Sample records for patient-provider encounter study

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


    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.

  2. 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


    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

  3. 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


    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

  4. A preliminary path analysis of expectancy and patient-provider encounter in an open-label randomized controlled trial of spinal manipulation for cervicogenic headache. (United States)

    Haas, Mitchell; Aickin, Mikel; Vavrek, Darcy


    The purpose of this article was to present a preliminary model to identify the effects of expectancy of treatment success and the patient-provider encounter (PPE) on outcomes in an open-label randomized trial. Eighty participants with chronic cervicogenic headache (CGH) were randomized to 4 groups: 2 levels of treatment dose (8 or 16) and 2 levels of therapy from a chiropractor (spinal manipulation or light massage). Providers were instructed to have equal enthusiasm for all care. Structural equation modeling with standardized path coefficients (beta) was used in a path analysis to identify the effects of patient expectancy and the PPE on CGH pain. The model included monthly pain from baseline to 12 weeks. Expectancy and PPE were evaluated on Likert scales. The patient-provider encounter was measured as patient perception of chiropractor enthusiasm, confidence, and comfort with care. Baseline patient expectancy was balanced across groups. The PPE measures were balanced across groups and consistent over the 8-week treatment period. Treatment and baseline pain had the strongest effects on pain outcomes (|beta| = .46-.59). Expectations had little effect on pain (abs value(beta) value(beta)= .03-.27) and on subsequent confidence in treatment success (abs value(beta)= .09 and .12). Encouraging equipoise in the PPE and balancing expectancy across treatment groups may protect against some confounding related to the absence of blinding in a randomized controlled trial of pain. In this trial, their effects were found to be small relative to the effects of treatment and baseline values. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  5. A mixed methods study of patient-provider communication about opioid analgesics. (United States)

    Hughes, Helen Kinsman; Korthuis, Philip Todd; Saha, Somnath; Eggly, Susan; Sharp, Victoria; Cohn, Jonathan; Moore, Richard; Beach, Mary Catherine


    To describe patient-provider communication about opioid pain medicine and explore how these discussions affect provider attitudes toward patients. We audio-recorded 45 HIV providers and 423 patients in routine outpatient encounters at four sites across the country. Providers completed post-visit questionnaires assessing their attitudes toward patients. We identified discussions about opioid pain management and analyzed them qualitatively. We used logistic regression to assess the association between opioid discussion and providers' attitudes toward patients. 48 encounters (11% of the total sample) contained substantive discussion of opioid-related pain management. Most conversations were initiated by patients (n=28, 58%) and ended by the providers (n=36, 75%). Twelve encounters (25%) contained dialog suggesting a difference of opinion or conflict. Providers more often agreed than disagreed to give the prescription (50% vs. 23%), sometimes reluctantly; in 27% (n=13) of encounters, no decision was made. Fewer than half of providers (n=20, 42%) acknowledged the patient's experience of pain. Providers had a lower odds of positive regard for the patient (adjusted OR=0.51, 95% CI: 0.27-0.95) when opioids were discussed. Pain management discussions are common in routine outpatient HIV encounters and providers may regard patients less favorably if opioids are discussed during visits. The sometimes-adversarial nature of these discussions may negatively affect provider attitudes toward patients. Empathy and pain acknowledgment are tools that clinicians can use to facilitate productive discussions of pain management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Patient-provider interaction from the perspectives of type 2 diabetes patients in Muscat, Oman: a qualitative study

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    Östenson Claes-Göran


    Full Text Available Abstract Background Patients' expectations and perceptions of the medical encounter and interactions are important tools in diabetes management. Some problems regarding the interaction during encounters may be related to a lack of communication skills on the part of either the physician or the patient. This study aimed at exploring the perceptions of type 2 diabetes patients regarding the medical encounters and quality of interactions with their primary health-care providers. Methods Four focus group discussions (two women and two men groups were conducted among 27 purposively selected patients (13 men and 14 women from six primary health-care centres in Muscat, Oman. Qualitative content analysis was applied. Results The patients identified some weaknesses regarding the patient-provider communication like: unfriendly welcoming; interrupted consultation privacy; poor attention and eye contact; lack of encouraging the patients to ask questions on the providers' side; and inability to participate in medical dialogue or express concerns on the patients' side. Other barriers and difficulties related to issues of patient-centeredness, organization of diabetes clinics, health education and professional competency regarding diabetes care were also identified. Conclusion The diabetes patients' experiences with the primary health-care providers showed dissatisfaction with the services. We suggest appropriate training for health-care providers with regard to diabetes care and developing of communication skills with emphasis on a patient-centred approach. An efficient use of available resources in diabetes clinics and distributing responsibilities between team members in close collaboration with patients and their families seems necessary. Further exploration of the providers' work situation and barriers to good interaction is needed. Our findings can help the policy makers in Oman, and countries with similar health systems, to improve the quality and

  7. Effective patient-provider communication about sexual concerns in breast cancer: a qualitative study. (United States)

    Reese, Jennifer Barsky; Beach, Mary Catherine; Smith, Katherine Clegg; Bantug, Elissa T; Casale, Kristen E; Porter, Laura S; Bober, Sharon L; Tulsky, James A; Daly, Mary B; Lepore, Stephen J


    Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development. Patient data (n = 28) were derived from focus groups and interviews with partnered and unpartnered women treated for breast cancer reporting sexual concerns. Provider data (n = 11) came from interviews with breast cancer oncologists and nurse practitioners. Patient and provider data were analyzed separately using the framework method of qualitative analysis. Findings revealed individual and institutional barriers to effective communication about sexual concerns and highlighted key communication facilitators (e.g., a positive patient-provider relationship, patient communication as a driver of provider communication, and vice versa). Patients expressed preferences for open, collaborative communication; providers expressed preferences for focused intervention targets (identifying concerns, offering resources/referrals) and convenient format. A model of effective communication of sexual concerns was developed to inform communication interventions. Findings suggest that to improve patient-provider communication about sexual concerns, knowledge and skills-based interventions that activate patients and that equip providers for effective discussions about sexual concerns are needed, as are institutional changes that could incentivize such discussions.

  8. Adolescent Perspectives on Patient-Provider Sexual Health Communication: A Qualitative Study. (United States)

    Hoopes, Andrea J; Benson, Samantha K; Howard, Heather B; Morrison, Diane M; Ko, Linda K; Shafii, Taraneh


    Adolescents in the United States are disproportionately affected by sexually transmitted infections and unintended pregnancy. Adolescent-centered health services may reduce barriers to health care; yet, limited research has focused on adolescents' own perspectives on patient-provider communication during a sexual health visit. Twenty-four adolescents (14-19 years old) seeking care in a public health clinic in Washington State participated in one-on-one qualitative interviews. Interviews explored participants' past experiences with medical providers and their preferences regarding provider characteristics and communication strategies. Interviews revealed that (1) individual patient dynamics and (2) patient-provider interaction dynamics shape the experience during a sexual health visit. Individual patient dynamics included evolving level of maturity, autonomy, and sexual experience. Patient-provider interaction dynamics were shaped by adolescents' perceptions of providers as sources of health information who distribute valued sexual health supplies like contraception and condoms. Participant concerns about provider judgment, power differential, and lack of confidentiality also emerged as important themes. Adolescents demonstrate diverse and evolving needs for sexual health care and interactions with clinicians as they navigate sexual and emotional development.

  9. Retained in HIV Care But Not on Antiretroviral Treatment: A Qualitative Patient-Provider Dyadic Study.

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    Katerina A Christopoulos


    Full Text Available Patients retained in HIV care but not on antiretroviral therapy (ART represent an important part of the HIV care cascade in the United States. Even in an era of more tolerable and efficacious ART, decision making in regards to ART offer and uptake remains complex and calls for exploration of both patient and provider perspectives. We sought to understand reasons for lack of ART usage in patients meeting the Health Resources Services Administration definition of retention as well as what motivated HIV primary care appointment attendance in the absence of ART.We conducted a qualitative study consisting of 70 in-depth interviews with ART-naïve and ART-experienced patients off ART and their primary care providers in two urban safety-net HIV clinics in San Francisco and New York. Twenty patients and their providers were interviewed separately at baseline, and 15 dyads were interviewed again after at least 3 mo and another clinic visit in order to understand any ART use in the interim. We applied dyadic analysis to our data. Nearly all patients were willing to consider ART, and 40% of the sample went on ART, citing education on newer antiretroviral drugs, acceptance of HIV diagnosis, social support, and increased confidence in their ability to adhere as facilitators. However, the strength of the provider recommendation of ART played an important role. Many patients had internalized messages from providers that their health was too good to warrant ART. In addition, providers, while demonstrating patient-centered care through sensitivity to patients experiencing psychosocial instability, frequently muted the offer of ART, at times unintentionally. In the absence of ART, lab monitoring, provider relationships, access to social services, opiate pain medications, and acute symptoms motivated care. The main limitations of this study were that treatment as prevention was not explored in depth and that participants were recruited from academic HIV clinics in

  10. Retained in HIV Care But Not on Antiretroviral Treatment: A Qualitative Patient-Provider Dyadic Study (United States)

    Christopoulos, Katerina A.; Olender, Susan; Lopez, Andrea M.; Lekas, Helen-Maria; Jaiswal, Jessica; Mellman, Will; Geng, Elvin; Koester, Kimberly A.


