounter Networks

    Directory of Open Access Journals (Sweden)

    Rodrigo Bruno

    2015-08-01

    Full Text Available Cutting-edge mobile devices like smartphones and tablets are equipped with various infrastructureless wireless interfaces, such as WiFi Direct and Bluetooth. Such technologies allow for novel mobile applications that take advantage of casual encounters between co-located users. However, the need to mimic the behavior of real-world encounter networks makes testing and debugging of such applications hard tasks. We present Termite, an emulation testbed for encounter networks. Our system allows developers to run their applications on a virtual encounter network emulated by software. Developers can model arbitrary encounter networks and specify user interactions on the emulated virtual devices. To facilitate testing and debugging, developers can place breakpoints, inspect the runtime state of virtual nodes, and run experiments in a stepwise fashion. Termite defines its own Petri Net variant to model the dynamically changing topology and synthesize user interactions with virtual devices. The system is designed to efficiently multiplex an underlying emulation hosting infrastructure across multiple developers, and to support heterogeneous mobile platforms. Our current system implementation supports virtual Android devices communicating over WiFi Direct networks and runs on top of a local cloud infrastructure. We evaluated our system using emulator network traces, and found that Termite is expressive and performs well.

  4. Predator-prey encounters in turbulent waters

    DEFF Research Database (Denmark)

    Mann, J.; Ott, Søren; Pécseli, H.L.

    2002-01-01

    With reference to studies of predator-prey encounters in turbulent waters, we demonstrate the feasibility of an experimental method for investigations of particle fluxes to an absorbing surface in turbulent flows. A laboratory experiment is carried out, where an approximately homogeneous and isot......With reference to studies of predator-prey encounters in turbulent waters, we demonstrate the feasibility of an experimental method for investigations of particle fluxes to an absorbing surface in turbulent flows. A laboratory experiment is carried out, where an approximately homogeneous...

  5. Plankton motility patterns and encounter rates

    DEFF Research Database (Denmark)

    Visser, Andre; Kiørboe, Thomas

    2006-01-01

    measure of run length to reaction distance determines whether the underlying encounter is ballistic or diffusive. Since ballistic interactions are intrinsically more efficient than diffusive, we predict that organisms will display motility with long correlation run lengths compared to their reaction...... distances to their prey, but short compared to the reaction distances of their predators. We show motility data for planktonic organisms ranging from bacteria to copepods that support this prediction. We also present simple ballistic and diffusive motility models for estimating encounter rates, which lead...

  6. Service encounters as bases for innovation

    DEFF Research Database (Denmark)

    Sundbo, Jon; Sundbo, Donna; Henten, Anders

    2015-01-01

    customers with the innovating organization. Based on literature studies and pilot case studies, seven propositions are proposed and tested in a qualitative, hermeneutic way in field experiments in nine service organizations. Important new results are that encounter-based innovation requires mutual empathy...... between employees and customers, employees investing stubbornness and time can be a driver for innovation, and several layers of management can be a barrier. In the field experiments three new factors for encounter-based innovation were found: translation, multitasking, and hyper-professionalism. The two...

  7. Physicians' perspectives on communication and decision making in clinical encounters for treatment of latent tuberculosis infection.

    Science.gov (United States)

    Dobler, Claudia C; Bosnic-Anticevich, Sinthia; Armour, Carol L

    2018-01-01

    The aim of the study was to explore the views of tuberculosis (TB) physicians on treatment of latent TB infection (LTBI), focusing on decision making and communication in clinical practice. 20 Australian TB physicians participated in a semistructured interview in person or over the telephone. Interviews were recorded, transcribed and analysed thematically. The study identified challenges that physicians face when discussing treatment for LTBI with patients. These included difficulties explaining the concept of latency (in particular to patients from culturally and linguistically diverse backgrounds) and providing guidance to patients while still framing treatment decisions as a choice. Tailored estimates of the risk of developing TB and the risk of developing an adverse effect from LTBI treatment were considered the most important information for decision making and discussion with patients. Physicians acknowledged that there is a significant amount of unwarranted treatment variation, which they attributed to the lack of evidence about the risk-benefit balance of LTBI treatment in certain scenarios and guidelines that refer to the need for case-by-case decision making in many instances. In order to successfully implement LTBI treatment at a clinical level, consideration should be given to research on how to best address communication challenges arising in clinical encounters.

  8. Physicians' perspectives on communication and decision making in clinical encounters for treatment of latent tuberculosis infection

    Directory of Open Access Journals (Sweden)

    Claudia C. Dobler

    2018-03-01

    Full Text Available The aim of the study was to explore the views of tuberculosis (TB physicians on treatment of latent TB infection (LTBI, focusing on decision making and communication in clinical practice. 20 Australian TB physicians participated in a semistructured interview in person or over the telephone. Interviews were recorded, transcribed and analysed thematically. The study identified challenges that physicians face when discussing treatment for LTBI with patients. These included difficulties explaining the concept of latency (in particular to patients from culturally and linguistically diverse backgrounds and providing guidance to patients while still framing treatment decisions as a choice. Tailored estimates of the risk of developing TB and the risk of developing an adverse effect from LTBI treatment were considered the most important information for decision making and discussion with patients. Physicians acknowledged that there is a significant amount of unwarranted treatment variation, which they attributed to the lack of evidence about the risk–benefit balance of LTBI treatment in certain scenarios and guidelines that refer to the need for case-by-case decision making in many instances. In order to successfully implement LTBI treatment at a clinical level, consideration should be given to research on how to best address communication challenges arising in clinical encounters.

  9. Chronic Pain, Patient-Physician Engagement, and Family Communication Associated With Drug-Using HIV Patients' Discussing Advanced Care Planning With Their Physicians.

    Science.gov (United States)

    Hansen, Eric D; Mitchell, Mary M; Smith, Tom; Hutton, Nancy; Keruly, Jeanne; Knowlton, Amy R

    2017-10-01

    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.

  10. Play-back theatre, theatre laboratory, and role-playing: new tools in investigating the patient-physician relationship in the context of continuing medical education courses.

    Science.gov (United States)

    Piccoli, G; Rossetti, M; Dell'Olio, R; Perrotta, L; Mezza, E; Burdese, M; Maddalena, E; Bonetto, A; Jeantet, A; Segoloni, G P

    2005-06-01

    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.

  11. Disruption or innovation? A qualitative descriptive study on the use of electronic patient-physician communication in patients with advanced cancer.

    Science.gov (United States)

    Voruganti, Teja; Husain, Amna; Grunfeld, Eva; Webster, Fiona

    2018-03-04

    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.

  12. Thinking about the service encounter enhances encounter-related word-of-mouth

    DEFF Research Database (Denmark)

    Mattsson, Jan; Söderlund, Magnus

    ) the memorability of the service encounter and (b) the extent to which what had happened had been subject to rehearsal with the purpose of telling others about it. These findings should be seen in relation to the literature’s view that customer satisfaction, not thinking, is a dominant predictor of word-of-mouth......This study examines the impact of thinking about a service encounter, after it has been completed, on telling others about it (i.e., word-of-mouth). The main finding was that encounter-related thinking boosted word-of-mouth. We also found that the think-talk association was mediated by (a....... Our results, however, indicate that satisfaction’s contribution to the variation in talking about the encounter was modest (and customer satisfaction played only a minor role in explaining why an encounter is thought about)....

  13. Entering a Crack: An Encounter with Gossip

    Science.gov (United States)

    Henderson, Linda

    2014-01-01

    In this paper, I enter a crack to think otherwise about the concept "gossip". Drawing on previous scholarship engaging with Deleuzian concepts to inform research methodologies, this paper builds on this body of work. Following Deleuze and Guattari, the paper undertakes a mapping of gossip, subsequent to an encounter with a crack.…

  14. Boundary Transgressions: An Issue In Psychotherapeutic Encounter ...

    African Journals Online (AJOL)

    Boundary transgressions tend to be conceptualized on a continuum ranging from boundary crossings to boundary violations. Boundary crossings (e.g. accepting an inexpensive holiday gift from a client, unintentionally encountering a client in public, or attending a client's special event) are described in the literature as ...

  15. Avoidance: From threat encounter to action execution

    NARCIS (Netherlands)

    Arnaudova, I.

    2015-01-01

    Every day we encounter many threats to survival: a car speeding on a small street or an angry neighbor carrying an axe. Mostly, people go through their days not worrying that their chance of survival might be small. They avoid many dangers without even thinking about them (e.g., looking at both

  16. Moral Relations in Encounters with Nature

    Science.gov (United States)

    Andersson, Karin; Öhman, Johan

    2015-01-01

    The overall aim of this article is to develop in-depth knowledge about the connection between outdoor experiences and moral attitudes towards nature. The study focuses on processes in which moral relations are at stake in encounters between students and nature. The purpose is to identify such events, describe their specific circumstances and…

  17. Domestic Violence Encountered among Kurdish Women

    Science.gov (United States)

    Ali, Sirwan Kamil

    2015-01-01

    Background and objective; There is growing recognition that violence against women has a large public health impact, in addition to being a gross violation of women's human rights. The study's aims were: To show the types of domestic abuse encountered by Kurdish women, and study the relationship between them. Methods; The study conducted in the…

  18. 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.

    Science.gov (United States)

    Eskelinen, Matti; Korhonen, Riika; Selander, Tuomas; Ollonen, Paula

    2015-03-01

    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.

  19. Coordination of head movements and speech in first encounter dialogues

    DEFF Research Database (Denmark)

    Paggio, Patrizia

    2015-01-01

    This paper presents an analysis of the temporal alignment be- tween head movements and associated speech segments in the NOMCO corpus of first encounter dialogues [1]. Our results show that head movements tend to start slightly before the onset of the corresponding speech sequence and to end...... slightly after, but also that there are delays in both directions in the range of -/+ 1s. Various factors that may influence delay duration are investigated. Correlations are found between delay length and the duration of the speech sequences associated with the head movements. Effects due to the different...

  20. Users’ encounter with normative discourses on Facebook

    DEFF Research Database (Denmark)

    Mathieu, David

    2016-01-01

    This study asks whether users’ encounter with normative discourses of lifestyle, consumption, and health on social media such as Facebook gives rise to agency. The theoretical framework draws on reception analysis, for its implied, but central interest in agency that lies at the intersection...... of texts and audiences. Based on a critique of the “participatory paradigm,” a paradigm that situates the locus of agency in the structural opposition between senders and users, in the norms of rational deliberation or in the figure of the activist, gaps are identified which can be filled by adopting...... an explicit focus on the socio-cultural practices of ordinary audiences in their encounters with media discourses. The study investigates user agency on seven Facebook groups and pages with the help of a three-pronged perspective based on the notion of the media–audience relationship as (1) power structure...

  1. Challenges in the professional care encounters

    DEFF Research Database (Denmark)

    Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth

    in the review. Data were extracted and the findings were categorized and themed on the basis of similarity of meaning and aggregated to produce a comprehensive set of synthesized findings. The review process resulted in 55 findings and 14 categories. The categories generated six themes: Psychological reactions...... to keep the patients happy as they try to avoid conflicts. The imagination and thoughts of what might happen in the encounter are based on the nursing students’ personal life experiences. They uses their close relatives as keys to the express empathy in the establishment of the nurse-patient relation...... are challenged by their personal boundaries in the professional care encounter and they experience a great psychological impact Patient contact is an unavoidable and complex component in the nursing education. The students have not yet built up a professional filter and are exposed to a wealth of emotional...

  2. Rethinking social identity theory in international encounters:

    DEFF Research Database (Denmark)

    Lauring, Jakob

    2008-01-01

    In a globalized business environment, interaction across linguistic boundaries is becoming a normal part of everyday life. In these encounters language differences may affect the formation of social identities among organization members. While studies based on Social Identity Theory perceive...... the link between identity and language to be linear, this article takes a different approach. By drawing on anthropological theories on ethnic identity it is argued that the relation between language and social identity is negotiated in interaction. In the empirical analysis the article focuses...... on the encounter between expatriates and local employees of a Danish subsidiary in England. The findings show that identity making may be actualized by competition for resources and recognition. This can be done by investing certain objects such as the symbolic application of language with certain identifications...

  3. Mobbing behaviors encountered by nurse teaching staff.

    Science.gov (United States)

    Yildirim, Dilek; Yildirim, Aytolan; Timucin, Arzu

    2007-07-01

    The term 'mobbing' is defined as antagonistic behaviors with unethical communication directed systematically at one individual by one or more individuals in the workplace. This cross-sectional and descriptive study was conducted for the purpose of determining the mobbing behaviors encountered by nursing school teaching staff in Turkey, its effect on them, and their responses to them. A large percentage (91%) of the nursing school employees who participated in this study reported that they had encountered mobbing behaviors in the institution where they work and 17% that they had been directly exposed to mobbing in the workplace. The academic staff who had been exposed to mobbing behaviors experienced various physiological, emotional and social reactions. They frequently 'worked harder and [were] more organized and worked very carefully to avoid criticism' to escape from mobbing. In addition, 9% of the participants stated that they 'thought about suicide occasionally'.

  4. Self. Propagating | a strategy of encounter |

    Directory of Open Access Journals (Sweden)

    Gabrielle Lorraine Fletcher

    2015-11-01

    Full Text Available This piece mobilises both creative non-fiction and ficto-criticism to expose the necessary terrains of narrativity as a Country of the Lived,  making visible the redactive cartography of the PhD in telling Indigenous selfhood, and mobilising an argument for authentic encounter under the comfortable maps of form.

  5. The prescription talk – an approach to teach patient-physician conversation about drug prescription to medical students

    Directory of Open Access Journals (Sweden)

    Hauser, Katarina

    2017-05-01

    Full Text Available Background: Medication communication from physicians to patients often is poor, by this among others enhancing the risk of non-adherence. In this context, a neglect regarding the prescription talk has been complained.Aim of the project: In a newly developed elective medical students work on physician-patient conversations dealing with drug prescription. Essential aspects related to an effective and safe drug treatment are combined with steps of shared decision-making. Together with a tutor, students develop a (model conversation guide that might be tailored according to individual needs and views.Description/Methods: In a one-week course 3rd-5th year medical students treat a paper case according to problem-based learning. This is accompanied by a one-hour lecture and literature provided on an online learning platform (ILIAS. During a workshop, aspects of drug treatment and patient participation are integrated into a guide for a prescription talk. At the end of the week the students are invited to apply the (if need be individualized guide in a simulated physician-patient communication with an actor. The conversation is evaluated using a checklist based upon the (model conversation guide.Results: Informal and formalized feedback indicate high acceptance and satisfaction of participants with this elective. The checklist turned out to be of acceptable to good reliability with mostly selective items. Portfolio entries and written evaluation suggest that participants’ positions and attitudes are influenced.

  6. The patient-physician partnership in asthma: real-world observations associated with clinical and patient-reported outcomes.

    Science.gov (United States)

    Small, M; Vickers, A; Anderson, P; Kay, S

    2010-09-01

    It is hypothesized that a good partnership between asthma patients and their physicians has a direct and positive influence on the patients' clinical and patient-reported outcomes. Conversely, poor partnership has a detrimental effect on clinical and patient-reported outcomes. This paper uses data from a real-world observational study to define partnership through matched physician and patient data and correlate the quality of partnership with observed clinical and patient-reported outcomes. Data were drawn from Adelphi's Respiratory Disease Specific Programme, a cross-sectional study of consulting patients in five European countries undertaken between June and September 2009. A range of clinical and patient-reported outcomes were observed allowing analysis of the partnership between 2251 asthma patients and their physicians. Analysis demonstrates that the better the partnership between patient and physician, the more likely the patient is to have their asthma condition controlled (PPartnership is also associated with lower impact on lifestyle (Ppartnership is a contributory factor in the improvement of asthma treatment, and patient education may lead to improvement in a patient's ability to contribute to this. Device satisfaction is one of the markers of good partnership.

  7. The importance of motivation, weapons, and foul odors in driving encounter competition in carnivores.

    Science.gov (United States)

    Allen, Maximilian L; Wilmers, Christopher C; Elbroch, L Mark; Golla, Julie M; Wittmer, Heiko U

    2016-08-01

    Encounter competition is interference competition in which animals directly contend for resources. Ecological theory predicts the trait that determines the resource holding potential (RHP), and hence the winner of encounter competition, is most often body size or mass. The difficulties of observing encounter competition in complex organisms in natural environments, however, has limited opportunities to test this theory across diverse species. We studied the outcome of encounter competition contests among mesocarnivores at deer carcasses in California to determine the most important variables for winning these contests. We found some support for current theory in that body mass is important in determining the winner of encounter competition, but we found that other factors including hunger and species-specific traits were also important. In particular, our top models were "strength and hunger" and "size and hunger," with models emphasizing the complexity of variables influencing outcomes of encounter competition. In addition, our wins above predicted (WAP) statistic suggests that an important aspect that determines the winner of encounter competition is species-specific advantages that increase their RHP, as bobcats (Lynx rufus) and spotted skunks (Spilogale gracilis) won more often than predicted based on mass. In complex organisms, such as mesocarnivores, species-specific adaptations, including strategic behaviors, aggressiveness, and weapons, contribute to competitive advantages and may allow certain species to take control or defend resources better than others. Our results help explain how interspecific competition shapes the occurrence patterns of species in ecological communities. © 2016 by the Ecological Society of America.

  8. "Professional Helper" or "Helping Professional?" The Patient-Physician Relationship in the Chronic Pain Setting, With Special Reference to the Current Opioid Debate.

    Science.gov (United States)

    Bäckryd, Emmanuel

    2016-01-01

    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.

  9. Avoiding humiliations in the clinical encounter.

    Science.gov (United States)

    Malterud, Kirsti; Hollnagel, Hanne

    2007-06-01

    To explore potentials for avoiding humiliations in clinical encounters, especially those that are unintended and unrecognized by the doctor. Furthermore, to examine theoretical foundations of degrading behaviour and identify some concepts that can be used to understand such behaviour in the cultural context of medicine. Finally, these concepts are used to build a model for the clinician in order to prevent humiliation of the patient. Empirical studies document experiences of humiliation among patients when they see their doctor. Philosophical and sociological analysis can be used to explain the dynamics of unintended degrading behaviour between human beings. Skjervheim, Vetlesen, and Bauman have identified the role of objectivism, distantiation, and indifference in the dynamics of evil acts, pointing to the rules of the cultural system, rather than accusing the individual of bad behaviour. Examining the professional role of the doctor, parallel traits embedded in the medical culture are demonstrated. According to Vetlesen, emotional awareness is necessary for moral perception, which again is necessary for moral performance. A better balance between emotions and rationality is needed to avoid humiliations in the clinical encounter. The Awareness Model is presented as a strategy for clinical practice and education, emphasizing the role of the doctor's own emotions. Potentials and pitfalls are discussed.

  10. Beyond the interface: Encountering artifacts in use

    DEFF Research Database (Denmark)

    Bødker, Susanne; Bannon, Liam

    1991-01-01

    did studies in Scandinavia, one primarily in North America. As both of us are concerned with making more useful and usable computer applications we decided to look further for frameworks to help us. In this paper we shall try to expose some of the problems that we encountered in our joint effort...... in their interactions with technology. He became uncomfortable with the gap between current cognitive theories and their utility in designing better interfaces to computer systems. The other person has a background in software engineering and computer systems design. In her search for a deeper understanding of  issues...... in HCi, she came across the cognitive science framework, but she felt that its methods did not provide much help for concrete design in real life situations. In many ways our personal histories reflect some of the developments within the HCI area - the search for more theoretical frameworks...

  11. Being Disoriented: Uncertain Encounters with Disability

    Directory of Open Access Journals (Sweden)

    Ryan C. Parrey

    2016-05-01

    Full Text Available Disorienting encounter with disability are those in which the meaning of disability is an open question, and in which our relation to it is questionable. This essay explores the relationship between disability and disorientation on conceptual but also concrete levels. First, I examine the connection between disability and disorientation within disability studies. Second, I provide a preliminary sketch of disorientation through what I call ontic disruption and ontological disorientation. Third, I take up Leder's (1990 articulation of bodily disappearance and embodied dysappearance to address ableist violence. Finally, I develop the notion of dysorientation — a prolonged, persistent or recurrent sense of disorientation — as a useful concept for understanding experiences of ableism but also as a significant meeting point between impairment and disability.

  12. Encounter Probability of Individual Wave Height

    DEFF Research Database (Denmark)

    Liu, Z.; Burcharth, H. F.

    1998-01-01

    wave height corresponding to a certain exceedence probability within a structure lifetime (encounter probability), based on the statistical analysis of long-term extreme significant wave height. Then the design individual wave height is calculated as the expected maximum individual wave height...... associated with the design significant wave height, with the assumption that the individual wave heights follow the Rayleigh distribution. However, the exceedence probability of such a design individual wave height within the structure lifetime is unknown. The paper presents a method for the determination...... of the design individual wave height corresponding to an exceedence probability within the structure lifetime, given the long-term extreme significant wave height. The method can also be applied for estimation of the number of relatively large waves for fatigue analysis of constructions....

  13. Brief encounters: Assembling cosmetic surgery tourism.

    Science.gov (United States)

    Holliday, Ruth; Bell, David; Cheung, Olive; Jones, Meredith; Probyn, Elspeth

    2015-01-01

    This paper reports findings from a large-scale, multi-disciplinary, mixed methods project which explores empirically and theoretically the rapidly growing but poorly understood (and barely regulated) phenomenon of cosmetic surgery tourism (CST). We explore CST by drawing on theories of flows, networks and assemblages, aiming to produce a fuller and more nuanced account of - and accounting for - CST. This enables us to conceptualise CST as an interplay of places, people, things, ideas and practices. Through specific instances of assembling cosmetic surgery that we encountered in the field, and that we illustrate with material from interviews with patients, facilitators and surgeons, our analysis advances understandings and theorisations of medical mobilities, globalisation and assemblage thinking. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Angular distribution of binary encounter electrons

    International Nuclear Information System (INIS)

    Liao, C.; Richard, P.; Grabbe, S.

    1993-01-01

    The double differential cross section, DDCS, of the binary encounter electrons (BEe) in 1 MeV/u F q+ + H 2 (q = 4, 6, 8, 9) is measured from 0 to 70 degrees with respect to the beam direction. At 0 degrees the data confirm the decrease of the cross section with increasing projectile charge state. At larger observation angles, the data are in fair agreement with the prediction proposed by Shingal et al. where the ratio of the DDCS for 6+ ions to bare ions is less than 1 for θ lab > 30 degrees and greater than 1 for θ lab q+ . We also observed that the energies of the BEe peak are charge state, q, independent at 0 degrees observation angle, but q dependent at larger observation angles

  15. Ethics in the bank internet encounter

    DEFF Research Database (Denmark)

    Rendtorff, Jacob Dahl; Mattsson, Jan

    2012-01-01

    /implications – The important implication for managerial research of this study would be for banks to focus on customer competency with an ethical concern instead of only being concerned with technical solutions for effective internet operations. Practical implications – Since more and more businesses are digitally based......Purpose – The purpose of this paper is to discuss some ethical issues in the internet encounter between customer and bank. Empirical data related to the difficulties that customers have when they deal with the bank through internet technology and electronic banking. The authors discuss...... the difficulties that customers expressed from an ethical standpoint. Design/methodology/approach – The key problem of the paper is “how does research handle the user's lack of competence in a web-based commercial environment?” The authors illustrate this ethical dilemma with data from a Danish Bank collected...

  16. Encountering women veterans with military sexual trauma.

    Science.gov (United States)

    Conard, Patricia L; Young, Cathy; Hogan, LaMicha; Armstrong, Myrna L

    2014-10-01

    As women veterans (WVs) are returning from Operation Iraqi Freedom and Operation Enduring Freedom with military sexual trauma (MST), the purpose of this article is twofold. First, important exploratory questions that can assist with a thorough assessment and history are presented as well as the applicable treatment for any new, recurrent, or unresolved symptoms that involve MST. Review of multiple literary materials, as well as a clinical situation. WVs will be encountered in a variety of military or civilian primary and community care healthcare settings. Every woman (and man) in the civilian sector should be asked, "Have you ever served in the military?" Recognition, acknowledgment, and applicable interventions for MST and associated comorbidities, especially post-traumatic stress disorder, are presented as currently 80-90% of MST experiences have gone unreported. Immediate treatment and follow-up are critical for the well-being of the WVs. © 2014 Wiley Periodicals, Inc.

  17. Guest-Host Encounters in Diaspora-Heritage Tourism: The Taglit-Birthright Israel Mifgash (Encounter)

    Science.gov (United States)

    Sasson, Theodore; Mittelberg, David; Hecht, Shahar; Saxe, Leonard

    2011-01-01

    More than 300,000 diaspora Jewish young adults and tens of thousands of their Israeli peers have participated in structured, cross-cultural encounters--"mifgashim"--in the context of an experiential education program known as Taglit-Birthright Israel. Drawing on field observations, interviews, and surveys, the formal and informal…

  18. Customer-to-customer roles and impacts in service encounters

    OpenAIRE

    Lee, Linda

    2016-01-01

    This thesis investigates customer-to-customer roles and impacts in the context of service encounters. This topic is studied from two angles: customer interactions during group service encounters and customer perceptions post service encounters. The first angle is a focus on group service encounters that addresses the lack of research on customer-to-customer interactions that occur in customer-to-customer interaction-intensive contexts. These are contexts where the interactions between custome...

  19. Translating medical documents improves students' communication skills in simulated physician-patient encounters.

    Science.gov (United States)

    Bittner, Anja; Bittner, Johannes; Jonietz, Ansgar; Dybowski, Christoph; Harendza, Sigrid

    2016-02-27

    Patient-physician communication should be based on plain and simple language. Despite communication skill trainings in undergraduate medical curricula medical students and physicians are often still not aware of using medical jargon when communicating with patients. The aim of this study was to compare linguistic communication skills of undergraduate medical students who voluntarily translate medical documents into plain language with students who do not participate in this voluntary task. Fifty-nine undergraduate medical students participated in this study. Twenty-nine participants were actively involved in voluntarily translating medical documents for real patients into plain language on the online-platform https://washabich.de (WHI group) and 30 participants were not (non-WHI group). The assessment resembled a virtual consultation hour, where participants were connected via skype to six simulated patients (SPs). The SPs assessed participants' communication skills. All conversations were transcribed and assessed for communication skills and medical correctness by a blinded expert. All participants completed a self-assessment questionnaire on their communication skills. Across all raters, the WHI group was assessed significantly (p = .007) better than the non-WHI group regarding the use of plain language. The blinded expert assessed the WHI group significantly (p = .018) better regarding the use of stylistic devices of communication. The SPs would choose participants from the WHI group significantly (p = .041) more frequently as their personal physician. No significant differences between the two groups were observed with respect to the medical correctness of the consultations. Written translation of medical documents is associated with significantly more frequent use of plain language in simulated physician-patient encounters. Similar extracurricular exercises might be a useful tool for medical students to enhance their communication skills with

  20. Wellness Tourism among Seniors in Taiwan: Previous Experience, Service Encounter Expectations, Organizational Characteristics, Employee Characteristics, and Customer Satisfaction

    Directory of Open Access Journals (Sweden)

    Kaung-Hwa Chen

    2015-08-01

    Full Text Available This study aimed to investigate the influence of the service encounter expectations of senior customers during wellness tours on customer satisfaction. The organizational attributes of hotels, organizational characteristics and employee characteristics, were adopted as mediating variables. A total of 346 valid questionnaires were retrieved from 50 year-old and above seniors in Taiwan. The results showed that the service encounter expectations of seniors had an indirect influence on customer satisfaction and the organizational attributes mediated the service encounter expectations of seniors and customer satisfaction. The moment of truth in the interactions between service staff members and seniors represents the pivotal management implication of this study.

  1. Co-creation of Innovations in ICT based service encounters

    DEFF Research Database (Denmark)

    Sørensen, Jannick Kirk; Henten, Anders

    2014-01-01

    Innovations in services often emanate from service encounters (i.e. the touch points between the service producers and the customers). Two different types of service encounters are dealt with: face-to-face and ICT-based service encounters. The aim of the chapter is to examine the specific...

  2. Innovation from the ICT-based service encounter

    DEFF Research Database (Denmark)

    Henten, Anders

    2012-01-01

    The pupose of the paper is to develop a framework for analyzing the dynamics of innovations emanating from the ICT-based service encounters. Many innovations are based on the direct encounter between employees and customers, and the paper aims to extend the analysis of such encounters to ICT...

  3. The Role of Individualism/Collectivism in Critical Classroom Encounters: A Four Country Study

    Science.gov (United States)

    Frankel, Robert; Swanson, Scott R.; Sagan, Mariusz

    2005-01-01

    Internationalization raises the issue of whether, and to what extent, the inherent culture of a country may have particular influence on the nature of service interactions, and on education (i.e., student-professor interactions) specifically. Thus the service encounter in the classroom becomes a subject of increasing importance and interest with…

  4. Assortment of encounters and evolution of cooperativeness.

    Science.gov (United States)

    Eshel, I; Cavalli-Sforza, L L

    1982-02-01

    The method of evolutionary stable strategies (ESS), in its current form, is confronted with a difficulty when it tries to explain how some social behaviors initiate their evolution. We show that this difficulty may be removed by changing the assumption made tacitly in game theory (and in ESS) of randomness of meetings or encounters. In reality, such randomness seems to be rare in nature. Family, population and social structure, customs, and habits impose various types of deviation from randomness. Introducing nonrandomness of meeting in a way formally similar to assortative mating, we show that the bar to initial increase of inherited cooperative or altruistic behaviors can be removed, provided there is sufficient assortment of meetings. Family structure may cause contacts predominantly between certain types of relatives, and one can reconstruct some results of classical kin selection in terms of evolutionary stable strategy with assortative meetings. Neighbor effects and group selection might be similarly treated. Assortment need not be a passive consequence of population and social structure, but it can also be actively pursued. Behaviors favoring the choice of cooperative companions will have the effect of favoring the evolution of cooperativeness. It can be shown that discrimination in the choice of companions, especially if combined with assortment, can favor the development of cooperativeness, making initial increase of cooperative behavior possible even at levels of assortment passively imposed which would not be adequate, per se, to guarantee the increase of cooperativeness. It is possible that, in some cases, cooperativeness and behavior favoring some type of assortment are coselected.

  5. Thermal fluctuation problems encountered in LMFRs

    International Nuclear Information System (INIS)

    Gelineau, O.; Sperandio, M.; Martin, P.; Ricard, J.B.; Martin, L.; Bougault, A.

    1994-01-01

    One of the most significant problems of LMFBRs deals with thermal fluctuations. The main reason is that LMFBRs operate with sodium coolant at very different temperatures which leads to the existence of several areas of transition between hot and cold sodium. These transitions areas which are the critical points, maybe found in the reactor block as well as in the secondary and auxiliary loops. The characteristics of these thermal fluctuations are not easy to quantify because of their complex (random) behaviour, and often demand the use of thermalhydraulic mock-up tests. A good knowledge of these phenomena is essential because of the potential high level of damage they can induce on structures. Two typical thermal fluctuation problems encountered on operation reactors are described. They were not originally anticipated at the design stage of the former Phenix and the latter Superphenix reactors. Description and the analyses performed to describe the damaging process are explained. A well known thermal fluctuation problem is presented. It is pointed out how the feedback from the damages observed on operating reactors is used to prevent the components from any high cycle fatigue

  6. Participants in urban Mexican male homosexual encounters.

    Science.gov (United States)

    Carrier, J M

    1971-12-01

    Preliminary data are presented on 53 urban Mexican males interviewed during 1970-1971 in a study of homosexual encounters in a large Mexican city. These data are compared with data from recent studies in the United States and England of male homosexual behavior. Although preliminary and limited, the Mexican data indicate that cultural factors are important determinants of life styles and sex practices of homosexual males. Forty-eight of the 53 (90%) preferred and usually practiced anal intercourse, four preferred oral contacts, and one preferred mutual masturbation. Interviewees were also grouped according to major type of sex activity during the first sustained year of homosexual activity after puberty. One intragroup comparison indicates significant differences between anal active and anal passive interviewees. For example, as children anal passive subjects had significantly more homosexual contacts with adults; they also considered themselves more effeminate and as children were more involved with female sex-typed activities. Comparison of data from the English and United States studies with the present data suggests that preference for a particular sexual technique is not as developed in the former two countries; when there is a preference, it is not usually for anal intercourse.

  7. LHC experiences close encounters with UFOs

    CERN Multimedia

    Mike Lamont for the LHC Team

    2011-01-01

    On 29 May, yet another record was set as 1092 bunches per beam were injected into the LHC, hitting a peak luminosity of 1.26x1033 cm-2 s-1. While running at 3.5 TeV each beam now packs a total energy of over 70 MJ – equivalent to a TGV travelling at a 70 kph.   Operators in the LHC Control Centre happily show off their display screens after succesfully injecting 1092 bunches injected into the machine for the first time.  As the total beam intensity has been pushed up, the LHC has encountered a number of related problems, such as the so-called UFOs (Unidentified Falling Objects). These are thought to be dust particles falling through the beam, causing localized beam loss. The losses can push nearby beam loss monitors over the threshold and dump the beam. This is more of an annoyance than a danger for the LHC, but UFOs do reduce the operational efficiency of the machine. Despite this, the luminosity delivered to the experiments has steadily increased. On three occasions there ha...

  8. Incorporating Hypnosis into Pediatric Clinical Encounters

    Directory of Open Access Journals (Sweden)

    Robert A. Pendergrast

    2017-03-01

    Full Text Available Increasing numbers of licensed health professionals who care for children have been trained in clinical hypnosis. The evidence base for the safety and efficacy of this therapeutic approach in a wide variety of conditions is also growing. Pediatricians and other health professionals who have received training may wish to apply these skills in appropriate clinical scenarios but still may be unsure of the practical matters of how to incorporate this skill-set into day to day practice. Moreover, the practical application of such skills will take very different forms depending on the practice setting, types of acute or chronic conditions, patient and family preferences, and the developmental stages of the child or teen. This article reviews the application of pediatric clinical hypnosis skills by describing the use of hypnotic language outside of formal trance induction, by describing natural trance states that occur in children and teens in healthcare settings, and by describing the process of planning a clinical hypnosis encounter. It is assumed that this article does not constitute training in hypnosis or qualify its readers for the application of such skills; rather, it may serve as a practical guide for those professionals who have been so trained, and may serve to inform other professionals what to expect when referring a patient for hypnotherapy. The reader is referred to specific training opportunities and organizations.

  9. Incorporating Hypnosis into Pediatric Clinical Encounters

    Science.gov (United States)

    Pendergrast, Robert A.

    2017-01-01

    Increasing numbers of licensed health professionals who care for children have been trained in clinical hypnosis. The evidence base for the safety and efficacy of this therapeutic approach in a wide variety of conditions is also growing. Pediatricians and other health professionals who have received training may wish to apply these skills in appropriate clinical scenarios but still may be unsure of the practical matters of how to incorporate this skill-set into day to day practice. Moreover, the practical application of such skills will take very different forms depending on the practice setting, types of acute or chronic conditions, patient and family preferences, and the developmental stages of the child or teen. This article reviews the application of pediatric clinical hypnosis skills by describing the use of hypnotic language outside of formal trance induction, by describing natural trance states that occur in children and teens in healthcare settings, and by describing the process of planning a clinical hypnosis encounter. It is assumed that this article does not constitute training in hypnosis or qualify its readers for the application of such skills; rather, it may serve as a practical guide for those professionals who have been so trained, and may serve to inform other professionals what to expect when referring a patient for hypnotherapy. The reader is referred to specific training opportunities and organizations. PMID:28300761

  10. Close encounters of the prototype kind

    CERN Multimedia

    2005-01-01

    CERN is building a new control centre for the operation of its entire accelerator complex and technical infrastructure. The prototype console for the new centre has just been installed and tested. Close encounters of the prototype kind CERN is building a new control centre for the operation of its entire accelerator complex and technical infrastructure. The prototype console for the new centre has just been installed and tested. The prototype of the control consoles that will be at the heart of the future CERN Control Centre (CCC) has just been installed in the Roy Billinge Room in Building 354. Until now, there have been four separate control rooms for the CERN accelerators and technical infrastructure. The CCC, which will be located on the Prévessin site, will bring them all together in a single room. The Centre will consist of 40 consoles for four different areas (LHC, SPS, PS complex and technical infrastructure). The prototype was tested by the technicians for a month. Following installation and con...

  11. Close Encounters of Lymphoid Cells and Bacteria

    Science.gov (United States)

    Cruz-Adalia, Aranzazu; Veiga, Esteban

    2016-01-01

    During infections, the first reaction of the host against microbial pathogens is carried out by innate immune cells, which recognize conserved structures on pathogens, called pathogen-associated molecular patterns. Afterward, some of these innate cells can phagocytose and destroy the pathogens, secreting cytokines that would modulate the immune response to the challenge. This rapid response is normally followed by the adaptive immunity, more specific and essential for a complete pathogen clearance in many cases. Some innate immune cells, usually named antigen-presenting cells, such as macrophages or dendritic cells, are able to process internalized invaders and present their antigens to lymphocytes, triggering the adaptive immune response. Nevertheless, the traditional boundary of separated roles between innate and adaptive immunity has been blurred by several studies, showing that very specialized populations of lymphocytes (cells of the adaptive immunity) behave similarly to cells of the innate immunity. These “innate-like” lymphocytes include γδ T cells, invariant NKT cells, B-1 cells, mucosal-associated invariant T cells, marginal zone B cells, and innate response activator cells, and together with the newly described innate lymphoid cells are able to rapidly respond to bacterial infections. Strikingly, our recent data suggest that conventional CD4+ T cells, the paradigm of cells of the adaptive immunity, also present innate-like behavior, capturing bacteria in a process called transinfection. Transinfected CD4+ T cells digest internalized bacteria like professional phagocytes and secrete large amounts of proinflammatory cytokines, protecting for further bacterial challenges. In the present review, we will focus on the data showing such innate-like behavior of lymphocytes following bacteria encounter. PMID:27774092

  12. Contact through canvas : an entertaining encounter

    NARCIS (Netherlands)

    van Boerdonk, K.; Tieben, R.; Klooster, S.; Hoven, van den E.A.W.H.

    2009-01-01

    When meeting someone new, the first impression is often influenced by someone's physical appearance and other types of prejudice. In this paper, we present TouchMeDare, an interactive canvas, which aims to provide an experience when meeting new people, while preventing visual prejudice and lowering

  13. Visuality – Textuality: An Uncanny Encounter

    Directory of Open Access Journals (Sweden)

    Elisabeth Bronfen

    2010-08-01

    Full Text Available

     

    Abstract (E: Given that visuality is as much a part of all narration as the fact that we view images by reading them as though they were texts, this essay proposes to speak about an uncanny encounter between the two. In order to illustrate this mutual implication, as well as to bring in the theme of the spectral (that Freud suggests all experiences of the uncanny entail, it offers a cross-mapping between three different media at three different historical moments: a novella by the late Victorian author Charlotte Perkins Gilman, a series of photographs by the late modern photographer Francesca Woodman, and a film by the postmodern film maker Amenábar.

    Abstract (F:

     

    Cet article part de deux observations : à savoir que la visualité fait partie du champ plus large du récit, et que nous regardons les images en les lisant comme si elles étaient des textes. À partir de là, on examine la rencontre du textuel et du visuel comme une forme de l’inquiétante étrangeté. Afin d’illustrer leur implication réciproque et d’introduire la notion de spectre (dont Freud pose qu’il est sous-entendu par toutes les expériences de l’inquiétante étrangeté, l’article procède à l’analyse comparative de trois médias à trois moments historiques différents : un récit par une auteure des dernières années de l’ère victorienne, Charlotte Perkins Gilman ; une suite de photographes par la photographe du modernisme tardif Francesca Woodman ; et un film par le r

  14. Resource-driven encounters among consumers and implications for the spread of infectious disease

    Science.gov (United States)

    Flynn, Jason M.

    2017-01-01

    Animals share a variety of common resources, which can be a major driver of conspecific encounter rates. In this work, we implement a spatially explicit mathematical model for resource visitation behaviour in order to examine how changes in resource availability can influence the rate of encounters among consumers. Using simulations and asymptotic analysis, we demonstrate that, under a reasonable set of assumptions, the relationship between resource availability and consumer conspecific encounters is not monotonic. We characterize how the maximum encounter rate and associated critical resource density depend on system parameters like consumer density and the maximum distance from which consumers can detect and respond to resources. The assumptions underlying our theoretical model and analysis are motivated by observations of large aggregations of black-backed jackals at carcasses generated by seasonal outbreaks of anthrax among herbivores in Etosha National Park, Namibia. As non-obligate scavengers, black-backed jackals use carcasses as a supplemental food resource when they are available. While jackals do not appear to acquire disease from ingesting anthrax carcasses, changes in their movement patterns in response to changes in carcass abundance do alter jackals' conspecific encounter rate in ways that may affect the transmission dynamics of other diseases, such as rabies. Our theoretical results provide a method to quantify and analyse the hypothesis that the outbreak of a fatal disease among herbivores can potentially facilitate outbreaks of an entirely different disease among jackals. By analysing carcass visitation data, we find support for our model's prediction that the number of conspecific encounters at resource sites decreases with additional increases in resource availability. Whether or not this site-dependent effect translates to an overall decrease in encounters depends, unexpectedly, on the relationship between the maximum distance of detection and

  15. Encountering whales: How encounter rates became the basis for managing whaling

    Directory of Open Access Journals (Sweden)

    Tim D Smith

    2009-09-01

    Full Text Available Declining rates of encountering whales, including both sighting and catching, were noted by whalers throughout the 19th century, and these declines became the first indication that whaling was adversely affecting whale abundance. The interpretation of declines in both sighting and catch rates proved to be a difficult scientific task. Satisfactory quantitative methods of interpreting changes in whale encounter rates were not developed until the second half of the 20th century. Rates of encountering whales played a key role in the International Whaling Commission (IWC Scientific Committee from its beginning in the early 1950s, as well as in the US in implementing its Marine Mammal Protection Act beginning in the early 1970s. The development of methods of collecting and interpreting sighting and catch data was intimately interwoven with the development of themanagement of whaling and cetacean by-catches in fisheries throughout the world, but especially within the context of the Scientific Committees of the IWC and the North Atlantic Marine Mammal Commission (NAMMCO. Although overfishing of whales was initially identified through the use of sighting rate data, catch rate data provided the IWC’s Committee its first firm footing for management advice. However, it was sighting rate data that ultimately became the basis for the scientific advice on whaling and for management advice in other settings. This led to the development of large scale cetacean sighting programmes, such as the IWC’s International Decade of Cetacean Researchsurveys in Antarctic aboard Japanese ships, the North Atlantic Sighting Surveys (NASS aboard Norwegian, Icelandic, Spanish, Greenlandic and Faroese vessels and aircraft (coordinated by NAMMCO through its Scientific Committee from 1995, and surveys under the US’s Marine Mammal Protection Act and the European Union’s Small Cetacean Abundance in the North Sea (SCANS programme. Fishery independent cetacean sighting surveys

  16. Due Regard Encounter Model Version 1.0

    Science.gov (United States)

    2013-08-19

    Note that no existing model covers encoun- ters between two IFR aircraft in oceanic airspace. The reason for this is that one cannot observe encounters...encounters between instrument flight rules ( IFR ) and non- IFR traffic beyond 12NM. 2 TABLE 1 Encounter model categories. Aircraft of Interest Intruder...Aircraft Location Flight Rule IFR VFR Noncooperative Noncooperative Conventional Unconventional CONUS IFR C C U X VFR C U U X Offshore IFR C C U X VFR C U

  17. Islamic Canon law encounters South African financing and banking ...

    African Journals Online (AJOL)

    Islamic Canon law encounters South African financing and banking institutions: Prospects and possibilities for Islamic economic empowerment and Black Economic Empowerment in a Democratic South Africa.