    Background Patients retained in HIV care but not on antiretroviral therapy (ART) represent an important part of the HIV care cascade in the United States. Even in an era of more tolerable and efficacious ART, decision making in regards to ART offer and uptake remains complex and calls for exploration of both patient and provider perspectives. We sought to understand reasons for lack of ART usage in patients meeting the Health Resources Services Administration definition of retention as well as what motivated HIV primary care appointment attendance in the absence of ART. Methods and Findings We conducted a qualitative study consisting of 70 in-depth interviews with ART-naïve and ART-experienced patients off ART and their primary care providers in two urban safety-net HIV clinics in San Francisco and New York. Twenty patients and their providers were interviewed separately at baseline, and 15 dyads were interviewed again after at least 3 mo and another clinic visit in order to understand any ART use in the interim. We applied dyadic analysis to our data. Nearly all patients were willing to consider ART, and 40% of the sample went on ART, citing education on newer antiretroviral drugs, acceptance of HIV diagnosis, social support, and increased confidence in their ability to adhere as facilitators. However, the strength of the provider recommendation of ART played an important role. Many patients had internalized messages from providers that their health was too good to warrant ART. In addition, providers, while demonstrating patient-centered care through sensitivity to patients experiencing psychosocial instability, frequently muted the offer of ART, at times unintentionally. In the absence of ART, lab monitoring, provider relationships, access to social services, opiate pain medications, and acute symptoms motivated care. The main limitations of this study were that treatment as prevention was not explored in depth and that participants were recruited from academic

  11. The Patient-Provider Relationship Is Associated with Hepatitis C Treatment Eligibility: A Prospective Mixed-Methods Cohort Study.

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    Shari S Rogal

    Full Text Available Hepatitis C virus (HCV treatment has the potential to cure the leading cause of cirrhosis and hepatocellular carcinoma. However, only those deemed eligible for treatment have the possibility of this cure. Therefore, understanding the determinants of HCV treatment eligibility is critical. Given that effective communication with and trust in healthcare providers significantly influences treatment eligibility decisions in other diseases, we aimed to understand patient-provider interactions in the HCV treatment eligibility process. This prospective cohort study was conducted in the VA Pittsburgh Healthcare System. Patients were recruited after referral for gastroenterology consultation for HCV treatment with interferon and ribavirin. Consented patients completed semi-structured interviews and validated measures of depression, substance and alcohol use, and HCV knowledge. Two coders analyzed the semi-structured interviews. Factors associated with patient eligibility for interferon-based therapy were assessed using multivariate logistic regression. Of 339 subjects included in this analysis, only 56 (16.5% were deemed eligible for HCV therapy by gastroenterology (GI providers. In the multivariate logistic regression, patients who were older (OR = 0.96, 95%CI = 0.92-0.99, p = .049, reported concerns about the GI provider (OR = 0.40, 95%CI = 0.10-0.87, p = 0.02 and had depression symptoms (OR = 0.32, 95%CI = 0.17-0.63, p = 0.001 were less likely to be eligible. Patients described barriers that included feeling stigmatized and poor provider interpersonal or communication skills. In conclusion, we found that patients' perceptions of the relationship with their GI providers were associated with treatment eligibility. Establishing trust and effective communication channels between patients and providers may lower barriers to potential HCV cure.

  12. Patient-provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study. (United States)

    Lyles, Courtney R; Sarkar, Urmimala; Ralston, James D; Adler, Nancy; Schillinger, Dean; Moffet, Howard H; Huang, Elbert S; Karter, Andrew J


    Patient-provider relationships influence diabetes care; less is known about their impact on online patient portal use. Diabetes patients rated provider communication and trust. In this study, we linked responses to electronic medical record data on being a registered portal user and using secure messaging (SM). We specified regression models to evaluate main effects on portal use, and subgroup analyses by race/ethnicity and age. 52% of subjects were registered users; among those, 36% used SM. Those reporting greater trust were more likely to be registered users (relative  risk (RR)=1.14) or SM users (RR=1.29). In subgroup analyses, increased trust was associated with being a registered user among white, Latino, and older patients, as well as SM use among white patients. Better communication ratings were also related to being a registered user among older patients. Since increased trust and communication were associated with portal use within subgroups, this suggests that patient-provider relationships encourage portal engagement.

  13. A fruitful encounter between Cognitive Science and Science & Technology Studies

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    Aleksandra Derra


    Full Text Available Scholars deriving from different schools of thought, especially if these grow out of different traditions, do not meet too frequently, and it is even more rare for these meeting to result in creating theories or research practices that would be cognitively surprising or rich in refreshing ideas. Therefore, the material we present in the current issue of Avant (1/2013 is exceptional. In the following part you can read articles by representatives of the so-called Toruń (postconstructivist school, “(Postconstructivism on the subject of techno-science” by Ewa Bińczyk and “A-socio-logy of a condition. A study of controversies surrounding etiology, diagnosis and therapy of ADHD” by Łukasz Afeltowicz and Michał Wróblewski.

  14. Studying the clinical encounter with the Adaptive Leadership framework

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    Bailey Jr DE


    Full Text Available Donald E Bailey Jr,1,2 Sharron L Docherty,1 Judith A Adams,1 Dana L Carthron,3 Kirsten Corazzini,1,2 Jennifer R Day,1 Elizabeth Neglia,1 Marcus Thygeson,4 Ruth A Anderson1,21School of Nursing, Duke University, 2Center for the Study of Aging and Human Development, Duke University, Durham, NC, 3School of Health Science, Division of Nursing, Winston Salem State University, Winston Salem, NC, 4Medical Services, Blue Shield of California, San Francisco, CA, USAAbstract: In this paper we discuss the concept of leadership as a personal capability, not contingent on one's position in a hierarchy. This type of leadership allows us to reframe both the care-giving and organizational roles of nurses and other front-line clinical staff. Little research has been done to explore what leadership means at the point of care, particularly in reference to the relationship between health care practitioners and patients and their family caregivers. The Adaptive Leadership framework, based on complexity science theory, provides a useful lens to explore practitioners' leadership behaviors at the point of care. This framework proposes that there are two broad categories of challenges that patients face: technical and adaptive. Whereas technical challenges are addressed with technical solutions that are delivered by practitioners, adaptive challenges require the patient (or family member to adjust to a new situation and to do the work of adapting, learning, and behavior change. Adaptive leadership is the work that practitioners do to mobilize and support patients to do the adaptive work. The purpose of this paper is to describe this framework and demonstrate its application to nursing research. We demonstrate the framework's utility with five exemplars of nursing research problems that range from the individual to the system levels. The framework has the potential to guide researchers to ask new questions and to gain new insights into how practitioners interact with

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


    SHIRAI, Toshiaki; SATOMI, Akira; KONDO, Junya


    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...

  16. Cosmopolitan encounters

    DEFF Research Database (Denmark)

    Plage, Stefanie; Willing, Indigo; Woodward, Ian


    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....

  17. Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences

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    Emily A. Hurley


    Full Text Available Effective patient-provider communication (PPC promotes patient adherence and retention in long-term care. Sub-Saharan Africa faces unprecedented demand for chronic care for HIV patients on antiretroviral therapy (ART, yet adherence and retention remain challenging. In high-income countries, research describing patient preferences for different PPC styles has guided interventions to improve PPC and patient outcomes. However, research on PPC preferences in sub-Saharan Africa is limited. We sought to define PPC dimensions relevant to ART programs in Bamako, Mali through recordings of clinical interactions, in-depth interviews and focus-group discussions with 69 patients and 17 providers. To assess preferences toward contrasting PPC styles within dimensions, we conducted a vignette-based survey with 141 patients across five ART facilities. Qualitative analysis revealed two PPC dimensions similar to those described in the literature on patient-centered communication (level of psychosocial regard, balance of power, and one unique dimension that emerged from the data (guiding patient behavior: easy/tough/sharp. Significantly more survey participants chose the vignette demonstrating high psychosocial regard (52.2% compared to a biomedical style (22.5% (p<0.001. Within balance of power, a statistically similar proportion of participants chose the vignette demonstrating shared power (40.2% compared to a provider-dominated style (35.8%. In guiding patient behavior, a similar proportion of participants preferred the vignette depicting the “easy” (38.4% and/or “tough” style (40.6%, but significantly fewer preferred the “sharp” style (14.5% (p<0.001. Highly educated participants chose biomedical and shared power styles more frequently, while less educated participants more frequently indicated “no preference”. Working to understand, develop, and tailor PPC styles to patients in chronic care may help support patient retention and ultimately

  18. Toward the Long-Term Scientific Study of Encounter Group Phenomena: I. Methodological Considerations. (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)…

  19. 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


    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

  20. ACES M and S: Unmitigated Factorial Encounter Study on DAA/TCAS Interoperability (United States)

    Thipphavong, David; Cone, Andrew; Park, Chunki; Lee, Seung Man; Santiago, Confesor


    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

  1. A transcultural study of Jordanian nursing students' care encounters within the context of clinical education. (United States)

    Nahas, V


    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.

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

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    Pedro Felipe da Costa Coelho


    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.

  3. Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient-Provider Communication in the START Study. (United States)

    Hirsch-Moverman, Yael; Daftary, Amrita; Yuengling, Katharine A; Saito, Suzue; Ntoane, Moeketsi; Frederix, Koen; Maama, Llang B; Howard, Andrea A


    mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment (START) study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). We describe the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers. Patients and treatment supporters received automated, coded medication and appointment reminders at their preferred time and frequency, using their own phones, and $3.70 in monthly airtime. Facility-based VHWs were trained to log patient information and text message preferences into a mobile application and were given a password-protected mobile phone and airtime to communicate with community-based VHWs. The use of mHealth tools was analyzed from process data over the study course. Acceptability was evaluated during monthly follow-up interviews with all participants and during qualitative interviews with a subset of 30 patients and 30 health care providers at intervention sites. Use and acceptability were contextualized by monthly adherence data. From April 2013 to August 2015, the automated SMS system successfully delivered 39,528 messages to 835 individuals, including 633 patients and 202 treatment supporters. Uptake of the SMS intervention was high, with 92.1% of 713 eligible patients choosing to receive SMS messages. Patient and provider interviews yielded insight into barriers and facilitators to mHealth utilization. The intervention improved the quality of health communication between patients, treatment supporters, and providers. HIV-related stigma and technical challenges were identified as potential barriers. The mHealth intervention for HIV/tuberculosis treatment support in Lesotho was found to be a low-tech, user-friendly intervention, which was acceptable to patients and health care providers.