  18. The impact of personal connection on customer behaviours (word-of-mouth intention and retention) in service encounters

    OpenAIRE

    Chen, Ning; Zhao, Qi; Ardley, Barry

    2015-01-01

    In services marketing it is widely acknowledged that a relationship approach may facilitate in customer retention and enhance customer loyalty, and further influence customer post-purchase behaviours e.g. word-of-mouth. In this study, a specific relationship in service encounters, personal connections between customers and service employees, is explored in its indications on different outcomes from service encounters including three types of word-of-mouth behaviour intention and retention. Th...

  19. Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system

    Directory of Open Access Journals (Sweden)

    Labrador Barba E

    2017-04-01

    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

  20. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters.

    Science.gov (United States)

    Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

    2013-01-16

    Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients' perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients' overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a

  1. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

    Science.gov (United States)

    2013-01-01

    Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly

  2. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

    Directory of Open Access Journals (Sweden)

    Chang Ching-Sheng

    2013-01-01

    Full Text Available Abstract Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A interpersonal-based medical

  3. The northern lakes of Egypt: Encounters with a wetland environment

    International Nuclear Information System (INIS)

    Parmenter, B.M.

    1991-01-01

    Five lakes fringe the northern coast of Egypt. Together they represent 25% of the remaining wetland habitat in the Mediterranean basin. Residents of these lakes traditionally exploited a wide variety of resources. Today these lakes face a number of threats to their existence, including large-scale reclamation and water pollution. Agricultural authorities, engineers, fishery managers, and conservationists in Egypt and abroad debate about how best to manage and develop the lake region's resources, but few of these groups understand or communicate with one another, or with residents of lake communities. This study explores how these various groups encounter the coastal lakes of Egypt, focusing particularly on Lakes Manzala and Burullus. Its purpose is to explore the ways in which the lakes, their resources and their inhabitants have been evaluated, and to analyze how underlying preconceptions, goals and structures of professional discourse influence such evaluations. The thesis is that environmental management is in reality not a rational plan but a process. Egypt is currently attempting to develop a coherent strategy to remedy its environmental problems without adversely affecting economic growth

  4. Customer-sales employee encounters: a dyadic perspective.

    NARCIS (Netherlands)

    Dolen, van W.; Lemmink, J.G.A.M.; Ruyter, de J.C.; Jong, de A.

    2003-01-01

    Although researchers have suggested that the performance of the salesperson during sales encounters is critical, many of the underlying mechanisms that govern the interaction between salespersons and customers are still unclear. In this research, we investigate sales encounters from a new approach

  5. Attributions of Intentions and Fairness Judgments regarding Interracial Peer Encounters

    Science.gov (United States)

    Killen, Melanie; Kelly, Megan Clark; Richardson, Cameron; Jampol, Noah Simon

    2010-01-01

    To investigate how adolescents interpret ambiguous actions in hypothetical interracial peer encounters, we conducted a study in which 8th- and 11th-grade students (N = 837) evaluated 4 interracial peer encounters in which the intentions of the protagonist were ambiguous. The sample was evenly divided by gender and included both African American…

  6. High-velocity runaway stars from three-body encounters

    Science.gov (United States)

    Gvaramadze, V. V.; Gualandris, A.; Portegies Zwart, S.

    2010-01-01

    We performed numerical simulations of dynamical encounters between hard, massive binaries and a very massive star (VMS; formed through runaway mergers of ordinary stars in the dense core of a young massive star cluster) to explore the hypothesis that this dynamical process could be responsible for the origin of high-velocity (≥ 200 - 400 km s-1) early or late B-type stars. We estimated the typical velocities produced in encounters between very tight massive binaries and VMSs (of mass of ≥ 200 M⊙) and found that about 3 - 4% of all encounters produce velocities ≥ 400 km s-1, while in about 2% of encounters the escapers attain velocities exceeding the Milky Ways's escape velocity. We therefore argue that the origin of high-velocity (≥ 200 - 400 km s-1) runaway stars and at least some so-called hypervelocity stars could be associated with dynamical encounters between the tightest massive binaries and VMSs formed in the cores of star clusters. We also simulated dynamical encounters between tight massive binaries and single ordinary 50 - 100 M⊙ stars. We found that from 1 to ≃ 4% of these encounters can produce runaway stars with velocities of ≥ 300 - 400 km s-1 (typical of the bound population of high-velocity halo B-type stars) and occasionally (in less than 1% of encounters) produce hypervelocity (≥ 700 km s-1) late B-type escapers.

  7. Value creation and knowledge development in tourism experience encounters

    DEFF Research Database (Denmark)

    Sørensen, Flemming; Jensen, Jens Friis

    2015-01-01

    It has been argued that service encounters between front-line employees and users support the development of knowledge about users' needs. However, the potential for this often remains unused, not least in tourism. This article argues that if tourism service encounters are changed into ‘experience...... encounters’ by integrating them into the tourism experience to which they are related, this will create added experiential value for tourists and increase the creation of knowledge about users. This is illustrated in an innovation field experiment in a retro design boutique hotel in which service encounters...... were developed into experience encounters. The experiment illustrates the potential that experience encounters have to create knowledge and value, but also suggests some barriers that need to be overcome....

  8. The space of togetherness--a caring encounter.

    Science.gov (United States)

    Holopainen, Gunilla; Kasén, Anne; Nyström, Lisbet

    2014-03-01

    Encounters in relation to the nurse-patient relationship are often discussed within nursing and caring literature without a reflection on the actual meaning of the concept. Assuming that an encounter is essential for nursing care, this article seeks to create a deeper understanding of the concept through a hermeneutic approach to texts by the philosophers Buber and Marcel. Presence, recognition, availability and mutuality seem to be essential prerequisites for an encounter. As these prerequisites are fulfilled within and between human beings who encounter each other, it is possible to speak of a space of togetherness, a mutual existence, where life's mystery shines forth and caring is realized. The challenge lies in creating these encounters within nursing care. © 2012 The Authors Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  9. FAMILY BUSINESSES AND THE DIFFICULTIES ENCOUNTERED BY

    Directory of Open Access Journals (Sweden)

    Alessandra Martins

    2009-05-01

    Full Text Available There are few family owned businesses that survive to the next generation. In general, 30% of these businesses are passed on to second generation families and less than 15% survive to third generation families. There has been little research done on third generation family businesses. Therefore the main purpose of this paper is to identify the principal difficulties of passing on managerial skills to the third generation owners. This study uses a case study of a Brazilian family organization composed of twelve enterprises. The instrument to collect data was an individually guided recorded interview with all of the family managers (1ª, 2ª e 3ª generation. The technique applied, was suggested for Miles & Huberman (1994 to group the data in analytical categories to facilitate the analyzed speeches contained in the 49 blocks of responses. As a result, the transition the business to the third generation owners has been strongly associated with the relation between family and business by the following factors: a the succession process influenced by emotional and family values; b conflicts, rivalries and divergences of strategic visions and business goals between the family generations; c lack of professional criteria to hire relatives; and d fragility of communication and consequent asymmetry of information among the family members.

  10. Common Factors Among Family Medicine Residents Who Encounter Difficulty.

    Science.gov (United States)

    Binczyk, Natalia M; Babenko, Oksana; Schipper, Shirley; Ross, Shelley

    2018-04-01

    Residents in difficulty are costly to programs in both time and resources, and encountering difficulty can be emotionally harmful to residents. Approximately 10% of residents will encounter difficulty at some point in training. While there have been several studies looking at common factors among residents who encounter difficulty, some of the findings are inconsistent. The objective of this study was to determine whether there are common factors among the residents who encounter difficulty during training in a large Canadian family medicine residency program. Secondary data analysis was performed on archived resident files from a Canadian family medicine residency program. Residents who commenced an urban family medicine residency program between the years of 2006 and 2014 were included in the study. Five hundred nine family medicine residents were included in data analysis. Residents older than 30 years were 2.33 times (95% CI: 1.27-4.26) more likely to encounter difficulty than residents aged 30 years or younger. Nontransfer residents were 8.85 times (95% CI: 1.17-66.67) more likely to encounter difficulty than transfer residents. The effects of sex, training site, international medical graduate status, and rotation order on the likelihood of encountering difficulty were nonsignificant. Older and nontransfer residents may be facing unique circumstances and may benefit from additional support from the program.

  11. Brain systems underlying encounter expectancy bias in spider phobia.

    Science.gov (United States)

    Aue, Tatjana; Hoeppli, Marie-Eve; Piguet, Camille; Hofstetter, Christoph; Rieger, Sebastian W; Vuilleumier, Patrik

    2015-06-01

    Spider-phobic individuals are characterized by exaggerated expectancies to be faced with spiders (so-called encounter expectancy bias). Whereas phobic responses have been linked to brain systems mediating fear, little is known about how the recruitment of these systems relates to exaggerated expectancies of threat. We used fMRI to examine spider-phobic and control participants while they imagined visiting different locations in a forest after having received background information about the likelihood of encountering different animals (spiders, snakes, and birds) at these locations. Critically, imagined encounter expectancies modulated brain responses differently in phobics as compared with controls. Phobics displayed stronger negative modulation of activity in the lateral prefrontal cortex, precuneus, and visual cortex by encounter expectancies for spiders, relative to snakes or birds (within-participants analysis); these effects were not seen in controls. Between-participants correlation analyses within the phobic group further corroborated the hypothesis that these phobia-specific modulations may underlie irrationality in encounter expectancies (deviations of encounter expectancies from objective background information) in spider phobia; the greater the negative modulation a phobic participant displayed in the lateral prefrontal cortex, precuneus, and visual cortex, the stronger was her bias in encounter expectancies for spiders. Interestingly, irrationality in expectancies reflected in frontal areas relied on right rather than left hemispheric deactivations. Our data accord with the idea that expectancy biases in spider phobia may reflect deficiencies in cognitive control and contextual integration that are mediated by right frontal and parietal areas.

  12. Relationship between Teach-back and patient-centered communication in primary care pediatric encounters.

    Science.gov (United States)

    Badaczewski, Adam; Bauman, Laurie J; Blank, Arthur E; Dreyer, Benard; Abrams, Mary Ann; Stein, Ruth E K; Roter, Debra L; Hossain, Jobayer; Byck, Hal; Sharif, Iman

    2017-07-01

    We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter. Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness. Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p=0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI)=4.97 (4.47-5.53)]and negative affect [AOR (95% CI)=5.39 (1.68-17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it. Teach-back was associated with more patient-centered communication and increased affective engagement of parents. Standardizing Teach-back use may strengthen patient-centered communication. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Storyboard GALILEO CRUISE SCIENCE OPPORTUNITIES describes asteroid encounters

    Science.gov (United States)

    1989-01-01

    Storyboard with mosaicked image of an asteroid and entitled GALILEO CRUISE SCIENCE OPPORTUNITIES describes asteroid objectives. These objectives include: first asteroid encounter; surface geology, composition size, shape, mass; and relation of primitive bodies to meteorites.

  14. Low velocity encounters of minor bodies with the outer planets

    International Nuclear Information System (INIS)

    Carusi, A.; Perozzi, E.; Valsecchi, G.B.

    1983-01-01

    Previous studies of close encounters of minor bodies with Jupiter have shown that the perturbations are stronger either if the encounter is very deep or if the velocity of the minor body relative to the planet is low. In the present research the author investigates the effects of low velocity encounters between fictitious minor bodies and the four outer planets. Two possible outcomes of this type of encounter are the temporary satellite capture of the minor body by the planet, and the exchange of perihelion with aphelion of the minor body orbit. Different occurrence rates of these processes are found for different planets, and the implications for the orbital evolution of minor bodies in the outer Solar System are discussed. (Auth.)

  15. Preliminary Uncorrelated Encounter Model of the National Airspace System

    National Research Council Canada - National Science Library

    Kochenderfer, M. J; Kuchar, J. K; Espindle, L. P; Gertz, J. L

    2008-01-01

    ...) and which may not be in contact with air traffic control. In response to the need to develop a model of these types of encounters, Lincoln Laboratory undertook an extensive radar data collection and modeling effort...

  16. Availability and Usability of BHO Encounter Data in MAX 2009

    Data.gov (United States)

    U.S. Department of Health & Human Services — Availability and Usability of Behavioral Health Organization Encounter Data in MAX 2009, published in Volume 4, Issue 2 of Medicare and Medicaid Research Review,...

  17. Spacecraft environment during the GIOTTO-Halley encounter: a summary

    International Nuclear Information System (INIS)

    Young, D.T.

    1983-01-01

    A summary of the present volume is presented in which the separate disciplines are drawn together to give an overview of the spacecraft environment during the GIOTTO-Halley interaction. Specific recommendations are made as to how the work of the Plasma Environment Working Group might continue to contribute to the GIOTTO program during encounter and post-encounter data analysis. 28 references, 3 tables

  18. Emotions in relation to healthcare encounters affecting self-esteem.

    Science.gov (United States)

    Räty, Lena; Gustafsson, Barbro

    2006-02-01

    This study identifies emotions in patients with epilepsy as a result of confirming and disconfirming healthcare experiences. A discussion of emotions as a motive for patients' goal-directed actions was a further aim of this study. The critical incident method was used for data collection. Emotions occurring in confirming and disconfirming healthcare encounters were analyzed using the Belief-Desire Theory of Emotions and were categorized as basic, complex, or self-evaluating. Confirming encounters aroused emotions like hope, a feeling of security, joy, relief, and pride, while disconfirming encounters aroused emotions like despair, fear, unrest, resignation, shame, and guilt. The emotions identified in the healthcare encounters were recognized as motives for action. An emotion such as a feeling of security aroused a desire in the patients to strengthen their positive self and motivated them to have a constructive and sympathetic attitude toward the healthcare experience. An emotion such as anger caused patients to strive to maintain their self-respect either by avoiding difficult situations and ignoring the problem (patients with a low self-esteem) or by trying to re-create a positive self-image (patients with a high self-esteem). Healthcare encounters between patient and caregiver considerably affect the patient's emotional status and thereby his or her well-being. The importance of establishing healthcare encounters that evoke positive emotions that strengthen patients' resources must be addressed in future nursing care.

  19. Older patients' attitudes towards and experiences of patient-physician end-of-life communication: a secondary analysis of interviews from British, Dutch and Belgian patients

    NARCIS (Netherlands)

    Evans, N.C.; Pasman, H.R.W.; Payne, S.A.; Seymour, J.; Pleschberger, S.; Deschepper, R.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    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

  20. Analyzing effects of service encounter quality on customer satisfaction in banking industry

    Directory of Open Access Journals (Sweden)

    Hossein Gazor

    2012-04-01

    Full Text Available Service quality represents a modern approach for quality in enterprises and organizations and serves the development of a truly customer-focused management and culture. Measuring service quality offers an immediate, meaningful and objective feedback about clients' preferences and expectations. In this paper, we study the relationship between customer perceptions from service encounter quality and loyalty of customer to organization and employees. The proposed study is implemented for banking sector in Iran using SERVQUAL factors and considers various factors influencing the quality of service. The results of the survey indicate that service quality systems, customer satisfaction are the most desirable factors based on the feedback we received from the customers. In addition, response to customers and loyalty to employees, service encounter quality, service and loyalty to organization, arrangements are in the next levels, respectively.

  1. Biographical Narratives of Encounter: The Significance of Mobility and Emplacement in Shaping Attitudes towards Difference

    Science.gov (United States)

    Sadgrove, Joanna

    2014-01-01

    This paper is located within work in urban studies about the significance of contact with difference as a means for reducing prejudice and achieving social change. Recent approaches, influenced by theories of affect, have emphasised non-conscious everyday negotiations of difference in the city. In this paper it is argued that such approaches lose sight of the significance of the subject: of the reflective judgements of ‘others’ made by individuals; of our ability to make decisions around the control of our feelings and identifications; and of the significance of personal pasts and collective histories in shaping the ways we perceive and react to encounters. Rather, this paper uses a biographical approach focusing on interviewees’ narratives of encounter. Through its attention to processes of mobility and emplacement, it contributes to debates about when contact with difference matters by highlighting the importance of everyday social normativities in the production of moral dispositions. PMID:26300566

  2. Close encounters: Moving along bumps, breaks, and bubbles on expanded trinucleotide tracts

    Energy Technology Data Exchange (ETDEWEB)

    Polyzos, Aris A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McMurray, Cynthia T. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-06-09

    Expansion of simple triplet repeats (TNR) underlies greater than 30 severe degenerative diseases. There is a good understanding of the major pathways generating an expansion, and the associated polymerases that operate during gap filling synthesis at these “difficult to copy” sequences. However, the mechanism by which a TNR is repaired depends on the type of lesion, the structural features imposed by the lesion, the assembled replication/repair complex, and the polymerase that encounters it. The relationships among these parameters are exceptionally complex and how they direct pathway choice is poorly understood. In this review, we consider the properties of polymerases, and how encounters with GC-rich or abnormal structures might influence polymerase choice and the success of replication and repair. Insights over the last three years have highlighted new mechanisms that provide interesting choices to consider in protecting genome stability.

  3. Humor During Clinical Practice: Analysis of Recorded Clinical Encounters.

    Science.gov (United States)

    Phillips, Kari A; Singh Ospina, Naykky; Rodriguez-Gutierrez, Rene; Castaneda-Guarderas, Ana; Gionfriddo, Michael R; Branda, Megan; Montori, Victor

    2018-01-01

    Little is known about humor's use in clinical encounters, despite its many potential benefits. We aimed to describe humor during clinical encounters. We analyzed 112 recorded clinical encounters. Two reviewers working independently identified instances of humor, as well as information surrounding the logistics of its use. Of the 112 encounters, 66 (59%) contained 131 instances of humor. Humor was similarly frequent in primary care (36/61, 59%) and in specialty care (30/51, 59%), was more common in gender-concordant interactions (43/63, 68%), and was most common during counseling (81/112, 62%). Patients and clinicians introduced humor similarly (63 vs 66 instances). Typically, humor was about the patient's medical condition (40/131, 31%). Humor is used commonly during counseling to discuss the patient's medical condition and to relate to general life events bringing warmth to the medical encounter. The timing and topic of humor and its use by all parties suggests humor plays a role in the social connection between patients and physicians and allows easier discussion of difficult topics. Further research is necessary to establish its impact on clinicians, patients, and outcomes. © Copyright 2018 by the American Board of Family Medicine.

  4. Protoplanetary disc truncation mechanisms in stellar clusters: comparing external photoevaporation and tidal encounters

    Science.gov (United States)

    Winter, A. J.; Clarke, C. J.; Rosotti, G.; Ih, J.; Facchini, S.; Haworth, T. J.

    2018-04-01

    Most stars form and spend their early life in regions of enhanced stellar density. Therefore the evolution of protoplanetary discs (PPDs) hosted by such stars are subject to the influence of other members of the cluster. Physically, PPDs might be truncated either by photoevaporation due to ultraviolet flux from massive stars, or tidal truncation due to close stellar encounters. Here we aim to compare the two effects in real cluster environments. In this vein we first review the properties of well studied stellar clusters with a focus on stellar number density, which largely dictates the degree of tidal truncation, and far ultraviolet (FUV) flux, which is indicative of the rate of external photoevaporation. We then review the theoretical PPD truncation radius due to an arbitrary encounter, additionally taking into account the role of eccentric encounters that play a role in hot clusters with a 1D velocity dispersion σv ≳ 2 km/s. Our treatment is then applied statistically to varying local environments to establish a canonical threshold for the local stellar density (nc ≳ 104 pc-3) for which encounters can play a significant role in shaping the distribution of PPD radii over a timescale ˜3 Myr. By combining theoretical mass loss rates due to FUV flux with viscous spreading in a PPD we establish a similar threshold for which a massive disc is completely destroyed by external photoevaporation. Comparing these thresholds in local clusters we find that if either mechanism has a significant impact on the PPD population then photoevaporation is always the dominating influence.

  5. Connection between encounter volume and diffusivity in geophysical flows

    Science.gov (United States)

    Rypina, Irina I.; Smith, Stefan G. Llewellyn; Pratt, Larry J.

    2018-04-01

    Trajectory encounter volume - the volume of fluid that passes close to a reference fluid parcel over some time interval - has been recently introduced as a measure of mixing potential of a flow. Diffusivity is the most commonly used characteristic of turbulent diffusion. We derive the analytical relationship between the encounter volume and diffusivity under the assumption of an isotropic random walk, i.e., diffusive motion, in one and two dimensions. We apply the derived formulas to produce maps of encounter volume and the corresponding diffusivity in the Gulf Stream region of the North Atlantic based on satellite altimetry, and discuss the mixing properties of Gulf Stream rings. Advantages offered by the derived formula for estimating diffusivity from oceanographic data are discussed, as well as applications to other disciplines.

  6. Binary encounter electron production in ion-atom collisions

    International Nuclear Information System (INIS)

    Grabbe, S.; Bhalla, C.P.; Shingal, R.

    1993-01-01

    The binary encounter electrons are produced by hard collisions between the target electrons and the energetic projectiles. Richard et al. found the measured double differential cross section for BEe production at zero degree laboratory scattering angle, in collisions of F q+ with H 2 and He targets, to increase as the charge state of the projectile was decreased. The binary encounter electron production has recently been a subject of detailed investigations. We have calculated the differential elastic scattering cross sections of electrons from several ions incorporating the exchange contribution of the continuum and the bound orbitals in addition to the static potential. The double differential binary encounter electron production cross sections are presented using the impulse approximation

  7. N-Body simulations of tidal encounters between stellar systems

    International Nuclear Information System (INIS)

    Rao, P.D.; Ramamani, N.; Alladin, S.M.

    1985-10-01

    N-Body simulations have been performed to study the tidal effects of a primary stellar system on a secondary stellar system of density close to the Roche density. Two hyperbolic, one parabolic and one elliptic encounters have been simulated. The changes in energy, angular momentum, mass distribution, and shape of the secondary system have been determined in each case. The inner region containing about 40% of the mass was found to be practically unchanged and the mass exterior to the tidal radius was found to escape. The intermediate region showed tidal distension. The thickness of this region decreased as we went from hyperbolic encounters to the elliptic encounter keeping the distance of closest approach constant. The numerical results for the fractional change in energy have been compared with the predictions of the available analytic formulae and the usefulness and limitations of the formulae have been discussed. (author)

  8. Pipeline negotiations as a challenging setting for organised cultural encounters

    DEFF Research Database (Denmark)

    Guerrieri, Valeria

    has linked together countries, cultures, identities, ultimately challenging, reorganizing and renegotiating them. Starting from these premises, the following paper intends to show how Canadian Mackenzie Valley represents a unique contact zone for the development of cultural encounters, where different...... with often competing interests and positions - the practice of public hearings can be approached as a form of organized cultural encounter, whose “implied purposes” are to deal with more or less substantial cultural differences and to provide a wider cultural understanding of each different position. Through......Within the context of resource extraction, cultural encounters have been historically performed in the way of more or less antagonistic social interactions, ranging from outright domination to more empowerment-oriented relations. Throughout the last decades, the building of pipelines in particular...

  9. Encounters of The Solar System With Molecular Clouds

    International Nuclear Information System (INIS)

    Wickramasinghe, J. T.

    2008-01-01

    The solar system has penetrated about 5 -- 10 giant molecular clouds over its history, and passes within 5 parsecs of a star-forming nebula every 100 million years or so. Numerical simulations of the effect of such encounters in perturbing the Oort cloud of comets are carried out using standard n-body computational techniques. It is found that the ingress of comets into the inner planetary system during such encounters amounts to factors of ∼100 over the average. During an encounter the impact rate of comets onto Earth increases by a comparable factor. The of ages of impact craters on the Earth is shown to be consistent with predictions from the model

  10. Value Encounters - Modeling and Analyzing Co-creation of Value

    Science.gov (United States)

    Weigand, Hans

    Recent marketing and management literature has introduced the concept of co-creation of value. Current value modeling approaches such as e3-value focus on the exchange of value rather than co-creation. In this paper, an extension to e3-value is proposed in the form of a “value encounter”. Value encounters are defined as interaction spaces where a group of actors meet and derive value by each one bringing in some of its own resources. They can be analyzed from multiple strategic perspectives, including knowledge management, social network management and operational management. Value encounter modeling can be instrumental in the context of service analysis and design.

  11. Ulysses at jupiter: an overview of the encounter.

    Science.gov (United States)

    Smith, E J; Wenzel, K P; Page, D E

    1992-09-11

    In February 1992, the Ulysses spacecraft flew through the giant magnetosphere of Jupiter. The primary objective of the encounter was to use the gravity field of Jupiter to redirect the spacecraft to the sun's polar regions, which will now be traversed in 1994 and 1995. However, the Ulysses scientific investigations were well suited to observations of the Jovian magnetosphere, and the encounter has resulted in a major contribution to our understanding of this complex and dynamic plasma environment. Among the more exciting results are (i) possible entry into the polar cap, (ii) the identification of magnetospheric ions originating from Jupiter's ionosphere, lo, and the solar wind, (iii) observation of longitudinal asymmetries in density and discrete wave-emitting regions of the lo plasma torus, (iv) the presence of counter-streaming ions and electrons, field-aligned currents, and energetic electron and radio bursts in the dusk sector on high-latitude magnetic field lines, and (v) the identification of the direction of the magnetic field in the dusk sector, which is indicative of tailward convection. This overview serves as an introduction to the accompanying reports that present the preliminary scientific findings. Aspects of the encounter that are common to all of the investigations, such as spacecraft capabilities, the flight path past Jupiter, and unique aspects of the encounter, are presented herein.

  12. Pet ownership increases human risk of encountering ticks.

    Science.gov (United States)

    Jones, E H; Hinckley, A F; Hook, S A; Meek, J I; Backenson, B; Kugeler, K J; Feldman, K A

    2018-02-01

    We examined whether pet ownership increased the risk for tick encounters and tickborne disease among residents of three Lyme disease-endemic states as a nested cohort within a randomized controlled trial. Information about pet ownership, use of tick control for pets, property characteristics, tick encounters and human tickborne disease were captured through surveys, and associations were assessed using univariate and multivariable analyses. Pet-owning households had 1.83 times the risk (95% CI = 1.53, 2.20) of finding ticks crawling on and 1.49 times the risk (95% CI = 1.20, 1.84) of finding ticks attached to household members compared to households without pets. This large evaluation of pet ownership, human tick encounters and tickborne diseases shows that pet owners, whether of cats or dogs, are at increased risk of encountering ticks and suggests that pet owners are at an increased risk of developing tickborne disease. Pet owners should be made aware of this risk and be reminded to conduct daily tick checks of all household members, including the pets, and to consult their veterinarian regarding effective tick control products. © 2017 Blackwell Verlag GmbH.

  13. Dyadic Interactions in Service Encounter: Bayesian SEM Approach

    Science.gov (United States)

    Sagan, Adam; Kowalska-Musiał, Magdalena

    Dyadic interactions are an important aspects in service encounters. They may be observed in B2B distribution channels, professional services, buying centers, family decision making or WOM communications. The networks consist of dyadic bonds that form dense but weak ties among the actors.

  14. Unethical Behaviours Preservice Teachers Encounter on Social Networks

    Science.gov (United States)

    Deveci Topal, Arzu; Kolburan Gecer, Aynur

    2015-01-01

    The development of web 2.0 technology has resulted in an increase in internet sharing. The scope of this study is social networking, which is one of the web 2.0 tools most heavily used by internet users. In this paper, the unethical behaviours that preservice teachers encounter on social networks and the ways to deal with these problems are…

  15. Littoral Encounters : The Shore as Cultural Interface in King Horn

    NARCIS (Netherlands)

    Sobecki, Sebastian

    2006-01-01

    1. III * Later Medieval: Excluding Chaucer -- Brown et al., 10.1093 ... ... between the Saracens and the londisse men allied to the protagonist (' Littoral Encounters: the Shore as Cultural Interface in King Horn', Al-Mas a ... www.ywes.oxfordjournals.org/cgi/content/full/man0092 2.Murray, Alan V.

  16. Exploring Festival Performance as a State of Encounter

    Science.gov (United States)

    O’Grady, Alice; Kill, Rebekka

    2013-01-01

    This article outlines the activities of the research network "Festival Performance as a State of Encounter", which was funded by the Arts and Humanities Research Council as part of the Beyond Text strategic programme. The network was formulated in 2008, and a range of different events were organized over the course of two years to…

  17. Fabricated Childhoods: Uncanny Encounters with the More-than-Human

    Science.gov (United States)

    Blaise, Mindy

    2016-01-01

    This article is based on uncanny encounters with Julia deVille's exhibit, "Phantasmagoria". Inspired by Deleuzian-informed research practices, the author experiments with provoking practices to defy dominant developmental notions of childhood. This article reworks a humanist ontology by bringing together the discursive, the material, the…

  18. Neuropeptides and social behavior of rats tested in dyadic encounters

    NARCIS (Netherlands)

    Niesink, R.J.M.; Ree, J.M. van

    1984-01-01

    The effects of various neuropeptides on social behavior was studied in a test procedure in which 7-day isolated animals were tested together with non-isolated partners in dyadic encounters. The short-term isolation procedure increased the frequency and duration of social activities of the rats, but

  19. Effect of Concentrated Language Encounter Method in Developing ...

    African Journals Online (AJOL)

    The paper examined the effect of concentrated language encounter method in developing sight word recognition skill in primary school pupils in cross river state. The purpose of the study was to find out the effect of Primary One pupils' reading level, English sight word recognition skill. It also examine the extent to which the ...

  20. Room with a View: Ethical Encounters in Room 13

    Science.gov (United States)

    Grube, Vicky

    2012-01-01

    In this article, the author describes ethical encounters in Room 13, a schoolroom where children made what they wanted, posed their own questions, and ran an art room like a small business. In Room 13 children had the responsibility to maintain all aspects of the art studio. Specific decisions fell to an annually elected management team, a small…

  1. Live Aircraft Encounter Visualization at FutureFlight Central

    Science.gov (United States)

    Murphy, James R.; Chinn, Fay; Monheim, Spencer; Otto, Neil; Kato, Kenji; Archdeacon, John

    2018-01-01

    Researchers at the National Aeronautics and Space Administration (NASA) have developed an aircraft data streaming capability that can be used to visualize live aircraft in near real-time. During a joint Federal Aviation Administration (FAA)/NASA Airborne Collision Avoidance System flight series, test sorties between unmanned aircraft and manned intruder aircraft were shown in real-time at NASA Ames' FutureFlight Central tower facility as a virtual representation of the encounter. This capability leveraged existing live surveillance, video, and audio data streams distributed through a Live, Virtual, Constructive test environment, then depicted the encounter from the point of view of any aircraft in the system showing the proximity of the other aircraft. For the demonstration, position report data were sent to the ground from on-board sensors on the unmanned aircraft. The point of view can be change dynamically, allowing encounters from all angles to be observed. Visualizing the encounters in real-time provides a safe and effective method for observation of live flight testing and a strong alternative to travel to the remote test range.

  2. Difficulties Encountered by Academicians in Academic Research Processes in Universities

    Science.gov (United States)

    Yalçin, Sinan; Altun Yalçin, Sema

    2017-01-01

    This present research, aimed to determine the occasions, which the academicians encountered during the academic research process and how these affect the research process, was prepared as a case study pattern among the qualitative research methods. 34 academicians, who were working in a university in Turkey, participated in the research. The data…

  3. Encountering Gender in Student Life at UDSM: Chrester Tells Her ...

    African Journals Online (AJOL)

    The article tells the life history of a young female student, Chrester, as she enjoyed her life while encountering gender contradictions throughout her student life during 1970s, 1980s, 1990s and 2000s at the University of Dar es Salaam. The narration covers the age of naiveté as well as her mature age as a senior student.

  4. Challenges teachers encounter in teaching English reading to the ...

    African Journals Online (AJOL)

    This study is a descriptive survey designed to investigate challenges teachers encounter in teaching English reading in the uThungulu District schools in the province of KwaZulu Natal. This study comprised ... Data were analysed using Statistical Package for Social Sciences (SPSS) version 24, resulting in descriptive data.

  5. Grassroots Leadership: Encounters with Power Dynamics and Oppression

    Science.gov (United States)

    Kezar, Adrianna

    2011-01-01

    This article focuses on the nature of power dynamics that faculty and staff grassroots leaders encounter as they attempt to create change. I identified five distinctive types of power dynamics--"oppression," "silencing," "controlling," "inertia," and "micro-aggressions" from the most overt to more subtle and covert forms. Staff experience multiple…

  6. Challenges Encountered in the Compilation of an Advanced Shona ...

    African Journals Online (AJOL)

    turvitenskap, Seksjon for Leksikografi, Oslo, Norway. Abstract: This paper highlights the challenges encountered by the African Languages Lexical ... looks at: (a) the limitations of the current Shona orthography, the selection and codification of ... that were suggested, without getting too deeply involved in theoretical issues.

  7. Reconsidering Children's Encounters with Nature and Place Using Posthumanism

    Science.gov (United States)

    Malone, Karen

    2016-01-01

    This article explores and reconsiders the view of children's encounters with place as central to a place-based pedagogy that seeks to dismantle rather than support constructions of a nature-culture binary. I unpack the current fervour for reinserting the child in nature and nature-based education as a significant phenomenon in environmental and…

  8. Preg-robbing of Gold by Carbonaceous Materials Encountered in ...

    African Journals Online (AJOL)

    Processing of gold from refractory ores containing carbonaceous materials (CM) poses challenges due to the ability of the CM to preg-rob dissolved gold. Depending on the type and maturity of CM encountered, preg-robbing of aurocyanide ion can lead to reduction in gold recovery ranging from a few percentages to more ...

  9. Very massive runaway stars from three-body encounters

    Science.gov (United States)

    Gvaramadze, Vasilii V.; Gualandris, Alessia

    2011-01-01

    Very massive stars preferentially reside in the cores of their parent clusters and form binary or multiple systems. We study the role of tight very massive binaries in the origin of the field population of very massive stars. We performed numerical simulations of dynamical encounters between single (massive) stars and a very massive binary with parameters similar to those of the most massive known Galactic binaries, WR 20a and NGC 3603-A1. We found that these three-body encounters could be responsible for the origin of high peculiar velocities (≥70 km s-1) observed for some very massive (≥60-70 M⊙) runaway stars in the Milky Way and the Large Magellanic Cloud (e.g. λ Cep, BD+43°3654, Sk -67°22, BI 237, 30 Dor 016), which can hardly be explained within the framework of the binary-supernova scenario. The production of high-velocity massive stars via three-body encounters is accompanied by the recoil of the binary in the opposite direction to the ejected star. We show that the relative position of the very massive binary R145 and the runaway early B-type star Sk-69°206 on the sky is consistent with the possibility that both objects were ejected from the central cluster, R136, of the star-forming region 30 Doradus via the same dynamical event - a three-body encounter.

  10. Stress Coping Techniques For Female Doctors Encountering Sexual ...

    African Journals Online (AJOL)

    ... Muslim and Christian female doctors encounter with sexual harassment. It was also found that sexual harassment cut across all age groups. The findings of these study indicated that stress coping techniques is an effective method in the reduction of stress posed by sexual harassment on female doctors from their patients.

  11. 'Shakespeare in the bush' and encountering the other in the ...

    African Journals Online (AJOL)

    'Shakespeare in the bush' and encountering the other in the hermeneutical dialectic of belonging and distanciation 'Shakespeare in the Bush' is an account of an anthropologist's hermeneutical experience among the Tiv people of Nigeria that serves as an illustration o f a hermeneutical circle which results in transforming ...

  12. Cross-cultural care encounters in paediatric care: minority ethnic parents' experiences.

    Science.gov (United States)

    Tavallali, Azar Gashasb; Jirwe, Maria; Kabir, Zarina Nahar

    2017-03-01

    Because of worldwide migration, the healthcare staff in general as well as in paedi"atric care specifically is challenged increasingly by people from various ethnic backgrounds. The challenge is related to providing culturally competent care and effectively communicating with people from diverse cultural and ethnic backgrounds who have different health beliefs, practices, values and languages. This also applies to the Swedish society and to Swedish paediatric care. The purpose of this study was to describe the expectations and experiences of cross-cultural care encounters among minority ethnic parents in Swedish paediatric care. A qualitative design was used in the study. Data were collected using semi-structured interviews between October 2011 and March 2012. The sample consisted of 12 parents of minority ethnic backgrounds who had their child in a ward at a children's hospital in the Stockholm County Council. The interviews were analysed using manifest content analysis. The Regional Ethical Review Committee approved the study (Ref: Nr: 2011/927-31/5). The analysis of the interviews led to three categories: fundamentals in nursing, cultural sensitivity and understanding, and influencing conditions. Generic knowledge and skills of nurses outweighed the need for the nurses to have culture-specific knowledge of their patients or relatives in cross-cultural care encounters. Language skills and the availability of bilingual nurses in a multi-ethnic society can facilitate communication and increase parents' satisfaction in cross-cultural care encounters. © 2016 Nordic College of Caring Science.

  13. An expression of love--midwives' experiences in the encounter with lesbian women and their partners.

    Science.gov (United States)

    Spidsberg, Bente Dahl; Sørlie, Venke

    2012-04-01

    This paper is a report of a descriptive study of midwives' lived experiences of caring for lesbian women and their partners. A growing body of qualitative studies describes lesbian women's experiences of maternity care. Studies about midwives' caring experiences in the encounter are needed to improve care for lesbian women and their partners. A qualitative study, using a phenomenological-hermeneutical method influenced by Ricoeur was conducted. Eleven midwives were recruited by snowball method. Interviews were conducted in 2009 and participants were encouraged to share events in their midwifery practice encountering lesbian women. The midwives described the lesbian love-relationship as strong and caring, but including elements of difference which could make the couple vulnerable. It was important for midwives to acknowledge their own attitudes and culturally sensitive non-verbal communication; also to consider the co-mother's needs and role as different compared with those of fathers. Although caring for lesbian couples was seen as unproblematic, midwives described experiences of ambivalence or anxiety in the encounter and they had noticed that some couples had had negative experiences with maternity care. Studies are required to map content, consequences and coping strategies regarding the ambivalent or uncertain caring situations and to assess a co-mother's particular role and needs during pregnancy, labour and the postnatal period to provide tailored care for lesbian couples. © 2011 Blackwell Publishing Ltd.

  14. Athletic Training Student Core Competency Implementation During Patient Encounters.

    Science.gov (United States)

    Cavallario, Julie M; Van Lunen, Bonnie L; Hoch, Johanna M; Hoch, Matthew; Manspeaker, Sarah A; Pribesh, Shana L

    2018-03-01

      Health care research evidence suggests that early patient encounters (PEs), as well as the purposeful implementation of professional core competencies (CCs), for athletic training students (ATSs) may be beneficial to their ability to provide care. However, no investigators have related facets of the clinical education experience with CC implementation as a form of summative assessment of the clinical experience.   To determine the relationship between the frequency and length of PEs, as well as the student's role and clinical site during PEs, and the students' perceived CC implementation during these encounters.   Cross-sectional study.   Professional athletic training program, National Collegiate Athletic Association Division I institution.   We purposefully recruited 1 athletic training program that used E*Value software; 40 participants (31 females, 9 males) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated.   Participants viewed a 20-minute recorded CC educational module followed by educational handouts, which were also posted online for reference throughout the semester. The E*Value software was used to track PEs, including the type of encounter (ie, actual patient, practice encounter, didactic practice scenario), the type of site where the encounter occurred (university, high school), and the participant's role (observed, assisted, performed), as well as responses to an added block of questions indicating which, if any, of the CCs were implemented during the PE.   Variables per patient were PE length (minutes), participant role, site at which the encounter occurred, and whether any of the 6 CCs were implemented ( yes/ no). Variables per participant were average encounter length (minutes), encounter frequency, modal role, clinical site assignment, and the number of times each CC was implemented. Separate 1-way analyses of variance were used to examine the relationships between role or clinical site

  15. Promoting and supporting self-management for adults living in the community with physical chronic illness: A systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter.

    Science.gov (United States)

    Rees, Sally; Williams, Anne

    example, people with diabetes, asthma, arthritis, coronary disease, lung disease, heart failure, epilepsy, kidney disease and inflammatory bowel disease. Since patients meet various professionals in a variety of community settings regarding their care, a practitioner in this review included doctors (physicians and General Practitioners), nurses, nurse specialists, dieticians, podiatrists and community health workers.A variety of outcomes measures was used to evaluate effective self-care management. These included physiological measurements such as: HbA1c, blood pressure, body weight, lipids; lifestyle measurements, for example physical activity; and self-care determinants such as knowledge, attitude; and self-care behaviours regarding, for example, diet and physical exercise, and medication. The outcome measures used to explore the meaningfulness of the patient-practitioner encounter, concerned patients', physicians' and nurses' views and perceptions of self-care management and support.The review considered all types of quantitative and qualitative evidence regarding the patient-practitioner encounter where self-care in chronic illness was the focus. The quantitative studies reviewed included systematic reviews, randomised controlled trials (RCTs), quasi-experimental studies, and survey studies.Qualitative studies reviewed included interview designs, vignette technique, qualitative evaluation, grounded theory, and exploratory descriptive design. The search sought to find both published and unpublished studies between 1990 and 2005. The year 1990 was deemed appropriate since it precedes the development of the Chronic Care Model in which self-management support for people living with chronic illness is heralded as an important part of care-management. An initial search of CINAHL and MEDLINE databases was undertaken to identify appropriate search terms regarding self-care and chronic illness. A search strategy was then developed using all identified MeSH headings and key

  16. Analysis of the relationships among perceived service encounter quality, service value, satisfaction and behavioral intention for physical therapy patients.

    Science.gov (United States)

    Ko, Min-Seok; Lee, Won-Hwee

    2017-11-01

    [Purpose] The purpose of this study was to investigate the relationships among perceived service encounter quality, service value, patient satisfaction, and behavioral intention in physical therapy patients. [Subjects and Methods] This study surveyed 335 patients who received physical therapy treatment at five medical institutions in Jeonju-si, Republic of Korea. This study conducted path analysis on the collected data using Smart PLS 2.0 M3. [Results] The analysis of this study showed that service encounter quality had significantly positive relationship with service value, patient satisfaction, and behavioral intention. Service value had significantly positive relationship with patient satisfaction and behavioral intention. Patient satisfaction had significantly positive relationship with behavioral intention. [Conclusion] Improving the perceived quality of service encounters for physical therapy patients increases service value and patient satisfaction, and positively influences behavioral intention.

  17. Patients' experiences of healthcare encounters in severe irritable bowel syndrome: an analysis based on narrative and feminist theory.

    Science.gov (United States)

    Björkman, Ida; Simrén, Magnus; Ringström, Gisela; Jakobsson Ung, Eva

    2016-10-01

    This study aimed to explore patients' experiences of healthcare encounters in severe irritable bowel syndrome. Irritable bowel syndrome is a common functional disorder with symptoms such as abdominal pain and disturbed bowel habits, the cause of which is not completely known. Treatments options are limited, and healthcare encounters in irritable bowel syndrome have been described as unsatisfying and frustrating for both patients and professional healthcare providers. Furthermore, the influence of power on healthcare encounters has long been recognised, especially regarding the disadvantaged position of those suffering from functional illness which cannot be identified by commonly used tests or investigations. We interviewed 10 patients during 2014, all attending an outpatient clinic and suffering from severe irritable bowel syndrome. Relying on narrative and feminist theory, we explored how they actively negotiate professional discourse communicated to them in the clinical encounter. The patients' experiences of healthcare encounters in irritable bowel syndrome were mostly described as negative, and often induced feelings of confusion and self-doubt. Positive encounters were described as being listened to, believed and taken seriously. Narrators found it especially problematic when healthcare professionals described irritable bowel syndrome as a minor disorder with primarily stress or psychological aetiology and put the responsibility for recovery onto the patient. Patients' actively negotiated such professional discourse by presenting a counternarrative describing their own suffering and strengths, experienced healthcare shortcomings and possible organic aetiology of irritable bowel syndrome. Patients suffering from severe irritable bowel syndrome described how they often felt a need to protect their positive identities in the face of trivialisation and disbelief by healthcare professionals. A deepened understanding of patients' experiences of healthcare

  18. The Tourism Encounter in Community-Based Tourism in Northern Thailand: Empty Meeting Ground or Space for Change?

    Directory of Open Access Journals (Sweden)

    Claudia Dolezal

    2015-12-01

    Full Text Available This article offers a contribution to the anthropology of tourism by investigating the tourism encounter in community-based tourism (CBT in Northern Thailand. It does so by discussing MacCannell’s (1992 idea of the Empty Meeting Grounds and Said’s Orientalism (1978, two works that contributed to research on power inequalities between tourists and residents in the developing world. By establishing a relationship between the two and embedding these in the wider literature on the tourism encounter, this article suggests moving away from binaries towards understanding the space of the tourism encounter and its potential for change. Building on empirical research conducted in Ban Mae Kampong, a CBT village in Northern Thailand, findings suggest that CBT shows signs of resident-host interactions that are based on understanding and learning rather than exploitation. While also in CBT friendships and meaning take time to emerge and the ‘Other’ is used as attraction, villagers’ agency and control over tourism are acknowledged. This paper therefore calls for a revisiting of the theoretical grounding that influences our understanding of the tourism encounter and argues for an investigation of community power relations in connection to the tourism encounter and its potential for residents’ empowerment in CBT.