  4. Drug use in business bathrooms: An exploratory study of manager encounters in New York City (United States)

    Wolfson-Stofko, Brett; Bennett, Alex S.; Elliott, Luther; Curtis, Ric


    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

  5. Mobile encounters

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


    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...

  6. Encountering Materiality

    DEFF Research Database (Denmark)

    Svabo, Connie


    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....

  7. MIT Project Apophis: Surface Evaulation & Tomography (SET) Mission Study for the April 2029 Earth Encounter (United States)

    Binzel, R. P.; Earle, A. M.; Vanatta, M.; Miller, D. W.


    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]

  8. 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


    (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...

  9. Dealing with Coronary Artery Disease in Early Encountering: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Mohammad Mojalli


    Full Text Available Background: The prevalence of cardiovascular diseases is rising in industrial and developing countries. Coronary Artery Disease (CAD is the most common cardiovascular disease. Thus, understanding the signs and risk factors of CAD from the patients’ perspective and their ways of dealing with this disease is of vital importance. Objectives: This qualitative study aimed to explore the Iranian patients’ viewpoints about CAD and how they dealt with it in their first encounter. Patients and Methods: This study was a qualitative content analysis conducted on 18 patients with CAD. The data were collected through semi-structured interviews. Initially, purposeful sampling was performed followed by maximum variety. Sampling continued until data saturation. Then, all the interviews were recorded and transcribed verbatim. After all, the data were analyzed by constant comparative analysis using MAXQUDA2010 software. Results: The themes manifested in this study included “invasion of disease” with subthemes of “warning signs” and “risk factors” and “confrontation strategies” with subthemes of “seeking for information”, “follow-up”, and “control measures”. Conclusions:: The results of this study described the patients’ perceptions of CAD and how they dealt with this disorder in early encountering. Based on the results, physicians and nurses should focus on empowerment of patients by facilitating this process as well as by educating them with regards to dealing with CAD.

  10. Negotiating frame ambiguity: a study of simulated encounters in medical education. (United States)

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


    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.

  11. Healthcare Engagement and Encounters in a Rural State: A Focus Group Study

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    Reshmi Singh


    Full Text Available Introduction: Rural populations have many barriers to quality health care including lack of access to primary care and specialty care and a greater likelihood to be underinsured or uninsured. They are also less likely to use preventive screening, or to participate in self-care and engage in their health when compared to urban residents. The purpose of this paper was to describe patients’ healthcare experiences in a rural western state focusing on their healthcare expectations and engagement. Methods: This qualitative study was conducted using a focus group protocol to elicit rural patients’ healthcare experiences. A purposeful sample of English speaking adult residents from a single county who were willing to discuss their healthcare experiences was included. Patients and community members (21 years and older were recruited through a local hospital as well as via flyers posted throughout the community. Each audio-recorded group took about two hours. A total of 15 focus groups were conducted to obtain sufficient text for theoretical saturation and thematic analysis. Each group had a range of 3-8 participants. A $25 visa gift card and lunch were provided for each participant as an incentive. Results: ‘Encounters with Healthcare Professionals’ and ‘Engagement in Health’ were the two dominant dimensions with two themes each. Themes centered around what characterized the best or worst encounters. Trust and Communication - both were based on time spent with the provider and establishment of rapport with the providers. The best encounters were those with health care providers or pharmacists who had sufficient time, adequately explained a diagnosis and new medications did not dismiss patient concerns, and treated individuals with respect. Typical responses describing the worst encounters included examples of misdiagnosis, dismissing patient’s symptoms, healthcare professionals whose attention was not focused on the patient, pushing too

  12. Human Resources Performance in Service Encounters – A Customer Service Case Study

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    Claudia GRIGORE


    Full Text Available Efficiency is generally defined as the extent to which resources or effort is employed in order to achieve a certain purpose or objective. As per an economic perspective, this term may also mean a minimum quantity of supplies which can generate a maximum result. But can we talk about efficiency in terms of human resources and their allocation to a specific task? And how one asses the activity of the employees when considering service encounters? This study aims to provide an answer to these two questions from an emotional labor perspective: individuals employ their emotional abilities in order to perform a certain job. This is a process under a commercial perspective: the wage represents the exchange value for these competencies.

  13. Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study. (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


    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.

  14. Moving Encounters

    Directory of Open Access Journals (Sweden)

    Ann Deslandes


    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.

  15. 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


    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

  16. Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study. (United States)

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


    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.


    Directory of Open Access Journals (Sweden)

    V. Vinod Kumar Viswanathan


    Full Text Available BACKGROUND With the ever increasing prevalence of diabetes, complications of diabetes are encountered across all specialities. Hence, it is imperative that all specialists should have a working knowledge of diabetes mellitus. This study was done to understand the prevalence and complications of diabetes among patients attending a pulmonologist OPD. Knowledge of diabetes and its complications will help pulmonary medicine specialists to identify and manage the complications of diabetes better. MATERIALS AND METHODS All patients attending a pulmonologist’s clinic for a period of one month were enquired regarding their diabetes status and patients with known history of diabetes were questioned using a standard questionnaire and their available records examined regarding their complications pertaining to diabetes and the results analysed. RESULTS In this study, 18.7% of patients attending pulmonologist clinic had diabetes mellitus and 13.5% of patients had diabetes of more than 10 years duration. Most of the patients were in the age group of 40 to 60 years and were predominantly male. Among the diabetic patients, 71.9% had complications due to diabetes. Infections were the most commonly associated complication followed by pulmonary and cardiovascular complications. Many cases of pulmonary tuberculosis were observed among these patients. Other respiratory infections observed included pneumonias and flu. Cardiovascular complications like systemic hypertension, coronary artery disease and dyslipidaemia were observed. CONCLUSION With the rising prevalence of diabetes mellitus, such cases are frequently observed across all medical specialities. Hence, it is vital that all specialists should be trained in a management of diabetes, which is a frequent comorbidity observed by all specialists. Knowledge of diabetes, identifying diabetes early and management of complications will go a long way in reducing the morbidity and mortality due to diabetes and also

  18. Adopting a Blended Learning Approach: Challenges Encountered and Lessons Learned in an Action Research Study (United States)

    Kenney, Jane; Newcombe, Ellen


    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…

  19. Pharmacy users' expectations of pharmacy encounters: a Q-methodological study. (United States)

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


    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.

  20. The Construction of Interculturality: A Study of Initial Encounters between Japanese and American Students. (United States)

    Mori, Junko


    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…

  1. The Role of Individualism/Collectivism in Critical Classroom Encounters: A Four Country Study (United States)

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


    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…

  2. Travel Medicine Encounters of Australian General Practice Trainees-A Cross-Sectional Study. (United States)

    Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Scott, John; van Driel, Mieke L; Spike, Neil A; McArthur, Lawrie A; Davey, Andrew R; Catzikiris, Nigel F; Magin, Parker J


    Travel medicine is a common and challenging area of clinical practice and practitioners need up-to-date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel medicine advice. We aimed to describe the rate and nature of travel medicine consultations, including both the clinical and educational aspects of the consultations. A cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations was performed. Trainees contemporaneously recorded demographic, clinical, and educational details of consecutive patient consultations. Proportions of all problems/diagnoses managed in these consultations that were coded "travel-related" and "travel advice" were both calculated with 95% confidence intervals (CIs). Associations of a problem/diagnosis being "travel-related" or "travel advice" were tested using simple logistic regression within the generalized estimating equations (GEE) framework. A total of 856 trainees contributed data on 169,307 problems from 108,759 consultations (2010-2014). Travel-related and travel advice problems were managed at a rate of 1.1 and 0.5 problems per 100 encounters, respectively. Significant positive associations of travel-related problems were younger trainee and patient age; new patient to the trainee and practice; privately billing, larger, urban, and higher socioeconomic status practices; and involvement of the practice nurse. Trainees sought in-consultation information and generated learning goals in 34.7 and 20.8% of travel advice problems, respectively, significantly more than in non-travel advice problems. Significant positive associations of travel advice problems were seeking in-consultation information, generation of learning goals, longer consultation duration, and more problems managed. Our findings reinforce the importance of focused training in travel medicine for GP trainees and adequate exposure to patients in the practice

  3. Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study. (United States)

    Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede; Ruland, Cornelia M


    Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers' beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies. The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR's strength of being broad and comprehensive also limits its


    Directory of Open Access Journals (Sweden)

    Adam A.J. DeVille


    Full Text Available Drawing on, but expanding and altering mutatis mutandis some principles enunciated by the greatest Byzantine liturgical historian writing today, Robert F. Taft (emeritus of the Pontifical Oriental Institute in Rome, this paper will propose some methodological considerations for the study of the encounters and relations between Eastern Christian and Muslim communities from the seventh century to the present day.