  19. Formation of massive clouds and dwarf galaxies during tidal encounters

    Science.gov (United States)

    Kaufman, Michele; Elmegreen, Bruce G.; Thomasson, Magnus; Elmegreen, Debra M.

    1993-01-01

    Gerola et al. (1983) propose that isolated dwarf galaxies can form during galaxy interactions. As evidence of this process, Mirabel et al. (1991) find 10(exp 9) solar mass clouds and star formation complexes at the outer ends of the tidal arms in the Antennae and Superantennae galaxies. We describe observations of HI clouds with mass greater than 10(exp 8) solar mass in the interacting galaxy pair IC 2163/NGC 2207. This pair is important because we believe it represents an early stage in the formation of giant clouds during an encounter. We use a gravitational instability model to explain why the observed clouds are so massive and discuss a two-dimensional N-body simulation of an encounter that produces giant clouds.

  20. Estimating the encounter rate variance in distance sampling

    Science.gov (United States)

    Fewster, R.M.; Buckland, S.T.; Burnham, K.P.; Borchers, D.L.; Jupp, P.E.; Laake, J.L.; Thomas, L.

    2009-01-01

    The dominant source of variance in line transect sampling is usually the encounter rate variance. Systematic survey designs are often used to reduce the true variability among different realizations of the design, but estimating the variance is difficult and estimators typically approximate the variance by treating the design as a simple random sample of lines. We explore the properties of different encounter rate variance estimators under random and systematic designs. We show that a design-based variance estimator improves upon the model-based estimator of Buckland et al. (2001, Introduction to Distance Sampling. Oxford: Oxford University Press, p. 79) when transects are positioned at random. However, if populations exhibit strong spatial trends, both estimators can have substantial positive bias under systematic designs. We show that poststratification is effective in reducing this bias. ?? 2008, The International Biometric Society.

  1. Design of an operations manager selection system in service encounter

    Directory of Open Access Journals (Sweden)

    Tanawin Nunthaphanich

    2015-10-01

    Full Text Available The purpose of this study is to provide criteria for selecting operations managers at the ‘service encounter’ for mobile telecommunication companies, and develop a system for this multi-criteria decision-making scheme based on the Analytical Hierarchy Process (AHP. There are three main criteria for evaluating the capability of service-encounter operation managers: (1 the ability to design service process; (2 the ability to operate service process; (3 the ability to conduct improvement. The AHP operation manager selection tool was developed based on the complex problems at the service encounter. It was created as a decision support system which was used to recruit and evaluate operations managers’ capability for the purpose of career advancement.

  2. Choosing a language in international office service encounters

    DEFF Research Database (Denmark)

    Hazel, Spencer

    Choosing a language in international office service encounters – from multilingual miscellany to medium-of-interaction in a matter of seconds Spencer Hazel Roskilde University, Denmark In higher education settings characterized by increasing transnational student and staff mobility, members...... to a multimodal interaction analysis following the ethnomethodological tradition of Conversation Analysis. Gafaranga, J. (2000). Medium repair vs. other-language repair: Telling the medium of a bilingual conversation. International Journal of Bilingualism, 4(3), 327-350. Hall, J. K., Hellermann, J., & Pekarek...... Preisler (eds.) Language alternation, language choice and language encounter in international education. Dordrecht: Springer Preisler, Bent, Ida Klitgård, and Anne H. Fabricius. (2011). Language and learning in the international university: from English uniformity to diversity and hybridity. Bristol...

  3. Beyond cultural competency: Bourdieu, patients and clinical encounters.

    Science.gov (United States)

    Lo, Ming-Cheng M; Stacey, Clare L

    2008-07-01

    In response to widely documented racial and ethnic disparities in health, clinicians and public health advocates have taken great strides to implement 'culturally competent' care. While laudable, this important policy and intellectual endeavour has suffered from a lack of conceptual clarity and rigour. This paper develops a more careful conceptual model for understanding the role of culture in the clinical encounter, paying particular attention to the relationship between culture, contexts and social structures. Linking Bourdieu's (1977) notion of 'habitus' and William Sewell's (1992) axioms of multiple and intersecting structures, we theorise patient culture in terms of 'hybrid habitus'. This conceptualisation of patient culture highlights three analytical dimensions: the multiplicity of schemas and resources available to patients, their specific patterns of integration and application in specific contexts, and the constitutive role of clinical encounters. The paper concludes with a discussion of directions for future research as well as reforms of cultural competency training courses.

  4. Challenges encountered during postgraduate program in orthodontics: An online survey

    Directory of Open Access Journals (Sweden)

    Amanish Singh Shinh

    2017-01-01

    Full Text Available Introduction: Orthodontics and Dentofacial Orthopedics requires profound and disciplined training over a considerable period. Given the rigorous nature of the program, it is but logical to assume that the students can encounter some difficulties during the course. The aim of the present study was to gather detailed first-hand information from the postgraduate students of all the practical challenges they encounter in academic programme of orthodontics in India. Materials and Methods: Utilizing a descriptive, cross-sectional survey, conducted through a web-based self-administered questionnaire, the sample population consisted of 799 orthodontic postgraduate students in India and 39 questions were put forward to them. Conclusion: Results showed that even while keeping the basics intact, every course should aim at inputs to help make the academic climate productive, less stressful and student-centric. Change in teaching technology, methodology and structure is needed in training our postgraduate students, to promote a more congenial academic climate.

  5. What Predicts Patients' Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship.

    Science.gov (United States)

    Roettl, Johanna; Bidmon, Sonja; Terlutter, Ralf

    2016-02-04

    treatment (B=.391, Pcommunication with the GP (B=.192, P=.001), highest education level (B=.178, Pcommunicate with the GP online more often in the future (B=.076, P=.03). Age, gender, and trust in the GP were not significant predictors for either willingness to undergo online treatment or to pay additionally for online treatment. Willingness to undergo online treatment was partly determined by the actual use of online communication with the GP, willingness to communicate online with the GP, health information-seeking personality, and social motivation for such behavior. Willingness to pay extra for online treatment was influenced by the monthly household net income category and education level. The results of this study are useful for online health care providers and physicians who are considering offering online treatments as a viable number of patients would appreciate the possibility of undergoing an online treatment offered by their GP.

  6. Physician Encounters with Human Trafficking: Legal Consequences and Ethical Considerations

    OpenAIRE

    Todres, Jonathan

    2017-01-01

    There is growing recognition and evidence that health care professionals regularly encounter - though they may not identify - victims of human trafficking in a variety of health care settings. Identifying and responding appropriately to trafficking victims or survivors requires not only training in trauma-informed care but also consideration of the legal and ethical issues that arise when serving this vulnerable population. This essay examines three areas of law that are relevant to this case...

  7. Ecopoetic Encounters: Amnesia and Nostalgia in Alexis Wright's Environmental Fiction

    OpenAIRE

    Barras Arnaud

    2015-01-01

    In Carpentaria (2006) and The Swan Book (2013), Alexis Wright establishes an allegorical mode where she reimagines Europeans' first encounters with Australia from an Aboriginal environmental perspective. In this narrative system, the discovery of Australia is not realised by exploring colonisers, but by vulnerable strangers who apprehend the continent both experientially and linguistically. In Carpentaria, the Stranger-figure of Elias Smith is left amnesic after surviving a shipwreck during a...

  8. Elucidating Dynamical Processes Relevant to Flow Encountering Abrupt Topography (FLEAT)

    Science.gov (United States)

    2015-09-30

    Encountering Abrupt Topography (FLEAT) Bo Qiu Dept of Oceanography, University of Hawaii at Manoa 1000 Pope Rd. Honolulu, HI 96822 phone: (808) 956...c) to explore relevant dynamics by using both simplified models and OGCM output with realistic topography and surface boundary conditions...scale abyssal circulation, we propose to use the Hallberg Isopycnal Model (HIM). The HIM allows sloping isopycnals to interact with bottom topography

  9. Strengthening student communication through pediatric simulated patient encounters

    Directory of Open Access Journals (Sweden)

    Ryan Whitt

    2014-08-01

    Full Text Available As medical students enter the role of physician, clinical outcomes not only rely on their mastery of clinical knowledge, but also on the effectiveness in which they can communicate with patients and family members. While students typically have numerous opportunities to practice clinical communication with adult patients, such practice in pediatric settings is limited. This study examines if simulated patient (SP encounters strengthen third-year medical students’ communication skills during the pediatrics clerkship. During 2011-2013, three SP encounters (comprising 3 pediatric scenarios were incorporated into a pediatrics clerkship at one United States medical school to give students a safe venue to practice advanced communication with observation and direct feedback. Third-year medical students engaged in the scenarios and received both written and oral feedback from an evaluator observing the encounter. With IRB approval, students’ self-perceived confidence and abilities at performing the advanced communication skills were measured using an eightitem, Likert scale questionnaire administered pre and post the SP encounter. Pre- and post-questionnaires (n = 215; response rate, 96% analyzed using a Wilcoxon-matched pairs signed-rank test demonstrated statistically significant increases in students’ perception of their confidence and abilities regarding their performance (P < 0.05; Bonferroni correction, P < 0.006. There was an increases in student confidence and self-perceived ability in: first, communicating with children and family members of young patients; second, managing confrontational situations involving parents; third, performing a thorough psychosocial history with an adolescent; and fourth, using Evidence Based Medicine to motivate parents.

  10. Proton therapy in ophthalmology: status report and problems encountered

    International Nuclear Information System (INIS)

    Chauvel, P.; Iborra-Brassart, N.; Courdi, A.; Herault, J.; Teissier, E.; Pignol, J.P.; Bondiau, P.Y.

    1996-01-01

    The proton therapy facility of the Centre Antoine-Lacassagne in Nice began of ocular tumors in June 1991. Up to October 1995, a total number of 600 patients were treated. An overview of the cases treated during the first 4 years of activity is given and the main problems encountered in the field, possibly interacting with the accuracy and reliability of the dose distribution, are listed. (author)

  11. Hotspots on Io During the Ganymede 2 Encounter

    Science.gov (United States)

    1996-01-01

    The Near Infrared Mapping Spectrometer (NIMS) on the Galileo spacecraft imaged Io at high spectral resolution at a range of 439,000 km (275,000 miles) during the G2 encounter on 6 September 1996. This image shows, on the right, Io as seen by NIMS, centered on 150 W longitude. The image on the left shows the same view point from Voyager data (from the encounters in 1979 and 1980). The NIMS image can be compared to the NIMS hotspot image from the G1 orbit (June 1996) to monitor changes on Io. The most dramatic feature of the G2 image is the hotspot at Malik Patera. Preliminary analysis of the data yields a temperature of at least 1000 K (727 C) for this hotspot, an increase of more than 300 K from the G1 encounter. In the overlap area of the G1 and G2 images all the hotspots seen during the G1 encounter are also seen in the G2 image. Other hotspots were seen, including one at the Pele plume origin site. This image is at the 4 micron band to best view the Malik hotspot. Most of the other hotspots are best seen at longer wavelengths. NIMS is continuing to observe Io to monitor volcanic activity throughout the Galileo mission.The Jet Propulsion Laboratory, Pasadena, CA manages the mission for NASA's Office of Space Science, Washington, DC.This image and other images and data received from Galileo are posted on the World Wide Web, on the Galileo mission home page at URL http://galileo.jpl.nasa.gov.

  12. Scientific misconduct encountered by APAME journals: an online survey.

    Science.gov (United States)

    Looi, Lai-Meng; Wong, Li Xuan; Koh, Cing Chai

    2015-12-01

    In June 2015, invitations were sent by email to 151 APAME journals to participate in an online survey with an objective of gaining insight into the common publication misconduct encountered by APAME editors. The survey, conducted through SurveyMonkey over a 20-day-period, comprised 10 questions with expansions to allow anecdotes limited to 400 characters, estimated to take less than 10 minutes to complete. Only one invitation was issued per journal, targeting (in order of priority) editors, editorial board members and editorial staff, and limited by email availability. 54 (36%) journals responded. 98% of respondents held Editor or Editorial Board positions. All respondent journals have editorial policies on publication ethics and 96% provide instructions related to ethics. 45% use anti-plagiarism software to screen manuscripts, the most popular being iThenticate, CrossCheck and Turnitin. Up to 50% of journals had encountered studies without IRB approval. Author misconduct encountered were (in rank order): plagiarism (75%), duplicate publication (58%), unjustified authorship (39%), authorship disputes (33%), data falsification (29%), data/image manipulation (27%), conflict of interest (25%), copyright violation (17%) and breach of confidentiality (10%). Reviewer misconduct encountered were: conflict of interest (19%), plagiarism (17%), obstructive behavior (17%), abusive language (13%) and breach of confidentiality (13%). Notwithstanding the limitations of the survey and the response rate, a few insights have been gained: (1) the need for strengthening the ethical culture of researchers/authors and reviewers, (2) anti-plagiarism software can improve plagiarism detection by about 15%, and (3) the need for technical support to detect plagiarism, duplicate publication and image manipulation.

  13. Giant left atrium encountered during right-sided thoracentesis

    Directory of Open Access Journals (Sweden)

    Rashmi Advani

    Full Text Available Giant left atrium is an uncommon pathology to encounter during bedside chest ultrasound, but is an important structure to be aware of when considering thoracentesis. This cardiac structure could easily be mistaken for loculated pleural fluid. This case also supports growing evidence that expert users can safely perform thoracentesis without completely reversing therapeutic anticoagulation. Keywords: Giant left atrium, Thoracentesis, Rheumatic heart disease, Ultrasound

  14. VERSIONS VERSUS BODIES: TRANSLATIONS IN THE MISSIONARY ENCOUNTER IN AMAZONIA

    OpenAIRE

    Vilaça, Aparecida

    2016-01-01

    Abstract This paper analyzes the two distinct concepts of translation at work in the encounter between the Amazonian Wari' and the New Tribes Mission evangelical missionaries, and the equivocations stemming from this difference. While the missionaries conceive translation as a process of converting meanings between languages, conceived as linguistic codes that exist independently of culture, for the Wari', in consonance with their perspectivist ontology, it is not language that differentiates...

  15. Effects of Soundscapes on Perceived Crowding and Encounter Norms

    Science.gov (United States)

    Kim, Sang-Oh; Shelby, Bo

    2011-07-01

    Soundscapes in recreation settings are becoming an important issue, but there are few studies of the effects of sounds on recreation experiences, especially crowding perceptions and encounter norms. This study compared effects of six types of sounds (an airplane, a truck engine, children playing, birds, water, and a control) on perceived crowding (PC) and encounter norms for hikers. Data were collected from 47 college students through lab experiments using simulated images, with moving hikers inserted in the original photo taken in the Jungmeori area of Mudeungsan Provincial Park in Korea. Overall, the motor-made sounds of the airplane and truck engine increased PC and decreased acceptability ratings, and the natural sounds of birds and water decreased PC and increased acceptability ratings. Ratings of the sound of children playing were similar to those in the control (i.e., no sound). In addition, as numbers of hikers increased, the overall effects of sounds decreased, and there were few significant differences in PC or acceptability ratings at the highest encounter levels. Theoretical and methodological implications are discussed.

  16. The Reality of Encounters with Local Life in Other Cultures

    Directory of Open Access Journals (Sweden)

    Jin-Young Kim

    2017-12-01

    Full Text Available Equipped with mobile technologies, travelers increasingly seek opportunities to encounter the real lives of the people residing in the focal destination. With this trend of pursuing local life experience, this study investigated how international visitors recognize the lives of people in the focal destination, and whether this recognition is related to satisfaction. Reviews for Teheran’s Grand Bazaar from an online review site, Tripadvisor.com, showed that visitors’ local encounters were linked with favorable emotions (good, interesting, and worthwhile. To lend support to the contact hypothesis, which posits that intercultural experiences can lead to more favorable evaluations of the host community; the visitors who recognized direct and indirect encounters with local life indicated higher satisfaction. Even if brief, the experience of local life appeared to create more intimate feelings for the focal destination. Interestingly, the number of past travel experiences, which was captured by the number of reviews written by the reviewer, was found to have a negative association with satisfaction. We draw further implications for the travelers as well as the local community.

  17. Encountering Anger in the Emergency Department: Identification, Evaluations and Responses of Staff Members to Anger Displays

    Directory of Open Access Journals (Sweden)

    Cheshin Arik

    2012-01-01

    Full Text Available Background. Anger manifestations in emergency departments (EDs occur daily, interrupting workflow and exposing staff to risk. Objectives. How staff assess and recognize patients’ angry outbursts in EDs and elucidate responses to anger expressions, while considering effects of institution guidelines. Methods. Observations of staff patient interaction in EDs and personal interviews of staff (n=38 were conducted. Two questionnaires were administered (n=80 & n=144. Assessment was based mainly on regression statistic tests. Results. Staff recognizes two types of anger displays. Magnitude of anger expressions were correlated with staff’s fear level. Staff’s responses ranged from ignoring incidents, giving in to patients’ requests or immediately calling security. When staff felt fear and became angry they tended to call security. Staff was more likely to ignore anger when incident responsibility was assigned to patients. Discussion. Anger encounters are differentiated according to intensity level, which influences interpretations and response. Organizational policy has an effect on staff’s response. Conclusions. Staff recognizes anger at varying levels and responds accordingly. The level of danger staff feels is a catalyst in giving in or calling security. Call security is influenced by fear, and anger. Permanent guidelines can help staff in responding to anger encounters.

  18. A Relação paciente-médico: para uma humanização da prática médica The patient-physician relationship: towards humanization of medical practice

    Directory of Open Access Journals (Sweden)

    Andrea Caprara

    1999-09-01

    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.

  19. Astrometry of 2014MU69 for New Horizons encounter

    Science.gov (United States)

    Buie, Marc

    2017-08-01

    We propose 12 orbits of time to make high-precision astrometric measurments of the New Horizons extendedmission target, (486958) 2014MU69. These observations are in direct support of the navigation of New Horizonsleading up to its encounter in Jan 2019. These visits represent an optimized plan for improved orbit estimates that willcomplete as the target becomes directly observable by New Horizons. This astrometry is a key element leadingup to a close investigation of a Cold-Classical Kuiper Belt Object, one of the most primitive members of our solarsystem.

  20. Doing Research in a Conflict Situation Encounters and Experiences

    Directory of Open Access Journals (Sweden)

    Suresh Dhakal

    2014-07-01

    Full Text Available Fieldwork, an anthropologist's vocation, is full of tensions and dilemmas. However, the experiences of any or all tensions, troubles and even failures are a 'source of ethnographic knowledge in themselves'. During the fieldwork for my PhD research, I encountered several such incidents, which have made my work more interesting and my experience richer. This article describes the situation of doing fieldwork in the conflict period, when the 'peace process' was not yet come to the conclusion.DOI: http://dx.doi.org/10.3126/dsaj.v8i0.10723Dhaulagiri Journal of Sociology and Anthropology Vol. 8, 2014; 87-98

  1. MMS Encounters with Reconnection Diffusion Regions in the Earth's Magnetotail

    Science.gov (United States)

    Torbert, R. B.; Burch, J. L.; Argall, M. R.; Farrugia, C. J.; Alm, L.; Dors, I.; Payne, D.; Rogers, A. J.; Strangeway, R. J.; Phan, T.; Ergun, R.; Goodrich, K.; Lindqvist, P. A.; Khotyaintsev, Y. V.; Giles, B. L.; Rager, A. C.; Gershman, D. J.; Kletzing, C.

    2017-12-01

    The Magnetospheric Multiscale (MMS) fleet of four spacecraft traversed the Earth's magnetotail in May through August of 2017 with an apogee of 25 Re, and encountered diffusion regions characteristic of symmetric reconnection. This presentation will describe in-situ measurements of large electric fields, strong electron cross-tail and Hall currents, and electron velocity distributions (frequently crescent-shaped) that are commonly observed in these regions. Positive electromagnetic energy conversion is also typical. The characteristics of symmetric reconnection observations will be contrasted with those of asymmetric reconnection that MMS observed previously at the dayside magnetopause.

  2. Trailing Vortex-Induced Loads During Close Encounters in Cruise

    Science.gov (United States)

    Mendenhall, Michael R.; Lesieutre, Daniel J; Kelly, Michael J.

    2015-01-01

    The trailing vortex induced aerodynamic loads on a Falcon 20G business jet flying in the wake of a DC-8 are predicted to provide a preflight estimate of safe trail distances during flight test measurements in the wake. Static and dynamic loads on the airframe flying in the near wake are shown at a matrix of locations, and the dynamic motion of the Falcon 20G during traverses of the DC-8 primary trailing vortex is simulated. Safe trailing distances for the test flights are determined, and optimum vortex traverse schemes are identified to moderate the motion of the trailing aircraft during close encounters with the vortex wake.

  3. The joy of discovery great encounters along the way

    CERN Document Server

    Thirring, Walter

    2011-01-01

    Walter Thirring is the last offspring of an Austrian family of scientists. In this moving narrative, he describes how he survived the Nazi occupation and became instrumental in reconstructing European science. Thirring is one of the last living physicists who worked on the greatest discoveries and with the greatest scientists of the 20th century. He recollects encounters with the old masters like Einstein, Schrodinger, Heisenberg, Pauli and others as well as his collaborations with the present stars like Murray Gell-Mann and Elliott Lieb. The book presents the challenges faced when one of the

  4. Challenges Encountered Using Ophthalmic Anesthetics in Space Medicine

    Science.gov (United States)

    Bayuse, T.; Law, J.; Alexander, D.; Moynihan, S.; LeBlanc, C.; Langford, K.; Magalhaes, L.

    2015-01-01

    On orbit, ophthalmic anesthetics are used for tonometry and off-nominal corneal examinations. Proparacaine has been flown traditionally. However, the manufacturers recently changed its storage requirements from room temperature storage to refrigerated storage to preserve stability and prolong the shelf-life. Since refrigeration on orbit is not readily available and there were stability concerns about flying proparacaine unrefrigerated, tetracaine was selected as an alternative ophthalmic anesthetic in 2013. We will discuss the challenges encountered flying and using these anesthetics on the International Space Station.

  5. Managing uncertainty: a grounded theory of stigma in transgender health care encounters.

    Science.gov (United States)

    Poteat, Tonia; German, Danielle; Kerrigan, Deanna

    2013-05-01

    A growing body of literature supports stigma and discrimination as fundamental causes of health disparities. Stigma and discrimination experienced by transgender people have been associated with increased risk for depression, suicide, and HIV. Transgender stigma and discrimination experienced in health care influence transgender people's health care access and utilization. Thus, understanding how stigma and discrimination manifest and function in health care encounters is critical to addressing health disparities for transgender people. A qualitative, grounded theory approach was taken to this study of stigma in health care interactions. Between January and July 2011, fifty-five transgender people and twelve medical providers participated in one-time in-depth interviews about stigma, discrimination, and health care interactions between providers and transgender patients. Due to the social and institutional stigma against transgender people, their care is excluded from medical training. Therefore, providers approach medical encounters with transgender patients with ambivalence and uncertainty. Transgender people anticipate that providers will not know how to meet their needs. This uncertainty and ambivalence in the medical encounter upsets the normal balance of power in provider-patient relationships. Interpersonal stigma functions to reinforce the power and authority of the medical provider during these interactions. Functional theories of stigma posit that we hold stigmatizing attitudes because they serve specific psychological functions. However, these theories ignore how hierarchies of power in social relationships serve to maintain and reinforce inequalities. The findings of this study suggest that interpersonal stigma also functions to reinforce medical power and authority in the face of provider uncertainty. Within functional theories of stigma, it is important to acknowledge the role of power and to understand how stigmatizing attitudes function to maintain

  6. Patient-physician communication regarding electronic cigarettes.

    Science.gov (United States)

    Steinberg, Michael B; Giovenco, Daniel P; Delnevo, Cristine D

    2015-01-01

    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.

  7. Encounters between degenerate stars and extrasolar comet clouds

    International Nuclear Information System (INIS)

    Pineault, S.; Poisson, E.

    1989-01-01

    Under the assumption that the presence of comet clouds around otherwise normal stars is a common occurrence in the Galaxy, the observational consequences of random penetration encounters between the general Galactic population of degenerate stars and these comet clouds is considered. The only case considered is where the compact stars is a single star. For this scenario, encounters involving neutron stars (NSs) result in impact rates 1000-10,000 times slower than in the model of Tremaine and Zytkow (1986). The rate for white dwarfs (WDs) is larger than the one for NSs by a factor of about 30 times the ratio of the degenerate star number densities. The mean impact rate is significantly increased if the number of comets in a cloud is nearly independent of the mass of the central star. It is concluded that some of the observed gamma-ray bursts may be caused by accretion of comets onto NSs and that this scenario, but with a WD as the accretor, probably contributes to the optical flash background rate. 38 refs

  8. The organisational stressors encountered by athletes with a disability.

    Science.gov (United States)

    Arnold, Rachel; Wagstaff, Christopher R D; Steadman, Lauren; Pratt, Yasmin

    2017-06-01

    Organisational stressors have been found to be prevalent and problematic for sport performers, with research identifying demographic differences in the stressors encountered. Nevertheless, extant sport psychology research on the topic of stress has generally focused on able-bodied athletes; whilst that which has been conducted on performers with a disability has typically recruited relatively small samples to explore a narrow selection of organisational stressors, or examined other components of the stress process. The purpose of the present study was to explore the various organisational stressors that athletes with a disability encounter. The sample comprised 18 elite athletes with a disability (10 male, 8 female) who had a classified disability and experience of competing at a major championships in their sport (e.g., Paralympic Games, World Championships). Participants took part in a semi-structured interview which was analysed by drawing from grounded theory procedures. A total of 316 organisational stressors were identified, which were abstracted into 31 concepts and four, previously conceptualised, exploratory schemes: leadership and personnel issues, cultural and team issues, logistical and environmental issues, and performance and personal issues. This study not only provides the first illustration of the prevalence of organisational stressors for athletes with a disability, but also significantly points to salient similarities and distinct differences between the stress experiences of performers with and without a disability.

  9. EJECTION AND CAPTURE DYNAMICS IN RESTRICTED THREE-BODY ENCOUNTERS

    International Nuclear Information System (INIS)

    Kobayashi, Shiho; Hainick, Yanir; Sari, Re'em; Rossi, Elena M.

    2012-01-01

    We study the tidal disruption of binaries by a massive point mass (e.g., the black hole at the Galactic center), and we discuss how the ejection and capture preference between unequal-mass binary members depends on which orbit they approach the massive object. We show that the restricted three-body approximation provides a simple and clear description of the dynamics. The orbit of a binary with mass m around a massive object M should be almost parabolic with an eccentricity of |1 – e| ∼ 1/3 1/3 times the binary rotation velocity, it would be abruptly disrupted, and the energy change at the encounter can be evaluated in a simple disruption model. We evaluate the probability distributions for the ejection and capture of circular binary members and for the final energies. In principle, for any hyperbolic (elliptic) orbit, the heavier member has more chance to be ejected (captured), because it carries a larger fraction of the orbital energy. However, if the orbital energy is close to zero, the difference between the two members becomes small, and there is practically no ejection and capture preferences. The preference becomes significant when the orbital energy is comparable to the typical energy change at the encounter. We discuss its implications to hypervelocity stars and irregular satellites around giant planets.

  10. The structure of service quality perceptions for multiple-encounter services.

    Science.gov (United States)

    Andaleeb, Syed Saad; Kara, Ali

    2013-01-01

    The objective of this study was to examine a complex service environment-hospitals-to suggest how service quality could be reframed and measured for multiple-encounter service situations more effectively. In this cross-sectional study, a sample of 371 patients completed the survey instrument. Service quality measures were guided by the literature but allowed to flow from the respondents at the preliminary stage. Confirmatory factor analysis, along with structural equation modeling, was used to test the hypothesized relationships among key actors' performance metrics (KAPMs). Patient satisfaction is significantly influenced by perceived service quality based on KAPMs. For multiple-encounter services, service quality dimensions and measures ought to be tied to KAPMs. Primary actors-ie, doctors-need knowledge and skills about patient psychology, negotiation, handling difficult patients, and, importantly, "putting the customer first." Sensitivity training on such matters should be provided. The secondary actors are the nurses who have more frequent contact with the patients. Nurses need to be perceived as "patient advocates." Effective advocacy begins with prompt and caring services to build trust. The tertiary actors in their support role also ought to be integrated into becoming vital part of the service provided.

  11. Negotiating frame ambiguity: a study of simulated encounters in medical education.

    Science.gov (United States)

    Seale, Clive; Butler, Christopher C; Hutchby, Ian; Kinnersley, Paul; Rollnick, Stephen

    2007-01-01

    We report an investigation of the sociolinguistic characteristics of simulated encounters (role plays) in medical education, focusing in particular on frame negotiation. The role played by context in influencing the nature of out-of-frame activity is noted through comparison with another published study of simulations (Linell and Thunqvist 2003). While in general sustaining a role-playing frame that involved an orientation to exact mimicry of clinical situations, the interactional work done to sustain this appearance of 'authenticity' at certain moments was revealed by out-of-frame utterances. One participating doctor in particular used humor to exploit the ambiguous realism of the role-playing frame. The success of this doctor in acquiring and applying new communication behaviors problematizes the view that 'realism', achieved through mimicry, is solely responsible for the success of training interventions. The implications for studying other kinds of simulated encounters, including an outline for a program of research into the sociolinguistics of acting tasks in general, are outlined. Sociolinguistic researchers involved in observational studies of talk would benefit from adopting the view that role-played, rehearsed, and even scripted talk of the sort used in dramatic performance is a variety of naturally occurring data and therefore worthy of study.

  12. The encounter with God in myth and madness.

    Science.gov (United States)

    Doerr, Otto; Velásquez, Oscar

    2007-07-03

    It is well known how often psychiatric patients report religious experiences. These are especially frequent in schizophrenic and epileptic patients as the subject of their delusions. The question we pose is: are there differences between this kind of religious experiences and those we find in religious texts or in the mythological tradition? An overview on famous mythological narratives, such as The Aeneid, allows us to establish that the divinities become recognizable to the human being at the moment of their departure. Thus, Aeneas does not recognise his mother, Venus, when she appears to him in the middle of the forest at the coast of Africa. A dialogue between the two takes place, and only at the end of the encounter, when she is going away and already with her back to Aeneas, she shows her son the signs of her divinity: the rose-flush emanating from her neck, her hair perfume and the majesty of her gait. Something analogous can be observed in the encounter of Moses with Yahweh on Mount Sinai. Moses asks God: "Show me your glory, I beg you". And God replies, among other things: "you shall see the back of me, but my face is not to be seen". In the same sense, the Emmaus disciples do not recognise Jesus till the moment of his disappearance ("but he had vanished from their sight"), and Saul of Tars falls off his horse just in the moment when he feels the divine presence. In short, the direct encounter with the divinity seems not to occur in the realm of myth or in religious tradition. The realm of madness is exactly the opposite. Our research on religious experiences in schizophrenic and epileptic patients leads us to conclude that God appears to them face to face, and the patient describes God the father, Jesus or the Virgin Mary in intimate detail, always in an everyday setting. So, the divinity is seen in the garden, or in the bedroom, or maybe above the wardrobe, without any of its majesty. The nearness to God also tends to be so extreme that even an

  13. The encounter with God in myth and madness

    Directory of Open Access Journals (Sweden)

    Doerr Otto

    2007-07-01

    Full Text Available Abstract Background It is well known how often psychiatric patients report religious experiences. These are especially frequent in schizophrenic and epileptic patients as the subject of their delusions. The question we pose is: are there differences between this kind of religious experiences and those we find in religious texts or in the mythological tradition? Results An overview on famous mythological narratives, such as The Aeneid, allows us to establish that the divinities become recognizable to the human being at the moment of their departure. Thus, Aeneas does not recognise his mother, Venus, when she appears to him in the middle of the forest at the coast of Africa. A dialogue between the two takes place, and only at the end of the encounter, when she is going away and already with her back to Aeneas, she shows her son the signs of her divinity: the rose-flush emanating from her neck, her hair perfume and the majesty of her gait. Something analogous can be observed in the encounter of Moses with Yahweh on Mount Sinai. Moses asks God: "Show me your glory, I beg you". And God replies, among other things: "you shall see the back of me, but my face is not to be seen". In the same sense, the Emmaus disciples do not recognise Jesus till the moment of his disappearance ("but he had vanished from their sight", and Saul of Tars falls off his horse just in the moment when he feels the divine presence. In short, the direct encounter with the divinity seems not to occur in the realm of myth or in religious tradition. The realm of madness is exactly the opposite. Our research on religious experiences in schizophrenic and epileptic patients leads us to conclude that God appears to them face to face, and the patient describes God the father, Jesus or the Virgin Mary in intimate detail, always in an everyday setting. So, the divinity is seen in the garden, or in the bedroom, or maybe above the wardrobe, without any of its majesty. The nearness to God

  14. Trust in initial encounters : a motivational, cognitive theory

    OpenAIRE

    Johansen, Svein Tvedt

    2007-01-01

    In this dissertation I develop a theoretical model on the effects of risk on the formation of trust in the initial stages of a relationship. Risk is proposed to influence trust in two ways: First, risk exerts a direct influence on trust. Risk may decrease trust, increase trust, or increase trust under specific conditions. Second, risk may affect the level of trust indirectly by influencing the effect of social stimuli on the formation of trust. In this second indirect effect of risk, ri...

  15. Inhomogeneous electrochemiluminescence. II Markovian encounter theory of the phenomenon

    International Nuclear Information System (INIS)

    Gladkikh, V.; Burshtein, A.I.

    2005-01-01

    The free energy dependence of the electro-chemiluminescence quantum yield is specified, with the Markovian encounter theory accounting for the reversibility of triplet production competing with the irreversible recombination to the ground state. It is shown that diffusional ion recombination is highly inhomogeneous in space. It proceeds at either large positive ionization free energy (mainly to the triplet product) or at large negative free energy when recombination to the ground state dominates. On the contrary at medium free energies, the quasi-resonant generation of triplets is under kinetic control and therefore much more homogeneous. In this case, both recombination products are generated in comparable amounts. The multiple reversible ionization is shown to act as an independent quenching mechanism previously unknown. The role of the triplet quenching at the electrode is also specified. These effects reduce noticeably the luminescence quantum yield but only at larger triplet life times and in different free energy regions

  16. Reexamination of plasma measurements from the Mariner 5 Venus encounter

    International Nuclear Information System (INIS)

    Shefer, R.E.; Lazarus, A.J.; Bridge, H.S.

    1979-01-01

    Mariner 5 plasma data from the Venus encounter have been analyzed with twice the time resolution of the original analysis of Bridge et al. (1967). The velocity distribution function for each spectrum is used to determine more precisely the locations of boundaries and characteristic flow parameters in the interaction region around the planet. We identify a new region in the flow located between magnetosheathlike plasma inside the shock front and an interior low-flux region near the geometrical shadow of the planet. The region is characterized by a wide velocity distribution function and a decrease in ion flux. Using the highest time resolution magnetic field data made available by Smith et al., we propose that rapid magnetic field fluctuations in this region may result in an artificial broadening of the distribution function. We conclude that very high time resolution is required in future experiments in order to determine the true nature of the plasma in this region

  17. Motility of copepod nauplii and implications for food encounter

    DEFF Research Database (Denmark)

    Titelman, Josefin; Kiørboe, Thomas

    2003-01-01

    (Centropages typicus, Calanus helgolandicus, Temora longicornis, Acartia tonsa, Eurytemora affinis and Euterpina acutifrons). Behaviors of individual nauphi were divided into sequences of sinking, swimming and jumping events. Motility behavior is both stage- and species-specific in terms of appearance......Velocity differences drive all encounter processes. Therefore, knowledge of both prey and predator motility are essential in order to understand feeding behavior and predict food acquisition rates. Here, we describe and quantify the motility behavior of young and old naupliar stages of 6 copepods...... of tracks, speeds, durations and frequencies of events as well as time budgets. Motility mode often changes drastically during naupliar ontogeny. Crudely, nauplii can be divided into those moving with a jump-sink type of motility of various frequencies (1 min(-1) to 3 s(-1)) and those swimming...

  18. Creating illusions of past encounter through brief exposure.

    Science.gov (United States)

    Brown, Alan S; Marsh, Elizabeth J

    2009-05-01

    Titchener (1928) suggested that briefly glancing at a scene could make it appear strangely familiar when it was fully processed moments later. The closest laboratory demonstration used words as stimuli, and showed that briefly glancing at a to-be-judged word increased the subject's belief that it had been presented in an earlier study list (Jacoby & Whitehouse, 1989). We evaluated whether a hasty glance could elicit a false belief in a prior encounter, from a time and place outside of the experiment. This goal precluded using word stimuli, so we had subjects evaluate unfamiliar symbols. Each symbol was preceded by a brief exposure to an identical symbol, a different symbol, or no symbol. A brief glance at an identical symbol increased attributions to preexperimental experience, relative to a glance at a different symbol or no symbol, providing a possible mechanism for common illusions of false recognition.

  19. Preliminary Exploration of Encounter During Transit Across Southern Africa

    Energy Technology Data Exchange (ETDEWEB)

    Stroud, Phillip David [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Cuellar-Hengartner, Leticia [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Kubicek, Deborah Ann [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Cleland, Timothy James [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-10-28

    Los Alamos National Laboratory (LANL) is utilizing the Probability Effectiveness Methodology (PEM) tools, particularly the Pathway Analysis, Threat Response and Interdiction Options Tool (PATRIOT) to support the DNDO Architecture and Planning Directorate’s (APD) development of a multi-region terrorist risk assessment tool. The effort is divided into three stages. The first stage is an exploration of what can be done with PATRIOT essentially as is, to characterize encounter rate during transit across a single selected region. The second stage is to develop, condition, and implement required modifications to the data and conduct analysis to generate a well-founded assessment of the transit reliability across that selected region, and to identify any issues in the process. The final stage is to extend the work to a full multi-region global model. This document provides the results of the first stage, namely preliminary explorations with PATRIOT to assess the transit reliability across the region of southern Africa.

  20. Encounters with medicines among ethnic minorities with chronic conditions

    DEFF Research Database (Denmark)

    Mygind, Anna

    of the study was to explore the challenges of encounters with medicines among ethnic minorities with chronic conditions in Denmark, exemplified by policy, professional and patient perspectives. Implications for community pharmacies was a particular focus. Methods: The study drew on different methods, types...... analysis of interviews with people with Pakistani background, type 2 diabetes and at least one other chronic condition, focusing on lived experiences with medicine use during Ramadan, reasons for fasting, and experiences with counselling on medicines. Sub-study IV encompassed an analysis of interviews......-study I. Most documents agreed that skin colour and skin covering were part of the definition of ethnic minorities at risk. Major discrepancies were found regarding the importance attributed to the Islamic religion, other traditions, immigration, gender and age, and an evolutionary explanation...

  1. Physician Encounters with Human Trafficking: Legal Consequences and Ethical Considerations.

    Science.gov (United States)

    Todres, Jonathan

    2017-01-01

    There is growing recognition and evidence that health care professionals regularly encounter-though they may not identify-victims of human trafficking in a variety of health care settings. Identifying and responding appropriately to trafficking victims or survivors requires not only training in trauma-informed care but also consideration of the legal and ethical issues that arise when serving this vulnerable population. This essay examines three areas of law that are relevant to this case scenario: criminal law, with a focus on conspiracy; service provider regulations, with a focus on mandatory reporting laws; and human rights law. In addition to imposing a legal mandate, the law can inform ethical considerations about how health care professionals should respond to human trafficking. © 2017 American Medical Association. All Rights Reserved.

  2. Professionalizations of Danish Teachers Encountering the 'Immigrant of School Age'

    DEFF Research Database (Denmark)

    Padovan-Özdemir, Marta

    of integration', and as such act on behalf of the imagined collective good (Larsen 2012). This educational optimism is understood in terms of the development of the universal welfare state (Sandin 2012) and its rational engineering of social life (Petersen 1997). Petersen (1997) argues that the government...... of the collective good in the modern welfare nation-state becomes highly dependent on "the acceptance of expert knowledge as the foundation of a good life" (p. 367, my translation). The paper argues that the act of and desire for professionalization of teachers encountering the immigrant of school age should...... for the perceived threat to the collective good and as signifiers of the appropriate solutions to this threat. The proposition of problem construction to be the inner logic of professionalization of teachers feeds into the analytical framework of the paper, where relations of power/knowledge make up the history...

  3. Bridging Identity Gaps : Supporting Identity Performance in Citizen Service Encounters

    DEFF Research Database (Denmark)

    Borchorst, Nikolaj Gandrup; McPhail, Brenda; Smith, Karen Louise

    2012-01-01

    administrative processes and the quality and swiftness of the service they receive. As we bring to light in this paper, this “fitting in” with rigid bureaucratic procedures and IT systems interestingly requires a substantial collaborative effort between the receiver(s) of the service and a complex constellation...... of surrounding stakeholders and intermediaries. This collaboration and the performing of multiple identities raises challenges for the design of e-government systems aimed at supporting physical and digital citizen service provision, as well as issues regarding privacy, citizenship, and public service quality......This paper explores in situ citizen service encounters in government offices. Drawing upon ethnographically informed fieldwork in Canada and Denmark, we discuss the challenges to supporting citizens in constructing and performing identities in public service settings. Our data suggests...

  4. Modifications in children's goals when encountering obstacles to conflict resolution.

    Science.gov (United States)

    Troop-Gordon, Wendy; Asher, Steven R

    2005-01-01

    Previous studies have demonstrated that children's goals are associated with their success in peer relationships. The current study extends earlier findings by examining changes in children's goals during hypothetical conflicts. Participants were 252 children ages 9 to 12 years old (133 boys, 119 girls). As predicted, children's goals changed significantly when they encountered obstacles to conflict resolution, and these changes were predictive of their subsequent strategy choices. Both aggressive- and submissive-rejected children were more likely to evidence antisocial changes in their goals, including an increased desire to retaliate. They also showed reluctance to forego instrumental objectives. Other findings highlighted the need to investigate the combinations of goals children pursue as predictors of their strategies and the quality of their peer relationships.

  5. POLITENESS IN REQUESTS: SOME RESEARCH FINDINGS RELEVANT FOR INTERCULTURAL ENCOUNTERS

    Directory of Open Access Journals (Sweden)

    Aura CODREANU; Alina DEBU

    2011-01-01

    Full Text Available The major aim of this article is to analyze the relationship between indirectness and politeness in requests. The research project supporting the findings of the paper was undertaken in order to find out to what extent politeness and indirectness are viewed as overlapping or mutually excluding categories by Romanians compared to other nationalities, such as the British and the Hebrew. Another inherent goal of the paper is to provide an example of the socio linguistics instruments that can be employed in the investigation of the differences and similarities likely to emerge in intercultural encounters. Thus, we believe that only through similar research undertaken in the fields contributing to the emerging field of interculturality one can actually trespass the theoretical assumptions and move on to the identification of the right tools and means through which intercultural discourse to be approached at a pragmatic level and thus better understood and taught in educational establishments.

  6. Collisionless encounters and the origin of the lunar inclination.

    Science.gov (United States)

    Pahlevan, Kaveh; Morbidelli, Alessandro

    2015-11-26

    The Moon is generally thought to have formed from the debris ejected by the impact of a planet-sized object with the proto-Earth towards the end of planetary accretion. Models of the impact process predict that the lunar material was disaggregated into a circumplanetary disk and that lunar accretion subsequently placed the Moon in a near-equatorial orbit. Forward integration of the lunar orbit from this initial state predicts a modern inclination at least an order of magnitude smaller than the lunar value--a long-standing discrepancy known as the lunar inclination problem. Here we show that the modern lunar orbit provides a sensitive record of gravitational interactions with Earth-crossing planetesimals that were not yet accreted at the time of the Moon-forming event. The currently observed lunar orbit can naturally be reproduced via interaction with a small quantity of mass (corresponding to 0.0075-0.015 Earth masses eventually accreted to the Earth) carried by a few bodies, consistent with the constraints and models of late accretion. Although the encounter process has a stochastic element, the observed value of the lunar inclination is among the most likely outcomes for a wide range of parameters. The excitation of the lunar orbit is most readily reproduced via collisionless encounters of planetesimals with the Earth-Moon system with strong dissipation of tidal energy on the early Earth. This mechanism obviates the need for previously proposed (but idealized) excitation mechanisms, places the Moon-forming event in the context of the formation of Earth, and constrains the pristineness of the dynamical state of the Earth-Moon system.

  7. Spatial capture-recapture models for search-encounter data

    Science.gov (United States)

    Royle, J. Andrew; Kery, Marc; Guelat, Jerome

    2011-01-01

    1. Spatial capture–recapture models make use of auxiliary data on capture location to provide density estimates for animal populations. Previously, models have been developed primarily for fixed trap arrays which define the observable locations of individuals by a set of discrete points. 2. Here, we develop a class of models for 'search-encounter' data, i.e. for detections of recognizable individuals in continuous space, not restricted to trap locations. In our hierarchical model, detection probability is related to the average distance between individual location and the survey path. The locations are allowed to change over time owing to movements of individuals, and individual locations are related formally by a model describing individual activity or home range centre which is itself regarded as a latent variable in the model. We provide a Bayesian analysis of the model in WinBUGS, and develop a custom MCMC algorithm in the R language. 3. The model is applied to simulated data and to territory mapping data for the Willow Tit from the Swiss Breeding Bird Survey MHB. While the observed density was 15 territories per nominal 1 km2 plot of unknown effective sample area, the model produced a density estimate of 21∙12 territories per square km (95% posterior interval: 17–26). 4. Spatial capture–recapture models are relevant to virtually all animal population studies that seek to estimate population size or density, yet existing models have been proposed mainly for conventional sampling using arrays of traps. Our model for search-encounter data, where the spatial pattern of searching can be arbitrary and may change over occasions, greatly expands the scope and utility of spatial capture–recapture models.

  8. East meets West: Mounted Encounters in Early and High Mediaeval Europe

    Directory of Open Access Journals (Sweden)

    Gassmann Jürg

    2017-05-01

    Full Text Available By the Late Middle Ages, mounted troops - cavalry in the form of knights - are established as the dominant battlefield arm in North-Western Europe. This paper considers the development of cavalry after the Germanic Barbarian Successor Kingdoms such as the Visigoths in Spain or the Carolingian Franks emerged from Roman Late Antiquity and their encounters with Islam, as with the Moors in Iberia or the Saracens (Arabs and Turks during the Crusades, since an important part of literature ascribes advances in European horse breeding and horsemanship to Arab influence. Special attention is paid to information about horse types or breeds, conformation, tactics - fighting with lance and bow - and training. Genetic studies and the archaeological record are incorporated to test the literary tradition.

  9. Satisfaction with the outpatient encounter - A comparison of patients' and physicians' views

    NARCIS (Netherlands)

    Zandbelt, Linda C.; Smets, Ellen M. A.; Oort, Frans J.; Godfried, Mieke H.; de Haes, Hanneke C. J. M.

    2004-01-01

    OBJECTIVE: To compare patients' and physicians' visit-specific satisfaction in an internal medicine outpatient setting, and to explain their respective views. DESIGN: Patients' and physicians' background characteristics were assessed prior to outpatient encounters. Immediately after the encounter,

  10. The Impact of Value-Orientations on Cross-cultural Encounters and ...

    African Journals Online (AJOL)

    encounters and mediation in the Tanzanian educational system. The purpose of the article is to give an emic perspective on value-orientations in crosscultural encounters and mediation situations in the educational system, to improve understanding of the conflictive aspects of these encounters. To achieve this purpose, the ...

  11. Shouting in a Desert: Dutch missionary encounters with Javanese Islam, 1850-1910 : Dutch missionary encounters with Javanese Islam, 1850-1910

    NARCIS (Netherlands)

    M.J. Kruithof (Maryse)

    2014-01-01

    markdownabstract__Abstract__ ‘‘Shouting in a desert’ Dutch missionary encounters with Javanese Islam’ concentrates on the shifts and developments in the Dutch mission discourse within the period from 1850 to 1910. It explores the Dutch missionary encounter with local communities and is conducted

  12. Volcanic Ash -Aircraft Encounter Damages: in Volcanological Point of View

    Science.gov (United States)

    Aydar, Erkan; Aladaǧ, Çaǧdaş Hakan; Menteş, Turhan

    2017-04-01

    The jet era or age began at 1930 and 40's in aviation sector, with the production of first jet engine for the aircrafts. Since 1950's, the commercial aviation with regular flights were established. Civil aviation and air-transport drastically increased due to intensive demand, and declared at least 10 fold since 1970 by IATA report. Parallelly to technological and economical developpement, the commercial jets became more comfortable, secure and rapid, bringing the world smaller, the countries closer. On the other hand, according to Global Volcanism Program Catalogues of Smithsonian Institute, about 1,500 volcanoes have erupted in the Holocene, 550 of them have had historical eruptions and considered as active. Besides an average of 55-60 volcanoes erupt each year, and about 8-10 of these eruptions produce ash clouds that reach aircraft flight altitudes (Salinas and Watt, 2004). Volcanic ash can be expected to be in air routes at altitudes greater than 9 km (30,000 ft) for roughly 20 days per year worldwide (Miller &Casadeval, 2000). A precious compilation of incidents due to encounters of aircrafts with volcanic ash clouds covering the years between 1953 and 2009 was used in this work (Guffanti et al., 2010-USGS Report) with an additional information on Eyfjallajökull-2010 eruption. According to this compilation,129 incidents happened within the concerned time interval. The damages, in general, fall in second and third class of Severity index, indicating the damages are limited on airframe of the planes, or some abrasions in jet engine, windblast etc.. We focused on fourth class of severity index involving the damages on jet engine of aircraft (engine fail) due to ingestion of volcanic ash and investigate eruption style and caused damage relationships. During the eruptive sequences of Mts Saint Helen (USA), Galunggung (Indonesia, 2 incidents), Redoubt (USA), Pinatubo (Philipinnes), Unzen (Japan), Manam (Papua New Guinea), Soufriere Hills (Lesser Antilles), Chaiten

  13. Gravitational wave bursts from Primordial Black Hole hyperbolic encounters

    CERN Document Server

    Garcia-Bellido, Juan

    2017-01-01

    We propose that Gravitational Wave (GW) bursts with millisecond durations can be explained by the GW emission from the hyperbolic encounters of Primordial Black Holes in dense clusters. These bursts are single events, with the bulk of the released energy happening during the closest approach, and emitted in frequencies within the AdvLIGO sensitivity range. We provide expressions for the shape of the GW emission in terms of the peak frequency and amplitude, and estimate the rates of these events for a variety of mass and velocity configurations. We study the regions of parameter space that will allow detection by both AdvLIGO and, in the future, LISA. We find for realistic configurations, with total mass M∼60 M⊙, relative velocities v∼0.01c, and impact parameters b∼10−3 AU, for AdvLIGO an expected event rate is O(10) events/yr/Gpc^3 with millisecond durations. For LISA, the typical duration is in the range of minutes to hours and the event-rate is O(10^3) events/yr/Gpc^3 for both 10^3 M⊙ IMBH and 1...

  14. “This is you”: Encountering Shakespeare with Tim Crouch

    Directory of Open Access Journals (Sweden)

    Sara Soncini

    2017-11-01

    Full Text Available This essay considers Tim Crouch's "I Shakespeare", a suite of monologue plays based on "The Tempest" ("I, Caliban", 2003, "A Midsummer Night's Dream" ("I, Peaseblossom", 2004, "Macbeth" ("I, Banquo", 2005, "Twelfth Night" ("I, Malvolio", 2010 and "Julius Caesar" ("I, Cinna (the poet", 2012. While originally designed for a young audience, Crouch's adaptations have been performed in a variety of theatrical contexts that have added new and probably unforeseen dimensions to their negotiations with Shakespeare. In my analysis I turn to the notion of mobility as a key analytical tool to elucidate the method, aims, as well as the broader cultural meaning of Tim Crouch's reworkings. In his hands, Shakespeare is mobilized as a powerful resource to activate spectators and emphasize their co-authorship in the process of theatre. Through a combination of textual strategies and performance methods, the monologues construct the identities of Shakespeare's characters as multiple and mutable and, in parallel, cast their addressees in fluid, often contradictory roles. My main line of argument is that the plays' propensity of motion is rooted in their emphasis on Shakespeare as a highly mobile cultural signifier which seems confirmed by the monologues' journeys outside the UK. The further adaptational practices triggered by these encounters with foreign audiences are testament to the flexibility of Crouch's dramaturgy of process and its aptitude to accommodate new discursive identities and adjust to each new context of reception.

  15. Smart City: Utilization of IT resources to encounter natural disaster

    Science.gov (United States)

    Hartama, D.; Mawengkang, Herman; Zarlis, M.; Sembiring, R. W.

    2017-09-01

    This study proposes a framework for the utilization of IT resources in the face of natural disasters with the concept of Smart City in urban areas, which often face the earthquake, particularly in the city of North Sumatra and Aceh. Smart City is a city that integrates social development, capital, civic participation, and transportation with the use of information technology to support the preservation of natural resources and improved quality of life. Changes in the climate and environment have an impact on the occurrence of natural disasters, which tend to increase in recent decades, thus providing socio-economic impacts for the community. This study suggests a new approach that combines the Geographic Information System (GIS) and Mobile IT-based Android in the form of Geospatial information to encounter disaster. Resources and IT Infrastructure in implementing the Smart Mobility with Mobile service can make urban areas as a Smart City. This study describes the urban growth using the Smart City concept and considers how a GIS and Mobile Systems can increase Disaster Management, which consists of Preparedness, mitigation, response, and recovery for recovery from natural disasters.

  16. Patient-centered communication in digital medical encounters.

    Science.gov (United States)

    Alpert, Jordan M; Dyer, Karen E; Lafata, Jennifer Elston

    2017-10-01

    Patients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses. A total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system. Content analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building. Patients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk. Partnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship. As secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Managing the bank service encounter: A conceptual model

    Directory of Open Access Journals (Sweden)

    K. K. Govender

    1999-06-01

    Full Text Available In financial services marketing, especially among banks, there are a limited number of chances to impress the customer, since the services are becoming more automated. Since personal interactions with customers are becoming less numerous, customers are expecting higher quality contacts and more individual treatment. This paper proposes a service encounter management model which may impact on the customers service experience. By matching service employees with customers, the effects of certain human resources strategies may be ascertained through the customers perception of the employee service quality and the overall service quality. Opsomming Daar is 'n beperkte geleenthede om die finansiele dienste klient, veral die in banke, te beindruk, aangesien dienste al meer ge-outomatiseer raak. Seinde persoonlike kontak met kliente al minder word, verwag kliente hoer gehalte kontak en meer individuele behandeling. Hierdie artikel stel 'n bestuursmodel vir diensontmoetings voor wat 'n impak op kliente se dienservarings mag he. Deur dienswerknemers met kliente te verbind kan bepaalde menslike hulpbronstrategie-effekte vasgestel word, deur middel van kliente se persepsie van werknemer-diensgehalte en algemene diensgehalte.

  18. An encounter between 4e cognition and attachment theory

    Science.gov (United States)

    Petters, Dean

    2016-10-01

    This paper explores a constructive revision of the conceptual underpinnings of Attachment Theory through an encounter with the diverse elements of 4e cognition. Attachment relationships involve the development of preference for one or a few carers and expectations about their availability and responsiveness as a haven of safety and a base from which to explore. In attachment theory, mental representations have been assigned a central organising role in explaining attachment phenomena. The 4e cognition approaches in cognitive science raise a number of questions about the development and interplay of attachment and cognition. These include: (1) the nature of what Bowlby called 'internal working models of attachment'; (2) the extent to which the infant-carer dyad functions as an extension of the infant's mind; and (3) whether Bowlby's attachment control system concept can be usefully re-framed in enactive terms where traditional cognitivist representations are: (3i) substituted for sensorimotor skill-focused mediating representations; (3ii) viewed as arising from autopoietic living organisms; and/or (3iii) mostly composed from the non-contentful mechanisms of basic minds? A theme that cross-cuts these research questions is how representations for capturing meaning, and structures for adaptive control, are both required to explain the full range of behaviour of interest to Attachment Theory researchers.

  19. UFOs and nukes. Extraordinary encounters at nuclear weapons sites

    International Nuclear Information System (INIS)

    Hastings, Robert L.

    2015-01-01

    Everyone knows about the reported recovery of a crashed alien spaceship near Roswell, New Mexico in July 1947. However, most people are unaware that, at the time of the incident, Roswell Army Airfield was home to the world's only atomic bomber squadron, the 509th Bomb Group. Was this merely a coincidence? During the Cold War, the United States and the Soviet Union built thousands of the far more destructive hydrogen bombs, some of them a thousand times as destructive as the first atomic bombs dropped on Japan. If the nuclear standoff between the superpowers had erupted into World War III, human civilization - and perhaps the very survival of our species - would have been at risk. Did this ominous state of affairs come to the attention of outside observers? Was there a connection between the atomic bomber squadron based at Roswell and the reported crash of a UFO nearby? Did those who pilot the UFOs monitor the superpowers' nuclear arms race during the dangerous Cold War era? Do they scrutinize American and Russian weapons sites even now? UFOs and Nukes provides the startling and sometimes shocking answers to these questions. Veteran researcher Robert Hastings has investigated nuclear weapons-related UFO incidents for more than three decades and has interviewed more than 120 ex-US Air Force personnel, from former Airmen to retired Colonels, who witnessed extraordinary UFO encounters at nuclear weapons sites. Their amazing stories are presented here.

  20. Daily Encounter Cards—Evaluating the Quality of Documented Assessments

    Science.gov (United States)

    Cheung, Warren J.; Dudek, Nancy; Wood, Timothy J.; Frank, Jason R.

    2016-01-01

    ABSTRACT Background  Concerns over the quality of work-based assessment (WBA) completion has resulted in faculty development and rater training initiatives. Daily encounter cards (DECs) are a common form of WBA used in ambulatory care and shift work settings. A tool is needed to evaluate initiatives aimed at improving the quality of completion of this widely used form of WBA. Objective  The completed clinical evaluation report rating (CCERR) was designed to provide a measure of the quality of documented assessments on in-training evaluation reports. The purpose of this study was to provide validity evidence to support using the CCERR to assess the quality of DEC completion. Methods  Six experts in resident assessment grouped 60 DECs into 3 quality categories (high, average, and poor) based on how informative each DEC was for reporting judgments of the resident's performance. Eight supervisors (blinded to the expert groupings) scored the 10 most representative DECs in each group using the CCERR. Mean scores were compared to determine if the CCERR could discriminate based on DEC quality. Results  Statistically significant differences in CCERR scores were observed between all quality groups (P < .001). A generalizability analysis demonstrated the majority of score variation was due to differences in DECs. The reliability with a single rater was 0.95. Conclusions  The CCERR is a reliable and valid tool to evaluate DEC quality. It can serve as an outcome measure for studying interventions targeted at improving the quality of assessments documented on DECs. PMID:27777675

  1. Daily Encounter Cards-Evaluating the Quality of Documented Assessments.

    Science.gov (United States)

    Cheung, Warren J; Dudek, Nancy; Wood, Timothy J; Frank, Jason R

    2016-10-01

    Concerns over the quality of work-based assessment (WBA) completion has resulted in faculty development and rater training initiatives. Daily encounter cards (DECs) are a common form of WBA used in ambulatory care and shift work settings. A tool is needed to evaluate initiatives aimed at improving the quality of completion of this widely used form of WBA. The completed clinical evaluation report rating (CCERR) was designed to provide a measure of the quality of documented assessments on in-training evaluation reports. The purpose of this study was to provide validity evidence to support using the CCERR to assess the quality of DEC completion. Six experts in resident assessment grouped 60 DECs into 3 quality categories (high, average, and poor) based on how informative each DEC was for reporting judgments of the resident's performance. Eight supervisors (blinded to the expert groupings) scored the 10 most representative DECs in each group using the CCERR. Mean scores were compared to determine if the CCERR could discriminate based on DEC quality. Statistically significant differences in CCERR scores were observed between all quality groups ( P  evaluate DEC quality. It can serve as an outcome measure for studying interventions targeted at improving the quality of assessments documented on DECs.

  2. Possibilities of creating meaningful encounters in anesthesia nursing

    DEFF Research Database (Denmark)

    Aagaard, Karin

    Anesthesia nursing is performed in a highly technological environment with restricted time for interaction with patients. Patients are in a vulnerable position, which can be characterized by anxiety regarding the anesthetic and surgical procedure. The bedrock of effective nursing care is to facil......Anesthesia nursing is performed in a highly technological environment with restricted time for interaction with patients. Patients are in a vulnerable position, which can be characterized by anxiety regarding the anesthetic and surgical procedure. The bedrock of effective nursing care...... of nursing. In this dissertation, focused ethnography is used to explore the interactions between patients and nurse anesthetists before general anesthesia. Moreover, it will explore the professional identity of nurse anesthetists, in relation to the situation of preparing patients for general anesthesia....... A micro-substantive theory is developed regarding the opportunities for creating meaningful encounters between patients and nurse anesthetists. The theory is based on three dominant motivations for interaction in anesthesia nursing. The context of care is not committed and responsive to the core elements...

  3. Complications encountered in contrast roentgenography of the colon

    International Nuclear Information System (INIS)

    Vogel, H.; Steinkamp, U.

    1983-01-01

    The following problems are analysed referring to the literature and to practical experience of the authors: - Types of complications encountered in contrast roentgenography or in endoscopy of the colon, and their frequency. - Risk factors and secondary injuries. Intestinal perforation is the most frequent complication experienced as a consequence of contrast barium enema. The main risk factors are to be seen in the use of balloon-tipped catheters, or of intestinal tubes with hard tips, in a rise of hydrostatic pressure above 80 cm water column, and in an excessively strong air insufflation. Frequency of complications for contrast barium enema is stated to be 0.002 p.c. (Welin and Welin, 1980) or 0.08 p.c. (Clark et al. 1961). The frequency of perforations in rectoscopy is shown to be in the same order of magnitude. For diagnostic colonoscopy, the frequency of complications is about one per mil. Existing diseases such as carcinoma, diverticulosis, diverticulitis, colitis ulcerosa, or morbus Crohn are factors enhancing the risk. Also, patients of advanced age are running a higher risk due to decreasing intestine wall elasticity with age. Previous biopsy or excision forbids contrast barium enema for the next two weeks. Injuries and sequelae to be expected after perforation are abscesses, phlegmon, peritonitis including formation of adhesion and bands, retroperitoneal fibrosis with formation of hydronephrosis, and anus praeter, the latter being temporary or permanent. An extensive literature survey covering 200 publications has been prepared and is available from the authors upon request. (orig.) [de

  4. Anticipated changes in reimbursements for US outpatient emergency department encounters after health reform.

    Science.gov (United States)

    Galarraga, Jessica E; Pines, Jesse M

    2014-04-01

    We study how reimbursements to emergency departments (EDs) for outpatient visits may be affected by the insurance coverage expansion of the Patient Protection and Affordable Care Act as previously uninsured patients gain coverage either through the Medicaid expansion or through health insurance exchanges. We conducted a secondary analysis of data (2005 to 2010) from the Medical Expenditure Panel Survey. We specified multiple linear regression models to examine differences in the payments, charges, and reimbursement ratios by insurance category. Comparisons were made between 2 groups to reflect likely movements in insurance status after the Patient Protection and Affordable Care Act implementation: (1) the uninsured who will be Medicaid eligible afterward versus Medicaid insured, and (2) the uninsured who will be Medicaid ineligible afterward versus the privately insured. From 2005 to 2010, as a percentage of total ED charges, outpatient ED encounters for Medicaid beneficiaries reimbursed 17% more than for uninsured individuals who will become Medicaid eligible after Patient Protection and Affordable Care Act implementation: 40.0% versus 34.0%, mean absolute difference=5.9%, 95% confidence interval 5.7% to 6.2%. During the same period, the privately insured reimbursed 39% more than for uninsured individuals who will not be Medicaid eligible after Patient Protection and Affordable Care Act implementation: 54.0% versus 38.8%, mean absolute difference=15.2%, 95% confidence interval 12.8% to 17.6%. Assuming historical reimbursement patterns remain after Patient Protection and Affordable Care Act implementation, outpatient ED encounters could reimburse considerably more for both the previously uninsured patients who will obtain Medicaid insurance and for those who move into private insurance products through health insurance exchanges. Although our study does provide insight into the future, multiple factors will ultimately influence reimbursements after implementation

  5. "What constitutes a 'problem'?" Producing 'alcohol problems' through online counselling encounters.

    Science.gov (United States)

    Savic, Michael; Ferguson, Nyssa; Manning, Victoria; Bathish, Ramez; Lubman, Dan I

    2017-08-01

    Typically, health policy, practice and research views alcohol and other drug (AOD) 'problems' as objective things waiting to be detected, diagnosed and treated. However, this approach to policy development and treatment downplays the role of clinical practices, tools, discourses, and systems in shaping how AOD use is constituted as a 'problem'. For instance, people might present to AOD treatment with multiple psycho-social concerns, but usually only a singular AOD-associated 'problem' is considered serviceable. As the assumed nature of 'the serviceable problem' influences what treatment responses people receive, and how they may come to be enacted as 'addicted' or 'normal' subjects, it is important to subject clinical practices of problem formulation to critical analysis. Given that the reach of AOD treatment has expanded via the online medium, in this article we examine how 'problems' are produced in online alcohol counselling encounters involving people aged 55 and over. Drawing on poststructural approaches to problematisation, we not only trace how and what 'problems' are produced, but also what effects these give rise to. We discuss three approaches to problem formulation: (1) Addiction discourses at work; (2) Moving between concerns and alcohol 'problems'; (3) Making 'problems' complex and multiple. On the basis of this analysis, we argue that online AOD counselling does not just respond to pre-existing 'AOD problems'. Rather, through the social and clinical practices of formulation at work in clinical encounters, online counselling also produces them. Thus, given a different set of circumstances, practices and relations, 'problems' might be defined or emerge differently-perhaps not as 'problems' at all or perhaps as different kinds of concerns. We conclude by highlighting the need for a critical reflexivity in AOD treatment and policy in order to open up possibilities for different ways of engaging with, and responding to, people's needs in their complexity

  6. Primo Levi and Franz Kafka: an Unheimlich Encounter

    Directory of Open Access Journals (Sweden)

    Stefano Bellin

    2016-11-01

    Full Text Available In 1983 Giulio Einaudi asked Primo Levi to translate Kafka’s Trial for the new series «Scrittori tradotti da scrittori». The proposal sounded original and provocative, and Levi accepted eagerly. The translation, however, had a negative effect on him. While working on The Trial, Levi relived his Auschwitz season, revived his deepest fears, and fell back into depression: he felt as if he was himself on trial. This was partially due to a clash of literary styles as well as to two contrasting – and yet at times kindred – conceptions of language and communication. The present study addresses the following questions: were Levi and Kafka’s literary styles as opposed as Levi implies? How is Levi’s “obscure part” connected to Kafka? Why did Levi associate The Trial with his Holocaust experience and identify himself with Josef K.? What does Levi’s encounter with Kafka tell us about the shame of being human and our capacity to give an account of ourselves? By investigating Levi’s uncanny encounter with Kafka, my essay will discuss Levi’s theory of language, showing how the Levi-Kafka intersection opens up new ways of interpreting Levi’s concerns about communication, the work of the witness, moral responsibility, and shame, which coalesced into the reflections of The Drowned and the Saved.Nel 1983 Giulio Einaudi chiese a Primo Levi di tradurre Il processo di Kafka per la nuova serie Scrittori tradotti da scrittori. La proposta parse a Levi originale ed intelligente, sicché la accettò immediatamente. La traduzione ebbe tuttavia un effetto negativo su di lui. Mentre lavorava al Processo, Levi rivisse la stagione di Auschwitz, risentì le sue più profonde paure e ricadde in depressione. Si sentiva come se fosse lui stesso processato. Ciò era in parte dovuto a due opposte concezioni di stile letterario e a due divergenti – anche se a volte paradossalmente affini – concezioni del linguaggio e della comunicazione. Il presente

  7. Medical device development: managing conflicts of interest encountered by physicians.

    Science.gov (United States)

    Baim, Donald S; Donovan, Aine; Smith, John J; Briefs, Nancy; Geoffrion, Richard; Feigal, David; Kaplan, Aaron V

    2007-04-01

    New technologies introduced over the past three decades have transformed medical diagnosis and treatment, and significantly improved patient outcomes. These changes have been mediated by the introduction of new medical devices, particularly for the treatment of cardiovascular, orthopedic, and ophthalmic disorders. These devices, in turn, have created large markets and spawned a burgeoning medical device industry, including six Fortune 500 companies whose combined market capitalization now exceeds 400 billion dollars. This success story, which has unquestionably benefited patients and society alike, has been dependent upon an intense collaboration among industry, clinicians, and regulatory authorities. However, when physicians actively involved in patient care participate in such collaborations, they are increasingly vulnerable to creating potential conflicts between these two (clinical and device development) roles. Such conflicts, which may ultimately erode public trust, have important consequences not only for the individual physicians, but also for their parent institutions, their patients, sponsoring companies, and the entire clinical research enterprise that makes the development and introduction of new devices possible. The third Dartmouth Device Development Symposium held in October 2005 brought together thought leaders within the medical device community, including academicians, clinical investigators, regulators from the Food and Drug Administration and Centers for Medicare and Medicaid Services (CMS), large and small device manufacturers and the financial (venture capital and investment banks) community. The Symposium examined the conflicts of interest encountered during the early development and commercialization of a medical device. The goal of these discussions was to (1) identify and characterize the conflicts that arise and (2) provide strategies to address these conflicts. This manuscript was prepared by a writing committee to provide a summary

  8. Translational neonatology research: transformative encounters across species and disciplines.

    Science.gov (United States)

    Dam, Mie S; Sangild, Per T; Svendsen, Mette N

    2018-01-22

    This paper explores the laborious and intimate work of turning bodies of research animals into models of human patients. Based on ethnographic research in the interdisciplinary Danish research centre NEOMUNE, we investigate collaboration across species and disciplines, in research aiming at improving survival for preterm infants. NEOMUNE experimental studies on piglets evolved as a platform on which both basic and clinical scientists exercised professional authority. Guided by the field of multi-species research, we explore the social and material agency of research animals in the production of human health. Drawing on Anna Tsing's concept of "collaborative survival", we show that sharing the responsibility of the life and death of up to twenty-five preterm piglets fostered not only a collegial solidarity between basic and clinical scientists, but also a transformative cross-fertilization across species and disciplines-a productive "contamination"-facilitating the day-to-day survival of piglets, the academic survival of scientists and the promise of survival of preterm infants. Contamination spurred intertwined identity shifts that increased the porosity between the pig laboratory and the neonatal intensive care unit. Of particular significance was the ability of the research piglets to flexibly become animal-infant-patient hybrids in need of a united effort from basic and clinical researchers. However, 'hybrid pigs' also entailed a threat to the demarcation between humans and animals that consolidates the use of animals in biomedical research, and efforts were continuously done to keep contamination within spatial limits. We conclude that contamination facilitates transformative encounters, yet needs spatial containment to materialize bench-to-bedside translation.

  9. The effect of observers on behavior and the brain during aggressive encounters.

    Science.gov (United States)

    Desjardins, Julie K; Becker, Lisa; Fernald, Russell D

    2015-10-01

    What effect does an audience have on an animal's behavior and where is this influence registered in the brain? To answer these questions, we analyzed male cichlid fish fighting in the presence of audiences of various compositions and measured expression of immediate early genes in the brain as a proxy for neural activity. We hypothesized their behavior would change depending on who was watching them. We measured behavioral responses from both the "watchers" and the "watched" during aggressive encounters and found that males fighting in the presence of an audience were more aggressive than males fighting without an audience. Depending on the nature of the audience, immediate early gene expression in key brain nuclei was differentially influenced. Both when an audience of larger males watched fighting males, and when they were watching larger males fighting, nuclei in the brain considered homologous with mammalian nuclei known to be associated with anxiety showed increased activity. When males were in the presence of any audience or when males saw any other males fighting, nuclei in the brain known to be involved in reproduction and aggression were differentially activated relative to control animals. In all cases, there was a close relationship between patterns of brain gene expression between fighters and observers. This suggests that the network of brain regions known as the social behavior network, common across vertebrates, are activated not only in association with the expression of social behavior but also by the reception of social information. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. The Columbian Encounter and Land-Use Change.

    Science.gov (United States)

    Turner, B. L. II, Butzer, Karl W.

    1992-01-01

    Discusses land use patterns in fifteenth-century Europe and in the Americas and the mutual influence (initiated by Columbus's arrival in the Americas) that led to land use change. Presents a historical perspective and categorization of contemporary global land use changes for the purpose of highlighting associations between past and present global…

  11. Mycobacteria and innate cells: critical encounter for immunogenicity

    Indian Academy of Sciences (India)

    Protective immunity against mycobacterial infections such as Mycobacterium tuberculosis is mediated by interactions between specific T cells and activated macrophages. To date, many aspects of mycobacterial immunity have shown that innate cells are the key elements that substantially influence the subsequent adaptive ...

  12. Portrayal of medical decision making around medical interventions life-saving encounters on three medical television shows.

    Science.gov (United States)

    Schwei, Rebecca J; Jacobs, Elizabeth A; Wingert, Katherine; Montague, Enid

    2015-07-01

    Previous literature has shown that patients obtain information about the medical system from television shows. Additionally, shared decision making is regularly cited as the ideal way to make decisions during a medical encounter. Little information exists surrounding the characteristics of medical decision-making, such as who makes the decision, on medical television shows. We evaluate the characteristics of medical decisions in lifesaving encounters on medical television shows and evaluate if these characteristics were different on staged and reality television shows. We coded type of medical intervention, patient's ability to participate in decision, presence of patient advocate during decision, final decision maker, decision to use intervention, and controversy surrounding decision on three television shows. Frequencies by show were calculated and differences across the three television shows and between staged (ER) and reality ( BostonMed and Hopkins ) television shows were assessed with chi-square tests. The final data set included 37 episodes, 137 patients and 593 interventions. On ER, providers were significantly more likely to make the decision about the medical intervention without informing the patient when a patient was capable of making a decision compared to BostonMed or Hopkins (ptelevision shows we analyzed. It is possible that what patients see on television influences their expectations surrounding the decision making process and the use of medical interventions in everyday healthcare encounters.

  13. Customer satisfaction in medical service encounters -- a comparison between obstetrics and gynecology patients and general medical patients.

    Science.gov (United States)

    Chang, Ching-Sheng; Weng, Hui-Ching; Chang, Hsin-Hsin; Hsu, Tsuen-Ho

    2006-03-01

    This study is concerned with the "service encounter", and seeks to describe, by use of the Service Encounter Evaluation Model, how the processes involved in the service encounter affect customer satisfaction. Its findings have implications for management practice and research directions, and recommendations are made. With the implementation of a national health insurance scheme, an ever-prospering economy and continually improving educational levels in Taiwan, demand among citizens for good health and medical care is ever increasing. Obstetrics and gynecology patients often differ greatly from general patients, in terms of their moods and emotions. This research involved an empirical study, whose subjects were 590 customers of general clinics and 339 customers of gynecology clinics, in various medical centers in southern Taiwan. By factor analysis, the study established four influencing factors, which were "Medical professionals", "Nursing professionals", "Service personnel" and "Space and facilities". Using the Linear Structural Relation Model (LISREL), it found that medical professionals, nursing professionals, service personnel and space and facilities were effective predictors of medical treatment satisfaction. We also found that the greatest positive impact on overall medical treatment satisfaction resulted from rises in satisfaction with medical professionals, but that the least impact was achieved in relation to service personnel in the general and gynecology clinics.

  14. What happens at the gap between knowledge and practice? Spaces of encounter and misencounter between environmental scientists and local people

    Directory of Open Access Journals (Sweden)

    Anne H. Toomey

    2016-06-01

    Full Text Available Researchers studying processes of global environmental change are increasingly interested in their work having impacts that go beyond academia to influence policy and management. Recent scholarship in the conservation sciences has pointed to the existence of a research-action gap and has proposed various solutions for overcoming it. However, most of these studies have been limited to the spaces of dissemination, where the science has already been done and is then to be passed over to users of the information. Much less attention has been paid to encounters that occur between scientists and nonscientists during the practice of doing scientific research, especially in situations that include everyday roles of labor and styles of communication (i.e., fieldwork. This paper builds on theories of contact that have examined encounters and relations between different groups and cultures in diverse settings. I use quantitative and qualitative evidence from Madidi National Park, Bolivia, including an analysis of past research in the protected area, as well as interviews (N = 137 and workshops and focus groups (N = 12 with local inhabitants, scientists, and park guards. The study demonstrates the significance of currently unacknowledged or undervalued components of the research-action gap, such as power, respect, and recognition, to develop a relational and reciprocal notion of impact. I explain why, within such spaces of encounter or misencounter between scientists and local people, knowledge can be exchanged or hidden away, worldviews can be expanded or further entrenched, and scientific research can be welcomed or rejected.

  15. From Parasite Encounter to Infection: Multiple-Scale Drivers of Parasite Richness in a Wild Social Primate Population

    Science.gov (United States)

    Benavides J. A.; Huchard, E.; Pettorelli, N.; King, A. J.; Brown, M. E.; Archer, C. E.; Appleton, C. C.; Raymond, M.; Cowlishaw, G.

    2011-01-01

    Host parasite diversity plays a fundamental role in ecological and evolutionary processes, yet the factors that drive it are still poorly understood. A variety of processes, operating across a range of spatial scales, are likely to influence both the probability of parasite encounter and subsequent infection. Here, we explored eight possible determinants of parasite richness, comprising rainfall and temperature at the population level, ranging behavior and home range productivity at the group level, and age, sex, body condition, and social rank at the individual level. We used a unique dataset describing gastrointestinal parasites in a terrestrial subtropical vertebrate (chacma baboons, Papio ursinus), comprising 662 faecal samples from 86 individuals representing all age-sex classes across two groups over two dry seasons in a desert population. Three mixed models were used to identify the most important factor at each of the three spatial scales (population, group, individual); these were then standardised and combined in a single, global, mixed model. Individual age had the strongest influence on parasite richness, in a convex relationship. Parasite richness was also higher in females and animals in poor condition, albeit at a lower order of magnitude than age. Finally, with a further halving of effect size, parasite richness was positively correlated to day range and temperature. These findings indicate that a range of factors influence host parasite richness through both encounter and infection probabilities, but that individual-level processes may be more important than those at the group or population level.

  16. Administrative encounters in general practice: low value or hidden value care?

    Science.gov (United States)

    Trevena, Lyndal J; Harrison, Christopher; Britt, Helena C

    2018-02-19

    To determine the frequency of general practice administrative encounters, and to determine whether they represent low value care. Secondary analysis of data from the Bettering Evaluation and Care of Health (BEACH) dataset. 1 568 100 GP-patient encounters in Australia, 2000-01 to 2015-16. An annual nationally representative random sample of about 1000 GPs, who each recorded the details of 100 consecutive encounters with patients. Proportions of general practice encounters that were potentially low value care encounters (among the patient's reasons for the encounter was at least one administrative, medication, or referral request) and potentially low value care only encounters (such reasons were the sole reason for the encounter). For 2015-16, we also examined other health care provided by GPs at these encounters. During 2015-16, 18.5% (95% CI, 17.7-19.3%) of 97 398 GP-patient encounters were potentially low value care request encounters; 7.4% (95% CI, 7.0-7.9%) were potentially low value care only encounters. Administrative work was requested at 3.8% (95% CI, 3.5-4.0%) of GP visits, 35.4% of which were for care planning and coordination, 33.5% for certification, and 31.2% for other reasons. Medication requests were made at 13.1% (95% CI, 12.4-13.7%) of encounters; other health care was provided at 57.9% of medication request encounters, counselling, advice or education at 23.4%, and pathology testing was ordered at 16.7%. Referrals were requested at 2.8% (95% CI, 1.7-3.0%) of visits, at 69.4% of which additional health care was provided. The problems managed most frequently at potentially low value care only encounters were chronic diseases. Most patients requested certificates, medications and referrals in the context of seeking help for other health needs. Additional health care, particularly for chronic diseases, was provided at most GP administrative encounters. The MBS Review should consider the hidden value of these encounters.

  17. Power imbalance and consumerism in the doctor-patient relationship: health care providers' experiences of patient encounters in a rural district in India.

    Science.gov (United States)

    Fochsen, Grethe; Deshpande, Kirti; Thorson, Anna

    2006-11-01

    The aim of this study is to explore health care providers' experiences and perceptions of their encounters with male and female patients in a rural district in India with special reference to tuberculosis (TB) care. The authors conducted semistructured interviews with 22 health care providers, 17 men and 5 women, from the public and private health care sectors. Findings reveal that doctors adopted an authoritarian as well as a consumerist approach in the medical encounter, indicating that power imbalances in the doctor-patient relationship are negotiable and subject to change. Gender was identified as an influencing factor of the doctor's dominance. A patient-centered approach, acknowledging patients' own experiences and shared decision making, is called for and should be included in TB control activities. This seems to be especially important for female patients, whose voices were not heard in the medical encounter.

  18. Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles

    NARCIS (Netherlands)

    Oerlemans, M.; Dielissen, P.W.; Timmerman, A.; Ram, P.; Maiburg, B.; Muris, J.; Vleuten, C. van der

    2017-01-01

    BACKGROUND: A variety of tools have been developed to assess performance which typically use a single clinical encounter as a source for making competency inferences. This strategy may miss consistent behaviors. We therefore explored experienced clinical supervisors' perceptions of behavioral

  19. IMMERSE: Interactive Mentoring for Multimodal Experiences in Realistic Social Encounters

    Science.gov (United States)

    2015-08-28

    ride to the airport, asking someone to watch your kids for an hour or pet for a few days; 1000 is characteristic of a large imposition—borrowing a...Influences of Sex and Status in Group Interactions. Journal of Nonverbal Behavior, Vol.(34), pp. 137-153. 44 Dovidio, J. F., Ellyson, S. L., Keating, C...Studies 1, pp. 328–333. 65 de Waal, F. (1982). Chimpanzee politics: Sex and power among apes. Baltimore: Johns Hopkins University Press. 67

  20. Acquisition of an Underway CTD System for the Flow Encountering Abrupt Topography DRI

    Science.gov (United States)

    2015-09-30

    Acquisition of an Underway CTD System for the Flow Encountering Abrupt Topography DRI T. M. Shaun Johnston Scripps Institution of Oceanography...westward flow in the North Equatorial Current (NEC) encounters tall, steep, submarine topography and islands. During the Flow Encountering Abrupt... Topography (FLEAT) DRI, investigators will determine: • Whether appreciable energy/momentum is lost from the large-scale NEC flow to smaller scales and

  1. Quantifying the Effects of Gas-Rich Flyby Encounters on Galaxy Evolution

    Science.gov (United States)

    Dumas, Julie; Holley-Bockelmann, Kelly; Lang, Meagan

    2017-01-01

    Recent work has shown that flyby encounters may be a common event in a galaxy's lifetime. Galaxy flybys are a one-time encounter when two halos interpenetrate, but unlike a galaxy merger, the two halos later detach. Relatively little work has been done to assess how flybys affect galaxy evolution. We present preliminary results of a suite of high-resolution hydrodynamical + N-body simulations of gas-rich flyby encounters, concentrating on Milky Way-like primaries. We track the bulk changes in structure, star formation history, kinematics, and morphology over a broad span of flyby encounters.

  2. Intimate Encounters: Affective Economies in Cuba and the Dominican Republic

    Directory of Open Access Journals (Sweden)

    Amalia L. Cabezas

    2011-10-01

    Full Text Available Drawing on research in Cuba and the Dominican Republic this paper explores the uses of intimacy in both the corporate sector and in romantic relationships. I use research with hotel workers and with people involved in sexual-affective exchanges connected to tourism to link intimacy to the political economic structures of transnational tourism. These are new spaces of analysis that present practices of transnational corporategenerated intimacy that combine love – or the exploitation of worker’s emotions − and labour. The central aim is to intertwine the intimate with the global, from the formal customer service policies of transnational hotels with the informal, on-the-ground, intimate encounters between tourists and hospitality workers. The commercialization of intimacy, including sexual-affective relations in the delivery of hospitality services, is linked to political and economic processes that are part of transnational tourism practices. This paper challenges the notion that sex tourism and sex work are individualistic practices that exist outside of the spaces of corporate global profit. It further posits that relationships where money is exchanged are not necessarily devoid of care and intimacy.Resumen: Encuentros íntimos: economías afectivas en Cuba y República Dominicana A partir de investigaciones en Cuba y la República Dominicana, este trabajo explora los usos de la intimidad, tanto en el sector empresarial como en las relaciones románticas. Se hicieron investigaciones entre trabajadores de hostelería y personas involucradas en el intercambio afectivosexual relacionado con el turismo con el fin de vincular la intimidad de las estructuras políticoeconómicas del turismo transnacional. Estos son nuevos espacios de análisis que las prácticas de las empresas transnacionales generan por el uso de la intimidad que combinan el amor – o la explotación de las emociones del trabajador – y la mano de obra. El objetivo central

  3. [Billroth and Brahms: personal encounter of medicine and music].

    Science.gov (United States)

    Hadaschik, B A; Hadaschik, E N; Hohenfellner, M

    2012-02-01

    Theodor Billroth and Johannes Brahms shared a decades long personal friendship. The music-loving Billroth influenced the work of the famous composer and in turn Brahms also left traces within Billroth's lifetime achievements. To shed light on the close relationship of medicine and music, this manuscript describes both Billroth's life and surgical career as they were influenced and stimulated by his close friendship to Brahms.Theodor Billroth and Johannes Brahms first met in 1865 in Zurich, Switzerland. After Billroth accepted the chair of surgery at the University of Vienna in 1867, Brahms moved to Vienna in 1869. During the following years, Billroth analyzed most of Brahms' compositions prior to publication. Similar to his effective way of teaching medical students and assistants, Billroth stimulated Brahms to publish many of his later compositions. Brahms on the other hand supported Billroth in writing his essay"Who is musical?". Furthermore, music helped Billroth to cope with the demanding working life of a surgeon.Music and surgery share both structural and emotional analogies. While both professions require meticulous techniques, personal interaction is a prerequisite for success. "Science and art scoop from the same well."