  5. Reimbursement issues facing patients, providers, and payers. (United States)

    Antman, K


    Escalating costs of health care delivery and the current constraints imposed by the federal budget deficit seriously threaten to compromise patient care and innovative biomedical research. Recent third-party refusal to cover some patients treated in protocols has had considerable impact on trial research. In addition, reimbursement for conventional care sometimes has been refused if delivered as part of a study (e.g., MOPP therapy versus ABVD therapy) or for an indication that is not specifically cited on the Food and Drug Administration label. Who should cover the patient care costs of patients participating in clinical trials? One approach would have patients cover these costs themselves. A second approach is the reinstitution of patient care costs into research grants. A third possibility is that the pharmaceutical industry support patient care costs of clinical research. Historically, hospital expenses of patients participating in studies have been paid by health insurance policies. In the absence of a clinical trial, many patients would be treated with Food and Drug Administration-approved therapies despite a lack of substantial benefit. Such marginal treatments are compensated by third-party payers routinely. The current system is arbitrary and expensive, compromises research and development, and equates new treatment with no treatment. By refusing to reimburse the patient care costs of investigational therapy, third-party carriers are, in fact, making medical decisions. There is a growing and legitimate concern that the pace of clinical research will be impeded significantly at a time when many exciting developments will be ready for clinical trials. The molecular steps in carcinogenesis are being documented rapidly for common malignancies, such as colon cancer. Immunologic, biologic, and hormonal approaches, and emerging technologies, such as marrow transplant or antibody toxin conjugates, already are being studied in the clinic. Health policy legislation

  6. Patients Provide Recommendations for Improving Patient Satisfaction. (United States)

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J


    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  7. It takes two to tango: A dyadic approach to understanding the medication dialogue in patient-provider relationships. (United States)

    Schoenthaler, Antoinette; Basile, Melissa; West, Tessa V; Kalet, Adina


    To describe typologies of dyadic communication exchanges between primary care providers and their hypertensive patients about prescribed antihypertensive medications. Qualitative analysis of 94 audiotaped patient-provider encounters, using grounded theory methodology. Four types of dyadic exchanges were identified: Interactive (53% of interactions), divergent-traditional (24% of interactions), convergent-traditional (17% of interactions) and disconnected (6% of interactions). In the interactive and convergent-traditional types, providers adopted a patient-centered approach and used communication behaviors to engage patients in the relationship. Patients in these interactions adopted either an active role in the visit (interactive), or a passive role (convergent-traditional). The divergent-traditional type was characterized by provider verbal dominance, which inhibited patients' ability to ask questions, seek information, or check understanding of information. In the disconnected types, providers used mainly closed-ended questions and terse directives to gather and convey information, which was often disregarded by patients who instead diverted the conversation to psychosocial issues. This study identified interdependent patient-provider communication styles that can either facilitate or hinder discussions about prescribed medications. Examining the processes that underlie dyadic communication in patient-provider interactions is an essential first step to developing interventions that can improve the patient-provider relationship and patient health behaviors. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. The Untidy Playground: An Irish Congolese Case Study in Sonic Encounters with the Sacred Stranger

    Directory of Open Access Journals (Sweden)

    Helen Phelan


    Full Text Available This paper explores the proposal that music, and particularly singing, has unique properties that render it amenable to encounters with “the other” or the sacred stranger. Drawing on the deconstructionist works of Kristeva and Derrida, as well as the postmodern hermeneutics of Kearney and Caputo, it explores current debate concerning the nature of “the sacred” in contemporary life and the erosion of the theistic/atheistic divide, while proposing a deepening of the debate through the inclusion of the performative. As philosophical and theological discourses embrace this aporia, it does so against the backdrop of unprecedented human migration. The concomitant cultural and social disruption throws up new questions around the nature and experience of religion, spirituality and the sacred. This paper explores these questions in the context of a Congolese choir called Elikya, which was established by a group of asylum seekers in Limerick city, Ireland, in 2001. In tracking the musical life of this choir over the last decade and a half, including two musical recordings and numerous liturgical, religious and secular performances, it suggests that the sonic world of the choir both performs and transcends these descriptors. Using a three-fold model of context, content and intent, the paper concludes that musical experiences such as those created by Elikya erode any easy divisions between the religious and the secular or the liturgical and the non-liturgical and provide sonic opportunities to encounter the sacred stranger in the untidy playground of creative chaos.

  9. 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...

  10. Aesthetic Encounters


    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 ...

  11. 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...

  12. The Effect of a Patient-Provider Educational Intervention to Reduce At-Risk Drinking on Changes in Health and Health-Related Quality of Life Among Older Adults: The Project SHARE Study. (United States)

    Barnes, Andrew J; Xu, Haiyong; Tseng, Chi-Hong; Ang, Alfonso; Tallen, Louise; Moore, Alison A; Marshall, Deborah C; Mirkin, Michelle; Ransohoff, Kurt; Duru, O Kenrik; Ettner, Susan L


    At-risk drinking, defined as alcohol use that is excessive or potentially harmful in combination with select comorbidities or medications, affects about 10% of older adults in the United States and is associated with higher mortality. The Project SHARE intervention, which uses patient and provider educational materials, physician counseling, and health educator support, was designed to reduce at-risk drinking among this vulnerable population. Although an earlier study showed that this intervention was successful in reducing rates of at-risk drinking, it is unknown whether these reductions translate into improved health and health-related quality of life (HRQL). The aim of this study was to examine changes in health and HRQL of older adult at-risk drinkers resulting from a patient-provider educational intervention. A randomized controlled trial to compare the health and HRQL outcomes of patients assigned to the Project SHARE intervention vs. care as usual at baseline, 6- and 12-months post assignment. Control patients received usual care, which may or may not have included alcohol counseling. Intervention group patients received a personalized patient report, educational materials on alcohol and aging, a brief provider intervention, and a telephone health educator intervention. Current drinkers 60years and older accessing primary care clinics around Santa Barbara, California (N=1049). Data were collected from patients using baseline, 6- and 12-month mail surveys. Health and HRQL measures included mental and physical component scores (MCS and PCS) based on the Short Form-12v2 (SF-12v2), the SF-6D, which is also based on the SF-12, and the Geriatric Depression Scale (GDS). Adjusted associations of treatment assignment with these outcomes were estimated using generalized least squares regressions with random provider effects. Regressions controlled for age group, sex, race/ethnicity, marital status, education, household income, home ownership and the baseline value of

  13. Privacy encounters in Teledialogue

    DEFF Research Database (Denmark)

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


    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...

  14. Encounters in cancer treatment

    DEFF Research Database (Denmark)

    Høybye, Mette Terp; Tjørnhøj-Thomsen, Tine


    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....

  15. Difficult medical encounters and job satisfaction - results of a cross sectional study with general practitioners in Germany. (United States)

    Goetz, Katja; Mahnkopf, Janis; Kornitzky, Anna; Steinhäuser, Jost


    In primary care 15% of patient encounters are perceived as challenging by general practitioners (GP). However it is unknown what impact these encounters have regarding job satisfaction. The aim of this study was to evaluate which encounters are perceived as challenging by German GPs and whether they were associated with job satisfaction. A total of 1538 questionnaires were sent to GPs in the federal state of Schleswig-Holstein, Germany. GPs should rate 14 medical conditions and 8 traits of patients on the perceived challenge using a Likert scale (1: 'not challenging at all' to 10: 'extremely challenging'). Job satisfaction was measured with the Warr-Cook-Wall job satisfaction scale. A linear regression analyses were used to explore potential associations between for the primary outcome variable 'overall job satisfaction'. Total response was 578 (38%). GPs perceived 16% of their patients as challenging. Psychiatric disorders such as somatization disorder (mean = 7.42), schizophrenia (mean = 6.83) and anxiety disorder (mean = 6.57) were ranked as high challenging while diabetes mellitus type 2 (mean = 4.87) and high blood pressure (mean = 3.22) were ranked as a rather low challenging condition. GPs were mostly satisfied with 'colleagues' (mean = 5.80) and mostly dissatisfied with their 'hours of work' (mean = 4.20). The linear regression analysis showed no association with challenging medical conditions and traits of patients but only with different aspects of job satisfaction concerning the outcome variable 'overall job satisfaction'. Especially psychiatric conditions are perceived as challenging the question arises, in what amount psychiatric competences are gained during the postgraduate specialty training in general practice and if GPs with a mandatory rotation in psychiatry perceive these conditions as less challenging. Interestingly this study indicates that challenging encounter in terms of challenging medical conditions and traits

  16. Global Diabetes Encounters

    DEFF Research Database (Denmark)

    Juul Nielsen, Annegrete; Langstrup, Henriette


    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...

  17. Ways of understanding the encounter with head and neck cancer patients in the hospital dental team--a phenomenographic study. (United States)

    Röing, Marta; Hirsch, J-M; Holmström, Inger


    Head and neck cancer is the sixth most common malignancy in the world. Fifty percent of the patients can be cured by surgery, radiotherapy or a combination approach. Head and neck cancer is life-threatening, and treatment may leave the patient with visible facial disfigurements and impairment of functions such as speech and eating. This affects not only the patient, but may arouse difficult feelings in the treatment staff. Dental personnel are involved in all facets of treatment, yet they have no specific training in cancer care. The aim of this study was to describe the variation in ways dental personnel understand and experience the encounter with head and neck cancer patients, as the way of understanding a certain phenomenon is judged to be fundamental to the way we act and form our beliefs. Twenty members of hospital dental teams were interviewed. The interviews focused on experiences of the encounter with head and neck cancer patients. A qualitative research approach, phenomenography, was used in analysing the interviews. The encounter was perceived in three qualitatively different ways: as an act of caring, as a serious and responsible task and as an overwhelming emotional situation. The results indicate that hospital dental personnel are not able to lean on education and professional training in finding ways of dealing with situations with strong emotional impact. This has implications for the treatment of patients with head and neck cancer, as well as education of dental personnel.

  18. Barriers and Facilitators to Patient-Provider Communication When Discussing Breast Cancer Risk to Aid in the Development of Decision Support Tools. (United States)

    Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S; Aguirre, Alejandra N; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D; Kukafka, Rita


    The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.

  19. Encountering the past in the present: An exploratory study of educational heritage tourism (United States)

    Gross, Magdalena H.; Kelman, Ari Y.