  4. Child Abuse by Teachers and Legal Ways to Encounter in Rural Areas

    Directory of Open Access Journals (Sweden)

    Mohtaram Rabbani

    2014-09-01

    Full Text Available Abstract Many children closely interact with teachers for nine months out of the year and schools are one of the safest places for students to be educated and teachers have a vital role for this education. Teachers should prevent from different kinds of child abuses and have an important role for preventing from child abuse. The primary purpose of this literature review study is to investigate of the phenomenon of child abuse within the school environment by teachers. The second aim of this paper is to determine the legal ways in different countries to encounter with physical child abuse by teachers. Child abuseby teachers has an in depth influence on children’s behaviors and their academic achievements. Abused children have been found to suffer from extreme deficits in school, exhibit poor academic performance, antisocial behaviour, poor self-respect, higher criminal behaviour rates, scepticism of adults, and central nervous system functioning. The findings of this paper showed that there are many reported cases of child abuse by teachers in rural areas, nevertheless, many countries banned or restricted physical abuse or corporal punishment and made legal decisions.

  5. Excerpt from Subverting Exclusion: Transpacific Encounters with Race, Caste, and Borders, 1885–1928

    Directory of Open Access Journals (Sweden)

    Andrea Geiger

    2011-12-01

    Full Text Available The Japanese immigrants who arrived in the North American West in the late nineteenth and early twentieth centuries included people with historical ties to Japan’s outcaste communities. In the only English-language book on the subject, Andrea Geiger examines the history of these and other Japanese immigrants in the United States and Canada and their encounters with two separate cultures of exclusion, one based in caste and the other in race.Geiger reveals that the experiences of Japanese immigrants in North America were shaped in part by attitudes rooted in Japan’s formal status system, mibunsei, decades after it was formally abolished. In the North American West, however, the immigrants’ understanding of social status as caste-based collided with American and Canadian perceptions of status as primarily race-based. Geiger shows how the lingering influence of Japan’s strict status system affected immigrants’ perceptions and understandings of race in North America and informed their strategic responses to two increasingly complex systems of race-based exclusionary law and policy.

  6. Commognitive analysis of undergraduate mathematics students' first encounter with the subgroup test

    Science.gov (United States)

    Ioannou, Marios

    2018-06-01

    This study analyses learning aspects of undergraduate mathematics students' first encounter with the subgroup test, using the commognitive theoretical framework. It focuses on students' difficulties as these are related to the object-level and metalevel mathematical learning in group theory, and, when possible, highlights any commognitive conflicts. In the data analysis, one can identify three types of difficulties, relevant to object-level learning: namely regarding the frequently observed confusion between groups and sets, the object-level rules of visual mediators, and the object-level rules of contextual notions, such as permutations, exponentials, sets and matrices. In addition, data analysis suggests two types of difficulties, relevant to metalevel learning. The first refers to the actual proof that the three conditions of subgroup test hold, and the second is related to syntactic inaccuracies, incomplete argumentation and problematic use of visual mediators. Finally, this study suggests that there are clear links between object-level and metalevel learning, mainly due to the fact that objectification of the various relevant mathematical notions influences the endorsement of the governing metarules.

  7. Interrelation between Neuroendocrine Disturbances and Medical Complications Encountered during Rehabilitation after TBI

    Directory of Open Access Journals (Sweden)

    Caroline I. E. Renner

    2015-09-01

    Full Text Available Traumatic brain injury is not a discrete event but an unfolding sequence of damage to the central nervous system. Not only the acute phase but also the subacute and chronic period after injury, i.e., during inpatient rehabilitation, is characterized by multiple neurotransmitter alterations, cellular dysfunction, and medical complications causing additional secondary injury. Neuroendocrine disturbances also influence neurological outcome and are easily overlooked as they often present with diffuse symptoms such as fatigue, depression, poor concentration, or a decline in overall cognitive function; these are also typical sequelae of traumatic brain injury. Furthermore, neurological complications such as hydrocephalus, epilepsy, fatigue, disorders of consciousness, paroxysmal sympathetic hyperactivity, or psychiatric-behavioural symptoms may mask and/or complicate the diagnosis of neuroendocrine disturbances, delay appropriate treatment and impede neurorehabilitation. The present review seeks to examine the interrelation between neuroendocrine disturbances with neurological complications frequently encountered after moderate to severe TBI during rehabilitation. Common neuroendocrine disturbances and medical complications and their clinical implications are discussed.

  8. Short and long-lasting behavioral consequences of agonistic encounters between male Drosophila melanogaster.

    Science.gov (United States)

    Trannoy, Séverine; Penn, Jill; Lucey, Kenia; Popovic, David; Kravitz, Edward A

    2016-04-26

    In many animal species, learning and memory have been found to play important roles in regulating intra- and interspecific behavioral interactions in varying environments. In such contexts, aggression is commonly used to obtain desired resources. Previous defeats or victories during aggressive interactions have been shown to influence the outcome of later contests, revealing loser and winner effects. In this study, we asked whether short- and/or long-term behavioral consequences accompany victories and defeats in dyadic pairings between male Drosophila melanogaster and how long those effects remain. The results demonstrated that single fights induced important behavioral changes in both combatants and resulted in the formation of short-term loser and winner effects. These decayed over several hours, with the duration depending on the level of familiarity of the opponents. Repeated defeats induced a long-lasting loser effect that was dependent on de novo protein synthesis, whereas repeated victories had no long-term behavioral consequences. This suggests that separate mechanisms govern the formation of loser and winner effects. These studies aim to lay a foundation for future investigations exploring the molecular mechanisms and circuitry underlying the nervous system changes induced by winning and losing bouts during agonistic encounters.

  9. Common Ground in Cross Cultural Communication: Sequential and Institutional Contexts in Front Desk Service Encounters.

    Science.gov (United States)

    Kidwell, Mardi

    2000-01-01

    Looks at interactions between English-as-a-Second-Language students and English-speaking staff at the front desk of a language institute. Analysis focuses on the sequential organization of front desk encounters, revealing ways the participant's shared orientations to the organization and goals of these encounters facilitate native…

  10. A Survey Instrument for Measuring the Experiential Value of Employee-Tourist Encounters

    DEFF Research Database (Denmark)

    Mattsson, Jan; Sørensen, Flemming; Jensen, Jens Friis

    In this paper, we develop and test a survey instrument that aims at estimating the experiential value of employee-tourist encounters in destination-based tourism companies, as well as the characteristics of encounters that affect such experiential value. We suggest that such an instrument can...... for their visitors, rather than simply delivering service quality....

  11. BodyHeat Encounter: Performing Technology in Pedagogical Spaces of Surveillance/Intimacy

    Science.gov (United States)

    Fels, Lynn; Ricketts, Kathryn

    2015-01-01

    What occurs when videographer and performer encounter each other through the lens of a camera? This collaborative performative inquiry focuses on embodiment and emergent narrative as realized through an encounter between technology and the visceral body--a relational body that smells, touches, sees, hears and feels the emergent world through…

  12. Multiple Codes, Multiple Impressions: An Analysis of Doctor-Client Encounters in Nigeria

    Science.gov (United States)

    Odebunmi, Akin

    2013-01-01

    Existing studies on doctor-client interactions have largely focused on monolingual encounters and the interactional effects and functions of the languages used in the communication between doctors and their clients. They have neither, to a large extent, examined the several codes employed in single encounters and their pragmatic roles nor given…

  13. Intercultural Reflection through the "Autobiography of Intercultural Encounters": Students' Accounts of Their Images of Alterity

    Science.gov (United States)

    Méndez García, María del Carmen

    2017-01-01

    The Council of Europe's "Autobiography of Intercultural Encounter" (AIE) is a tool to develop intercultural competence (IC) in education by encouraging users to reflect upon and learn from momentous intercultural encounters they have experienced face to face. Its parallel resource, the "Autobiography of Intercultural Encounters…

  14. Association of volume of patient encounters with residents' in-training examination performance.

    Science.gov (United States)

    McCoy, Christopher P; Stenerson, Matthew B; Halvorsen, Andrew J; Homme, Jason H; McDonald, Furman S

    2013-08-01

    Patient care and medical knowledge are Accreditation Council for Graduate Medical Education (ACGME) core competencies. The correlation between amount of patient contact and knowledge acquisition is not known. To determine if a correlation exists between the number of patient encounters and in-training exam (ITE) scores in internal medicine (IM) and pediatric residents at a large academic medical center. Retrospective cohort study Resident physicians at Mayo Clinic from July 2006 to June 2010 in IM (318 resident-years) and pediatrics (66 resident-years). We tabulated patient encounters through review of clinical notes in an electronic medical record during post graduate year (PGY)-1 and PGY-2. Using linear regression models, we investigated associations between ITE score and number of notes during the previous PGY, adjusted for previous ITE score, gender, medical school origin, and conference attendance. For IM, PGY-2 admission and consult encounters in the hospital and specialty clinics had a positive linear association with ITE-3 % score (β = 0.02; p = 0.004). For IM, PGY-1 conference attendance is positively associated with PGY-2 ITE performance. We did not detect a correlation between PGY-1 patient encounters and subsequent ITE scores for IM or pediatric residents. No association was found between IM PGY-2 ITE score and inpatient, outpatient, or total encounters in the first year of training. Resident continuity clinic and total encounters were not associated with change in PGY-3 ITE score. We identified a positive association between hospital and subspecialty encounters during the second year of IM training and subsequent ITE score, such that each additional 50 encounters were associated with an increase of 1 % correct in PGY-3 ITE score after controlling for previous ITE performance and continuity clinic encounters. We did not find a correlation for volume of encounters and medical knowledge for IM PGY-1 residents or the pediatric cohort.

  15. Dispersion of the Himalia family of jovian irregular satellites by planetesimal encounters

    Science.gov (United States)

    Li, Daohai; Christou, Apostolos

    2017-06-01

    Giant planets are believed to have migrated significant radial distances due to interaction with a primordial planetesimal disk (Tsiganis et al. 2005). This process profoundly sculpted the solar system, shaping the distribution of the different types of heliocentric objects: the giant planets, the Trojans, the Main Asteroid Belt and the KBOs. Meanwhile, the same migration may have influenced the distribution of objects in the local planetocentric system as well. Since migration is achieved mainly by planet-planetesimal encounters, we focus on irregular satellites far from the host, thus susceptible to planetesimal perturbations. Specifically, we aim to reproduce a puzzling feature of the jovian Himalia group of prograde satellites: a wide spread in $a$ and $e$, with all group members being $>200$ m/s from Himalia and apparently too high to be consistent with a purely collisional origin. Here we investigate the evolution of a pre-existing Himalia group during planetary migration.We do this in a two-step procedure. Firstly, we perform migration simulations and record the states of planetesimals approaching Jupiter. Secondly, a nascent, closely-packed Himalia group with velocity dispersion of a few 10 m/s is integrated under the gravitational disturbance of the planetesimal fly-bys. We find that these planetesimal encounters disperse the group dramatically, bumping $\\sim 60\\%$ of the members to $>200$ m/s with respect to Himalia. Particularly, $a$ and $e$ suffer the most variation while the change in $i$ is often limited, matching the actual values for the observed group fairly well.Current models posit extensive collisional processing of the irregular satellite population following the planet migration phase (Bottke et al. 2010). In evaluating the collisional probability between a group member and Himalia, we find that the closer they are, the more likely that collisions occur. This suggests that members adjacent to Himalia are more likely to be collisionally

  16. Malting and Brewing Industries Encounter Fusarium spp. Related Problems

    Directory of Open Access Journals (Sweden)

    Kristina Mastanjević

    2018-01-01

    Full Text Available Versatile microbiota are inevitably naturally present on cereals. Fungi, yeasts and bacteria and their metabolites all contribute to the quality and safety of the final products derived from most common beer cereals—barley and wheat. The microorganisms that are most often associated with the safety and quality of cereals for beer production belong to the Fusarium spp. They greatly influence yields from the field, and can modify and diminish economic success for farmers. However, the real problem is their harmful metabolites—mycotoxins—that affect the health of humans and animals. In the era of emerging analytical methodologies, the spectrum of known toxins originating from microorganisms that can pose a threat to humans has grown tremendously. Therefore, it is necessary to monitor microflora throughout the productive “barley to beer” chain and to act suppressive on the proliferation of unwanted microorganisms, before and during malting, preventing the occurrence of mycotoxins in final products and by-products. Multi-mycotoxin analyses are very advanced and useful tools for the assessment of product safety, and legislation should follow up and make some important changes to regulate as yet unregulated, but highly occurring, microbial toxins in malt and beer.

  17. How cancer survivors experience their changed body encountering others.

    Science.gov (United States)

    Rasmussen, Dorte Malig; Hansen, Helle Ploug; Elverdam, Beth

    2010-04-01

    Psychosocial cancer research illustrates how women treated for breast cancer experience physical changes in their bodies and the way they perceive, that, others see their body. But how patients with other types of cancer have experienced changes in their bodies and how this affects their relationship with others is less researched. To explore how cancer survivors with different types of cancer and cancer treatment, experience and handle their changed body, especially when meeting others, and how this influences their everyday life of survivorship, i.e. long after treatment has been completed. Participant observation at a Cancer Rehabilitation Centre (CRC). Of the observed participants 23 were selected and interviewed twice. Many participants had a changed body due to the cancer and its treatment. When the cancer survivors meet others they experience that their changed body means that they are avoided, looked at in specific ways, or greeted with a specific compliment. The verbal and nonverbal language that the cancer survivors are met with indicates the existence of a specific discursive aesthetic in relation to the disease and the changed body. This discursive aesthetic represents a silence and secrecy about cancer, which makes it impossible for survivors to talk about their experiences with cancer and a changed body. The changed body not only represents the physical sign of cancer, it also represents the social presence and representation of cancer. The analysis gives an insight into general questions of meaning related to the changed body in late modernity. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  18. An archival analysis of stall warning system effectiveness during airborne icing encounters

    Science.gov (United States)

    Maris, John Michael

    An archival study was conducted to determine the influence of stall warning system performance on aircrew decision-making outcomes during airborne icing encounters. A Conservative Icing Response Bias (CIRB) model was developed to explain the historical variability in aircrew performance in the face of airframe icing. The model combined Bayes' Theorem with Signal Detection Theory (SDT) concepts to yield testable predictions that were evaluated using a Binary Logistic Regression (BLR) multivariate technique applied to two archives: the NASA Aviation Safety Reporting System (ASRS) incident database, and the National Transportation Safety Board (NTSB) accident databases, both covering the period January 1, 1988 to October 2, 2015. The CIRB model predicted that aircrew would experience more incorrect response outcomes in the face of missed stall warnings than with stall warning False Alarms. These predicted outcomes were observed at high significance levels in the final sample of 132 NASA/NTSB cases. The CIRB model had high sensitivity and specificity, and explained 71.5% (Nagelkerke R2) of the variance of aircrew decision-making outcomes during the icing encounters. The reliability and validity metrics derived from this study suggest indicate that the findings are generalizable to the population of U.S. registered turbine-powered aircraft. These findings suggest that icing-related stall events could be reduced if the incidence of stall warning Misses could be minimized. Observed stall warning Misses stemmed from three principal causes: aerodynamic icing effects, which reduced the stall angle-of-attack (AoA) to below the stall warning calibration threshold; tail stalls, which are not monitored by contemporary protection systems; and icing-induced system issues (such as frozen pitot tubes), which compromised stall warning system effectiveness and airframe envelope protections. Each of these sources of missed stall warnings could be addressed by Aerodynamic Performance

  19. VizieR Online Data Catalog: Stellar encounters with long-period comets (Feng+, 2015)

    Science.gov (United States)

    Feng, F.; Bailer-Jones, C. A. L.

    2016-07-01

    We have conducted simulations of the perturbation of the Oort cloud in order to estimate the significance of known encounters in generating long-period comets. We collected the data of stellar encounters from three sources: (Bailer-Jones, 2015, Cat. J/A+A/575/A35, hereafter BJ15), Dybczynski & Berski (2015MNRAS.449.2459D), and Mamajek et al. (2015ApJ...800L..17M). Following BJ15, we use the term 'object' to refer to each encountering star in our catalogue. A specific star may appear more than once but with different data, thus leading to a different object. (1 data file).

  20. Initiating Service Encounter-based Innovation by Word-of-Business

    DEFF Research Database (Denmark)

    Mattsson, Jan

    2015-01-01

    Purpose – This paper aims to set up a natural experiment as action research and to develop a framework of cognitive distance of informants to improve the initiation of service encounter-based innovation. Design/methodology/approach – Natural experiment as action research in one Scandinavian case...... transcriptions of interviews and transcriptions. Research limitations/implications – Only one Scandinavian company and a limited number of informants were activated. Also, the time period only included the initiation phase of service encounter-based innovation. Practical implications – Three different strategies...... in an emerging innovation field, open/user-driven innovation. Theory from business marketing, service encounter and innovation is also used....

  1. [Encounters and re-encounters - philosophy and religion of the physicist Carl Friedrich von Weizsäcker].

    Science.gov (United States)

    Meyer-Abich, Michael

    2014-01-01

    (1) Quantum theory deals not just with reality but with the physical (scientific) reality of its objects. Carl Friedrich von Weizsäcker understood this to imply that scientific knowledge of objects converges with philosophical knowledge of their objectivity but did not succeed in rounding off physics. (2) We are actors as well as spectators not only in scientific knowledge but in political processes as well, particularly by means of science. It is, therefore, not justified to deny political responsibility even in 'basic research'. Carl Friedrich von Weizsacker identified classical physics as the venture of knowledge without love but believed that this boundary could be transcended. The apparent neutrality of science must not be tolerated by the churches, however. (3) In religion Weizsäcker felt most at home in Buddhist spirituality, this being akin to Christian spirituality which has been more or less lost by the Christian churches. Yet he tried to support his church and to participate in its actions. (4) Lack of love corresponds to an excess of power in the religious critique of science. In both respects Weizsäcker presented the mirror to industrial society but people in general did not recognize their image. The Max-Planck-Society, however, shut up Weizsäcker's "Institute for the study of the conditions of life in the modern world" (Starnberg 1970-1980) as soon as possible. (5) Weizsäcker always refrained from exerting any power except that of reason or truth. According to Lao Tse this is the power least perceived as such. In politics he generally followed the mainstream after once having been tempted to action in 1941/42. His influence on German society was based on his charismatic spirituality.

  2. Towards observing the encounter of the T7 DNA replication fork with a lesion site at the Single molecule level

    KAUST Repository

    Shirbini, Afnan

    2017-05-01

    Single-molecule DNA flow-stretching assays have been a powerful approach to study various aspects on the mechanism of DNA replication for more than a decade. This technique depends on flow-induced force on a bead attached to a surface-tethered DNA. The difference in the elastic property between double-strand DNA (long) and single-strand DNA (short) at low regime force allows the observation of the beads motion when the dsDNA is converted to ssDNA by the replisome machinery during DNA replication. Here, I aim to develop an assay to track in real-time the encounter of the bacteriophage T7 replisome with abasic lesion site inserted on the leading strand template. I optimized methods to construct the DNA substrate that contains the abasic site and established the T7 leading strand synthesis at the single molecule level. I also optimized various control experiments to remove any interference from the nonspecific interactions of the DNA with the surface. My work established the foundation to image the encounter of the T7 replisome with abasic site and to characterize how the interactions between the helicase and the polymerase could influence the polymerase proofreading ability and its direct bypass of this highly common DNA damage type.

  3. Social behaviour of dogs encountering AIBO, an animal-like robot in a neutral and in a feeding situation.

    Science.gov (United States)

    Kubinyi, Eniko; Miklósi, Adám; Kaplan, Frédéric; Gácsi, Márta; Topál, József; Csányi, Vilmos

    2004-03-31

    The use of animal-like autonomous robots might offer new possibilities in the study of animal interactions, if the subject recognises it as a social partner. In this paper we investigate whether AIBO, a dog-like robot of the Sony Corp. can be used for this purpose. Twenty-four adult and sixteen 4-5 months old pet dogs were tested in two situations where subjects encountered one of four different test-partners: (1) a remote controlled car; (2) an AIBO robot; (3) AIBO with a puppy-scented furry cover; and (4) a 2-month-old puppy. In the neutral situation the dog could interact freely with one of the partners for 1 min in a closed arena in the presence of its owner. In the feeding situation the encounters were started while the dog was eating food. Our results show that age and context influence the social behaviour of dogs. Further, we have found that although both age groups differentiated the living and non-living test-partners for some extent, the furry AIBO evoked significantly increased responses in comparison to the car. These experiments show the first steps towards the application of robots in behavioural studies, notwithstanding that at present AIBO's limited ability to move constrains its effectiveness as social partner for dogs.

  4. Trends in the utilization of medical imaging from 2003 to 2011: clinical encounters offer a complementary patient-centered focus.

    Science.gov (United States)

    Dodoo, Martey S; Duszak, Richard; Hughes, Danny R

    2013-07-01

    The aim of this study was to investigate trends in utilization and spending for medical imaging, using medical visits resulting in imaging as a novel metric of utilization. Utilization and spending for medical imaging were examined using (1) Medicare Part B claims data from 2003 to 2011 to measure per-enrollee spending and (2) household component events data on the elderly Medicare-age population from the Medical Expenditure Panel Survey from 2003 to 2010 to measure utilization as a function of clinical encounters. Annual health spending and Medicare payments for imaging for the elderly population grew from $294 per enrollee in 2003 to $418 in 2006 and had declined to $390 by 2011. Over this entire time, however, annual medical visits by a similar Medicare-age (≥ 65 years old) population resulting in imaging trended consistently downward, from 12.8% in 2003 to 10.6% in 2011. Despite early growth and then more recent declines in average Medicare spending per enrollee since 2003, the percentage of patient encounters resulting in medical imaging has significantly and consistently declined nationwide. Spending alone is thus an incomplete measure of changes in the role and utilization of medical imaging in overall patient care. As policymakers focus on medical imaging, a thoughtful analysis of payment policy influencing imaging utilization, and its role in concurrent and downstream patient care, will be critical to ensure appropriate patient access. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  5. Patient-provider interaction during medication encounters : A study in outpatient pharmacies in the Netherlands

    NARCIS (Netherlands)

    Koster, Ellen S.; van Meeteren, Marijke M.; Van Dijk, M; van de Bemt, Bart J F; Ensing, Hendrikus T.; Bouvy, Marcel L.; Blom, Lyda; van Dijk, Liset

    2015-01-01

    Objective: To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. Methods: Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed

  6. Patient–provider interaction during medication encounters: a study in outpatient pharmacies in the Netherlands.

    NARCIS (Netherlands)

    Koster, E.S.; Meeteren, M.M. van; Dijk, M. van; Bemt, B.J.F. van de; Ensing, H.T.; Bouvy, M.; Blom, L.; Dijk, L. van

    2015-01-01

    Objective: To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. Methods: Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed

  7. Patient-provider interaction during medication encounters: A study in outpatient pharmacies in the Netherlands

    NARCIS (Netherlands)

    Koster, E.S.; Meeteren, M.M. van; Dijk, M.; Bemt, B.J.F van den; Ensing, H.T.; Bouvy, M.L.; Blom, L.; Dijk, L. van

    2015-01-01

    OBJECTIVE: To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. METHODS: Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed

  8. VG2 LECP 0.4S HIGH RESOLUTION SATURN FAR ENCOUNTER DATA

    Data.gov (United States)

    National Aeronautics and Space Administration — This far encounter data set consists of electron and ion counting rate data from the Low Energy Charged Particle (LECP) experiment on Voyager 2 while the spacecraft...

  9. Patient participation during oncological encounters: barriers and facilitators experienced by elderly cancer patients.

    NARCIS (Netherlands)

    Noordman, J.; Driesenaar, J.A.; Henselmans, I.; Heijmans, M.; Verboom, J.; Dulmen, S. van

    2017-01-01

    Objective: To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. Method: A mixed method design, including both quantitative (secondary survey data

  10. Projected role of nuclear power in Egypt and problems encountered in implementing the first nuclear plant

    International Nuclear Information System (INIS)

    Effat, K.E.A.; Sirry, H.; El-Fouly, M.F.; El-Sharkawy, E.; El-Saiedi, A.F.

    1977-01-01

    This paper reviews the present and projected power demands in Egypt and the factors behind the decision to introduce a nuclear power generation program. Different problems encountered and anticipated in introducing the first nuclear power plant are also discussed

  11. Cultural diversity, democracy and the prospects of cosmopolitanism: a theory of cultural encounters.

    Science.gov (United States)

    Delanty, Gerard

    2011-12-01

    The most appropriate way of theorizing cultural diversity is to situate it in the context of a broader relational theory of culture in which the key dynamic is cultural encounters. The relational conception of culture places the emphasis on the relations between social actors and the processes by which some of these relations generate enduring cultural regularities and forms. This has important implications for political community and in particular for cosmopolitanism. It is in relationships that cultural phenomena are generated and become the basis of different kinds of political community. The paper outlines a typology of six kinds of cultural encounters and discusses four major cultural trends that variously emerge from these encounters. This approach with its emphasis on cultural encounters is the broad sociological context in which questions about cultural change and the prospects of cosmopolitanism should be discussed. © London School of Economics and Political Science 2011.

  12. Potentials and pitfalls of the encounter between leisure-time centers and primary schools

    DEFF Research Database (Denmark)

    Ringskou, Lea Thomsen; Gravesen, David Thore

    Our research offers a qualitative, in depth-perspective on the encounter between leisure-time centers and primary schools in Denmark. In our presentration we will, in a cross-cultural perspective, reappraise the roles of leisure-time pedagogues and discuss the potentials and pitfalls of the encou......Our research offers a qualitative, in depth-perspective on the encounter between leisure-time centers and primary schools in Denmark. In our presentration we will, in a cross-cultural perspective, reappraise the roles of leisure-time pedagogues and discuss the potentials and pitfalls...... of the encounter between leisure-time centers and primary schools. In 2014, the Danish Primary School was reformed. To a considerable extent, the reform can be understood in response to receding results in international tests (Knudsen 2010). The official aim of the reform is to challenge all pupils, regardless...... the encounter between leisure-time centers and primary schools?...

  13. VG2 LECP 0.4S HIGH RESOLUTION SATURN NEAR ENCOUNTER DATA

    Data.gov (United States)

    National Aeronautics and Space Administration — This near encounter data set consists of electron and ion counting rate data from the Low Energy Charged Particle (LECP) experiment on Voyager 1 while the spacecraft...

  14. Joseph Maran and Philipp W. Stockhammer (eds. Materiality and Social Practice: Transformative Capacities of Intercultural Encounters

    Directory of Open Access Journals (Sweden)

    Uroš Matić

    2016-03-01

    Full Text Available Prikaz zbornika Materiality and Social Practice: Transformative Capacities of Intercultural Encounters, urednika Džozefa Marana i Filipa Stokamera, Oxford and Oakville: Oxbow Books, 220 pp.

  15. Revisiting Rossion and Pourtois with new ratings for automated complexity, familiarity, beauty, and encounter.

    Science.gov (United States)

    Forsythe, Alex; Street, Nichola; Helmy, Mai

    2017-08-01

    Differences between norm ratings collected when participants are asked to consider more than one picture characteristic are contrasted with the traditional methodological approaches of collecting ratings separately for image constructs. We present data that suggest that reporting normative data, based on methodological procedures that ask participants to consider multiple image constructs simultaneously, could potentially confounded norm data. We provide data for two new image constructs, beauty and the extent to which participants encountered the stimuli in their everyday lives. Analysis of this data suggests that familiarity and encounter are tapping different image constructs. The extent to which an observer encounters an object predicts human judgments of visual complexity. Encountering an image was also found to be an important predictor of beauty, but familiarity with that image was not. Taken together, these results suggest that continuing to collect complexity measures from human judgments is a pointless exercise. Automated measures are more reliable and valid measures, which are demonstrated here as predicting human preferences.

  16. Health care encounters in Danish chiropractic practice from a consumer perspectives - a mixed methods investigation.

    Science.gov (United States)

    Myburgh, Corrie; Boyle, Eleanor; Larsen, Johanne Brinch; Christensen, Henrik Wulff

    2016-01-01

    Perceived value is the key ingredient to carving and maintaining a competitive business niche. The opportunities to interact with consumers to understand and enhance perceived value are termed 'touch points'. Due to the out-of-pocket expense incurred by patients, Danish chiropractors are subject to consumer trends and behaviors. The purpose of this investigation was to explore and describe consumer touch points relevant to perceived value through healthcare journeys in chiropractic practices. We designed a convergent parallel, mixed methods study. Our purposive sampling framework identified 11 chiropractic clinics from which we collected observational field notes, video recordings and face-to-face interviews. Data was collected between April 14(th) and June 26(th) 2014. We described the exteriors and interiors of all participant clinics, interviewed 32 staff members, 12 new patients and 36 follow-up patients and finally video recorded 11 new and 24 follow-up consultations. Categorization and analysis led to the emergence six consumer touch point themes: 'the internet', 'the physical environment', 'practice models', 'administrative staff', 'the consultation sequence and timing' and 'a consultation that adds value'. The Internet functions as a tool when choosing/confirming a clinic as appropriate, developing and initial image and managing appointments. The administrative hub appears integral to the shaping of positive consumer experiences outside of the consultation. Clinic location, practice model and interior design may contribute to context effects and thus may influence value perception during the clinical encounter. The duration of hands-on treatment received from the chiropractor is not an apparent consumer focus point. Rather, through a seven stage clinical procedure patients value consultations with clinicians who demonstrate professional competence by effective communication diagnosis/management and facilitating satisfactory treatment outcomes. At least six

  17. Desistance from Delinquency through Social Encounters with Significant Others: Case Studies of Japanese Juvenile Criminals

    OpenAIRE

    SHIRAI, Toshiaki; SATOMI, Akira; KONDO, Junya

    2013-01-01

    In order to clarify how young people stop delinquency, we conducted life history analysis, survey study and case studies. The findings indicate that, first, the encounter with significant persons can make them stop delinquency through the capacity to tolerate their depression and, second, the psychologists can play a role of the significant other using the framework of rehabilitation institutions. The encounter with significant others offers intrinsic motivation and the readiness for their pe...

  18. Patient-provider interaction during medication encounters: A study in outpatient pharmacies in the Netherlands.

    Science.gov (United States)

    Koster, Ellen S; van Meeteren, Marijke M; van Dijk, Marloes; van de Bemt, Bart J F; Ensing, Hendrikus T; Bouvy, Marcel L; Blom, Lyda; van Dijk, Liset

    2015-07-01

    To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed based on an observation protocol for the following information: content of encounter, initiator of a theme and pharmacy staff's communication style. In total, 119 encounters were recorded which concerned 42 first prescriptions, 16 first refill prescriptions and 61 follow-up refill prescriptions. During all encounters, discussion was mostly initiated by pharmacy staff (85%). In first prescription encounters topics most frequently discussed included instructions for use (83%) and dosage instructions (95%). In first refill encounters, patient experiences such as adverse effects (44%) and beneficial effects (38%) were regularly discussed in contrast to follow-up refills (7% and 5%). Patients' opinion on medication was hardly discussed. Pharmacy staff in outpatient pharmacies generally provide practical information, less frequently they discuss patients' experiences and seldom discuss patients' perceptions and preferences about prescribed medication. This study shows there is room for improvement, as communication is still not according to professional guidelines. To implement professional guidelines successfully, it is necessary to identify underlying reasons for not following the guidelines. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. CLOSE STELLAR ENCOUNTERS IN YOUNG, SUBSTRUCTURED, DISSOLVING STAR CLUSTERS: STATISTICS AND EFFECTS ON PLANETARY SYSTEMS

    International Nuclear Information System (INIS)

    Craig, Jonathan; Krumholz, Mark R.

    2013-01-01

    Both simulations and observations indicate that stars form in filamentary, hierarchically clustered associations, most of which disperse into their galactic field once feedback destroys their parent clouds. However, during their early evolution in these substructured environments, stars can undergo close encounters with one another that might have significant impacts on their protoplanetary disks or young planetary systems. We perform N-body simulations of the early evolution of dissolving, substructured clusters with a wide range of properties, with the aim of quantifying the expected number and orbital element distributions of encounters as a function of cluster properties. We show that the presence of substructure both boosts the encounter rate and modifies the distribution of encounter velocities compared to what would be expected for a dynamically relaxed cluster. However, the boost only lasts for a dynamical time, and as a result the overall number of encounters expected remains low enough that gravitational stripping is unlikely to be a significant effect for the vast majority of star-forming environments in the Galaxy. We briefly discuss the implications of this result for models of the origin of the solar system, and of free-floating planets. We also provide tabulated encounter rates and orbital element distributions suitable for inclusion in population synthesis models of planet formation in a clustered environment.

  20. CLOSE STELLAR ENCOUNTERS IN YOUNG, SUBSTRUCTURED, DISSOLVING STAR CLUSTERS: STATISTICS AND EFFECTS ON PLANETARY SYSTEMS

    Energy Technology Data Exchange (ETDEWEB)

    Craig, Jonathan; Krumholz, Mark R., E-mail: krumholz@ucolick.org [Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA 95064 (United States)

    2013-06-01

    Both simulations and observations indicate that stars form in filamentary, hierarchically clustered associations, most of which disperse into their galactic field once feedback destroys their parent clouds. However, during their early evolution in these substructured environments, stars can undergo close encounters with one another that might have significant impacts on their protoplanetary disks or young planetary systems. We perform N-body simulations of the early evolution of dissolving, substructured clusters with a wide range of properties, with the aim of quantifying the expected number and orbital element distributions of encounters as a function of cluster properties. We show that the presence of substructure both boosts the encounter rate and modifies the distribution of encounter velocities compared to what would be expected for a dynamically relaxed cluster. However, the boost only lasts for a dynamical time, and as a result the overall number of encounters expected remains low enough that gravitational stripping is unlikely to be a significant effect for the vast majority of star-forming environments in the Galaxy. We briefly discuss the implications of this result for models of the origin of the solar system, and of free-floating planets. We also provide tabulated encounter rates and orbital element distributions suitable for inclusion in population synthesis models of planet formation in a clustered environment.

  1. Close Stellar Encounters in Young, Substructured, Dissolving Star Clusters: Statistics and Effects on Planetary Systems

    Science.gov (United States)

    Craig, Jonathan; Krumholz, Mark R.

    2013-06-01

    Both simulations and observations indicate that stars form in filamentary, hierarchically clustered associations, most of which disperse into their galactic field once feedback destroys their parent clouds. However, during their early evolution in these substructured environments, stars can undergo close encounters with one another that might have significant impacts on their protoplanetary disks or young planetary systems. We perform N-body simulations of the early evolution of dissolving, substructured clusters with a wide range of properties, with the aim of quantifying the expected number and orbital element distributions of encounters as a function of cluster properties. We show that the presence of substructure both boosts the encounter rate and modifies the distribution of encounter velocities compared to what would be expected for a dynamically relaxed cluster. However, the boost only lasts for a dynamical time, and as a result the overall number of encounters expected remains low enough that gravitational stripping is unlikely to be a significant effect for the vast majority of star-forming environments in the Galaxy. We briefly discuss the implications of this result for models of the origin of the solar system, and of free-floating planets. We also provide tabulated encounter rates and orbital element distributions suitable for inclusion in population synthesis models of planet formation in a clustered environment.

  2. The Association Between Law Enforcement Encounters and Syringe Sharing Among IDUs on Skid Row: A Mixed Methods Analysis

    Science.gov (United States)

    Simon-Freeman, Rebecca; Bluthenthal, Ricky N.

    2013-01-01

    The legal environment is one factor that influences injection drug users' (IDUs) risk for HIV and other bloodborne pathogens such as hepatitis C virus (HCV). We examined the association between law enforcement encounters (i.e., arrests and citations) and receptive syringe sharing among IDUs in the context of an intensified policing effort. We conducted a mixed methods analysis of 30 qualitative and 187 quantitative interviews with IDUs accessing services at a Los Angeles, CA syringe exchange program from 2008 to 2009. Qualitative findings illustrate concerns related to visibility, drug withdrawal, and previous history of arrest/incarceration. In quantitative analysis, the number of citations received, current homelessness, and perceiving that being arrested would be a “big problem” were independently associated with recent syringe sharing. Findings illustrate some of the unintended public health consequences associated with intensified street-level policing, including risk for HIV and HCV transmission. PMID:23620243

  3. Web-based versus face-to-face interprofessional team encounters with standardized patients.

    Science.gov (United States)

    Lempicki, Kelly A; Holland, Christine S

    2018-03-01

    Challenges exist in developing interprofessional education (IPE) activities including coordinating schedules and obtaining appropriate space for teams to work. Virtual worlds have been explored as a means to overcome some of these challenges. We sought to develop a web-based interprofessional team interaction with a standardized patient (SP), as compared to a face-to-face SP interaction, focusing on the competency area of interprofessional communication. Interprofessional teams of students were randomized to complete a web-based or face-to-face SP encounter. The web-based encounter was conducted via video conference that students accessed using their own electronic device. Interprofessional communication was evaluated by faculty observers and the SPs. Participants of the web-based encounter also completed a perceptions questionnaire. Interprofessional communication was rated as average/above average by the authors and SPs. Perceptions of the web-based encounter were mixed with not all students willing to complete such an encounter again despite finding it enjoyable and a positive learning experience. The need for adequate preparation was identified, including the opportunity to review the patient case before the encounter. The web-based SP encounter afforded students the opportunity to utilize communication technology to provide patient-centered care while collaborating as an interprofessional team. Video conferencing presents an opportunity to bypass some logistical challenges in scheduling IPE experiences and can be implemented as a co-curricular activity, avoiding course revisions. Additional studies are needed to further explore student and patient perspectives and clarify when, and with what level of trainees, the experiences are most valuable. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Encountering Difference

    DEFF Research Database (Denmark)

    Foulkes, Nicol Marie

    2011-01-01

    and navigate the social system in the Indian mega-cities Bangalore, Delhi and Mumbai. The analysis takes into consideration how Nordic shared values like trust and equality are negotiated in locations where there are stark cultural and environmental differences, investigating how these negotiations affect...

  5. Encountering Difference

    DEFF Research Database (Denmark)

    Savinetti, Nicol Marie Foulkes

    migrants’ social citizenship is affected by the move to the mega-cities Mumbai, Delhi and Bangalore, which have been recognized as challenging destinations for foreign highly skilled migrant workers. I apply Rainer Bauböck’s (2010) citizenship constellation as a theoretical frame. It does not conform...

  6. Encountering Drawing

    Science.gov (United States)

    Gregory, Nuala

    2017-01-01

    This article divides into two roughly equal parts, both of which aim to address the "act" rather than the "art" of drawing. The second part focuses on a theoretical discussion of drawing. The first bears on a number of themes including the role of drawing in colonial history, drawing and data collection, and drawing and memory.…

  7. Aesthetic Encounters

    OpenAIRE

    Bertelsen, Marianne

    2016-01-01

    By studying what goes on in the world of art, it is possible not only to make observations about art and the artist but also to understand how modern-day culture is being organized and negotiated. From this perspective, understanding the experiences of autonomy and contemporaneity in being an artist today, and how these relate to cultural structures, can serve to explain some of the cultural structures that organize the world of art. In this thesis, my empirical starting point ...

  8. Aesthetic Encounters

    DEFF Research Database (Denmark)

    Bertelsen, Marianne

    By studying what goes on in the world of art, it is possible not only to make observations about art and the artist but also to understand how modern-day culture is being organized and negotiated. From this perspective, understanding the experiences of autonomy and contemporaneity in being...... an artist today, and how these relate to cultural structures, can serve to explain some of the cultural structures that organize the world of art. In this thesis, my empirical starting point is the local context of a Danish art school and global attitudes to cultural policy-making and art education....... These attitudes, in turn, carry my research process across the global world of art, involving the local context of a Chinese art school. Moving away from the somewhat simplified conflicts of autonomy and heteronomy, the global and the local, and the traditional and the contemporary, the three main themes...

  9. Drug-related police encounters across the globe: How do they compare?

    Science.gov (United States)

    Hughes, Caitlin E; Barratt, Monica J; Ferris, Jason A; Maier, Larissa J; Winstock, Adam R

    2018-06-01

    Drug law enforcement subsumes the majority of drug policy expenditure across the globe. Fuelled by knowledge that much of this investment is ineffective or counter-productive there have been increasing calls for cross-national comparisons to identify where policing approaches differ and what types of approaches may be more effective. Yet, to date cross-national comparison of drug law enforcement has proven a methodologically hazardous affair. Using a new drug policing module added to the 2017 Global Drug Survey, this study seeks to provide the first cross-national comparison of the incidence, nature and intensity of illicit drug-related police encounters amongst people who use drugs. The Global Drug Survey was administered in late 2016. Across 26 countries including Australia, Germany, Italy, Mexico, Switzerland, the UK and the USA a total of 45,942 people who had recently used drugs completed the drug policing module. Key variables assessed included the incidence and frequency of drug-related police encounters in the last 12 months that involved: a) being stopped and searched; b) encountering a drug detection dog; c) being given a caution or warning; d) being charged and arrested; and e) paying a bribe. Multi-level models were used to control for pre-existing national differences in drug use prevalence and non-drug specific policing (including the total number of police personnel in each country). Drug-related police encounters were most commonly reported in Italy and Scotland. Conversely, police encounters were most likely to lead to arrest in Norway, Finland and Sweden. The type and locations of encounters further differed across countries, with for example stop and search most reported in Greece and Colombia, and encounters with drug detection dogs most reported in Scotland, Italy, UK and Australia. Multi-level models showed that the incidence of reported policing encounters continued to differ significantly across countries after controlling for pre

  10. Penguin head movement detected using small accelerometers: a proxy of prey encounter rate.

    Science.gov (United States)

    Kokubun, Nobuo; Kim, Jeong-Hoon; Shin, Hyoung-Chul; Naito, Yasuhiko; Takahashi, Akinori

    2011-11-15

    Determining temporal and spatial variation in feeding rates is essential for understanding the relationship between habitat features and the foraging behavior of top predators. In this study we examined the utility of head movement as a proxy of prey encounter rates in medium-sized Antarctic penguins, under the presumption that the birds should move their heads actively when they encounter and peck prey. A field study of free-ranging chinstrap and gentoo penguins was conducted at King George Island, Antarctica. Head movement was recorded using small accelerometers attached to the head, with simultaneous monitoring for prey encounter or body angle. The main prey was Antarctic krill (>99% in wet mass) for both species. Penguin head movement coincided with a slow change in body angle during dives. Active head movements were extracted using a high-pass filter (5 Hz acceleration signals) and the remaining acceleration peaks (higher than a threshold acceleration of 1.0 g) were counted. The timing of head movements coincided well with images of prey taken from the back-mounted cameras: head movement was recorded within ±2.5 s of a prey image on 89.1±16.1% (N=7 trips) of images. The number of head movements varied largely among dive bouts, suggesting large temporal variations in prey encounter rates. Our results show that head movement is an effective proxy of prey encounter, and we suggest that the method will be widely applicable for a variety of predators.

  11. THE RINGS OF CHARIKLO UNDER CLOSE ENCOUNTERS WITH THE GIANT PLANETS

    Energy Technology Data Exchange (ETDEWEB)

    Araujo, R. A. N.; Sfair, R.; Winter, O. C., E-mail: ran.araujo@gmail.com, E-mail: rsfair@feg.unesp.br, E-mail: ocwinter@gmail.com [UNESP - Univ. Estadual Paulista, Grupo de Dinâmica Orbital e Planetologia, CEP 12516-410, Guaratingueta, SP (Brazil)

    2016-06-20

    The Centaur population is composed of minor bodies wandering between the giant planets that frequently perform close gravitational encounters with these planets, leading to a chaotic orbital evolution. Recently, the discovery of two well-defined narrow rings was announced around the Centaur 10199 Chariklo. The rings are assumed to be in the equatorial plane of Chariklo and to have circular orbits. The existence of a well-defined system of rings around a body in such a perturbed orbital region poses an interesting new problem. Are the rings of Chariklo stable when perturbed by close gravitational encounters with the giant planets? Our approach to address this question consisted of forward and backward numerical simulations of 729 clones of Chariklo, with similar initial orbits, for a period of 100 Myr. We found, on average, that each clone experiences during its lifetime more than 150 close encounters with the giant planets within one Hill radius of the planet in question. We identified some extreme close encounters that were able to significantly disrupt or disturb the rings of Chariklo. About 3% of the clones lose their rings and about 4% of the clones have their rings significantly disturbed. Therefore, our results show that in most cases (more than 90%), the close encounters with the giant planets do not affect the stability of the rings in Chariklo-like systems. Thus, if there is an efficient mechanism that creates the rings, then these structures may be common among these kinds of Centaurs.