    This article presents an educational programme designed to explore the multicultural history of Poland. Targeting Jewish and non-Jewish students of Polish heritage, the Polonia Programme (PP) was conceptualised with the aim of applying the tools of experiential education to initiate a new approach to examining one of the world's most challenging and fraught historical narratives. The programme, piloted in the summer of 2014, takes two groups of young people from the United States to Poland each year. It features a combination of formal lectures and interactive tours, complemented by structured and semi-structured discussions. The destination of this particular tour, with these particular participants, both challenges and reinforces accepted notions of "heritage tourism" within an experiential educational framework. This framework enables a sense of group connectivity which allows students to be, perhaps, more open to alternative narratives about the past. The authors of this article, who were involved in evaluating the pilot launch of the Polonia Programme, found that the programme's experiential approach succeeded in encouraging participants in the pilot cohort to challenge ideas about their definitions of and preconceptions about "who and what counts as Polish". For many, the experience shifted their understanding of Poland towards one which took its multi-ethnic and multicultural history into account. Several discovered new perspectives on their own identity and heritage, while others reached a new understanding of the shared histories of Poles and Jews. The experiential nature of this programme also allowed students to encounter difficult histories: experience, then, became a vehicle for more challenging conversations and deeper learning.

  20. Stream Lifetimes Against Planetary Encounters (United States)

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


    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.

  1. Patient-provider language concordance and colorectal cancer screening. (United States)

    Linsky, Amy; McIntosh, Nathalie; Cabral, Howard; Kazis, Lewis E


    Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES: We performed a retrospective cohort study of individuals age 50 years and older who were categorized as English-Concordant (spoke English at home, n = 21,594); Other Language-Concordant (did not speak English at home but someone at their provider's office spoke their language, n = 1,463); or Other Language-Discordant (did not speak English at home and no one at their provider's spoke their language, n = 240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening. Compared to English speakers, non-English speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51-0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58-1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46-0.71). Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.

  2. Come Closer to Feminism: Gratitude as Activist Encounter in Women's and Gender Studies 101 (United States)

    Hogan, Katie


    Many teachers of introductory women's and gender studies find themselves in the position of introducing bad news to an already hostile audience. To deal directly with this dilemma, author Katie Hogan has approached student resistance to women's and gender studies (WGST) with carefully constructed syllabi designed to encourage…

  3. Language and Faith Encounters: Bridging Language--Ethnicity and Language--Religion Studies (United States)

    Souza, Ana


    There has been growing interest by British policy-makers in the importance of acknowledging the role of migrant children's background in their educational progress. Therefore, this article draws on studies of language-ethnicity and of language-religion to understand the linguistic and the religious heritage of four groups of Brazilian migrants in…

  4. Close Encounters with Nature in an Urban Kindergarten: A Study of Learners' Inquiry and Experience (United States)

    Ghafouri, Farveh


    This article reports on the findings of a recent qualitative grounded theory research study in a metropolitan area in the south-east of Canada examining one junior/senior kindergarten classroom's engagement with nature. It focuses on the role of the learners, the children and the teacher, in co-constructing two very different learning experiences.…

  5. Intercultural Encounters as a "Mind Body" Experience: A Case Study in Jerusalem (United States)

    Bar Shalom, Yehuda; Grebelsy-Lichtman, Tsfira; Alayan, Fatima


    This study presents new techniques for teaching diversity, when dealing with the challenges of multicultural society. We present a course model, which incorporates methods that have been developed by the Center for Mind-Body Medicine (CMBM), and continue to disclose and analyse some of the reactions and evaluations we received from the…

  6. Encountering abuse in health care; lifetime experiences in postnatal women - a qualitative study

    DEFF Research Database (Denmark)

    Schroll, Anne-Mette; Kjærgaard, Hanne; Midtgaard, Julie


    BACKGROUND: Abuse in health care (AHC) has been associated with potential severe health consequences, and has further been related to maternal morbidity and mortality in childbirth. To improve our understanding of what qualifies as AHC and to support and optimise the health of women with these ex......BACKGROUND: Abuse in health care (AHC) has been associated with potential severe health consequences, and has further been related to maternal morbidity and mortality in childbirth. To improve our understanding of what qualifies as AHC and to support and optimise the health of women...... with these experiences, the objective of this study was to describe how women, who had previously endured AHC, gave meaning to and managed their experience during pregnancy, childbirth, and in the early postnatal period. METHOD: Women, who had reported substantial suffering as a result of a previous experience of abuse...... within the healthcare system, were purposefully selected from a Danish sample of a multinational cohort study on negative life events among pregnant women (the BIDENS Study). Eleven women were interviewed individually by means of a semi-structured interview guide. Transcripts of the interviews were...

  7. Studies on resin degradation products encountered during purification of plutonium by anion exchange

    International Nuclear Information System (INIS)

    Ramanujam, A.; Dhami, P.S.; Gopalakrishnan, V.; Dhumwad, R.K.


    Among the methods available for the purification of plutonium in Purex process, anion exchange method offers several advantages. However, on repeated use, the resin gets degraded due to thermal, radiolytic and chemical attacks resulting in chemical as well as physical damage. Frequently, plutonium product eluted from such resin contains significant quantities of white precipitates. A few anion exchange resins were leached with 8 M HNO 3 at 60-80degC and the resin degradation products (RDP) in the leach-extract were found to give similar precipitates with tetravalent metal ions like Pu(IV), Th(IV) etc. Tetra propyl ammonium hydroxide in 8 M HNO 3 (TPAN) also gave a white precipitate with plutonium similar to the one found in the elution streams. The results indicate that delinked quaternary ammonium functional groups might be responsible for the formation of precipitate. The characteristics of precipitates Th-RDP, Th-TPAN and that isolated from elution stream have been investigated. In a separate study a tentative formula for Th-RDP compound is proposed. The influence of RDP on the extraction of plutonium and other components in Purex process was studied and it was found that RDP complexes metal ions thus marginally affecting the kd values. A spectrophotometric method has been standardised to monitor the extent of degradation of anion exchange resins which is based on the ability of RDP to reduce the colour intensity of Th-thoron complex. This technique can be used to study the stability of the anion exchange resins. (author). 8 refs., 8 tabs., 5 figs.,

  8. Internet health information in the patient-provider dialogue. (United States)

    Hong, Traci


    A patient discussing Internet health information with a health care provider (referred to as "patient-provider communication about Internet health information") can contribute positively to health outcomes. Although research has found that once Internet access is achieved, there are no ethnic differences in Internet health information seeking, it is unclear if there are ethnic differences in patient-provider communication about Internet health information. To help fill this gap in the literature, the National Cancer Institute's Health Information National Trends Survey 2005 was analyzed with Stata 9. Two sets of logistic regression analyses were conducted, one for a subsample of Internet users (n = 3,244) and one for a subsample of Internet users who are first-generation immigrants (n = 563). The dependent variable was patient-provider communication about Internet health information, which assessed whether survey participants had discussed online health information with a health care provider. The predictor variables included trust of health care provider, trust of online health information, Internet use, health care coverage, frequency of visits to health care provider, health status, and demographics. Among all Internet users, Whites had higher levels of patient-provider communication about Internet health information than Blacks and Asians. Similarly, among Internet users who are immigrants, Whites had higher levels of patient-provider communication about Internet health information than Blacks and Asians. While the digital divide is narrowing in terms of Internet access, racial differences in patient-provider communication about Internet health information may undermine the potential benefits of the information age.

  9. Victorian paramedics' encounters and management of women in labour: an epidemiological study. (United States)

    McLelland, Gayle; Morgans, Amee; McKenna, Lisa


    Although it is generally accepted that paramedics attend unexpected births, there is a paucity of literature about their management of women in labour. This study aimed to investigate the caseload of women in labour attended by a statewide ambulance service in Australia during one year and the management provided by paramedics. Retrospective clinical data collected on-scene by paramedics via in-field electronic patient care records were provided by Ambulance Victoria. Patient case reports were electronically extracted from the Ambulance Victoria's Clinical Data Warehouse via comprehensive filtering followed by manual sorting. Descriptive statistics were analysed using Statistical Package for Social Sciences (SPSS v.19). Over a 12-month period, paramedics were called to 1517 labouring women. Two thirds of women were at full-term gestation, and 40% of pre-term pregnancies were less than 32 weeks gestation. Paramedics documented 630 case reports of women in early labour and a further 767 in established labour. There were 204 women thought to be second stage labour, including 134 who progressed to childbirth under paramedic care. When paramedics assisted with births, the on-scene time was significantly greater than those patients transported in labour. Pain relief was provided significantly more often to women in established labour than in early labour. Oxygen was given to significantly more women in preterm labour. While paramedics performed a range of procedures including intravenous cannulation, administration of analgesia and oxygen, most women required minimal intervention. Paramedics needed to manage numerous obstetric and medical complications during their management. Paramedics provide emergency care and transportation for women in labour. Most of the women were documented to be at term gestation with minimal complications. To enable appropriate decision making about management and transportation, paramedics require a range of clinical assessment skills

  10. Organised Cultural Encounters

    DEFF Research Database (Denmark)

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


    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...

  11. Cultural geography. Different encounters, encountering difference


    Longhurst, Robyn


    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...

  12. A method of encountering the ratio of adjacent sides and its applied study in nuclear engineering survey

    International Nuclear Information System (INIS)

    Wu Jingqin


    The cross side or range net survey method is to compute the average error of the measured lengths of sides. With the increment of the side length, the viewing variance increases greatly. Generally the photo-electrical distance survey equipment has a high inside precision, but it is affected by typical weather error so that the outside precision is decreased, and this weather error similar to systematic error greatly decreases the viewing side precision. To solve this problem, theoretical study and field test were carried out for the correlation of ratios among short sides by photo-electrical survey, and the stability degree of the ratios of sides, a new method of ratio encountering of adjacent sides is put forward. Because of the weights of the ration variance σ γ 2 = 2η 2 γ 2 and the angular variance σ β 2 = 2J 2 ρ 2 match each other, so the systematic error can be eliminated completely, and a survey point co-ordinate of high precision can be obtained. It is easy to operate, as it does not require multi-photo-band survey or to operate at the optimal observation time, and is especially suitable to nuclear engineering survey applications. (3 tabs.)

  13. Encounters with immigrant customers

    DEFF Research Database (Denmark)

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


    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...

  14. Patient-Provider Teamwork via Cooperative Note Taking on Tele-Board MED. (United States)

    Perlich, Anja; Meinel, Christoph


    There is significant, unexploited potential to improve the patients' engagement in psychotherapy treatment through technology use. We develop Tele-Board MED (TBM), a digital tool to support documentation and patient-provider collaboration in medical encounters. Our objective is the evaluation of TBM's practical effects on patient-provider relationships and patient empowerment in the domain of talk-based mental health interventions. We tested TBM in individual therapy sessions at a psychiatric ward using action research methods. The qualitative results in form of therapist observations and patient stories show an increased acceptance of diagnoses and patient-therapist bonding. We compare the observed effects to patient-provider relationship and patient empowerment models. We can conclude that the functions of TBM - namely that notes are shared and cooperatively taken with the patient, that diagnostics and treatment procedures are depicted via visuals and in plain language, and that patients get a copy of their file - lead to increased patient engagement and an improved collaboration, communication and integration in consultations.

  15. Male Escorts' and Male Clients' Sexual Behavior During Their Last Commercial Sexual Encounter: Comparing and Contrasting Findings from Two Online Studies. (United States)

    Grov, Christian; Rodríguez-Díaz, Carlos E; Jovet-Toledo, Gerardo G


    Much of what is known about commercial sexual encounters between men is based on data gathered from escorts. With few exceptions, studies have not compared male clients' reports of behavior during commercial sexual encounters with male escorts'. The present study draws from two datasets, a 2012 survey of clients (n = 495) and a 2013 survey of escorts (n = 387)--both used virtually identical measures of sexual behavior during the most recent commercial sexual encounter. For clients and escorts, the majority eschewed having sex without a condom, and kissing and oral sex were among the most common behaviors reported. Using logistic regression, both samples were compared across 15 sexual behaviors, finding significant differences in six--the escort sample had greater odds of reporting their last commercial sexual encounter involved watching the client masturbate, viewing porn, role play (dad/son, dominant/submissive), and having prior sexual experience with their commercial partner. The escort sample had lower odds of reporting that the client watched the escort masturbate, and being told partner's HIV status. In multivariable modeling, both samples did not significantly differ in reports of condomless anal sex. Male-male commercial sexual encounters appear to be involved in a wide range of sexual behaviors, many of which convey low-to-no risk of HIV transmission.

  16. A Decolonizing Encounter: Ward Churchill and Antonia Darder in Dialogue. Counterpoints: Studies in the Postmodern Theory of Education. Volume 430 (United States)

    Orelus, Pierre W., Ed.


    "A Decolonizing Encounter" examines the effects of western colonialism on historically marginalized and colonized populations living both in the West and the "third world". Specifically, it explores crucial issues such as the decolonizing of schools and communities of color; the decentralization of power of the capitalist and…

  17. Dental Encounter System (DES) (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...

  18. Encounter with comet Halley

    International Nuclear Information System (INIS)

    Sagdeev, R.Z.


    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

  19. Patients' views on the use of an Option Grid for knee osteoarthritis in physiotherapy clinical encounters: An interview study. (United States)

    Kinsey, Katharine; Firth, Jill; Elwyn, Glyn; Edwards, Adrian; Brain, Katherine; Marrin, Katy; Nye, Alan; Wood, Fiona


    Patient decision support tools have been developed as a means of providing accurate and accessible information in order for patients to make informed decisions about their care. Option Grids ™ are a type of decision support tool specifically designed to be used during clinical encounters. To explore patients' views of the Option Grid encounter tool used in clinical consultations with physiotherapists, in comparison with usual care, within a patient population who are likely to be disadvantaged by age and low health literacy. Semi-structured interviews with 72 patients (36 who had been given an Option Grid in their consultation and 36 who had not). Thematic analysis explored patients' understanding of treatment options, perceptions of involvement, and readability and utility of the Option Grid. Interviews suggested that the Option Grid facilitated more detailed discussion about the risks and benefits of a wider range of treatment options for osteoarthritis of the knee. Participants indicated that the Option Grid was clear and aided their understanding of a structured progression of the options as their condition advanced, although it was not clear whether the Option Grid facilitated greater engagement in shared decision making. The Option Grid for osteoarthritis of the knee was well received by patient participants who reported that it helped them to understand their options, and made the notion of choice explicit. Use of Option Grids should be considered within routine consultations. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  20. Automatically annotating topics in transcripts of patient-provider interactions via machine learning. (United States)

    Wallace, Byron C; Laws, M Barton; Small, Kevin; Wilson, Ira B; Trikalinos, Thomas A


    Annotated patient-provider encounters can provide important insights into clinical communication, ultimately suggesting how it might be improved to effect better health outcomes. But annotating outpatient transcripts with Roter or General Medical Interaction Analysis System (GMIAS) codes is expensive, limiting the scope of such analyses. We propose automatically annotating transcripts of patient-provider interactions with topic codes via machine learning. We use a conditional random field (CRF) to model utterance topic probabilities. The model accounts for the sequential structure of conversations and the words comprising utterances. We assess predictive performance via 10-fold cross-validation over GMIAS-annotated transcripts of 360 outpatient visits (>230,000 utterances). We then use automated in place of manual annotations to reproduce an analysis of 116 additional visits from a randomized trial that used GMIAS to assess the efficacy of an intervention aimed at improving communication around antiretroviral (ARV) adherence. With respect to 6 topic codes, the CRF achieved a mean pairwise kappa compared with human annotators of 0.49 (range: 0.47-0.53) and a mean overall accuracy of 0.64 (range: 0.62-0.66). With respect to the RCT reanalysis, results using automated annotations agreed with those obtained using manual ones. According to the manual annotations, the median number of ARV-related utterances without and with the intervention was 49.5 versus 76, respectively (paired sign test P = 0.07). When automated annotations were used, the respective numbers were 39 versus 55 (P = 0.04). While moderately accurate, the predicted annotations are far from perfect. Conversational topics are intermediate outcomes, and their utility is still being researched. This foray into automated topic inference suggests that machine learning methods can classify utterances comprising patient-provider interactions into clinically relevant topics with reasonable accuracy.

  1. Clinical implications of patient-provider agreements in opioid prescribing. (United States)

    Kraus, Carl N; Baldwin, Alan T; Curro, Frederick A; McAllister, R G


    In June, 2012 the United States Food and Drug Administration (FDA) developed a "blueprint" for prescriber education as a means of directing Certified Medical Education (CME) activities that included content which would meet the regulatory requirements of the class-wide, longacting/ extended-release (LA-ER) opioid Risk Evaluation Mitigation Strategies (REMS). Within the blueprint is the suggested adoption of Patient-Provider Agreements (PPAs) to be used in association with opioid prescribing, but, to our knowledge, there have been no reported evaluations of the role played by opioid-agent PPAs in clinical practice, or of the perceptions of this regulatory mandate by clinicians. Therefore, we conducted a survey regarding PPA perceptions by opioid prescribers that was posted for five weeks on a well-trafficked online CME service provider (Medscape). Of the 1,232 respondents (reflecting a 99.5% completion rate), 52.4% treat acute or chronic pain with opioids. The survey identified an improvement of opioid safe-use education (21% of respondents) as the most frequently selected beneficial element of PPAs. Conversely, the challenges to adoption included time constraints (21% of physicians) as well as lack of evidence that PPAs will reduce drug misuse, and the lack of a uniform, patient-friendly PPA. Based on our survey, clinicians consider the PPA of potential value, but data regarding the utility of such an instrument are lacking.

  2. African American women and prenatal care: perceptions of patient-provider interaction. (United States)

    Dahlem, Chin Hwa Y; Villarruel, Antonia M; Ronis, David L


    Poor patient-provider interaction among racial/ethnic minorities is associated with disparities in health care. In this descriptive, cross-sectional study, we examine African American women's perspectives and experiences of patient-provider interaction (communication and perceived discrimination) during their initial prenatal visit and their influences on perceptions of care received and prenatal health behaviors. Pregnant African American women (n = 204) and their providers (n = 21) completed a pre- and postvisit questionnaire at the initial prenatal visit. Women were also interviewed face to face at the subsequent return visit. Women perceived high quality patient-provider communication (PPC) and perceived low discrimination in their interaction with providers. Multiple regression analyses showed that PPC had a positive effect on trust in provider (p prenatal care satisfaction (p prenatal health behaviors. Findings suggest that quality PPC improves the prenatal care experience for African American women. © The Author(s) 2014.

  3. Patient-centered communication in digital medical encounters. (United States)

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


    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.

  4. Awkward Encounters and Ethnography

    DEFF Research Database (Denmark)

    Koning, Juliette; Ooi, Can-Seng


    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...