  12. Dental case manager encounters: the association with retention in dental care and treatment plan completion.

    Science.gov (United States)

    Lemay, Celeste A; Tobias, Carol; Umez-Eronini, Amarachi A; Brown, Carolyn; McCluskey, Amanda; Fox, Jane E; Bednarsh, Helene; Cabral, Howard J

    2013-01-01

    Little is known about dental case managers as few programs have been scientifically evaluated. The goal of this study was to explore the impact of dental case manager on retention in dental care and completion of treatment plans, while specifically exploring the number of dental case manager encounters. Fourteen programs enrolled people with HIV/AIDS (PLWHA) in dental care and a longitudinal study between 2007 and 2009. The 758 participants had a total of 2715 encounters with a dental case manager over twelve months: 29% had a single encounter; 21% had two; 27% had 3-4 and; 23% had 5-29 encounters. Adjusting for baseline characteristics, participants receiving more encounters were significantly more likely to complete their Phase 1 treatment plan, be retained in dental care, and experience improvements in overall oral health status. Organizations considering efforts to improve the oral health of vulnerable, hard-to-engage populations should consider these findings when planning interventions. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

  13. Stereotype threat and racial differences in citizens' experiences of police encounters.

    Science.gov (United States)

    Najdowski, Cynthia J; Bottoms, Bette L; Goff, Phillip Atiba

    2015-10-01

    We conducted 2 studies to investigate how cultural stereotypes that depict Blacks as criminals affect the way Blacks experience encounters with police officers, expecting that such encounters induce Blacks to feel stereotype threat (i.e., concern about being judged and treated unfairly by police because of the stereotype). In Study 1, we asked Black and White participants to report how they feel when interacting with police officers in general. As predicted, Blacks, but not Whites, reported concern that police officers stereotype them as criminals simply because of their race. In addition, this effect was found for Black men but not Black women. In Study 2, we asked Black and White men to imagine a specific police encounter and assessed potential downstream consequences of stereotype threat. Consistent with Study 1, Black but not White men anticipated feeling stereotype threat in the hypothetical police encounter. Further, racial differences in anticipated threat translated into racial differences in anticipated anxiety, self-regulatory efforts, and behavior that is commonly perceived as suspicious by police officers. By demonstrating that Blacks might expect to be judged and treated unfairly by police because of the negative stereotype of Black criminality, this research extends stereotype threat theory to the new domain of criminal justice encounters. It also has practical implications for understanding how the stereotype could ironically contribute to bias-based policing and racial disparities in the justice system. (c) 2015 APA, all rights reserved).

  14. Oil spill encounter rate: A means of estimating advancing skimmer performance

    International Nuclear Information System (INIS)

    Schulze, R.

    1993-01-01

    A high rate of oil spill recovery can only be achieved if the spilled oil can be collected fast enough for the skimming and pumping systems to operate at their rated capacity. For advancing skimmers, recovery capacity depends on the rate at which the skimming system encounters the oil slick. For these systems, encounter rate depends on skimming speed, sweep width, and the amount of oil available, in this case measured in terms of slick thickness. The computation of the spill encounter rate is described, and a chart is provided that permits the user to determine encounter rate for candidate skimming systems by inspection. Furthermore, a contingency planning worksheet for advancing skimmers is provided that allows the user to evaluate a particular response system. The resulting data can be used to determine the oil slick area that can be covered in a period of time, the volume of oil that can be expected to be recovered in that time based on oil spill planning scenarios, the pumping capacity required for skimming and transfer systems, and the storage requirements for recovered oil. Finally, suggestions are presented on how computations of oil spill encounter rate can be used to make important decisions in procuring advancing skimmers for specific applications. 1 fig., 1 tab

  15. arXiv Gravitational wave energy emission and detection rates of Primordial Black Hole hyperbolic encounters

    CERN Document Server

    García-Bellido, Juan

    2018-01-01

    We describe in detail gravitational wave bursts from Primordial Black Hole (PBH) hyperbolic encounters. The bursts are one-time events, with the bulk of the released energy happening during the closest approach, which can be emitted in frequencies that could be within the range of both LIGO (10-1000Hz) and LISA ($10^{-6}-1$ Hz). Furthermore, we correct the results for the power spectrum of hyperbolic encounters found in the literature and present new exact and approximate expressions for the peak frequency of the emission. Note that these GW bursts from hyperbolic encounters between PBH are complementary to the GW emission from the bounded orbits of BHB mergers detected by LIGO, and help breaking degeneracies in the determination of the PBH mass, spin and spatial distributions.

  16. Application of the binary-encounter theory to proton impact double ionization of atoms. [Cross sections

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, A; Roy, B N [Bihar Univ. (India). Dept. of Physics

    1977-10-21

    Proton impact double ionisation of He has been investigated in the double-encounter model of Gryzinski (Phys. Rev.; 138A:305, 322 and 336 (1965)). The binary-encounter expressions developed by Vriens (Proc. Phys. Soc.; 89:13 (1966), Ibid 90:935 (1967)) along with an accurate quantum-mechanical velocity distribution for the bound electrons in both encounters have been used to obtain double-ionisation cross sections. These results have been compared with the experimental observations and earlier calculations by Gryzinski's method. The variation of sigmasub(+)/sigmasub(++) (single-ionisation cross section/double-ionisation cross section) with incident proton energy is also found to be in qualitative agreement with the experimentally observed variation.

  17. Investigating Effect of Service Encounter, Value, and Satisfaction on Word of Mouth: An Outpatient Service Context.

    Science.gov (United States)

    Hsu, Li-Chun

    2018-01-13

    This study investigates the relationships among service encounter, service value, patient satisfaction, and word-of-mouth (WOM) intention from the viewpoint of interactive marketing. Data were collected using a questionnaire survey. A total of 372 questionnaires were obtained and 350 of these questionnaires were valid (94.09%), and a structural equation model was used to analyze the data. This study proposed seven hypotheses, and five of the seven hypotheses were supported. Service encounters indirectly affect their patient WOM through service value and satisfaction. Therefore, service value and satisfaction play a crucial mediating role in linking service encounters and WOM. This study determined WOM intentions in an outpatient service context and provides crucial business implications for teaching hospitals to enable them to improve their service quality and achieve a sustainable operation.

  18. Investigating Effect of Service Encounter, Value, and Satisfaction on Word of Mouth: An Outpatient Service Context

    Directory of Open Access Journals (Sweden)

    Li-Chun Hsu

    2018-01-01

    Full Text Available This study investigates the relationships among service encounter, service value, patient satisfaction, and word-of-mouth (WOM intention from the viewpoint of interactive marketing. Data were collected using a questionnaire survey. A total of 372 questionnaires were obtained and 350 of these questionnaires were valid (94.09%, and a structural equation model was used to analyze the data. This study proposed seven hypotheses, and five of the seven hypotheses were supported. Service encounters indirectly affect their patient WOM through service value and satisfaction. Therefore, service value and satisfaction play a crucial mediating role in linking service encounters and WOM. This study determined WOM intentions in an outpatient service context and provides crucial business implications for teaching hospitals to enable them to improve their service quality and achieve a sustainable operation.

  19. Construct validity of the reporter-interpreter-manager-educator structure for assessing students' patient encounter skills

    DEFF Research Database (Denmark)

    Tolsgaard, Martin G.; Arendrup, Henrick; Lindhardt, Bjarne O.

    2012-01-01

    PURPOSE: The aim of this study, done in Denmark, was to explore the construct validity of a Reporter-Interpreter-Manager-Educator (RIME)-structured scoring format for assessing patient encounter skills. METHOD: The authors developed a RIME-structured scoring form and explored its construct validity...... in a two-step procedure. The first step (implemented in 2009) was a randomized, controlled, experimental study in which the performance of three groups (16 fourth-year medical students, 16 sixth-year medical students, and 16 interns) was assessed in two simulated patient encounters. The second step...... (carried out during 2009-2010) was an observational study of patient encounter skills where clinician examiners used the scoring form in end-of-clerkship oral examinations of three consecutive cohorts of a total of 547 fourth-year medical students. RESULTS: In the experimental study, RIME scores showed...

  20. Estimating migratory connectivity of birds when re-encounter probabilities are heterogeneous

    Science.gov (United States)

    Cohen, Emily B.; Hostelter, Jeffrey A.; Royle, J. Andrew; Marra, Peter P.

    2014-01-01

    Understanding the biology and conducting effective conservation of migratory species requires an understanding of migratory connectivity – the geographic linkages of populations between stages of the annual cycle. Unfortunately, for most species, we are lacking such information. The North American Bird Banding Laboratory (BBL) houses an extensive database of marking, recaptures and recoveries, and such data could provide migratory connectivity information for many species. To date, however, few species have been analyzed for migratory connectivity largely because heterogeneous re-encounter probabilities make interpretation problematic. We accounted for regional variation in re-encounter probabilities by borrowing information across species and by using effort covariates on recapture and recovery probabilities in a multistate capture–recapture and recovery model. The effort covariates were derived from recaptures and recoveries of species within the same regions. We estimated the migratory connectivity for three tern species breeding in North America and over-wintering in the tropics, common (Sterna hirundo), roseate (Sterna dougallii), and Caspian terns (Hydroprogne caspia). For western breeding terns, model-derived estimates of migratory connectivity differed considerably from those derived directly from the proportions of re-encounters. Conversely, for eastern breeding terns, estimates were merely refined by the inclusion of re-encounter probabilities. In general, eastern breeding terns were strongly connected to eastern South America, and western breeding terns were strongly linked to the more western parts of the nonbreeding range under both models. Through simulation, we found this approach is likely useful for many species in the BBL database, although precision improved with higher re-encounter probabilities and stronger migratory connectivity. We describe an approach to deal with the inherent biases in BBL banding and re-encounter data to demonstrate

  1. Physician as partner or salesman? Shared decision-making in real-time encounters.

    Science.gov (United States)

    Karnieli-Miller, Orit; Eisikovits, Zvi

    2009-07-01

    The results of recent research have led to the increased advocacy of shared decision-making regarding medical treatment. Nonetheless, only a limited number of studies have focused on the process of decision-making in real-time encounters. The present paper aims to document and analyze this process. Specifically, we assess whether these decisions are the result of partnership or of persuasive tactics based on power and hierarchical relationships. We will describe and analyze different strategies used by pediatric gastroenterologists in breaking bad news encounters, as well as their consequences. The analysis is based on a multi-method, multi-participant phenomenological study on breaking bad news to adolescents and their families regarding a chronic illness. It included 17 units of analysis (actual encounters and 52 interviews with physicians, parents and adolescents). Data were collected from three hospitals in Northern Israel using observations and audiotapes of diagnosis disclosure encounters and audio-taped interviews with all participants. The analysis identified eight different presentation tactics used in actual encounters during which physicians made various use of language, syntax and different sources of power to persuade patients to agree with their preferred treatment choice. The tactics included various ways of presenting the illness, treatment and side effects; providing examples from other success or failure stories; sharing the decision only concerning technicalities; and using plurals and authority. The findings suggest that shared decision-making may be advocated as a philosophical tenet or a value, but it is not necessarily implemented in actual communication with patients. Rather, treatment decisions tend to be unilaterally made, and a variety of persuasive approaches are used to ensure agreement with the physician's recommendation. The discussion is focused on the complexity of sharing a decision, especially in the initial bad news encounter

  2. Strange culinary encounters::stranger fetichism in "Jamie's Italian escape" and "Gordon's great escape"

    OpenAIRE

    Leer, Jonatan; Kjær, Katrine Meldgaard

    2015-01-01

    In this article, we examine the ways in which the encountering of 'other' food cultures is played out in the two travelogue cooking shows Gordon's Great Escape and Jamie's Italian Escape. We investigate how the two protagonist chefs Jamie Oliver and Gordon Ramsay imagine, meet and evaluate the ‘other’ food cultures in these programs, paying special attention to how the encounter with the local Indian and Italian is imagined to be a gateway to an authentic and/or primitive experience. Our main...

  3. Border Encounters: American Cultural Politics and the U.S.-Mexico Border

    OpenAIRE

    Reimer, Jennifer Andrea

    2011-01-01

    AbstractBorder Encounters: American Cultural Politics and the U.S.-Mexico BorderbyJennifer Andrea ReimerDoctor of Philosophy in Ethnic StudiesUniversity of California, BerkeleyProfessor José David Saldívar, Co-ChairProfessor Laura E. Pérez, Co-ChairBorder Encounters: American Cultural Politics and the U.S.-Mexico Border is a transnational, interdisciplinary cultural study of the contemporary U.S.-Mexico border that argues for the critical role of the international border in the racial past, p...

  4. Reflexivity: The Creation of Liminal Spaces--Researchers, Participants, and Research Encounters.

    Science.gov (United States)

    Enosh, Guy; Ben-Ari, Adital

    2016-03-01

    Reflexivity is defined as the constant movement between being in the phenomenon and stepping outside of it. In this article, we specify three foci of reflexivity--the researcher, the participant, and the encounter--for exploring the interview process as a dialogic liminal space of mutual reflection between researcher and participant. Whereas researchers' reflexivity has been discussed extensively in the professional discourse, participants' reflexivity has not received adequate scholarly attention, nor has the promise inherent in reflective processes occurring within the encounter. © The Author(s) 2015.

  5. Is my child sick? Parents management of signs of illness and experiences of the medical encounter

    DEFF Research Database (Denmark)

    Ertmann, Ruth Kirk; Reventlow, Susanne; Söderström, Margareta

    2011-01-01

    for improvements in the medical encounter. DESIGN: Semi-structured interviews. SETTING AND SUBJECTS: Twenty strategically selected families with a child from a birth cohort in Frederiksborg County, Denmark were interviewed. RESULTS: Parents wanted to consult their GP at the right time, i.e. neither too early nor...... to be acknowledged as competent collaborators. The GP's failure to acknowledge the parents' knowledge of their child's current illness, and the parents' attempt to identify what is wrong with the child and make the child feel better before the encounter may have consequences for the GP's credibility. It is therefore...

  6. 338 Stressors and their Influence on Job Performance of Career ...

    African Journals Online (AJOL)

    Nekky Umera

    The purpose of this study was to determine stressors and how they influence university career ... staff are often faced with struggling to maintain a continual balance among .... time working, reporting and encountering stress in their work life.

  7. Encounters of aircraft with volcanic ash clouds; A compilation of known incidents, 1953-2009

    Science.gov (United States)

    Guffanti, Marianne; Casadevall, Thomas J.; Budding, Karin

    2010-01-01

    Information about reported encounters of aircraft with volcanic ash clouds from 1953 through 2009 has been compiled to document the nature and scope of risks to aviation from volcanic activity. The information, gleaned from a variety of published and other sources, is presented in database and spreadsheet formats; the compilation will be updated as additional encounters occur and as new data and corrections come to light. The effects observed by flight crews and extent of aircraft damage vary greatly among incidents, and each incident in the compilation is rated according to a severity index. Of the 129 reported incidents, 94 incidents are confirmed ash encounters, with 79 of those having various degrees of airframe or engine damage; 20 are low-severity events that involve suspected ash or gas clouds; and 15 have data that are insufficient to assess severity. Twenty-six of the damaging encounters involved significant to very severe damage to engines and (or) airframes, including nine encounters with engine shutdown during flight. The average annual rate of damaging encounters since 1976, when reporting picked up, has been approximately 2 per year. Most of the damaging encounters occurred within 24 hours of the onset of ash production or at distances less than 1,000 kilometers from the source volcanoes. The compilation covers only events of relatively short duration for which aircraft were checked for damage soon thereafter; documenting instances of long-term repeated exposure to ash (or sulfate aerosols) will require further investigation. Of 38 source volcanoes, 8 have caused 5 or more encounters, of which the majority were damaging: Augustine (United States), Chaiten (Chile), Mount St. Helens (United States), Pacaya (Guatemala), Pinatubo (Philippines), Redoubt (United States), Sakura-jima (Japan), and Soufriere Hills (Montserrat, Lesser Antilles, United Kingdom). Aircraft have been damaged by eruptions ranging from small, recurring episodes to very large

  8. Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research.

    Science.gov (United States)

    Land, Victoria; Parry, Ruth; Seymour, Jane

    2017-12-01

    Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale). © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  9. Flee or fight: ontogenetic changes in the behavior of cobweb spiders in encounters with spider-hunting wasps.

    Science.gov (United States)

    Uma, Divya B; Weiss, Martha R

    2012-12-01

    An animal's body size plays a predominant role in shaping its interspecific interactions, and, in encounters between two predators, often determines which shall be predator and which shall be prey. Spiders are top predators of insects, yet can fall prey to mud-dauber wasps that provision their larval nests with paralyzed spiders. Here we examined predator-prey interactions between Chalybion californicum (Saussure) (Sphecidae), a mud-dauber wasp, and Parasteatoda tepidariorum C. L. Koch (Theridiidae), a cobweb spider. We examined whether a spider's size influences its response to an attacking wasp, and report a size-dependent change in spider behavior: small-sized spiders fled, whereas medium- and large-sized spiders fought in response to wasp attacks. From the wasps' perspective, we examined whether spider size influences a wasp's hunting behavior and capture success. We found that wasps commonly approached small spiders, but were much less likely to approach medium and large spiders. However, wasp capture success did not vary with spider size. We also report a strategy used by Chalybion wasps toward cobweb spiders that is consistent with an interpretation of aggressive mimicry.

  10. Strong, female and Black: Stereotypes of African Caribbean women's body shape and their effects on clinical encounters.

    Science.gov (United States)

    Andrews, Nicole; Greenfield, Sheila; Drever, Will; Redwood, Sabi

    2017-03-01

    The aim of this article is to explore how tendencies to stereotype minority ethnic groups intersect with lay discourses about them in ways that can reproduce cultural prejudices and reinforce inequalities in access to services and health outcomes. Drawing upon Black feminist and cultural studies literature, we present a theoretical examination, the stereotypes of the Black woman as 'mammy' and 'matriarch'. We suggest that the influence of these two images is central to understanding the normalisation of the larger Black female body within African Caribbean communities. This representation of excess weight contradicts mainstream negative discourses of large bodies that view it as a form of moral weakness. Seeking to stimulate reflection on how unacknowledged stereotypes may shape clinical encounters, we propose that for Black women, it is the perception of strength, tied into these racial images of 'mammy' and 'matriarch' which may influence when or how health services or advice are both sought by them and offered to them. This has particular significance in relation to how body weight and weight management are/are not talked about in primary care-based interactions and what support Black women are/are not offered. We argue that unintentional bias can have tangible impacts and health outcomes for Black women and possibly other minority ethnic groups.

  11. The Consequences of Service Encounter Failure in Shopping Centers: A Study with Visually Impaired Consumers

    Directory of Open Access Journals (Sweden)

    Pedro Felipe da Costa Coelho

    2017-06-01

    Full Text Available The advent of the Brazilian Law on the Inclusion of People with Disabilities, in 2015, has brought a series of implications for marketing researchers, since it concerns the rights to include people with disabilities in public and private consumption spaces, such as shopping malls. Despite the growth of these consumer spaces in Brazil, several failures in service encounters are frequent, especially when consumers are visually impaired. Therefore, this study aims to understand the consequences of service encounters failures in shopping malls for the consumer with visual disabilities. To reach this goal, we used a qualitative approach of phenomenological nature. Data were collected through direct and naturalistic observations and conduct of nine face-to-face interviews with visually impaired consumers. Through content analysis of the results, we concluded that there is a diversity of failures occurred in service encounters, such as excessive piety of sellers to consumers, contempt and the sudden change in the service script. For this reason, the consequences of service encounter failure were from the verbal confrontation and the withdrawal of the transaction to the word-of-mouth and negative expressions of frustration in virtual social networks. This article also presents managerial and academic contributions for marketing researchers.

  12. Adopting a Blended Learning Approach: Challenges Encountered and Lessons Learned in an Action Research Study

    Science.gov (United States)

    Kenney, Jane; Newcombe, Ellen

    2011-01-01

    Adopting a new teaching approach is often a daunting task especially if one is an early adopter in a limited-resource environment. This article describes the challenges encountered and the strategies used in pilot testing a blended instructional method in a large size class within the college of education at a medium-sized university. The main…

  13. Difficulties That English Teachers Encounter While Teaching Listening Comprehension and Their Attitudes towards Them

    Science.gov (United States)

    Alrawashdeh, Ayah Isam; Al-zayed, Norma Nawaf

    2017-01-01

    This study is aimed at investigating the difficulties that English teachers encountered while teaching listening comprehension and their attitudes towards the subjectin Karak schools. To achieve the objectives of the study, the researcher used two instruments: a teacher's questionnaire and informal interviews. In order to answer the questions of…

  14. An encounter between psychology and religion: humanistic psychology and the Immaculate Heart of Mary nuns.

    Science.gov (United States)

    Kugelmann, Robert

    2005-01-01

    In the 1960s, humanistic psychology changed the relationship between psychology and religion by actively asserting the value of individual experience and self-expression. This was particularly evident in the encounter group movement. Beginning in 1967, Carl Rogers conducted a series of encounter groups, in order to promote "self-directed change in an educational system," for the Sisters of the Immaculate Heart of Mary, a religious order in California running an educational system. William Coulson, one of Rogers's associates in the project, later charged that the encounter groups undermined the religious order and played a major contributing part in the breakup of the order in 1970. The article examines these charges, situating the incident within the context of the changes occurring in religious life and in psychology in the 1960s. The article concludes that an already existing conflict the nuns had with the conservative Cardinal McIntyre of Los Angeles led to the departure of some 300 nuns from the order, who began the Immaculate Heart Community, an organization existing today. Nevertheless, encounter groups proved to be a psychological technology that helped to infuse a modern psychological--specifically, a humanistic psychological--perspective into contemporary religious life. 2005 Wiley Periodicals, Inc.

  15. Body_Machine? Encounters of the Human and the Mechanical in Education, Industry and Science

    Science.gov (United States)

    Herman, Frederik; Priem, Karin; Thyssen, Geert

    2017-01-01

    This paper unveils the body_machine as a key element of dynamic mental maps that have come to shape both educational praxis and research. It traces and analyses instances in which the human and the mechanical encountered each other in metaphorical, material and visual forms, thereby blurring to some extent the boundaries between them while…

  16. Interlingual Encounter in Pierre Garnier and Niikuni Seiichi's French-Japanese Concrete Poetry

    Science.gov (United States)

    Wong, Elaine S.

    2015-01-01

    In the latter half of the 1960s, without meeting each other and without knowing each other's language, French poet Pierre Garnier and Japanese poet Niikuni Seiichi [Japanese characters omitted] collaborated to create French-Japanese concrete poems. This essay examines the interlingual encounters in the two poets' bilingual poems that facilitate…

  17. Problems Encountered during the Scientific Research Process in Graduate Education: The Institute of Educational Sciences

    Science.gov (United States)

    Akyürek, Erkan; Afacan, Özlem

    2018-01-01

    This study was conducted to determine the problems faced by graduate students when conducting scientific research and to make suggestions for solving these problems. The research model was a case study. Semi-structured interviews were conducted with participants in the study with questions about the problems encountered during scientific research…

  18. Tactics Employed and Problems Encountered by University English Majors in Hong Kong in Using a Dictionary

    Science.gov (United States)

    Chan, Alice Yin Wa

    2005-01-01

    Building on the results of a small-scale survey which investigated the general use of dictionaries by university English majors in Hong Kong using a questionnaire survey and their specific use of dictionaries using an error correction task, this article discusses the tactics these students employed and the problems they encountered when using a…

  19. Households' Stories of Their Encounters with a Plug-In Hybrid Electric Vehicle

    Science.gov (United States)

    Caperello, Nicolette D.; Kurani, Kenneth S.

    2012-01-01

    One way to progress toward greenhouse gas reductions is for people to drive plug-in hybrid electric vehicles (PHEVs). Households in this study participated in a 4- to 6-week PHEV driving trial. A narrative of each household's encounter with the PHEV was constructed by the researchers from multiple in-home interviews, questionnaires completed by…

  20. Concentrated Language Encounter Approach in Practice for Global Teaching of Literacy: Lighthouse Strategy Implementation

    Science.gov (United States)

    Rattanavich, Saowalak

    2015-01-01

    This article presents the lighthouse literacy strategies model using the concentrated language encounter (CLE) approach that has been successfully replicated in many countries in different languages and cultures. A review of CLE research studies and the project implementation in Thailand showed highly significant results in students' literacy…

  1. Nurses' use of pliable and directed strategies when encountering children in child and school healthcare.

    Science.gov (United States)

    Harder, Maria; Enskär, Karin; Golsäter, Marie

    2017-03-01

    Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3-16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.

  2. The National Long Term Care Demonstration: operational issues encountered in developing the research design.

    Science.gov (United States)

    Carcagno, G J; Kemper, P

    1983-01-01

    This paper describes the design of the National Long Term Care Demonstration and its evaluation and discusses a number of operational issues encountered in the design process: simultaneous design of research and operations, identification of the target population, randomization, collection of comparable data, development of an assessment instrument, potential changes in existing programs, and termination planning.

  3. Difficulties EFL Jordanian University Students Encounter in Translating English Idioms into Arabic

    Science.gov (United States)

    Alrishan, Amal; Smadi, Oqlah

    2015-01-01

    This study aimed at investigating the difficulties that Jordanian EFL University students encounter in translating English idioms into Arabic. The participants of the study were all M.A translation students at Yarmouk University and the University of Jordan who were selected purposefully. The total number of the students who participated in the…

  4. Pharmacy users' expectations of pharmacy encounters: a Q-methodological study.

    Science.gov (United States)

    Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Asa; Tully, Mary P

    2011-12-01

    Pharmacy practice is evolving according to general health-care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients' expectations of service encounters at pharmacies is an under-explored topic but crucial to understanding how pharmacy practice can evolve efficiently. To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Eighty-five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual's own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health-care and lifestyle support. The systematic Q-methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients' expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. © 2010 Blackwell Publishing Ltd.

  5. A transcultural study of Jordanian nursing students' care encounters within the context of clinical education.

    Science.gov (United States)

    Nahas, V

    2000-06-01

    Clinical education is an integral part of nursing education. Clinical teachers are the vital link in this teaching-learning process. The quality and quantity of student-teacher interactions in the clinical area can either facilitate or hinder students' learning. This paper presents a part of a larger study that discovered, described, explained and compared Australian and Jordanian nursing students' caring and non-caring encounters with their clinical teachers within the context of clinical education. The study was guided by Leininger's theory of culture care universality and diversity and Leininger's ethnonursing research method was utilised. The informants consisted of 12 key informants and 35 general informants. Three major themes emerged from the analysis of the data: (1) clinical teacher's caring behaviours; (2) student-teacher caring encounters; and (3) caring encounter consequences. Under these themes, care constructs emerged which gave light to the Jordanian nursing students' care meanings, expressions and values within their cultural environment, social structures and world view. The overall findings revealed that Jordanian nursing students found their clinical experiences as beneficial when their encounters with the clinical teacher were conducted through mothering, translating, sustaining, negotiating and transforming processes.

  6. Orchestrating Professional Development for Baby Room Practitioners: Raising the Stakes in New Dialogic Encounters

    Science.gov (United States)

    Goouch, Kathleen; Powell, Sacha

    2013-01-01

    This article has emerged from a research and development project, The Baby Room, which was designed to examine how babies are cared for in daycare settings. Within the project, a form of professional development was created which designated a central space for dialogic encounter, primarily to enable the baby room practitioners who participated in…

  7. Encounter success of free-ranging marine predator movements across a dynamic prey landscape.

    Science.gov (United States)

    Sims, David W; Witt, Matthew J; Richardson, Anthony J; Southall, Emily J; Metcalfe, Julian D

    2006-05-22

    Movements of wide-ranging top predators can now be studied effectively using satellite and archival telemetry. However, the motivations underlying movements remain difficult to determine because trajectories are seldom related to key biological gradients, such as changing prey distributions. Here, we use a dynamic prey landscape of zooplankton biomass in the north-east Atlantic Ocean to examine active habitat selection in the plankton-feeding basking shark Cetorhinus maximus. The relative success of shark searches across this landscape was examined by comparing prey biomass encountered by sharks with encounters by random-walk simulations of 'model' sharks. Movements of transmitter-tagged sharks monitored for 964 days (16754 km estimated minimum distance) were concentrated on the European continental shelf in areas characterized by high seasonal productivity and complex prey distributions. We show movements by adult and sub-adult sharks yielded consistently higher prey encounter rates than 90% of random-walk simulations. Behavioural patterns were consistent with basking sharks using search tactics structured across multiple scales to exploit the richest prey areas available in preferred habitats. Simple behavioural rules based on learned responses to previously encountered prey distributions may explain the high performances. This study highlights how dynamic prey landscapes enable active habitat selection in large predators to be investigated from a trophic perspective, an approach that may inform conservation by identifying critical habitat of vulnerable species.

  8. Nursing students’ experiences of professional patient care encounters in a hospital unit

    DEFF Research Database (Denmark)

    Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth

    2015-01-01

    experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing...

  9. Tourism and its discontents : Suri-tourist encounters in southern Ethiopia

    NARCIS (Netherlands)

    Abbink, J.

    2000-01-01

    Encounters between foreign tourists and people of different cultural background become very common in a globalized world. The nature of this exchange in cultural terms relates questions of identity construction and the emergence or creation of difference. This article addresses tourist-'native'

  10. Inclusion as heterotopia: Spaces of encounter between people with and without intellectual disability

    Directory of Open Access Journals (Sweden)

    Herman Meininger

    2013-08-01

    Full Text Available The public space to which - in line with common definitions of inclusion - persons with intellectual disability are designated often turns out to be a space of discrimination. The aim of this study is to identify spaces of encounter. Michel Foucault's concept of heterotopia - 'other spaces' - and its subsequent interpretations are used as an analytical tool for evaluating efforts to include persons with intellectual disability in society. In Foucault's work 'space' refers to geographical places and to 'sites' that can be defined by sets of relations. Among these spaces are 'counter-sites' like large scale residential facilities for people with intellectual disability. Though policies of deinstitutionalisation aim at erasure of these places of exclusion, the results are often disappointing, largely because these policies ignore the analysis of power dynamics that install exclusionary processes and structures. Recent interpretations of the concept of heterotopia position the 'other places' in the middle of ordinary life as social spaces of encounter and dialogue between the 'normal' and the 'abnormal'. Characteristics and practical conditions of such spaces of encounter are explored. These interpretations open up a new conceptualisation of inclusion in terms of niches in which encounter and dialogue are cultivated and an alternative social ordering can be exercised.

  11. Commognitive Analysis of Undergraduate Mathematics Students' First Encounter with the Subgroup Test

    Science.gov (United States)

    Ioannou, Marios

    2018-01-01

    This study analyses learning aspects of undergraduate mathematics students' first encounter with the subgroup test, using the commognitive theoretical framework. It focuses on students' difficulties as these are related to the object-level and metalevel mathematical learning in group theory, and, when possible, highlights any commognitive…

  12. Logic of Accounting: The Case of Reporting Previous Options in Norwegian Activation Encounters

    Science.gov (United States)

    Solberg, Janne

    2017-01-01

    The article deals with the enactment of client resistance in Norwegian vocational rehabilitation encounters. More specific, a practice here called "reporting previous options" is analyzed by using the resources of ethnomethodological conversation analysis (CA) in five instances as doing some sort of accounting. In response to the…

  13. Frontline employees' intercultural competence: Does it impact customers' evaluations of intercultural service encounters?

    NARCIS (Netherlands)

    Hoefnagels, A.H.J.M.; Bloemer, J.M.M.; Pluymaekers, M.

    2014-01-01

    Globalization has led to an exponential growth of intercultural service encounters. In view of the importance of customer-orientation in services, we investigate the effect of the frontline employee’s intercultural competence on customer’s affective and cognitive evaluations of intercultural

  14. The Effects of Physical Attractiveness and Anxiety on Heterosexual Attraction Over a Series of Five Encounters

    Science.gov (United States)

    Mathes, Eugene W.

    1975-01-01

    The "information availability model" of heterosexual attraction was tested by having subjects go on a series of five encounters. It was found that both physical attractiveness and the personality variable, anxiety, had early and continuous effects on liking. It was concluded the model is an inadequate explanation of heterosexual…

  15. Linked analysis for definition of nurse advice line syndrome groups, and comparison to encounters.

    Science.gov (United States)

    Magruder, Steven F; Henry, J; Snyde, M

    2005-08-26

    Nurse advice call centers are a potentially important source of data for syndromic surveillance purposes. For this reason, researchers at Johns Hopkins University Applied Physics Laboratory and Kaiser Permanente of the Mid-Atlantic States (KPMAS) have been collaborating to develop methods to use this data within the ESSENCE II Syndromic Surveillance System in the National Capital Region. The objective of this report is to present a general method for finding syndrome groups in data sources that can be linked to physician encounters and to determine effective advice call syndrome groups for use with KPMAS advice data. Advice calls are linked to physician encounters and stratified by patient age. They are placed in groups according to a maximum positive predictive value criterion. The groups are evaluated by correlating the resulting syndrome time series against physician encounter data. Potentially useful advice syndrome groups are found for respiratory, lower gastrointestinal (GI), and total GI syndromes for each age stratum. The time series of the advice data for respiratory, lower GI, and upper GI syndromes accurately predict the physician encounter time series for the corresponding syndromes for each age stratum.

  16. Researching Children's Rights in Education: Sociology of Childhood Encountering Educational Theory

    Science.gov (United States)

    Quennerstedt, Ann; Quennerstedt, Mikael

    2014-01-01

    This paper aims to explore and develop a theoretical approach for children's rights research in education formed through an encounter between the sociology of childhood and John Dewey's educational theory. The interest is mainly methodological, in the sense that the primary ambition of the investigation is to suggest a fruitful and useful…

  17. Identifying the Ethical Challenges Encountered by Information Technology Professionals Working within the Nevada Casino Industry

    Science.gov (United States)

    Essig, Michael R.

    2014-01-01

    A thematic analysis qualitative study was used to identify the unethical challenges encountered by Information Technology (IT) professionals working within the Nevada casino industry. Fourteen current and former IT leaders working or who worked in the Nevada casino industry were interviewed. Using thematic analysis, nine themes regarding ethical…

  18. Encountering Heidi: meeting others as a central aspect of the river experience

    Science.gov (United States)

    Lilian Jonas; Kevin Larkin

    2000-01-01

    Over the past few decades, numerous studies have investigated relationships between encounters and the backcountry recreation experience. Although academics and professionals may recognize that meeting others in backcountry areas could result in positive interactions that are beneficial to the experience, research directed at the positive aspects of intergroup...

  19. 78 FR 23623 - Culturally Significant Objects Imported for Exhibition Determinations: “American Encounters...

    Science.gov (United States)

    2013-04-19

    ... exhibition ``American Encounters: Genre Painting and Everyday Life,'' imported from abroad for temporary... the exhibit objects at the Crystal Bridges Museum of American Art, Bentonville, Arkansas, from on or about May 11, 2013, until on or about August 12, 2013, the High Museum of Art, Atlanta, Georgia, from on...

  20. Changing Things as They Are: Promoting Social Justice through Encounters with the Arts

    Science.gov (United States)

    Gulla, Amanda Nicole

    2009-01-01

    Beyond having value as an assessment tool, engagement with the arts in the K-12 classroom can offer aesthetic experiences that have the potential to transform the way students encounter the world, engaging the imagination in acts of perception that stir them to "wide-awakeness." Advocates for the arts in education call for a variety of…

  1. Cunning Pedagogics: The Encounter between the Jesuit Missionaries and Amerindians in Th-Century New France

    Science.gov (United States)

    Welton, Michael

    2005-01-01

    The Jesuit encounter with the Amerindians of the St. Lawrence Valley in Th-century New France provides us with incalculable insights into the inner workings of the "colonial imagination" that believes the objects of instruction have everything to learn and nothing of value to teach. This article explicates how the Jesuits got to know their…

  2. A Reflective Encounter with the Fine Sand Area in a Nursery School Setting

    Science.gov (United States)

    Barnett, Anthony

    2016-01-01

    This article draws on a model of reflection that involves creating meanings through repeated encounters with evocative objects. Responses to one such evocative object, a 20-second video clip of children playing in the fine sand area, illustrates the "turning toward" and then "turning away" from the object to engage with broader…

  3. Alternative modalities – A Review of Graphic Encounters: Comics and the Sponsorship of Multimodal Literacy

    Directory of Open Access Journals (Sweden)

    Aaron Scott Humphrey

    2014-05-01

    Full Text Available Research exploring the multimodal characteristics of comics has recently flourished, and Dale Jacobs has been one of the early prolific authors on this topic. Jacobs expands these ideas further in 'Graphic Encounters: Comics and the Sponsorship of Multimodal Literacy', a monograph which engages with theories of multimodality, but shifts its focus primarily to literacy sponsorship.

  4. The Autobiography of Intercultural Encounters through Visual Media: Exploring Images of Others in Telecollaboration

    Science.gov (United States)

    Lindner, Rachel; Méndez Garcia, Maria del Carmen

    2014-01-01

    Positioned against the background of the Council of Europe's interest in developing intercultural competence through education, the study presented in this paper investigates the impact on intercultural visual literacy of the Council of Europe's "Images of Others--An Autobiography of Intercultural Encounters through Visual Media"…

  5. Retention of New Words: Quantity of Encounters, Quality of Task, and Degree of Knowledge

    Science.gov (United States)

    Laufer, Batia; Rozovski-Roitblat, Bella

    2015-01-01

    We examined how learning new second language (L2) words was affected by three "task type" conditions (reading only, reading with a dictionary, reading and word focused exercises), three "number of encounters" conditions and their combinations. Three groups of L2 learners (n = 185) were exposed to 30 target words (one group in…

  6. Seasonal and among-stream variation in predator encounter rates for fish prey

    Science.gov (United States)

    Bret C. Harvey; Rodney J. Nakamoto

    2013-01-01

    Recognition that predators have indirect effects on prey populations that may exceed their direct consumptive effects highlights the need for a better understanding of spatiotemporal variation in predator–prey interactions. We used photographic monitoring of tethered Rainbow Trout Oncorhynchus mykiss and Cutthroat Trout O. clarkii to quantify predator encounter rates...

  7. The Construction of Interculturality: A Study of Initial Encounters between Japanese and American Students.

    Science.gov (United States)

    Mori, Junko

    2003-01-01

    Investigates how Japanese and American students initiate topical talk as they get acquainted with each other during their initial encounter at a student-organized conversation table. Looks at the observable and reportable ways in which the participants demonstrate the relevance, or the irrelevance, of interculturality in the development of the…

  8. Barriers Encountered in the Transfer of Educational Training to Workplace Practice in Saudi Arabia

    Science.gov (United States)

    Almannie, Mohamed

    2015-01-01

    This study introduces a critical issue in the practicality of training programs, not only in Saudi Arabia, but also in other developing countries where billions of dollars are spent on training human resources without evaluation of these programs on workplace practice and organization development. This study investigates barriers encountered in…

  9. Toward the Long-Term Scientific Study of Encounter Group Phenomena: I. Methodological Considerations.

    Science.gov (United States)

    Diamond, Michael Jay; Shapiro, Jerrold Lee

    This paper proposes a model for the long-term scientific study of encounter, T-, and sensitivity groups. The authors see the need for overcoming major methodological and design inadequacies of such research. They discuss major methodological flaws in group outcome research as including: (1) lack of adequate base rate or pretraining measures; (2)…

  10. Encounters for common illnesses in general practice increased in obese patients

    NARCIS (Netherlands)

    Wayenburg, van C.A.M.; Lerniengre, M.B.T.; Reenen-Schimmel, van A.H.; Bor, J.H.J.; Bakx, J.C.; Staveren, van W.A.; Weel, van C.; Binsbergen, van J.J.

    2008-01-01

    Background. Obese patients are known to have more chronic medical conditions. Objective. To compare the frequency of encounter for episodes of the 10 most common illnesses in general practice between obese and non-overweight patients. Methods. Data were derived from the Continuous Morbidity

  11. Learning to be Seen: The Depiction of Encounters Between Israeli and Newcomer Children in Children's Literature

    Science.gov (United States)

    Golden, Deborah; Drubetskoy, Tatyana

    2005-01-01

    Books written for and about children may serve to convey central cultural tenets to new members of society. This paper looks at the depiction of encounters between newcomer and locally born children in contemporary Hebrew literature aimed at teenage readers and presents the major resources and practices by means of which the newcomer protagonists…

  12. Improvising in the Vulnerable Encounter: Using Improvised Participatory Theatre in Change for Healthcare Practice

    Science.gov (United States)

    Larsen, Henry; Friis, Preben; Heape, Chris

    2018-01-01

    Healthcare practitioners are often presented with vulnerable encounters where their professional experience is insufficient when dealing with patients who suffer from illnesses such as chronic pain. How can one otherwise understand chronic pain and develop practices whereby medical healthcare practitioners can experience alternative ways of doing…

  13. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice.

    NARCIS (Netherlands)

    Bensing, J.M.; Verheul, W.; Dulmen, A.M. van

    2008-01-01

    Purpose: Many patients feel anxious when entering the consultation room, but seldom verbalize their emotions explicitly in the medical encounter. The authors designed a study to analyse the visibility of patient pre-consultation (state) anxiety in their communication during the consultation. In an

  14. Reading the copepod personal ads : increasing encounter probability with hydromechanical signals

    NARCIS (Netherlands)

    van Duren, LA; Stamhuis, EJ; Videler, JJ

    1998-01-01

    Females of the calanoid copepod Temora longicornis react to chemical exudates of male conspecifics with little hops, quite distinct from their normal smooth uniform swimming motion. These hops possibly serve to create a hydrodynamical signal in the surrounding water, to increase encounter

  15. ACES M and S: Unmitigated Factorial Encounter Study on DAA/TCAS Interoperability

    Science.gov (United States)

    Thipphavong, David; Cone, Andrew; Park, Chunki; Lee, Seung Man; Santiago, Confesor

    2016-01-01

    Realization of the expected proliferation of Unmanned Aircraft System (UAS) operations in the National Airspace System (NAS) depends on the development and validation of standards for UAS Detect and Avoid (DAA) Systems. The RTCA Special Committee 228 is charged with leading the development of draft Minimum Operational Performance Standards (MOPS) for UAS DAA Systems. NASA, as a participating member of RTCA SC-228 is committed to supporting the development and validation of draft requirements for DAA alerting and guidance systems. This presentation contains the results of two combinatorial encounter analysis studies using NASA's SAA Control fast-time simulation capability for this purpose. In these studies, encounters between two aircraft were simulated one at a time for the full factorial combination of encounter geometries (e.g., encounter angle, CPA offset) and aircraft performance (e.g., ownership and intruder ground speeds and vertical rates). The first study analyzes the relationships (e.g., timeline) between the different alerting-safety regions in the SC-228 MOPS (in order of increasing severity): 1) DAA warning alert, 2) well clear recovery (WCR) guidance, 3) DAA-Collision Avoidance (CA), and 4) TCAS RA. This study will focus primarily on encounter situations in which TCAS RA occurs prior to any of the other alerting-safety boundaries. In particular, this study will investigate whether using vertical distance or vertical distance at closest point of approach (i.e., vertical miss distance or VMD) is more appropriate for the definition of the DAA-CA region. In addition, cases where transitions between different regions skip an intermediate region will be analyzed. The second study in this presentation explores a proposal to use an altitude rate error threshold to determine if vertical maneuvers are acceptable for DAA WCR guidance against non-cooperative intruders. This study incorporates the radar from the Honeywell sensor model and examines a series of

  16. Modeling close encounters with massive asteroids: a Markovian approach. An application to the Vesta family

    Science.gov (United States)

    Carruba, V.; Roig, F.; Michtchenko, T. A.; Ferraz-Mello, S.; Nesvorný, D.