  5. A Lakatosian Encounter (United States)

    Chick, Helen


    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…

  6. 實徵研究/a study on online information encountering and personal characteristics/蔡怡欣、黃元鶴

    Directory of Open Access Journals (Sweden)

    蔡怡欣、黃元鶴 Yi-Hsin Tsai, Yuan-Ho Huang


    Full Text Available The purpose of this study was to explore the individual online information encountering (IE experience and investigate the effects of their personal characteristics on IE experience. The study were conducted a qualitative research and a total of 11 respondents were interviewed. The results were as follows: Most online encountered information could satisfy the individual's present and future information needs. Most people acquire encountered information by themselves, and the encountered information came from various sources on the web. Frequent Internet users could be more sensitive to information than others. Moreover, people with higher intrinsic motivation, usually interested or curious about many things, are easy to acquire online IE experience. After having online IE experience, the individuals occasionally feel anxious because of time pressure, furthermore, they want to avoid encountering more information. However, most individuals feel novel and joyful while they encountered information. They even further process encountering information resources and expect to gain more experience about information encountering. In addition, the ideal environments of online information encountering include no commercial advertising, credibility, and a personalized database with the powerful searchable function. 本研究目的在瞭解個體的線上資訊偶遇經驗情形,以及個體所具備的個人特徵對其線上資訊偶遇經驗的影響。本研究分析11 位受訪者的資訊偶遇經驗並整合研究發現後,得出以下結論並提出後續的實務建議:線上偶遇資訊多為滿足個體現在及未來的資訊需求,且多由自己獲得、資訊來源廣泛。較常接觸並使用網路者,對自己的資訊敏感度具相當信心。內在學習動機較高、對許多事物都感興趣、或好奇心重的個體均易產生線上資訊偶遇經驗。個體偶爾會因資訊的繁雜或時間壓力而對於

  7. Festival as embodied encounters

    DEFF Research Database (Denmark)

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


    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...

  8. Strange culinary encounters:

    DEFF Research Database (Denmark)

    Leer, Jonatan; Kjær, Katrine Meldgaard


    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....

  9. Frontcountry encounter norms among three cultures (United States)

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


    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...

  10. 'Wouldn't it be easier if you continued to be a guy?' - a qualitative interview study of transsexual persons' experiences of encounters with healthcare professionals. (United States)

    von Vogelsang, Ann-Christin; Milton, Camilla; Ericsson, Ingrid; Strömberg, Lars


    To describe transsexual persons' experiences of encounters with healthcare professionals during the sex reassignment process. Transsexual persons are individuals who use varying means to alter their natal sex via hormones and/or surgery. Transsexual persons may experience stigma, which increases the risk of psychological distress. Mistreatments by healthcare professionals are common. Qualitative studies addressing transsexual persons' experiences of healthcare are scarce. Qualitative descriptive design. A Swedish non-clinical convenience sample was used, consisting of six persons who had been diagnosed as transsexual, gone through sex reassignment surgery or were at the time of the interview awaiting surgery. Semi-structured interviews were undertaken, and data were analysed using manifest qualitative content analysis. Three categories and 15 subcategories were identified. The encounters were perceived as good when healthcare professionals showed respect and preserved the transsexual person's integrity, acted in a professional manner and were responsive and built trust and confidence. However, the participants experienced that healthcare professionals varied in their level of knowledge, exploited their position of power, withheld information, expressed gender stereotypical attitudes and often used the wrong name. They felt vulnerable by having a condescending view of themselves, and they could not choose not to be transsexual. They felt dependent on healthcare professionals, and that the external demands were high. Transsexual persons are in a vulnerable position during the sex reassignment surgery process. The encounters in healthcare could be negatively affected if healthcare professionals show inadequate knowledge, exploit their position of power or express gender stereotypical attitudes. A good encounter is characterised by preserved integrity, respect, responsiveness and trust. Improved education on transgender issues in nursing and medical education is

  11. Encountering spiritual tourism in Kathmandu


    Børø, Nora


    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...

  12. Being a bridge: Swedish antenatal care midwives' encounters with Somali-born women and questions of violence; a qualitative study. (United States)

    Byrskog, Ulrika; Olsson, Pia; Essén, Birgitta; Allvin, Marie-Klingberg


    Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women's' strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman's access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives' ability to identify Somali born woman's resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the

  13. Processing changes across reading encounters. (United States)

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


    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.

  14. Feminist Encounters with Evolutionary Psychology


    O'Neill, Rachel


    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...


    Caldwell, Hannah D; Minkoff, Neil B; Murthy, Kalyani


    Patient Web portals (PWPs) have been gaining traction as a means to collect patient-reported outcomes and maintain quality patient care between office visits. PWPs have the potential to impact patient-provider relationships by rendering additional channels for communication outside of clinic visits and could help in the management of common chronic medical conditions. Studies documenting their effect in primary care settings are limited. This perspective aims to summarize the benefits and drawbacks of using PWPs in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma, focusing on communication, disease management, compliance, potential barriers, and the impact on patient-provider dynamic. After a review of these topics, we present potential future directions. We conducted an exploratory PubMed search of the literature published from inception through December 2015, and focused our subsequent searches specifically to assess benefits and drawbacks of using PWPs in the management of diabetes mellitus, hypertension, and asthma. Our search revealed several potential benefits of PWP implementation in the management of chronic conditions with regards to patient-provider relationships, such as improved communication, disease management, and compliance. We also noted drawbacks such as potentially unreliable reporting, barriers to use, and increased workload. PWPs offer opportunities for patients to report symptoms and outcomes in a timely manner and allow for secure online communication with providers. Despite the drawbacks noted, the overall benefits from successful PWP implementation could improve patient-provider relationships and help in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma.

  16. The Age of Studies and Reports: Selected Elements Concerning the Background of Encounters Defining the Power of Education (United States)

    Tašner, Veronika; Gaber, Slavko


    In the present paper, we discuss the time before the "age of reports". Besides the Coleman Report in the period of Coleman, the Lady Plowden Report also appeared, while there were important studies in France (Bourdieu & Passeron, 1964; Peyre, 1959) and studies that inaugurated comprehensive education in Nordic countries. We focus on…

  17. Reducing symbolic-violence in the research encounter: collaborating with a survivor of domestic abuse in a qualitative study in UK primary care. (United States)

    Malpass, Alice; Sales, Kim; Feder, Gene


    This paper explores ideas of symbolic violence inherent in the research encounter (Bourdieu 1999). After defining symbolic violence and how the concept enters into domestic violence and abuse (DVA) research, we discuss the challenges arising from a (DVA) survivor taking on the role of interviewer in a qualitative study nested within a UK primary care based trial: IRIS (Identification and Referral to Improve Safety). KS, a survivor of DVA, conducted interviews with 12 women who had been referred to a domestic violence agency by primary care clinicians taking part in the IRIS trial in two UK cities (Bristol and east London) during 2009. Field notes were kept during all of the research meetings with KS and these were included in analysis. Our analysis maps the research pathway of 'non-violent communication' and discusses the role of social symmetry and proximity in the research encounter. We conclude that while a welcoming disposition, empathy and active listening are all generic skills to qualitative research; if a researcher can enter fieldwork with a claim of social proximity and symmetry, their use of these generic skills is enhanced through a process of shared objectification and empowerment talk. We explore the limitations of social proximity, its relationship to feminist and anthropological theories of 'insider' research and its relevance to primary care research. © 2015 Foundation for the Sociology of Health & Illness.

  18. Danish and British Architects at Work: A Micro-Study of Architectural Encounters after the Second World War (United States)

    de Coninck-Smith, Ning


    Invoking a statement by the cultural geographer David Livingstone--that location is essential to knowing--this paper focuses on Danish school architecture during the 1950s and 1960s and the interplay between local geography and developments and discussions on the national and international scene. Through exhibitions and study tours and…

  19. ASRS Reports on Wake Vortex Encounters (United States)

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


    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.

  20. Context factors in general practitioner - patient encounters and their impact on assessing communication skills - an exploratory study (United States)


    Background Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor’s proficiency. Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account. Methods We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests. Results In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p communication was set at 3.17. Conclusions Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent ‘adequate GP communication behaviour’. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as ‘signal’ instead of ‘noise’ in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of

  1. Context factors in general practitioner-patient encounters and their impact on assessing communication skills--an exploratory study. (United States)

    Essers, Geurt; Kramer, Anneke; Andriesse, Boukje; van Weel, Chris; van der Vleuten, Cees; van Dulmen, Sandra


    Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor's proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account. We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests. In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (pcommunication was set at 3.17. Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent 'adequate GP communication behaviour'. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as 'signal' instead of 'noise' in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.

  2. The Age of Studies and Reports: Selected Elements Concerning the Background of Encounters Defining the Power of Education

    Directory of Open Access Journals (Sweden)

    Veronika Tašner and Slavko Gaber


    Full Text Available In the present paper, we discuss the time before the “age of reports”. Besides the Coleman Report in the period of Coleman, the Lady Plowden Report also appeared, while there were important studies in France (Bourdieu & Passeron, 1964; Peyre, 1959 and studies that inaugurated comprehensive education in Nordic countries. We focus on the period after the World War II, which was marked by rising economic nationalism, on the one hand, and by the second wave of mass education, on the other, bearing the promise of more equality and a reduction of several social inequalities, both supposed to be ensured by school. It was a period of great expectations related to the power of education and the rise of educational meritocracy. On this background, in the second part of the paper, the authors attempt to explore the phenomenon of the aforementioned reports, which significantly questioned the power of education and, at the same time, enabled the formation of evidence-based education policies. In this part of the paper, the central place is devoted to the case of socialist Yugoslavia/Slovenia and its striving for more equality and equity through education. Through the socialist ideology of more education for all, socialist Yugoslavia, with its exaggerated stress on the unified school and its overemphasised belief in simple equality, overstepped the line between relying on comprehensive education as an important mechanism for increasing the possibility of more equal and just education, on the one hand, and the myth of the almighty unified school capable of eradicating social inequalities, especially class inequalities, on the other. With this radical approach to the reduction of inequalities, socialist policy in the then Yugoslavia paradoxically reduced the opportunity for greater equality, and even more so for more equitable education.