    2007-04-01

    Context: Nearly all members of the Vesta family cross the orbits of (4) Vesta, one of the most massive asteroids in the main belt, and some of them approach it closely. When mutual velocities during such close encounters are low, the trajectory of the small body can be gravitationally deflected, consequently changing its heliocentric orbital elements. While the effect of a single close encounter may be small, repeated close encounters may significantly change the proper element distribution of members of asteroid families. Aims: We develop a model of the long-term effect of close encounters with massive asteroids, so as to be able to predict how far former members of the Vesta family could have drifted away from the family. Methods: We first developed a new symplectic integrator that simulates both the effects of close encounters and the Yarkovsky effect. We analyzed the results of a simulation involving a fictitious Vesta family, and propagated the asteroid proper element distribution using the probability density function (pdf hereafter), i.e. the function that describes the probability of having an encounter that modifies a proper element x by Δx, for all the possible values of Δx. Given any asteroids' proper element distribution at time t, the distribution at time t+T may be predicted if the pdf is known (Bachelier 1900, Théorie de la spéculation; Hughes 1995, Random Walks and Random Environments, Vol. I). Results: We applied our new method to the problem of V-type asteroids outside the Vesta family (i.e., the 31 currently known asteroids in the inner asteroid belt that have the same spectral type of members as the Vesta family, but that are outside the limits of the dynamical family) and determined that at least ten objects have a significant diffusion probability over the minimum estimated age of the Vesta family of 1.2 Gyr (Carruba et al. 2005, A&A, 441, 819). These objects can therefore be explained in the framework of diffusion via repeated close

  17. Use, misuse and extensions of "ideal gas" models of animal encounter.

    Science.gov (United States)

    Hutchinson, John M C; Waser, Peter M

    2007-08-01

    Biologists have repeatedly rediscovered classical models from physics predicting collision rates in an ideal gas. These models, and their two-dimensional analogues, have been used to predict rates and durations of encounters among animals or social groups that move randomly and independently, given population density, velocity, and distance at which an encounter occurs. They have helped to separate cases of mixed-species association based on behavioural attraction from those that simply reflect high population densities, and to detect cases of attraction or avoidance among conspecifics. They have been used to estimate the impact of population density, speeds of movement and size on rates of encounter between members of the opposite sex, between gametes, between predators and prey, and between observers and the individuals that they are counting. One limitation of published models has been that they predict rates of encounter, but give no means of determining whether observations differ significantly from predictions. Another uncertainty is the robustness of the predictions when animal movements deviate from the model's assumptions in specific, biologically relevant ways. Here, we review applications of the ideal gas model, derive extensions of the model to cover some more realistic movement patterns, correct several errors that have arisen in the literature, and show how to generate confidence limits for expected rates of encounter among independently moving individuals. We illustrate these results using data from mangabey monkeys originally used along with the ideal gas model to argue that groups avoid each other. Although agent-based simulations provide a more flexible alternative approach, the ideal gas model remains both a valuable null model and a useful, less onerous, approximation to biological reality.

  18. Social Workers' Reflections on the Therapeutic Encounter With Elder Abuse and Neglect.

    Science.gov (United States)

    Goldblatt, Hadass; Band-Winterstein, Tova; Alon, Sara

    2016-02-24

    The aim of this qualitative study was to explore social workers' reflections on their experience of the therapeutic encounter with victims and perpetrators of elder abuse and neglect. The research questions were as follows: How do social workers tune themselves toward the therapeutic encounter with elder abuse? How do they position themselves vis-à-vis the clients? How do social workers describe the meaning of the intervention both for the clients and for themselves? What is the added value of the therapeutic encounter in this field for the social workers? Participants were 17 experienced women social workers, who worked with abusers and with abused and neglected older adults in Israel. Data were collected via in-depth semi-structured interviews, which were later transcribed and content analyzed. Two main themes emerged from the findings, emphasizing two key aspects of the social workers' reflective process experienced during the therapeutic encounter: (a) focus on the client: "This is the journey of their lives"-reflection on the therapeutic "journey"; (b) focus on the social worker's inner and professional world: "'There is nothing to be done' is no longer in my vocabulary"-a personal and professional maturation process. The social workers expressed a positive attitude toward their elder clients. A unique dialogue developed in the therapeutic encounter, whereby the social workers considered any change as valuable if it allowed the elders a sense of control and self-worth, whereas the social workers were enriched by the elders' life experience, and matured both personally and professionally. Thus, both sides benefited from this reciprocal relationship. Implications for further research and practice are discussed. © The Author(s) 2016.

  19. Nature and frequency of exchanges on medications during primary care encounters.

    Science.gov (United States)

    Richard, Claude; Lussier, Marie-Thérèse

    2006-12-01

    To describe the exchanges, related to discussion of all medications during primary care medical consultations. Descriptive study of audio recordings of 422 medical encounters. Coding was done with MEDICODE, a validated instrument developed to analyse verbal exchanges on medications. The unit of analysis is the medication. An average of 3.9 medications (S.D.=2.8; range 1-21) are discussed per interview and 4.2 themes are broached for each drug (S.D.=2.6; range 1-17). "Active Discussed", "Represcribed" and "Newly Prescribed" drugs account for 43.1, 16.3 and 10.6%, respectively of all medications discussed. Themes most often discussed are Name, Instructions, Observed Main Effect, Class, Reasons for Taking the Drug, General Use of the Medication, Expected Effect on Symptoms, Form of the Medication, Indications Another Consultation Needed, and Alternative Medication. The least often discussed themes include clinically significant ones such as Possible Adverse Effects, Observed Adverse Effects, Expression of Attitudes and Emotions with regard to the medication, Compliance and Warnings. The average number of themes discussed differed between medications that were prescribed during the encounter, either New prescriptions or Represcribed drugs, compared to medications that were only discussed during the encounter. Our results show that medication discussions are heterogeneous and vary with the status of the medication and the theme. Also, the nature and extent of the discussions about medications do not support the shared-decision making model. Though it is too soon to make specific recommendations about discussions on medications, it seems clear that information-sharing about medications during medical encounters is a process that extends beyond any single encounter. Although communication skills are now part of most medical curriculums, there is an obvious need to put forth the concept of patient medication knowledge-building over multiple physician-patient encounters and

  20. Imaging Obsearvations of Jupiter's Sodium Magneto-Nebula During the Ulysses Encounter.

    Science.gov (United States)

    Mendillo, M; Flynn, B; Baumgardner, J

    1992-09-11

    Jupiter's great sodium nebula represents the largest visible structure traversed by the Ulysses spacecraft during its encounter with the planet in February 1992. Ground-based imaging conducted on Mount Haleakala, Hawaii, revealed a nebula that extended to at least +/-300 Jovian radii (spanning approximately 50 million kilometers); it was somewhat smaller in scale and less bright than previously observed. Analysis of observations and results of modeling studies suggest reduced volcanic activity on the moon lo, higher ion temperatures in the plasma torus, lower total plasma content in the torus, and fast neutral atomic clouds along the Ulysses inbound trajectory through the magnetosphere. Far fewer neutrals were encountered by the spacecraft along its postencounter, out-of-ecliptic trajectory.

  1. Dealing with Moms and Dads: Family Dilemmas Encountered by Youth Program Leaders

    Directory of Open Access Journals (Sweden)

    Aisha Griffith

    2014-06-01

    Full Text Available The leaders of youth programs encounter a range of challenging situations that involve youth’s parents or families. This qualitative study obtained data on the variety and nature of these family-related “dilemmas of practice.” Longitudinal interviews with leaders of 10 high quality programs for high-school-aged youth yielded narrative information on a sample of 32 family dilemmas that they had encountered. Grounded theory analysis identified four categories of family dilemmas: 1 problems at home that become a concern to the leader, 2 parents’ expectations are incongruent with program norms or functioning, 3 parents do not support youth’s participation in the program or an aspect of the program, and 4 communicating with parents on sensitive matters. Each of these categories of dilemmas entailed distinct considerations and underlying issues that effective leaders need to be able to understand.

  2. Encounters with service professionals experienced by children from families with alcohol problems

    DEFF Research Database (Denmark)

    Werner, Anne; Malterud, Kirsti

    2016-01-01

    Aim: The aim of this study was to explore encounters with service professionals experienced in childhood and adolescence by children who grew up with parental alcohol abuse. We focused on their accounts from situations indicating children’s struggles or parental drinking problems. Methods: Semi......-structured qualitative interview study was conducted with retrospective data from nine adults. Systematic text condensation was used to understand childhood experiences from encounters with professionals. Results: Participants believed that professionals rarely recognised their parents’ drinking problems. The children...... parental drinking. Even when problems were obvious, participants felt that professionals took no further action. Medical and social problems were managed within very confined perspectives. Conclusions: Specific commitment to confront cultural taboos is needed to attend to children’s unmet needs...

  3. HIV-positive migrants’ encounters with the Swedish health care system

    DEFF Research Database (Denmark)

    Mehdiyar, Manijeh; Andersson, Rune; Hjelm, Katarina

    2016-01-01

    of access and adversity’ was identified as the core category of the study. Three additional categories were ‘appreciation of free access to treatment’, ‘the impact of the Swedish Disease Act on everyday life’, and ‘encountering discrimination in the general health care system’. The main finding indicated......Background: There is limited knowledge about human immunodeficiency virus (HIV)-positive migrants and their experiences in the Swedish health care system. It is necessary to increase our knowledge in this field to improve the quality of care and social support for this vulnerable group of patients....... Objective: The aim of this study was to describe the experiences of HIV-positive migrants and their encounters with the health care system in Sweden. Design: This is a Grounded Theory study based on qualitative interviews with 14 HIV-positive migrants living in Sweden, aged 29–55 years. Results: ‘A hybrid...

  4. Interim communities between singularities: encounters of delicacy, artistic creation and difference

    Directory of Open Access Journals (Sweden)

    Juliana Araújo Silva

    2015-09-01

    Full Text Available This article is an outcome of the dissertation “Poetics and marginality: the Project Cidadãos Cantantes experience” that focused on the chorus collective experience, in the project focusing the formation of groupality, the ways of being together or coexisting, and presents an analysis of these procedures. This Project was created on 1992 in the interface of antimanicomial movement. It consists in two workshops: a scenic chorus workshop and a workshop of dance and body expression. Through the project, the authors elaborated a narrative that leads the analyses of the mentioned experience. It is understood that promoting encounters between any kind of people, with or without psychic suffering - and not grouped based on a definition or diagnosis, the project can bring people in a desiring and cooperatively manner-. Therefore, the relationships developed during the project’s workshops strengthen the production of guided encounters in power, in the creation and respect for differences.

  5. Transformative Theatre: A Promising Educational Tool for Improving Health Encounters With LGBT Older Adults.

    Science.gov (United States)

    Hughes, Anne K; Luz, Clare; Hall, Dennis; Gardner, Penny; Hennessey, Chris Walker; Lammers, Lynn

    2016-01-01

    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.

  6. Prospects for asteroid mass determination from close encounters between asteroids: ESA's Gaia space mission and beyond

    Science.gov (United States)

    Ivantsov, Anatoliy; Hestroffer, Daniel; Eggl, Siegfried

    2018-04-01

    We present a catalog of potential candidates for asteroid mass determination based on mutual close encounters of numbered asteroids with massive perturbers (D>20 km). Using a novel geometric approach tuned to optimize observability, we predict optimal epochs for mass determination observations. In contrast to previous studies that often used simplified dynamical models, we have numerically propagated the trajectories of all numbered asteroids over the time interval from 2013 to 2023 using relativistic equations of motion including planetary perturbations, J2 of the Sun, the 16 major asteroid perturbers and the perturbations due to non-sphericities of the planets. We compiled a catalog of close encounters between asteroids where the observable perturbation of the sky plane trajectory is greater than 0.5 mas so that astrometric measurements of the perturbed asteroids in the Gaia data can be leveraged. The catalog v1.0 is available at ftp://dosya.akdeniz.edu.tr/ivantsov.

  7. Problems Encountered by Primary School Teachers in the Teaching of Music

    Directory of Open Access Journals (Sweden)

    Ilgım KILIÇ

    2009-04-01

    Full Text Available The aim of this research is to identify the problems encountered by primary school teachers and to makesuggestions to solve the problems. This is a descriptive study and also a case study. A questionnaire form wasused for data collection. The surveys were administered on the elementary education teachers working underAnkara Province Directorate of the Ministry of Education in 2006 – 2007 academic year. The data collectedwere analyzed using SPSS program and statistical analyses were carried out. It was concluded that theprimary school teachers’ music education was not sufficient and that they had encountered problems inimproving themselves with regard to music education. A number of suggestions were made in line with theresults obtained.

  8. Environmental Catastrophes in the Earth's History Due to Solar Systems Encounters with Giant Molecular Clouds

    Science.gov (United States)

    Pavlov, Alexander A.

    2011-01-01

    In its motion through the Milky Way galaxy, the solar system encounters an average density (>=330 H atoms/cubic cm) giant molecular cloud (GMC) approximately every 108 years, a dense (approx 2 x 103 H atoms/cubic cm) GMC every approx 109 years and will inevitably encounter them in the future. However, there have been no studies linking such events with severe (snowball) glaciations in Earth history. Here we show that dramatic climate change can be caused by interstellar dust accumulating in Earth's atmosphere during the solar system's immersion into a dense (approx ,2 x 103 H atoms/cubic cm) GMC. The stratospheric dust layer from such interstellar particles could provide enough radiative forcing to trigger the runaway ice-albedo feedback that results in global snowball glaciations. We also demonstrate that more frequent collisions with less dense GMCs could cause moderate ice ages.

  9. Assessment of the Gaussian Covariance Approximation over an Earth-Asteroid Encounter Period

    Science.gov (United States)

    Mattern, Daniel W.

    2017-01-01

    In assessing the risk an asteroid may pose to the Earth, the asteroids state is often predicted for many years, often decades. Only by accounting for the asteroids initial state uncertainty can a measure of the risk be calculated. With the asteroids state uncertainty growing as a function of the initial velocity uncertainty, orbit velocity at the last state update, and the time from the last update to the epoch of interest, the asteroids position uncertainties can grow to many times the size of the Earth when propagated to the encounter risk corridor. This paper examines the merits of propagating the asteroids state covariance as an analytical matrix. The results of this study help to bound the efficacy of applying different metrics for assessing the risk an asteroid poses to the Earth. Additionally, this work identifies a criterion for when different covariance propagation methods are needed to continue predictions after an Earth-encounter period.

  10. An examination of the role of perceived support and employee commitment in employee-customer encounters.

    Science.gov (United States)

    Vandenberghe, Christian; Bentein, Kathleen; Michon, Richard; Chebat, Jean-Charles; Tremblay, Michel; Fils, Jean-François

    2007-07-01

    The authors examined the relationships between perceived organizational support, organizational commitment, commitment to customers, and service quality in a fast-food firm. The research design matched customer responses with individual employees' attitudes, making this study a true test of the service provider-customer encounter. On the basis of a sample of matched employee-customer data (N = 133), hierarchical linear modeling analyses revealed that perceived organizational support had both a unit-level and an employee-level effect on 1 dimension of service quality: helping behavior. Contrary to affective organizational commitment, affective commitment to customers enhanced service quality. The 2 sub-dimensions of continuance commitment to the organization--perceived high sacrifice and perceived lack of alternatives--exerted effects opposite in sign: The former fostered service quality, whereas the latter reduced it. The implications of these findings are discussed within the context of research on employee-customer encounters.

  11. General Disinfection in Medical and Dental Hospitals, Selection of Disinfectant Type and Problems Encountered

    OpenAIRE

    Akça, Gülin

    2015-01-01

    Hospitals are the places where, either the patients or other health workers can encounter with dangerous problem of several bacterial, fungal, viral, parasitic infectious agents, especially the emerging and life threatening ones such as, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus faecalis (VRE), Stenotrophomonas sp., and multi drug resistant Acinetobacter sp., Pseudomonas sp.. The reasons of these resistant microorganisms that can threaten the life o...

  12. Undesirable Behaviors Elementary School Classroom Teachers Encounter in the Classroom and Their Reasons

    OpenAIRE

    E.G. Balcik; S. Gulec

    2011-01-01

    The present study aims to determine how often elementary school teachers encounter undesirable behaviors in the classroom and what their thoughts regarding possible reasons of these behaviors are. The teachers’ opininon about the prevalence of these behaviors and their possible reasons were evaluated according to gender, marital status, level of class being taught, size of class being taught and it was tried to be determined if there were significant differences between variables. The measure...

  13. Encountering energy strategies and plans with the social context of household practice

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Nyborg, Sophie; Røpke, Inge

    Encountering energy strategies and plans with the social context of household practices Governments and utility companies have developed a great deal of strategies and plans on how to cope with energy saving in households, since this represents a major issue for climate change remediation. Many...... in households, and provides important clues about the potentiality to anchor energy strategies and plans in the social context of local households....

  14. Travel Behavior Change in Older Travelers: Understanding Critical Reactions to Incidents Encountered in Public Transport

    OpenAIRE

    Sundling, Catherine

    2015-01-01

    Accessibility of travel may be better understood if psychological factors underlying change in travel behavior are known. This paper examines older (65+) travelers? motives for changing their travel behavior. These changes are grounded in critical incidents earlier encountered in public-transport travel. A scientific framework is developed based on cognitive and behavioral theory. In 29 individual interviews, travelers? critical reactions (i.e., cognitive, emotional, and/or behavioral) to 77 ...

  15. Formation of Tidally Induced Bars in Galactic Flybys: Prograde versus Retrograde Encounters

    Science.gov (United States)

    Łokas, Ewa L.

    2018-04-01

    Bars in disk galaxies can be formed by interactions with other systems, including those of comparable mass. It has long been established that the effect of such interactions on galaxy morphology depends strongly on the orbital configuration, in particular the orientation of the intrinsic spin of the galactic disk with respect to its orbital angular momentum. Prograde encounters modify the morphology strongly, including the formation of tidally induced bars, while retrograde flybys should have little effect on morphology. Recent works on the subject reached conflicting conclusions, one using the impulse approximation and claiming no dependence on this angle in the properties of tidal bars. To resolve the controversy, we performed self-consistent N-body simulations of hyperbolic encounters between two identical Milky Way-like galaxies assuming different velocities and impact parameters, with one of the galaxies on a prograde and the other on a retrograde orbit. The galaxies were initially composed of an exponential stellar disk and an NFW dark halo, and they were stable against bar formation in isolation for 3 Gyr. We find that strong tidally induced bars form only in galaxies on prograde orbits. For smaller impact parameters and lower relative velocities, the bars are stronger and have lower pattern speeds. Stronger bars undergo extended periods of buckling instability that thicken their vertical structure. The encounters also lead to the formation of two-armed spirals with strength inversely proportional to the strength of the bars. We conclude that proper modeling of prograde and retrograde encounters cannot rely on the simplest impulse approximation.

  16. Common Ground in Cross-Cultural Communication: Sequential and Institutional Contexts in Front Desk Service Encounters

    OpenAIRE

    Kidwell, Mardi

    2000-01-01

    How do native and nonnative English-speaking participants understand one another in front desk service encounters? Specifically, what are the resources that enable them to transact their business at the desk? In this paper, I use the notion of "shared background" to show how participants at the front desk of a university-sponsored English language program rely on the sequential and institutional contexts in which their talk is produced to accomplish their service activities. In particular, I ...

  17. Selecting and implementing scientific objectives. [for Voyager 1 and 2 planetary encounters

    Science.gov (United States)

    Miner, E. D.; Stembridge, C. H.; Doms, P. E.

    1985-01-01

    The procedures used to select and implement scientific objectives for the Voyager 1 and 2 planetary encounters are described. Attention is given to the scientific tradeoffs and engineering considerations must be addressed at various stages in the mission planning process, including: the limitations of ground and spacecraft communications systems, ageing of instruments in flight, and instrument calibration over long distances. The contribution of planetary science workshops to the definition of scientific objectives for deep space missions is emphasized.

  18. Learned Helplessness Encountered by Michael Oher in the Blind Side Movie

    OpenAIRE

    PAMUNGKAS, DIMAS PROBO

    2014-01-01

    Pamungkas, Dimas Probo. 2014. Learned Helplessness Encountered by Michael Oher in The Blind Side Movie. Study Program of English, Department of Languages and Literature, Faculty of Culture Studies, Universitas Brawijaya. Supervisor: Dyah Eko Hapsari;Co-supervisor: Sarlettina Vidyayani EkaKeywords: Learned Helplessness, African-American, Psychological, Social Behavior, Depression, The Blind Side.Social behavior shows several interactions between person and social situations, which stress...

  19. The prevalence of two ‘commonly’ encountered synthetic target fibres within a large urban environment

    OpenAIRE

    Palmer, Ray; Burnett, Elisabeth; Luff, Natalie; Wagner, Craig; Stinga, Georgia; Carney, Clare; Sheridan, Kelly

    2015-01-01

    A target fibre study was carried out to assess the random prevalence of two ostensibly commonly encountered synthetic fibre types; black acrylic and blue polyester. The study was performed in an environment which maximised the number of random contacts between textile garments in the population and specific surfaces, namely; seating relating to buses, public houses and cinemas found within a large urban conurbation.\\ud \\ud Surface debris tapings were collected from samples of bus seats (30), ...

  20. The main security problems encountered in the definition of the PWR 1300 MWe stage

    International Nuclear Information System (INIS)

    Guimbail, H.; Auvergnon, F.

    1980-01-01

    The main problems of security encountered in the definition of the PWR 1300 stage originated from the necessity to ensure the continuity of a stage with the preceding one, the overture to technical progress, the acceptance of responsibility for the gaines experience and the control of cost prices. A few examples show how desirable it is for a project to be managed with the design and construction rules stabilized as early as possible [fr

  1. Universities as spaces for engaging the other: A pedagogy of encounter for intercultural and interreligious education

    Science.gov (United States)

    Gill, Scherto

    2016-08-01

    Internationalisation of Higher Education coupled with students' mobility across the globe in the 21st century has led to universities in many countries having to deal with an unprecedented flow of human diversity. Such diversity can become a potential source of conflict due to increased "otherness", but at the same time, it also presents an ideal lifelong learning opportunity for engaging the other through intercultural and interreligious education. This paper begins with a literature review, exploring the challenges of international higher education and the opportunities it offers in fostering intercultural and interreligious dialogue and deeper engagement across values, beliefs, world views, habits of mind and ways of being. The review highlights that on the one hand, rich diversity and otherness within universities can easily be built up in so-called educated individuals as givens and therefore be treated with insensitivity or indifference. On the other hand, diversity can evoke the possibility for the exchange of thoughts, values and world views, sharing experiences, engaging with each other's foreignness, and making the encounter a real enrichment and transformation. Next, using the narrative of a case study about conflicts within an international students' residence, the author illustrates the necessity of encounter and engagement with otherness as decisive avenues for intercultural learning and interreligious understanding. Through a further analysis of the case study, she establishes that pedagogical strategies formulated around encounter, dialogue and engagement should be integrated into the students' life at international universities so that they serve to bridge religions, cultures, world views and other differences, thus creating a sustainable culture of dialogue and peace. The paper concludes by suggesting a few key elements which seem useful for implementing a pedagogy of encounter in both formal and informal lifelong learning settings.

  2. The Proposed MACRA/MIPS Threshold for Patient-Facing Encounters: What It Means for Radiologists.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Hirsch, Joshua A; Allen, Bibb; Wang, Wenyi; Hughes, Danny R; Nicola, Gregory N

    2017-03-01

    In implementing the Merit-Based Incentive Payment System (MIPS), CMS will provide special considerations to physicians with infrequent face-to-face patient encounters by reweighting MIPS performance categories to account for the unique circumstances facing these providers. The aim of this study was to determine the impact of varying criteria on the fraction of radiologists who are likely to receive special considerations for performance assessment under MIPS. Data from the 2014 Medicare Physician and Other Supplier file for 28,710 diagnostic radiologists were used to determine the fraction of radiologists meeting various proposed criteria for receiving special considerations. For each definition, the fraction of patient-facing encounters among all billed codes was determined for those radiologists not receiving special considerations. When using the criterion proposed by CMS that physicians will receive special considerations if billing ≤25 evaluation and management services or surgical codes, 72.0% of diagnostic radiologists would receive special considerations, though such encounters would represent only 2.1% of billed codes among remaining diagnostic radiologists without special considerations. If CMS were to apply an alternative criterion of billing ≤100 evaluation and management codes exclusively, 98.8% of diagnostic radiologists would receive special considerations. At this threshold, patient-facing encounters would represent approximately 10% of billed codes among remaining radiologists without special considerations. The current CMS proposed criterion for special considerations would result in a considerable fraction of radiologists being evaluated on the basis of measures that are not reflective of their practice and beyond their direct control. Alternative criteria could help ensure that radiologists are provided a fair opportunity for success in performance review under the MIPS. Copyright © 2016 American College of Radiology. Published by Elsevier

  3. Challenges Encountered in Creating Personalised Learning Activities to Suit Students Learning Preferences

    OpenAIRE

    O'Donnell, Eileen; Wade, Vincent; Sharp, Mary; O'Donnell, Liam

    2013-01-01

    This book chapter reviews some of the challenges encountered by educators in creating personalised e-learning activities to suit students learning preferences. Technology-enhanced learning (TEL) alternatively known as e-learning has not yet reached its full potential in higher education. There are still many potential uses as yet undiscovered and other discovered uses which are not yet realisable by many educators. TEL is still predominantly used for e-dissemination and e-administration. This...

  4. Meteorology Associated with Turbulence Encounters During NASA's Fall-2000 Flight Experiments

    Science.gov (United States)

    Hamilton, David W.; Proctor, Fred H.

    2002-01-01

    Initial flight experiments have been conducted to investigate convectively induced turbulence and to test technologies for its airborne detection. Turbulence encountered during the experiments is described with sources of data measured from in situ sensors, groundbased and airborne Doppler radars, and aircraft video. Turbulence measurements computed from the in situ system were quantified in terms of RMS normal loads (sigma(sub Delta n)), where 0.20 g is less than or equal to sigma(sub Delta n) is less than or equal to 0.30 g is considered moderate and sigma(sub Delta n) is greater than 0.30 g is severe. During two flights, 18 significant turbulence encounters (sigma(sub Delta) is greater than or equal to 0.20 g) occurred in the vicinity of deep convection; 14 moderate and 4 severe. In all cases, the encounters with turbulence occurred along the periphery of cumulus convection. These events were associated with relatively low values of radar reflectivity, i.e. RRF is less than 35 dBz, with most levels being below 20 dBz. The four cases of severe turbulence occurred in precipitation and were centered at the interface between a cumulus updraft turret and a downwind downdraft. Horizontal gradients of vertical velocity at this interface were found to be strongest on the downwind side of the cumulus turrets. Furthermore, the greatest loads to the aircraft occurred while flying along, not orthogonal to, the ambient environmental wind vector. During the two flights, no significant turbulence was encountered in the clear air (visual meteorological conditions), not even in the immediate vicinity of the deep convection.

  5. INTERACTION BEHAVIOUR LEADING TO COMFORTIN SERVICE ENCOUNTER OF NOTEBOOK PERIPHERAL SERVICE CENTER BUSINESS

    OpenAIRE

    Dr. Wachyudi.N.*

    2018-01-01

    This study aims to determine the effect of interaction behavior that elicits a sense of comfort for customers in the service encounter of notebook peripheral business, and investigating the mediating role of comfort on overall service quality, customer satisfaction, word of mouth and the repurchase intention. Based on 250 valid responses collected from a survey questionnaire used structural equation modeling (SEM) to examine the research model. The findings showed that all hypotheses on the r...

  6. The Effect of Community-Level Socio-Economic Conditions on Threatening Racial Encounters

    OpenAIRE

    Heather Antecol; Deborah A. Cobb-Clark

    2008-01-01

    This paper contributes to the emerging literature on racial and ethnic tension by analyzing the relationship between local socio-economic conditions and the propensity for outsiders to have threatening racial encounters with insiders. We use unique data for a sample of active-duty Army personnel that allow us to first, link personnel to the local communities in which they are located and second, to avoid any selectivity bias associated with endogenous community selection. We find at best mixe...

  7. Isolated Femoral Muscle and Bone Metastases Rarely Encountered in Testicular Seminoma

    Directory of Open Access Journals (Sweden)

    Serkan Degirmencioglu

    2013-01-01

    Full Text Available Isolated muscle and bone metastases are rarely encountered in patients with testicular seminomas. In the present study, a patient who was admitted with pain, loss of motion, and swelling in the right leg 20 months following surgery for stage I seminoma was presented. Hypermetabolic lesion was detected in the right femoral muscle and bone via positron emission tomography. After the presence of metastasis from seminoma was confirmed by biopsy, bleomycin, cisplatin, and etoposide, combination chemotherapy was administered to the patient.

  8. Uncorrelated Encounter Model of the National Airspace System, Version 2.0

    Science.gov (United States)

    2013-08-19

    can exist to certify avoidance systems for operational use. Evaluations typically include flight tests, operational impact studies, and simulation of...appropriate for large-scale air traffic impact studies— for example, examination of sector loading or conflict rates. The focus here includes two types of...between two IFR aircraft in oceanic airspace. The reason for this is that one cannot observe encounters of sufficient fidelity in the available data

  9. Encounters and Content Sharing in an Urban Village: Reading Texts Through an Archaeological Lens

    Science.gov (United States)

    Garcia, Nicole; Foth, Marcus; Hearn, Greg

    Archaeology provides a framework of analysis and interpretation that is useful for disentangling the textual layers of a contemporary lived-in urban space. The producers and readers of texts may include those who planned and developed the site and those who now live, visit, and work there. Some of the social encounters and content sharing between these people may be artificially produced or manufactured in the hope that certain social situations will occur. Others may be serendipitous. With archaeology's original focus on places that are no longer inhabited, it is often only the remaining artifacts and features of the built environment that form the basis for interpreting the social relationships of past people. Our analysis, however, is framed within a contemporary notion of archaeological artifacts in an urban setting. Unlike an excavation, where the past is revealed through digging into the landscape, the application of landscape archaeology within a present day urban context is necessarily more experiential, visual, and based on recording and analyzing the physical traces of social encounters and relationships between residents and visitors. These physical traces are present within the creative content, and the built and natural elements of the environment. This chapter explores notions of social encounters and content sharing in an urban village by analyzing three different types of texts: the design of the built environment; content produced by residents through a geospatial web application; and, print and online media produced in digital storytelling workshops.

  10. How superdiffusion gets arrested: ecological encounters explain shift from Lévy to Brownian movement.

    Science.gov (United States)

    de Jager, Monique; Bartumeus, Frederic; Kölzsch, Andrea; Weissing, Franz J; Hengeveld, Geerten M; Nolet, Bart A; Herman, Peter M J; van de Koppel, Johan

    2014-01-07

    Ecological theory uses Brownian motion as a default template for describing ecological movement, despite limited mechanistic underpinning. The generality of Brownian motion has recently been challenged by empirical studies that highlight alternative movement patterns of animals, especially when foraging in resource-poor environments. Yet, empirical studies reveal animals moving in a Brownian fashion when resources are abundant. We demonstrate that Einstein's original theory of collision-induced Brownian motion in physics provides a parsimonious, mechanistic explanation for these observations. Here, Brownian motion results from frequent encounters between organisms in dense environments. In density-controlled experiments, movement patterns of mussels shifted from Lévy towards Brownian motion with increasing density. When the analysis was restricted to moves not truncated by encounters, this shift did not occur. Using a theoretical argument, we explain that any movement pattern approximates Brownian motion at high-resource densities, provided that movement is interrupted upon encounters. Hence, the observed shift to Brownian motion does not indicate a density-dependent change in movement strategy but rather results from frequent collisions. Our results emphasize the need for a more mechanistic use of Brownian motion in ecology, highlighting that especially in rich environments, Brownian motion emerges from ecological interactions, rather than being a default movement pattern.

  11. Changes in heart rate associated with contest outcome in agonistic encounters in lobsters.

    Science.gov (United States)

    Hernáindez-Falcón, Jesús; Basu, Alo C; Govindasamy, Siddhartan; Kravitz, Edward A

    2005-03-01

    Agonistic contests between lobsters housed together in a confined space progress through encounters of increasing intensity until a dominance relationship is established. Once this relationship is established, losing animals continually retreat from the advances of winners. These encounters are likely to consume much energy in both winning and losing animals. Therefore, one might expect involvement of many physiological systems before, during and after fights. Here, we report effects of agonistic encounters on cardiac frequency in winning and losing adult lobsters involved in dyadic interactions. The results show that: (i) small but significant increases in heart rate are observed upon chemical detection of a conspecific; (ii) during agonistic interactions, further increases in heart rate are seen; and (iii) ultimate winners exhibit greater increases in heart rate lasting longer periods of time compared to ultimate losers. Heart rate in winners remains elevated for at least 15 min after the contests have ended and animals have been returned to their home tanks. Reduced effects are seen in second and third pairings between familiar opponents. The sustained changes in heart rate that we observe in winning lobsters may result from hormonal modulation of cardiac function related to the change in social status brought about by contest outcome.

  12. Neural Correlates of Racial Ingroup Bias in Observing Computer-Animated Social Encounters

    Directory of Open Access Journals (Sweden)

    Yuta Katsumi

    2018-01-01

    Full Text Available Despite evidence for the role of group membership in the neural correlates of social cognition, the mechanisms associated with processing non-verbal behaviors displayed by racially ingroup vs. outgroup members remain unclear. Here, 20 Caucasian participants underwent fMRI recording while observing social encounters with ingroup and outgroup characters displaying dynamic and static non-verbal behaviors. Dynamic behaviors included approach and avoidance behaviors, preceded or not by a handshake; both dynamic and static behaviors were followed by participants’ ratings. Behaviorally, participants showed bias toward their ingroup members, demonstrated by faster/slower reaction times for evaluating ingroup static/approach behaviors, respectively. At the neural level, despite overall similar responses in the action observation network to ingroup and outgroup encounters, the medial prefrontal cortex showed dissociable activation, possibly reflecting spontaneous processing of ingroup static behaviors and positive evaluations of ingroup approach behaviors. The anterior cingulate and superior frontal cortices also showed sensitivity to race, reflected in coordinated and reduced activation for observing ingroup static behaviors. Finally, the posterior superior temporal sulcus showed uniquely increased activity to observing ingroup handshakes. These findings shed light on the mechanisms of racial ingroup bias in observing social encounters, and have implications for understanding factors related to successful interactions with individuals from diverse backgrounds.

  13. How superdiffusion gets arrested: ecological encounters explain shift from Lévy to Brownian movement

    Science.gov (United States)

    de Jager, Monique; Bartumeus, Frederic; Kölzsch, Andrea; Weissing, Franz J.; Hengeveld, Geerten M.; Nolet, Bart A.; Herman, Peter M. J.; van de Koppel, Johan

    2014-01-01

    Ecological theory uses Brownian motion as a default template for describing ecological movement, despite limited mechanistic underpinning. The generality of Brownian motion has recently been challenged by empirical studies that highlight alternative movement patterns of animals, especially when foraging in resource-poor environments. Yet, empirical studies reveal animals moving in a Brownian fashion when resources are abundant. We demonstrate that Einstein's original theory of collision-induced Brownian motion in physics provides a parsimonious, mechanistic explanation for these observations. Here, Brownian motion results from frequent encounters between organisms in dense environments. In density-controlled experiments, movement patterns of mussels shifted from Lévy towards Brownian motion with increasing density. When the analysis was restricted to moves not truncated by encounters, this shift did not occur. Using a theoretical argument, we explain that any movement pattern approximates Brownian motion at high-resource densities, provided that movement is interrupted upon encounters. Hence, the observed shift to Brownian motion does not indicate a density-dependent change in movement strategy but rather results from frequent collisions. Our results emphasize the need for a more mechanistic use of Brownian motion in ecology, highlighting that especially in rich environments, Brownian motion emerges from ecological interactions, rather than being a default movement pattern. PMID:24225464

  14. Variation of the binary encounter peak energy as a function of projectile atomic number

    International Nuclear Information System (INIS)

    Sanders, J.M.

    1994-01-01

    The energy of the binary encounter peak, in spectra of electrons emitted at 0 degrees with respect to the projectile beam direction, has been studied to investigate its dependence on the atomic number of the projectile ion. The projectiles all had the same squared velocity of 0.6 MeV/u, and all had the same charge q=7. The Z of the projectiles ranged from 8 to 35, and the target was H 2 . The Energy E BEP of the binary encounter peak and also the energy t of the cusp formed by electron loss or electron capture to the projectile continuum (ELC or ECC) were obtained from fits to the spectra. Considerable care was required in fitting the cusp in order to properly ascertain the cusp energy. The energy shift ΔE, defined as the difference between 4t and E BEP , was obtained for each projectile. It is found that the energy shift decreases as the projectile Z increases. This trend is the opposite of that seen for projectile charge where the shift increases as q increases. Such a trend is not well described by the simple elastic scattering model of binary encounter electron production

  15. Physician assistant program education on spirituality and religion in patient encounters.

    Science.gov (United States)

    Berg, Gina M; Whitney, Melissa P; Wentling, Callie J; Hervey, Ashley M; Nyberg, Sue

    2013-01-01

    To describe educational practices of physician assistant (PA) programs regarding spirituality and religion discussions during patient encounters. Patients want their health care provider to be aware of their spiritual and religious beliefs. This topic is addressed in physician and nursing education but may not be included in PA programs. Data regarding curriculum were collected via electronic survey emailed to 143 PA programs across the United States. Thirty-eight programs responded for a response rate of 27%. Most (68.4%) program respondents reported students' desire to be trained to discuss spirituality and religion, yet 36.8% do not offer this training. Just over half (69.2%) would consider adding curriculum to teach students to discuss spirituality, but the majority (92.3%) would not add curriculum to discuss religion during patient encounters. PA programs offer training to discuss spirituality in patient encounters but not to discuss religiosity. Programs may want to consider adding some curriculum to increase PAs awareness of spirituality and religion needs of patients.

  16. Drug use in business bathrooms: An exploratory study of manager encounters in New York City

    Science.gov (United States)

    Wolfson-Stofko, Brett; Bennett, Alex S.; Elliott, Luther; Curtis, Ric

    2017-01-01

    Background Though public bathroom drug injection has been documented from the perspective of people who inject drugs, no research has explored the experiences of the business managers who oversee their business bathrooms and respond to drug use. These managers, by default, are first-responders in the event of a drug overdose and thus of intrinsic interest during the current epidemic of opioid-related overdoses in the United States. This exploratory study assists in elucidating the experiences that New York City business managers have with people who inject drugs, their paraphernalia, and their overdoses. Methods A survey instrument was designed to collect data on manager encounters with drug use occurring in their business bathrooms. Recruitment was guided by convenience and purposive approaches. Results More than half of managers interviewed (58%, n = 50/86) encountered drug use in their business bathrooms, more than a third (34%) of these managers also found syringes, and the vast majority (90%) of managers had received no overdose recognition or naloxone training. Seven managers encountered unresponsive individuals who required emergency assistance. Conclusion The results from this study underscore the need for additional research on the experiences that community stakeholders have with public injection as well as educational outreach efforts among business managers. This research also suggests that there is need for a national dialogue about potential interventions, including expanded overdose recognition and naloxone training and supervised injection facilities (SIF)/drug consumption rooms (DCR), that could reduce public injection and its associated health risks. PMID:27768996

  17. Analyzing communication skills of Pediatric Postgraduate Residents in Clinical Encounter by using video recordings.

    Science.gov (United States)

    Bari, Attia; Khan, Rehan Ahmed; Jabeen, Uzma; Rathore, Ahsan Waheed

    2017-01-01

    To analyze communication skills of pediatric postgraduate residents in clinical encounter by using video recordings. This qualitative exploratory research was conducted through video recording at The Children's Hospital Lahore, Pakistan. Residents who had attended the mandatory communication skills workshop offered by CPSP were included. The video recording of clinical encounter was done by a trained audiovisual person while the resident was interacting with the patient in the clinical encounter. Data was analyzed by thematic analysis. Initially on open coding 36 codes emerged and then through axial and selective coding these were condensed to 17 subthemes. Out of these four main themes emerged: (1) Courteous and polite attitude, (2) Marginal nonverbal communication skills, (3) Power game/Ignoring child participation and (4) Patient as medical object/Instrumental behaviour. All residents treated the patient as a medical object to reach a right diagnosis and ignored them as a human being. There was dominant role of doctors and marginal nonverbal communication skills were displayed by the residents in the form of lack of social touch, and appropriate eye contact due to documenting notes. A brief non-medical interaction for rapport building at the beginning of interaction was missing and there was lack of child involvement. Paediatric postgraduate residents were polite while communicating with parents and child but lacking in good nonverbal communication skills. Communication pattern in our study was mostly one-way showing doctor's instrumental behaviour and ignoring the child participation.

  18. FORMATION OF CENTAURS’ RINGS THROUGH THEIR PARTIAL TIDAL DISRUPTION DURING PLANETARY ENCOUNTERS

    International Nuclear Information System (INIS)

    Hyodo, Ryuki; Charnoz, Sébastien; Genda, Hidenori; Ohtsuki, Keiji

    2016-01-01

    Centaurs are minor planets orbiting between Jupiter and Neptune that have or had crossing orbits with one or more giant planets. Recent observations and reinterpretation of previous observations have revealed the existence of ring systems around 10199 Chariklo and 2060 Chiron. However, the origin of the ring systems around such a minor planet is still an open question. Here, we propose that the tidal disruption of a differentiated object that experiences a close encounter with a giant planet could naturally form diverse ring–satellite systems around the Centaurs. During the close encounter, the icy mantle of the passing object is preferentially ripped off by the planet's tidal force and the debris is distributed mostly within the Roche limit of the largest remnant body. Assuming the existence of a 20−50 wt% silicate core below the icy mantle, a disk of particles is formed when the objects pass within 0.4–0.8 of the planet's Roche limit with the relative velocity at infinity 3−6 km s"−"1 and 8 hr initial spin period of the body. The resultant ring mass is 0.1%–10% of the central object's mass. Such particle disks are expected to spread radially, and materials spreading beyond the Roche limit would accrete into satellites. Our numerical results suggest that ring formation would be a natural outcome of such extreme close encounters, and Centaurs can naturally have such ring systems because they cross the orbits of the giant planets.

  19. Encounters With Health-Care Providers and Advance Directive Completion by Older Adults.

    Science.gov (United States)

    Koss, Catheryn

    2018-01-01

    The Patient Self-Determination Act (PSDA) requires hospitals, home health agencies, nursing homes, and hospice providers to offer new patients information about advance directives. There is little evidence regarding whether encounters with these health-care providers prompt advance directive completion by patients. To examine whether encounters with various types of health-care providers were associated with higher odds of completing advance directives by older patients. Logistic regression using longitudinal data from the 2012 and 2014 waves of the Health and Retirement Study. Participants were 3752 US adults aged 65 and older who reported not possessing advance directives in 2012. Advance directive was defined as a living will and/or durable power of attorney for health care. Four binary variables measured whether participants had spent at least 1 night in a hospital, underwent outpatient surgery, received home health or hospice care, or spent at least one night in a nursing home between 2012 and 2014. Older adults who received hospital, nursing home, or home health/hospice care were more likely to complete advance directives. Outpatient surgery was not associated with advance directive completion. Older adults with no advance directive in 2012 who encountered health-care providers covered by the PSDA were more likely to have advance directives by 2014. The exception was outpatient surgery which is frequently provided in freestanding surgery centers not subject to PSDA mandates. It may be time to consider amending the PSDA to cover freestanding surgery centers.

  20. Crowdsourcing for Context: Regarding Privacy in Beacon Encounters via Contextual Integrity

    Directory of Open Access Journals (Sweden)

    Bello-Ogunu Emmanuel

    2016-07-01

    Full Text Available Research shows that context is important to the privacy perceptions associated with technology. With Bluetooth Low Energy beacons, one of the latest technologies for providing proximity and indoor tracking, the current identifiers that characterize a beacon are not sufficient for ordinary users to make informed privacy decisions about the location information that could be shared. One solution would be to have standardized category and privacy labels, produced by beacon providers or an independent third-party. An alternative solution is to find an approach driven by users, for users. In this paper, we propose a novel crowdsourcing based approach to introduce elements of context in beacon encounters.We demonstrate the effectiveness of this approach through a user study, where participants use a crowd-based mobile app designed to collect beacon category and privacy information as a scavenger hunt game. Results show that our approach was effective in helping users label beacons according to the specific context of a given beacon encounter, as well as the privacy perceptions associated with it. This labeling was done with an accuracy of 92%, and with an acceptance rate of 82% of all recommended crowd labels. Lastly, we conclusively show how crowdsourcing for context can be used towards a user-centric framework for privacy management during beacon encounters.

  1. Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study☆

    Science.gov (United States)

    van Ryn, Michelle; Hardeman, Rachel R.; Phelan, Sean M.; Burke, Sara E.; Przedworski, Julia; Allen, Michele L.; Burgess, Diana J.; Ridgeway, Jennifer; White, Richard O.; Dovidio, John F.

    2014-01-01

    Objective Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students’ attitudes toward the value of physician empathy in clinical encounters. Methods First year students (n = 4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being. Results Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students’ attitudes toward the benefit of physician empathy in clinical encounters. Conclusion Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care. Practice implications Curricula in medical school promoting empathic care may be more universally effective if students’ preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students. PMID:25065328

  2. Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: a report from the CHANGES study.

    Science.gov (United States)

    van Ryn, Michelle; Hardeman, Rachel R; Phelan, Sean M; Burke, Sara E; Przedworski, Julia; Allen, Michele L; Burgess, Diana J; Ridgeway, Jennifer; White, Richard O; Dovidio, John F

    2014-09-01

    Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students' attitudes toward the value of physician empathy in clinical encounters. First year students (n=4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being. Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students' attitudes toward the benefit of physician empathy in clinical encounters. Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care. Curricula in medical school promoting empathic care may be more universally effective if students' preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students. Copyright © 2014. Published by Elsevier Ireland Ltd.

  3. Medical professionalism from a socio-cultural perspective: evaluating medical residents communicative attitudes during the medical encounter in malaysia.

    Science.gov (United States)

    Ganasegeran, K; Al-Dubai, S A R

    2014-01-01

    The practice of medicine requires good communication skills to foster excellent rapport in doctor patient relationship. Reports on communication skills learning attitude among medical professionals are key essentials toward improving patient safety and quality of care. We aimed to determine factors affecting communication skills learning attitudes among medical residents in Malaysia. Cross-sectional survey, in a Malaysian public health hospital. A total of 191 medical residents across medical and surgical based rotations were included. We assessed the validated communication skills attitude scale among medical residents from different rotations. Statistical Package of Social Sciences (SPSS®) (version 16.0, IBM, Armonk, NY) was used. Cronbach's alpha was used to test the internal consistency of the scale. Descriptive analysis was conducted for all variables. Bivariate analysis was employed across the socio-demographic variables. Majority of the residents believed that communication skills training should be made compulsory in Malaysia (78.5%). Medical residents agreed that acquiring good communication skills is essential to be a good doctor. However, the majority cited time pressures for not being able to learn communication skills. Significant differences in communication skills learning attitude scores were found between Malays and Chinese. The majority of medical residents had a positive attitude toward communication skills learning. Socio-demographic factors influenced communication skills learning attitude among medical residents. Incorporating communicative skills modules during hospital Continuous Medical Education for medical residents is essential to cultivate communicative skills attitudes for effective doctor-patient relationship during the routine medical encounters.

  4. Excerpt from Subverting Exclusion: Transpacific Encounters with Race, Caste, and Borders, 1885–1928

    Directory of Open Access Journals (Sweden)

    Andrea Geiger

    2011-12-01

    Full Text Available

    The Japanese immigrants who arrived in the North American West in the late nineteenth and early twentieth centuries included people with historical ties to Japan’s outcaste communities. In the only English-language book on the subject, Andrea Geiger examines the history of these and other Japanese immigrants in the United States and Canada and their encounters with two separate cultures of exclusion, one based in caste and the other in race.

    Geiger reveals that the experiences of Japanese immigrants in North America were shaped in part by attitudes rooted in Japan’s formal status system, mibunsei, decades after it was formally abolished. In the North American West, however, the immigrants’ understanding of social status as caste-based collided with American and Canadian perceptions of status as primarily race-based. Geiger shows how the lingering influence of Japan’s strict status system affected immigrants’ perceptions and understandings of race in North America and informed their strategic responses to two increasingly complex systems of race-based exclusionary law and policy.

  5. Traditional Korean islanders encounters with the British navy in the 1880s: The Port Hamilton Affair of 1885–1887

    Directory of Open Access Journals (Sweden)

    Stephen A. Royle

    2016-06-01

    Full Text Available This article deals with the encounters between a traditional Korean rural and island population and western military forces when the British navy occupied Geomundo, an archipelago known to them as Port Hamilton, for 22 months between 1885 and 1887. The paper first outlines the sometimes painful process of East Asian countries being opened up to trade and outside influences in the 19th century, a process sometimes urged upon them by naval weapons in this era of gunboat diplomacy. This provides the setting for the Port Hamilton Affair itself when in preparation for possible war with Russia, a British naval squadron steamed into Port Hamilton and took it without reference to the local people or their national government. After brief reference to the political consequences of this action, the focus is then on what the records from the occupation and earlier investigations by the British, who had long coveted the islands’ strategic harbour, reveal about the life of the islanders. The article considers both their traditional life, from a time rather before western travel accounts were written about the Korean mainland, and how the islanders fared under the British.

  6. Using systematically observed clinical encounters (SOCEs to assess medical students’ skills in clinical settings

    Directory of Open Access Journals (Sweden)

    George R Bergus

    2010-11-01

    Full Text Available George R Bergus1–3, Jerold C Woodhead4, Clarence D Kreiter2,51Performance Based Assessment Program, Office of Student Affairs and Curriculum, 2Department of Family Medicine, 3Department of Psychiatry, 4Department of Pediatrics, 5Office of Consultation and Research in Medical Education, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA, USAIntroduction: The Objective Structured Clinical Examination (OSCE is widely used to assess the clinical performance of medical students. However, concerns related to cost, availability, and validity, have led educators to investigate alternatives to the OSCE. Some alternatives involve assessing students while they provide care to patients – the mini-CEX (mini-Clinical Evaluation Exercise and the Long Case are examples. We investigated the psychometrics of systematically observed clinical encounters (SOCEs, in which physicians are supplemented by lay trained observers, as a means of assessing the clinical performances of medical students.Methods: During the pediatrics clerkship at the University of Iowa, trained lay observers assessed the communication skills of third-year medical students using a communication checklist while the students interviewed and examined pediatric patients. Students then verbally presented their findings to faculty, who assessed students’ clinical skills using a standardized form. The reliability of the combined communication and clinical skills scores was calculated using generalizability theory.Results: Fifty-one medical students completed 199 observed patient encounters. The mean combined clinical and communication skills score (out of a maximum 45 points was 40.8 (standard deviation 3.3. The calculated reliability of the SOCE scores, using generalizability theory, from 10 observed patient encounters was 0.81. Students reported receiving helpful feedback from faculty after 97% of their observed clinical encounters.Conclusion: The SOCE can

  7. Radar Astrometry of Asteroid 99942 (2004 MN4): Predicting the 2029 Earth Encounter and Beyond

    Science.gov (United States)

    Giorgini, J. D.; Benner, L. A. M.; Nolan, M. C.; Ostro, S. J.

    2005-08-01

    Asteroid 2004 MN4 is expected to pass 4.6 (+/- 1.6) Earth-radii above the surface of the Earth on 2029-Apr-13. Such close approaches by objects as large as 2004 MN4 (D ≳ 0.3 km) are thought to occur at ≳ 1000-year intervals on average. 2004 MN4 is expected to reach 3rd magnitude and thus be visible to the unaided eye. With a disk 2-4 arcseconds across, it may be resolved by ground-based telescopes. Arecibo (2380-MHz) delay-Doppler radar astrometry, obtained in late January 2005, significantly corrected 2004 MN4's orbit by revealing a 1.4 arcsecond bias in pre-discovery optical measurements. Doppler-shifted echoes were acquired 4.8σ (176.4 mm/s) away from the predicted frequency on Jan 27. Range on Jan 29 was found to be 747 km (2.8σ ) closer to Earth than the pre-radar orbit predicted. Incorporation of these delay-Doppler measurements into a new weighted least-squares orbit solution moved the 2029-Apr-13 encounter prediction 5σ closer to the Earth, illustrating the problematic nature of prediction and statistical analysis with single-apparition optical data-sets. Without delay-Doppler data, the bias was not apparent, even when optical measurements spanned a full orbit period. The current combined data-set does not permit reliable trajectory propagation to encounters beyond 2029; Monte Carlo analysis shows that, by 2036, the 3σ confidence region wraps >300 degrees of heliocentric longitude around the Sun, with some sections of this statistical region experiencing low-probability encounters with the Earth in the 2030's, gravitationally scattering some possible trajectories inward to the orbit of Venus, or outward toward Mars. Future measurements from radar opportunities in August 2005 and May 2006 (SNR ≈5-10) have the potential to eliminate statistical encounters in the 2030's. Delay-Doppler astrometry from 2013 (SNR ≈30) should permit deterministic encounter prediction through 2070, shrinking the along-track uncertainty in 2036 by two orders of magnitude

  8. Encounters with immigrant customers: perspectives of Danish community pharmacy staff on challenges and solutions.

    Science.gov (United States)

    Mygind, Anna; Espersen, Sacha; Nørgaard, Lotte Stig; Traulsen, Janine M

    2013-06-01

    To explore the challenges that Danish community pharmacy staff encounter when serving non-Western immigrant customers. Special attention was paid to similarities and differences between the perceptions of pharmacists and pharmacy assistants. A questionnaire was distributed to one pharmacist and one pharmacy assistant employed at each of the 55 community pharmacies located in the five local councils in Denmark with the highest number of immigrant inhabitants. The total response rate was 76% (84/110). Most respondents found that the needs of immigrant customers were not sufficiently assessed at the counter (n = 55, 65%), and that their latest encounter with an immigrant customer was less satisfactory than a similar encounter with an ethnic Danish customer (n = 48, 57%) (significantly more pharmacists than assistants: odds ratio, OR, 3.19; 95% confidence interval, CI, 1.27-8.04). Forty-two per cent (n = 35) perceived that immigrant customers put pressure on pharmacy staff resources, while 27% (n = 23) found that the immigrant customer group make work more interesting. More pharmacists than assistants agreed on the latter (OR, 3.43; 95% CI, 1.04-11.33). Within the past 14 days, 86% (n = 72) experienced that their advice and counselling were not understood by immigrant customers, whereas 49% (n = 41) experienced lack of understanding by ethnic Danes; and 30% (n = 25) had consciously refrained from counselling an immigrant, whereas 19% (n = 16) had done so with an ethnic Dane. Use of under-aged children as interpreters during the past month was reported by 79% of respondents. Regarding suggestions on how to improve encounters with immigrant customers, most respondents listed interventions aimed at patients, general practitioners and pharmaceutical companies. Community pharmacy staff report poorer quality in their encounters with immigrant customers, including sub-optimal counselling and frequent use of under-aged children as

  9. Transformation of a wave energy spectrum from encounter to absolute domain when observing from an advancing ship

    DEFF Research Database (Denmark)

    Nielsen, Ulrik Dam

    2017-01-01

    directly in the encounter domain. The encounter domain is that observed from a ship when it advances in a seaway, whereas the absolute domain is that corresponding to making observations from a fixed point in the inertial frame. Spectrum transformation can be uniquely carried out if the ship sails ”against...

  10. Toward a Theory of the Educational Encounter: Gert Biesta's Educational Theory and the Right to the City

    Science.gov (United States)

    Ford, Derek R.

    2013-01-01

    This paper outlines a theory of the educational encounter, the space of, and the right to that encounter. Situated in response to neoliberal educational reforms, this theory is developed through a reading and synthesis of the educational theory of Gert Biesta, the architectural component of his theory, and literature on the right to the city. The…

  11. Switches to English during French Service Encounters: Relationships with L2 French Speakers' Willingness to Communicate and Motivation

    Science.gov (United States)

    McNaughton, Stephanie; McDonough, Kim

    2015-01-01

    This exploratory study investigated second language (L2) French speakers' service encounters in the multilingual setting of Montreal, specifically whether switches to English during French service encounters were related to L2 speakers' willingness to communicate or motivation. Over a two-week period, 17 French L2 speakers in Montreal submitted…

  12. Internet advertisements for public sexual encounters among men who have sex with men: are safe behaviors communicated?

    Science.gov (United States)

    Downing, Martin J

    2011-09-01

    Public and commercial sex venues typically provide easy access to sexual encounters that are often anonymous and, therefore, may facilitate HIV/STD transmission among those men who attend. Recently, researchers have suggested that men who have sex with men may be using the Internet to search for sexual encounters to occur within sex venues. The current study explored the extent to which men who advertise for public or commercial sexual encounters initially communicate to potential partners their safe-sex intentions. Advertisements for sexual encounters (n = 99) were collected from a publicly accessible website and examined for content related to venue type, sexual behavior, and indications of sexual safety or risk. Word frequencies were calculated to provide a closer investigation of how individuals negotiate safe sex within these communications. The findings revealed that approximately half of the men who advertised for sex in a public or commercial sex venue failed to communicate to potential partners in their initial advertisement a desire to be safe during sexual encounters involving oral and anal practices. Additionally, a small percentage of men advertised specifically for risky encounters (e.g., barebacking). Together, these findings suggest that men do use the Internet to coordinate public sexual encounters, some of which may be unprotected from HIV/STD transmission. Future research should address the process of condom negotiation among men who initially meet their male sex partners on the Internet for subsequent encounters in sex venues.

  13. Problems Encountered by Religious Vocational Secondary School and Other Secondary School Students in Physical Education and Sports Activities

    Science.gov (United States)

    Bar, Mustafa; Yaman, Menzure Sibel; Hergüner, Gülten

    2016-01-01

    The study aimed to determine problems encountered by Religious Vocational Secondary School and other Secondary School students in physical education and sports activities and to compare these problems according to school type and gender. A questionnaire named "Problems encountered in attending to physical education and sports activities"…

  14. With an Open Mind: Openness to Experience Moderates the Effect of Interethnic Encounters on Support for Immigration

    DEFF Research Database (Denmark)

    Danckert, Bolette; Dinesen, Peter Thisted; Klemmensen, Robert

    2017-01-01

    to new experiences, react more positively/less negatively to interethnic encounters. We test this conjecture on two surveys collected in Denmark and Canada. In line with our expectations, the analyses suggest that openness positively moderates the effect of interethnic encounters on immigration attitudes...

  15. Male clients' behaviours with and perspectives about their last male escort encounter: comparing repeat versus first-time hires.

    Science.gov (United States)

    Wolff, Margaret M; Grov, Christian; Smith, Michael D; Koken, Juline A; Parsons, Jeffrey T

    2014-01-01

    Research on men who have sex with men suggests that condomless anal intercourse occurs more frequently in established sexual relationships. While comparable data regarding male-for-male escorting is unavailable, research implies that many clients seek emotional as well as physical connections with the men they hire. In 2012, 495 male clients, recruited via daddysreviews.com completed an online survey about their last hiring experience. Most participants were from the USA (85.7%), the UK and Canada (3.2% each). In total, 75% of encounters involved an escort hired for the first time; 25% were with a previously hired escort ('repeat encounter'). The client's age, lifetime number of escorts hired and number hired in the past year were positively associated with the last encounter being a repeat encounter. Cuddling, sharing a meal, drinking alcohol, taking a walk, watching a show and shopping were also positively associated with repeat encounters. Conversely, none of the sexual behaviours were significantly associated with repeat encounters. Repeat encounters were significantly more likely to include non-sexual behaviours alongside sexual activities, but no more likely to involve condomless anal intercourse. Moreover, clients' knowledge of escorts' HIV status was not significantly associated with engaging in condomless anal intercourse with repeat encounters.

  16. Education in patient-physician communication : How to improve effectiveness?

    NARCIS (Netherlands)

    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

  17. [General features of the patient-physician relationship].

    Science.gov (United States)

    Baeza, H; Bueno, G

    1997-03-01

    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.

  18. Bone quality: educational tools for patients, physicians, and educators.

    Science.gov (United States)

    Shams, Junaid; Spitzer, Allison B; Kennelly, Ann M; Tosi, Laura L

    2011-08-01

    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.

  19. The patient-physician covenant: an affirmation of Asklepios.

    Science.gov (United States)

    Cassel, C K

    1996-05-01

    Medicine is, at its center, a moral enterprise grounded in a covenant of trust. This covenant obliges physicians to be competent and to use their competence in the patient's best interests. Physicians, therefore, are both intellectually and morally obliged to act as advocates for the sick wherever their welfare is threatened and for their health at all times. Today, this covenant of trust is significantly threatened. From within, there is growing legitimation of the physician's materialistic self-interest; from without, for-profit forces press the physician into the role of commercial agent to enhance the profitability of health care organizations. Such distortions of the physician's responsibility degrade the physician-patient relationship that is the central element and structure of clinical care. To capitulate to these alterations of the trust relationship is to significantly alter the physician's role as healer, carer helper, and advocate for the sick and for the health of all. By its traditions and very nature, medicine is a special kind of human activity--one that cannot be pursued effectively without the virtues of humility, honesty, intellectual integrity, compassion, and effacement of excessive self-interest. These traits mark physicians as members of a moral community dedicated to something other than its own self-interest. Our first obligation must be to serve the good of those persons who seek our help and trust us to provide it. Physicians, as physicians, are not, and must never be, commercial entrepreneurs, gateclosers, or agents of fiscal policy that runs counter to our trust. Any defection from primacy of the patient's well-being places the patient at risk by treatment that may compromise quality of or access to medical care. We believe the medical profession must reaffirm the primacy of its obligation to the patient through national, state, and local professional societies; our academic, research, and hospital organizations; and especially through 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.

  20. MSFC Stream Model Preliminary Results: Modeling the 1998-2002 Leonid Encounters and the 1993,1994, and 2004 Perseid Encounters

    Science.gov (United States)

    Moser, D. E.; Cooke, W. J.

    2004-01-01

    The cometary meteoroid ejection models of Jones (1996) and Crifo (1997) were used to simulate ejection from comets 55P/Tempel-Tuttle during the last 12 revolutions, and the 1862, 1737, and 161 0 apparitions of 1 OSP/Swift-Tuttle. Using cometary ephemerides generated by the JPL HORIZONS Solar System Data and Ephemeris Computation Service, ejection was simulated in 1 hour time steps while the comet was within 2.5 AU of the Sun. Also simulated was ejection occurring at the hour of perihelion passage. An RK4 variable step integrator was then used to integrate meteoroid position and velocity forward in time, accounting for the effects of radiation pressure, Poynting-Robertson drag, and the gravitational forces of the planets, which were computed using JPL's DE406 planetary ephemerides. An impact parameter is computed for each particle approaching the Earth, and the results are compared to observations of the 1998-2002 Leonid showers, and the 1993-1 994 Perseids. A prediction for Earth's encounter with the Perseid stream in 2004 is also presented.

  1. Strange Encounter: Depicting An “Other” Reality for Young Readers

    Directory of Open Access Journals (Sweden)

    YOU Chengcheng

    2015-04-01

    Full Text Available This article explores fantastic encounters between humans and non-humans inChinese and Japanese Children’s literature. Naoko Awa’s collection of short storiesThe Fox’s Window and Other Stories is closely read to elucidate narrative features ofwhat I call as “strange encounter”, the magic realistic human-animal encounter inChinese and Japanese cultural context. Chinese supernatural literature and culturaltradition of yaoguai, which have been assimilated into Japanese culture (Japaneseyōkai, are referred to throughout my discussion.  Todorov’s approach to thefantastic, Judith Zeitlin’s study of Strange Tales of Liaozhai Studio, and RosemaryJackson’s study of fantasy are drawn upon to illuminate the meaning of encountersbetween men and animals. I argue that magic realism as a relatively new genrefor young readers, not only reflects the author’s individual creative experienceof the fantastic but also partakes in the sense of an “other” reality that resonatesthroughout a cultural community. Perjumpaan Ganjil: Gambaran suatu Realitas “Liyan” bagi Pembaca Muda.Artikel ini membahas perjumpaan fantastis antara ‘manusia’ dan ‘non-manusia’ didalam sastra anak Cina dan Jepang. Antologi cerita pendek karangan Naoko Awa TheFox’s Window and Other Stories akan dikupas untuk memaparkan fitur naratif yangdisebut sebagai ‘perjumpaan aneh’ (strange encounter, perjumpaan magis-realis antaramanusia dengan binatang dalam konteks kebudayaan Cina dan Jepang. Karya sastrasupernatural Cina dan keberadaan yaoguai yang telah diasimilasi dalam kebudayaanJepang (disebut youkai menjadi sebuah referensi penting dalam artikel ini. Pendekatanfantasi dari Todorov, studi Judith Zeitlin tentang Strange Tales of Liaozhai Studio,dan studi fantasi dari Rosemary Jackson digunakan untuk memperjelas arti dariperjumpaan antara manusia dan binatang. Magis-realis sebagai sesuatu yang baru bagi pembaca muda tidak hanya merefleksikan pengalaman

  2. An Automated System to Quantify Convectively induced Aircraft encounters with Turbulence over Europe and North Atlantic

    Science.gov (United States)

    Meneguz, Elena; Turp, Debi; Wells, Helen

    2015-04-01

    It is well known that encounters with moderate or severe turbulence can lead to passenger injuries and incur high costs for airlines from compensation and litigation. As one of two World Area Forecast Centres (WAFCs), the Met Office has responsibility for forecasting en-route weather hazards worldwide for aviation above a height of 10,000 ft. Observations from commercial aircraft provide a basis for gaining a better understanding of turbulence and for improving turbulence forecasts through verification. However there is currently a lack of information regarding the possible cause of the observed turbulence, or whether the turbulence occurred within cloud. Such information would be invaluable for the development of forecasting techniques for particular types of turbulence and for forecast verification. Of all the possible sources of turbulence, convective activity is believed to be a major cause of turbulence. Its relative importance over the Europe and North Atlantic area has not been yet quantified in a systematic way: in this study, a new approach is developed to automate identification of turbulent encounters in the proximity of convective clouds. Observations of convection are provided from two independent sources: a surface based lightning network and satellite imagery. Lightning observations are taken from the Met Office Arrival Time Detections network (ATDnet). ATDnet has been designed to identify cloud-to-ground flashes over Europe but also detects (a smaller fraction of) strikes over the North Atlantic. Meteosat Second Generation (MSG) satellite products are used to identify convective clouds by applying a brightness temperature filtering technique. The morphological features of cold cloud tops are also investigated. The system is run for all in situ turbulence reports received from airlines for a total of 12 months during summer 2013 and 2014 for the domain of interest. Results of this preliminary short term climatological study show significant intra

  3. Demotivating infant feeding counselling encounters in southern Africa: do counsellors need more or different training?

    Science.gov (United States)

    Buskens, I; Jaffe, A

    2008-03-01

    Ethnographic research was conducted in eleven low-resource settings across Swaziland, Namibia and South Africa to explore how the perceptions and experiences of counselling health workers, pregnant women and recent mothers could be used to improve infant feeding counselling in the context of mother to child transmission (MTCT) of HIV. We found many counselling encounters to be demotivating. Mothers often reported feeling judged, stigmatised and shamed. Counsellors complained of mothers' poor compliance and passive resistance and reported suffering from stress, depression and burnout. We observed a rift between the mothers and counselling nurses, with both parties holding opposing agendas grounded in conflicting realities, expectations, experiences and needs. While the clients framed the visit as a consultation, counsellors framed it as health education, towards one exclusive purpose; to save the baby. Two communication modes prevailed in the counselling encounter: in theory, the counselling format was non-directive and client-centred but, in practice, most encounters reverted to information-based health education. Neither counselling format enabled the counsellors to acknowledge the reality of the two opposing agendas in the conversation and manage its dynamics. In order to achieve success - which, for the health service, is framed as persuading mothers to test for HIV and disclose the result - counsellors often felt compelled to be prescriptive and authoritative and reverted at times to confronting, judging and shaming mothers. Yet to adhere to their feeding choice consistently, mothers need to be motivated towards the significant behaviour change that this implies: to change their traditional roles and identities as women. For infant feeding counselling in the context of HIV/AIDS to become effective in southern Africa, a different format is therefore required; one that can acknowledge and manage these opposing agendas and conflicting realities and also enable

  4. Difficulties that Students who Learn Turkish as a Foreign Language Encounter During Listening Skills

    Directory of Open Access Journals (Sweden)

    Abdullah KALDIRIM

    2017-04-01

    Full Text Available Listening skills play an important role in an individual’s communication with others and in their understanding of the environment. Since it provides a basis for the acquisition of language skills it is one of the most important learning tools, and because it is frequently used in everyday life and in the learning process, listening skill is the foreground of foreign language teaching. It is important for students to understand what they listen to in order that they do not encounter any difficulties in the language learning process. To ensure success in the environments where the Turkish language is taught as a foreign language, it is necessary to follow the listening processes of the students attentively and to identify the problems they face during this process. This study aims to identify the listening barriers encountered by university students learning Turkish as a foreign language at level B2, and was designed based on a qualitative research approach and a phenomenological design. Within the scope of the study, eight students studying at Dumlupınar University’s TÖMER (Turkish & Foreign Languages Research and Application Center were identified as participants. Data were collected through semi-structured interviews conducted with students included in the sample, and descriptive analysis technique was applied in the analysis of the research data. Participants expressed views that they often encountered problems such as accented speech, frequent use of idioms and proverbs during listening, lack of vocabulary development, and lack of emphasis and voice intonation during speech. Also, factors that make listening easy to understand are identified as the other languages they speak, good vocabulary knowledge, interesting topics, listening to audiovisual elements, and the speaker’s use of gestures and mimics.

  5. MIT Project Apophis: Surface Evaulation & Tomography (SET) Mission Study for the April 2029 Earth Encounter

    Science.gov (United States)

    Binzel, R. P.; Earle, A. M.; Vanatta, M.; Miller, D. W.

    2017-12-01

    Nature is providing a once-per-thousand year opportunity to study the geophysical outcome induced on an unprecedentedly large (350 meter) asteroid making an extremely close passage by the Earth (inside the distance of geosynchronous satellites) on Friday April 13, 2029. The aircraft carrier-sized (estimated 20 million metric ton) asteroid is named Apophis. While many previous spacecraft missions have studied asteroids, none has ever had the opportunity to study "live" the outcome of planetary tidal forces on their shapes, spin states, surface geology, and internal structure. Beyond the science interest directly observing this planetary process, the Apophis encounter provides an invaluable opportunity to gain knowledge for any eventuality of a known asteroid found to be on a certain impact trajectory. MIT's Project Apophis [1] is our response to nature's generous opportunity by developing a detailed mission concept for sending a spacecraft to orbit Apophis with the objectives of surveying its surface and interior structure before, during, and after its 2029 near-Earth encounter. The Surface Evaluation & Tomography (SET) mission concept we present is designed toward accomplishing three key science objectives: (1) bulk physical characterization, (2) internal structure, and (3) long-term orbit tracking. For its first mission objective, SET will study Apophis' bulk properties, including: shape, size, mass, volume, bulk density, surface geology, and composition, rotation rate, and spin state. The second mission objective is to characterize Apophis' internal structure before and after the encounter to determine its strength and cohesion - including tidally induced changes. Finally, the third objective studies the process of thermal re-radiation and consequential Yarkovsky drift, whose results will improve orbit predictions for Apophis as well as other potentially hazardous asteroids. [1] https://eapsweb.mit.edu/mit-project-apophis

  6. The substance of love when encountering suffering: an interpretative research synthesis with an abductive approach.

    Science.gov (United States)

    Thorkildsen, Kari Marie; Eriksson, Katie; Råholm, Maj-Britt

    2013-06-01

    This study presents the results of an interpretative research synthesis undertaken to explore the essence of love when encountering suffering. The idea of caring as an expression of love and compassion belongs with ideas that have shaped caring for hundreds of years. Love and suffering are the core concepts in caring science and thus demand a basic research approach. The synthesis was undertaken by the interpretation of 15 articles focusing on love in different aspects, but within a caring science perspective. The research process was guided by a hermeneutical perspective with an abductive approach. The substance of love, when encountering suffering, reveals itself in three themes: love as a holy power, love as fundamental for being and love as an ethical act, which are to be found, respectively, within three dimensions: love as holiness, love as a communion and love as an art. Love is a holy power and encompasses everything; it is the well of strength that heals. No human can exist without love: this points to the ethical responsibility one has as a neighbour. In the ethical act, love is evident in concrete caring actions. The core of the substance of love within the three dimensions can be understood as agape. Agape connects and mirrors the dimensions, while at the same time it is clear that agape stems from and moves towards holiness, enabling love to be the ethical foundation when encountering suffering. Through the dimensions of love as communion and love as an art agape intertwine with eros forming caritas enabling the human being to move towards the dimension of holiness, which signifies becoming through suffering. © 2012 Nordic College of Caring Science.

  7. FORMATION OF CENTAURS’ RINGS THROUGH THEIR PARTIAL TIDAL DISRUPTION DURING PLANETARY ENCOUNTERS

    Energy Technology Data Exchange (ETDEWEB)

    Hyodo, Ryuki; Charnoz, Sébastien [Institut de Physique du Globe, F-75005 Paris, France (France); Genda, Hidenori [Earth-Life Science Institute, Tokyo Institute of Technology, Tokyo 152-8550 (Japan); Ohtsuki, Keiji [Department of Planetology, Kobe University, Kobe 657-8501 (Japan)

    2016-09-01

    Centaurs are minor planets orbiting between Jupiter and Neptune that have or had crossing orbits with one or more giant planets. Recent observations and reinterpretation of previous observations have revealed the existence of ring systems around 10199 Chariklo and 2060 Chiron. However, the origin of the ring systems around such a minor planet is still an open question. Here, we propose that the tidal disruption of a differentiated object that experiences a close encounter with a giant planet could naturally form diverse ring–satellite systems around the Centaurs. During the close encounter, the icy mantle of the passing object is preferentially ripped off by the planet's tidal force and the debris is distributed mostly within the Roche limit of the largest remnant body. Assuming the existence of a 20−50 wt% silicate core below the icy mantle, a disk of particles is formed when the objects pass within 0.4–0.8 of the planet's Roche limit with the relative velocity at infinity 3−6 km s{sup −1} and 8 hr initial spin period of the body. The resultant ring mass is 0.1%–10% of the central object's mass. Such particle disks are expected to spread radially, and materials spreading beyond the Roche limit would accrete into satellites. Our numerical results suggest that ring formation would be a natural outcome of such extreme close encounters, and Centaurs can naturally have such ring systems because they cross the orbits of the giant planets.

  8. Two massive stars possibly ejected from NGC 3603 via a three-body encounter

    Science.gov (United States)

    Gvaramadze, V. V.; Kniazev, A. Y.; Chené, A.-N.; Schnurr, O.

    2013-03-01

    We report the discovery of a bow-shock-producing star in the vicinity of the young massive star cluster NGC 3603 using archival data of the Spitzer Space Telescope. Follow-up optical spectroscopy of this star with Gemini-South led to its classification as O6 V. The orientation of the bow shock and the distance to the star (based on its spectral type) suggest that the star was expelled from the cluster, while the young age of the cluster (˜2 Myr) implies that the ejection was caused by a dynamical few-body encounter in the cluster's core. The relative position on the sky of the O6 V star and a recently discovered O2 If*/WN6 star (located on the opposite side of NGC 3603) allows us to propose that both objects were ejected from the cluster via the same dynamical event - a three-body encounter between a single (O6 V) star and a massive binary (now the O2 If*/WN6 star). If our proposal is correct, then one can `weigh' the O2 If*/WN6 star using the conservation of the linear momentum. Given a mass of the O6 V star of ≈30 M⊙, we found that at the moment of ejection the mass of the O2 If*/WN6 star was ≈175 M⊙. Moreover, the observed X-ray luminosity of the O2 If*/WN6 star (typical of a single star) suggests that the components of this originally binary system have merged (e.g., because of encounter hardening).

  9. Motivational Interviewing Skills in Health Care Encounters (MISHCE): Development and psychometric testing of an assessment tool.

    Science.gov (United States)

    Petrova, Tatjana; Kavookjian, Jan; Madson, Michael B; Dagley, John; Shannon, David; McDonough, Sharon K

    2015-01-01

    Motivational interviewing (MI) has demonstrated a significant impact as an intervention strategy for addiction management, change in lifestyle behaviors, and adherence to prescribed medication and other treatments. Key elements to studying MI include training in MI of professionals who will use it, assessment of skills acquisition in trainees, and the use of a validated skills assessment tool. The purpose of this research project was to develop a psychometrically valid and reliable tool that has been designed to assess MI skills competence in health care provider trainees. The goal was to develop an assessment tool that would evaluate the acquisition and use of specific MI skills and principles, as well as the quality of the patient-provider therapeutic alliance in brief health care encounters. To address this purpose, specific steps were followed, beginning with a literature review. This review contributed to the development of relevant conceptual and operational definitions, selecting a scaling technique and response format, and methods for analyzing validity and reliability. Internal consistency reliability was established on 88 video recorded interactions. The inter-rater and test-retest reliability were established using randomly selected 18 from the 88 interactions. The assessment tool Motivational Interviewing Skills for Health Care Encounters (MISHCE) and a manual for use of the tool were developed. Validity and reliability of MISHCE were examined. Face and content validity were supported with well-defined conceptual and operational definitions and feedback from an expert panel. Reliability was established through internal consistency, inter-rater reliability, and test-retest reliability. The overall internal consistency reliability (Cronbach's alpha) for all fifteen items was 0.75. MISHCE demonstrated good inter-rater reliability and good to excellent test-retest reliability. MISHCE assesses the health provider's level of knowledge and skills in brief

  10. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

    Directory of Open Access Journals (Sweden)

    Rasmussen Finn

    2011-02-01

    Full Text Available Abstract Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men and 10 district nurses (7 women, 3 men from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and

  11. Challenges encountered when expanding activated sludge models: a case study based on N2O production

    DEFF Research Database (Denmark)

    Snip, Laura; Boiocchi, Riccardo; Flores Alsina, Xavier

    2014-01-01

    (WWTPs). As a consequence, these experiments might not be representative for full-scale performance, and unexpected behaviour may be observed when simulating WWTP models using the derived process equations. In this paper we want to highlight problems encountered using a simplified case study: a modified......: problems related to the overall mathematical model structure and problems related to the published set of parameter values. The paper describes the model implementation incompatibilities, the variability in parameter values and the difficulties of reaching similar conditions when simulating a full...

  12. Adrenal lesions encountered in current medical practice − a review of their radiological imaging

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    Vanesha Naidu

    2013-11-01

    Full Text Available Modern radiological technology has transformed the way that adrenal lesions are currently investigated. The contemporary radiologist has been catapulted to the forefront in the management of adrenal disease. With the increasing use of cross-sectional imaging, adrenal lesions are being serendipitously discovered in radiological studies undertaken for non-adrenal-related conditions – the so-called adrenal ‘incidentaloma’. This review discusses the imaging modalities available for characterising these lesions, highlighting current concepts and controversies in differentiating benign from malignant pathology. The article also provides a brief overview of the spectrum of adrenal pathology commonly encountered in the adult population.

  13. Understanding interprofessional education as an intergroup encounter: The use of contact theory in programme planning.

    Science.gov (United States)

    Carpenter, John; Dickinson, Claire

    2016-01-01

    A key underlying assumption of interprofessional education (IPE) is that if the professions are brought together they have the opportunity to learn about each other and dispel the negative stereotypes which are presumed to hamper interprofessional collaboration in practice. This article explores the application of contact theory in IPE with reference to eight evaluation studies (1995-2012) which adopted this theoretical perspective. It proposes that educators should pay explicit attention to an intergroup perspective in designing IPE programmes and specifically to the "contact variables" identified by social psychologists studying intergroup encounters. This would increase the chances of the planned contact having a positive effect on attitude change.

  14. Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study.

    Science.gov (United States)

    Click, Benjamin; Anderson, Alyce M; Ramos Rivers, Claudia; Koutroubakis, Ioannis E; Hashash, Jana G; Dunn, Michael A; Schwartz, Marc; Swoger, Jason; Barrie, Arthur; Szigethy, Eva; Regueiro, Miguel; Schoen, Robert E; Binion, David G

    2018-04-01

    Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated. We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency. Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (Pfinancial charges the following year after controlling for demographic, utilization, and medication covariates. Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.

  15. Examining the spatial distribution of law enforcement encounters among people who inject drugs after implementation of Mexico's drug policy reform.

    Science.gov (United States)

    Gaines, Tommi L; Beletsky, Leo; Arredondo, Jaime; Werb, Daniel; Rangel, Gudelia; Vera, Alicia; Brouwer, Kimberly

    2015-04-01

    In 2009, Mexico decriminalized the possession of small amounts of illicit drugs for personal use in order to refocus law enforcement resources on drug dealers and traffickers. This study examines the spatial distribution of law enforcement encounters reported by people who inject drugs (PWID) in Tijuana, Mexico to identify concentrated areas of policing activity after implementation of the new drug policy. Mapping the physical location of law enforcement encounters provided by PWID (n = 461) recruited through targeted sampling, we identified hotspots of extra-judicial encounters (e.g., physical/sexual abuse, syringe confiscation, and money extortion by law enforcement) and routine authorized encounters (e.g., being arrested or stopped but not arrested) using point density maps and the Getis-Ord Gi* statistic calculated at the neighborhood-level. Approximately half of the participants encountered law enforcement more than once in a calendar year and nearly one third of these encounters did not result in arrest but involved harassment or abuse by law enforcement. Statistically significant hotspots of law enforcement encounters were identified in a limited number of neighborhoods located in areas with known drug markets. At the local-level, law enforcement activities continue to target drug users despite a national drug policy that emphasizes drug treatment diversion rather than punitive enforcement. There is a need for law enforcement training and improved monitoring of policing tactics to better align policing with public health goals.

  16. 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

    Directory of Open Access Journals (Sweden)

    Joan Guix Oliver

    2006-12-01

    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

  17. Bimolecular encounters and re-encounters (cage effect) of a spin-labeled analogue of cholestane in a series of n-alkanes: effect of anisotropic exchange integral.

    Science.gov (United States)

    Vandenberg, Andrew D; Bales, Barney L; Salikhov, K M; Peric, Miroslav

    2012-12-27

    Electron paramagnetic resonance (EPR) spectra of the nitroxide spin probe 3β-doxyl-5α-cholestane (CSL) are studied as functions of the molar concentration, c, and the temperature, T, in a series of n-alkanes. The results are compared with a similar study of a much smaller spin probe, perdeuterated 2,2,6,6-tetramethyl-4-oxopiperidine-1-oxyl (pDT). The Heisenberg spin exchange (HSE) rate constants, K(ex), of CSL are similar in hexane, octane, and decane and are about one-half of those for pDT in the same solvents. They are also about one-half of the Stokes-Einstein-Perrin prediction. This reduction in HSE efficiency is attributed to an effective steric factor, f(eff), which was evaluated by comparing the results with the Stokes-Einstein-Perrin prediction or with pDT, and it is equal to 0.49 ± 0.03, independent of temperature. The unpaired spin density in CSL is localized near one end of the long molecule, so the exchange integral, J, leading to HSE, is expected to be large in some collisions and small in others; thus, J is modeled by an ideal distribution of values of J = J(0) with probability f and J = 0 with probability (1 - f). Because of rotational and translation diffusion during contact and between re-encounters of the probe, the effective steric factor is predicted to be f(eff) = f(1/2). Estimating the fraction of the surface of CSL with rich spin density yields a theoretical estimate of f(eff) = 0.59 ± 0.08, in satisfactory agreement with experiment. HSE is well described by simple hydrodynamic theory, with only a small dependence on solvent-probe relative sizes at the same value of T/η, where η is the viscosity of the solvent. This result is probably due to a fortuitous interplay between long- and short-range effects that describe diffusion processes over relatively large distances. In contrast, dipole-dipole interactions (DD) as measured by the line broadening, B(dip), and the mean time between re-encounters within the cage, τ(RE), vary significantly

  18. A Systematic Review of Patients’ Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity

    Science.gov (United States)

    Rocque, Rhea; Leanza, Yvan

    2015-01-01

    Communication difficulties persist between patients and physicians. In order to improve care, patients’ experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients’ experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients’ experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients’ experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients’ evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion

  19. Hildegard Peplau’s Theory and the Healthcare Encounters of Survivors of Sexual Violence

    Science.gov (United States)

    Courey, Tamra J.; Martsolf, Donna S.; Draucker, Claire B.; Strickland, Karen B.

    2011-01-01

    Background Individuals who experience sexual violence often seek services in a variety of healthcare settings. Although research indicates that survivors often report that interactions with healthcare professionals are distressing, little is known about what renders these encounters helpful or hurtful. Objective The purpose of this study was to use Hildegard Peplau’s (1952) conceptualization of nurses’ helping roles (i.e., stranger, resource person, teacher, leadership, surrogate, counselor, technical expert) in nurse-client interactions to explore how survivors of sexual violence perceive their encounters with healthcare professionals. Study Design Content analysis was conducted on the transcripts of 60 minimally structured interviews in which participants discussed their experiences of sexual violence. Results The results revealed that the helping roles of counselor and technical expert, as identified by Peplau, were most important to survivors of sexual violence. Regardless of role, participants perceived healthcare professionals to be helpful when they exhibited interpersonal sensitivity, especially in regards to the participants’ experiences with violence. Conclusions The findings indicate that healthcare professionals need to maintain an attentive and compassion stance when working with survivors of sexual violence. Those who serve in a counselor role need to create an atmosphere of trust so that clients may explore in depth how violence has affected their lives. PMID:21665762

  20. On the encounter of health with education: Thenew school and its developments in discussion

    Directory of Open Access Journals (Sweden)

    Marcelo Rito

    2017-03-01

    Full Text Available Based on Foucauldian ideas, the present studyaimed at analyzing the discursive games established on the encounter between health and Brazilian pedagogy from the 1920s – encounter which was featured by escolanovismo. Therefore, we analyzed, at first, some books from the Bibliotheca de Educação collection, carried out by key authors of the Movimento Escola Nova (New School Movement, in which emerges the primacy of that cognition would be subjected to pertinent procedures to brain physiology. In a second moment, we investigated academic papers in a set of contemporary educational journals dedicated to criticise hygienists, ideological or normative biases supposedly inherent to the New School, whose analyses have proved captive of a denunciatory approach to the relations of power-knowledge in force; these relations, according to the examined authors, generated unfailing pathologizing effects to school practices. As a conclusion, we suggested an analytical turning able to put into question approaches based on a priori notions, such as development, enlightenment and representation in favor of reflections focused on the uninterrupted game between subjective processes and veridiction policies that outline the current educational field.