  3. Experts' Encounters in Antenatal Diabetes Care: A Descriptive Study of Verbal Communication in Midwife-Led Consultations

    Directory of Open Access Journals (Sweden)

    Christina Furskog Risa


    Full Text Available Aim. We regard consultations as cocreated communicatively by the parties involved. In this paper on verbal communication in midwife-led consultations, we consequently focus on the actual conversation taking place between the midwife and the pregnant woman with diabetes, especially on those sequences where the pregnant woman initiated a topic of concern in the conversation. Methods. This paper was undertaken in four hospital outpatient clinics in Norway. Ten antenatal consultations between midwives and pregnant women were audiotaped, transcribed to text, and analyzed using theme-oriented discourse analysis. Two communicative patterns were revealed: an expert's frame and a shared experts' frame. Within each frame, different communicative variations are presented. The topics women initiated in the conversations were (i delivery, time and mode; (ii previous birth experience; (iii labor pain; and (iv breast feeding, diabetes management, and fetal weight. Conclusion. Different ways of communicating seem to create different opportunities for the parties to share each other's perspectives. Adequate responses and a listening attitude as well as an ambiguous way of talking seem to open up for the pregnant women's perspectives. Further studies are needed to investigate the obstacles to, and premises for, providing midwifery care in a specialist outpatient setting.

  4. Universalist ethics in extraterrestrial encounter (United States)

    Baum, Seth D.


    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.

  5. Impact of Patient-Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey. (United States)

    Malhotra, Jyoti; Rotter, David; Tsui, Jennifer; Llanos, Adana A M; Balasubramanian, Bijal A; Demissie, Kitaw


    Background: Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive. Methods: In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest. Results: Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs. Conclusions: Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study. Impact: Our findings highlight the importance of gender concordance in improving cancer screening rates. Cancer Epidemiol Biomarkers Prev; 26

  6. Studying Legal Cultures and Encounters?

    DEFF Research Database (Denmark)

    Petersen, Hanne


    This article discusses the cultural and other turns in relation to legal culture and situates Western legal culture in context. It deals with concepts and their relations to trends and fashions and introduces methodological reflections such as use of interdisciplinary methods, personal experience...

  7. Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial. (United States)

    Allen, Kelli D; Oddone, Eugene Z; Coffman, Cynthia J; Jeffreys, Amy S; Bosworth, Hayden B; Chatterjee, Ranee; McDuffie, Jennifer; Strauss, Jennifer L; Yancy, William S; Datta, Santanu K; Corsino, Leonor; Dolor, Rowena J


    A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. ( NCT01435109). 10 Duke University Health System community-based primary care clinics. 537 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. The study involved 1 health care network. Data on provider referrals were not collected. Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically

  8. Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm. (United States)

    Brown-Johnson, Cati G; Burbank, Andrea; Daza, Eric J; Wassmann, Arianna; Chieng, Amy; Rutledge, Geoffrey W; Prochaska, Judith J


    E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs. An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function. An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco (18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks. Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches. Copyright © 2016 American Journal of Preventive Medicine. Published by

  9. [A tale of two encounters]. (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.

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


    Lee, Linda


    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...

  11. 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)....

  12. Transitions from hospital to community care: the role of patient-provider language concordance. (United States)

    Rayan, Nosaiba; Admi, Hanna; Shadmi, Efrat


    Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients' discharge from hospital to community care, specifically examining the relationship between patient-provider language concordance and the quality of transitional care. This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0-100 scale)) and on the primary-care post-discharge visit. Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient-provider language concordance was present in 49% of minority patients' discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

  13. Christian meditation. A Path to oneself and Others. Qualitative study of Christian meditation and cultural encounters in lives of adults in Latvia


    Šķupele, Alise


    Abstract This master thesis examines individual experiences regarding “Christian Meditation” of John Main and cultural encounters. Through qualitative interviews with Christian meditators the thesis aims to understand the subjective meanings of Christian Meditation from the informant’s point of view. The purpose of the thesis is to explore the subjective experiences of Christian Meditation and cultural encounters; and to explore the subjective experiences of the meaning of Chri...

  14. Validity Evidence and Scoring Guidelines for Standardized Patient Encounters and Patient Notes From a Multisite Study of Clinical Performance Examinations in Seven Medical Schools. (United States)

    Park, Yoon Soo; Hyderi, Abbas; Heine, Nancy; May, Win; Nevins, Andrew; Lee, Ming; Bordage, Georges; Yudkowsky, Rachel


    To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring. Data included scores from standardized patient encounters for history taking, physical examination, and PNs. Descriptive statistics were used to examine scores from the different assessment components. Generalizability studies (G-studies) using variance components were conducted to estimate reliability for composite scores. Validity evidence was collected for response process (rater perception), internal structure (variance components, reliability), relations to other variables (interassessment correlations), and consequences (composite score). Student performance varied by case and task. In the PNs, justification of differential diagnosis was the most discriminating task. G-studies showed that schools accounted for less than 1% of total variance; however, for the PNs, there were differences in scores for varying cases and tasks across schools, indicating a school effect. Composite score reliability was maximized when the PN was weighted between 30% and 40%. Raters preferred using case-specific scoring guidelines with clear point-scoring systems. This multisite study presents validity evidence for PN scores based on scoring rubric and case-specific scoring guidelines that offer rigor and feedback for learners. Variability in PN scores across participating sites may signal different approaches to teaching clinical reasoning among medical schools.

  15. Disparities in perceived patient-provider communication quality in the United States: Trends and correlates. (United States)

    Spooner, Kiara K; Salemi, Jason L; Salihu, Hamisu M; Zoorob, Roger J


    This study aimed to describe disparities and temporal trends in the level of perceived patient-provider communication quality (PPPCQ) in the United States, and to identify sociodemographic and health-related factors associated with elements of PPPCQ. A cross-sectional analysis was conducted using nationally-representative data from the 2011-2013 iterations of the Health Information National Trends Survey (HINTS). Descriptive statistics, multivariable linear and logistic regression analyses were conducted to examine associations. PPPCQ scores, the composite measure of patients' ratings of communication quality, were positive overall (82.8; 95% CI: 82.1-83.5). However, less than half (42-46%) of respondents perceived that providers always addressed their feelings, spent enough time with them, or helped with feelings of uncertainty about their health. Older adults and those with a regular provider consistently had higher PPPCQ scores, while those with poorer perceived general health were consistently less likely to have positive perceptions of their providers' communication behaviors. Disparities in PPPCQ can be attributed to patients' age, race/ethnicity, educational attainment, employment status, income, healthcare access and general health. These findings may inform educational and policy efforts which aim to improve patient-provider communication, enhance the quality of care, and reduce health disparities. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. UAS in the NAS Air Traffic Controller Acceptability Study-1: The Effects of Horizontal Miss Distances on Simulated UAS and Manned Aircraft Encounters (United States)

    Ghatas, Rania W.; Comstock, James R., Jr.; Consiglio, Maria C.; Chamberlain, James P.; Hoffler, Keith D.


    This study examined air traffic controller acceptability ratings based on the effects of differing horizontal miss distances (HMDs) for encounters between UAS and manned aircraft. In a simulation of the Dallas/Fort Worth (DFW) East-side airspace, the CAS-1 experiment at NASA Langley Research Center enlisted fourteen recently retired DFW air traffic controllers to rate well-clear volumes based on differing HMDs that ranged from 0.5 NM to 3.0 NM. The controllers were tasked with rating these HMDs from "too small" to "too excessive" on a defined, 1-5, scale and whether these distances caused any disruptions to the controller and/or to the surrounding traffic flow. Results of the study indicated a clear favoring towards a particular HMD range. Controller workload was also measured. Data from this experiment and subsequent experiments will play a crucial role in the FAA's establishment of rules, regulations, and procedures to safely and efficiently integrate UAS into the NAS.

  17. Disciplining the audiological encounter

    DEFF Research Database (Denmark)

    Hindhede, Anette Lykke


    This article addresses the social power variations in the context of audiological rehabilitation. The empirically based study examines the everyday interaction between professional medicine and the patient when hearing aids are being provided. By the use of video recordings an analysis is conduct...

  18. Encountering the Everyday

    DEFF Research Database (Denmark)

    life traditions such as Chicago sociology, phenomenology, American pragmatism, symbolic interactionism, existentialism and critical everyday life sociologies, but also to the later developments by Erving Goffman, French everyday life thinkers, the ethnomethodologists, conversation analysts...... and the absurdists. Finally, a section deals with the most recent approaches such as the specifically Scandinavian everyday life perspectives, the sociology of emotions, social semiotics, cultural studies and postmodern interpretive interactionism. The chapters all accessibly introduce the reader to the ‘core...

  19. The First Encounter

    DEFF Research Database (Denmark)

    Vedel, Jane Bjørn


    Much work in Science and Technology Studies (STS) assumes that scientists enter into research collaborations as entities characterized by difference. It is assumed that in order to collaborate these differences must be aligned. In this paper, I investigate the intriguing role of difference...... collaboration. I conclude the paper by suggesting that if collaboration is in fact not held back by dissimilarities this suggests a need to rethink the dynamics of science-industry relations....

  20. The impact of gender stereotypes on the evaluation of general practitioners' communication skills: an experimental study using transcripts of physician-patient encounters. (United States)

    Nicolai, Jennifer; Demmel, Ralf


    The present study has been designed to test for the effect of physicians' gender on the perception and assessment of empathic communication in medical encounters. Eighty-eight volunteers were asked to assess six transcribed interactions between physicians and a standardized patient. The effects of physicians' gender were tested by the experimental manipulation of physicians' gender labels in transcripts. Participants were randomly assigned to one of two testing conditions: (1) perceived gender corresponds to the physician's true gender; (2) perceived gender differs from the physician's true gender. Empathic communication was assessed using the Rating Scales for the Assessment of Empathic Communication in Medical Interviews. A 2 (physician's true gender: female vs. male)x2 (physician's perceived gender: female vs. male)x2 (rater's gender: female vs. male) mixed multivariate analysis of variance (MANOVA) yielded a main effect for physician's true gender. Female physicians were rated higher on empathic communication than male physicians irrespective of any gender labels. The present findings suggest that gender differences in the perception of physician's empathy are not merely a function of the gender label. These findings provide evidence for differences in male and female physicians' empathic communication that cannot be attributed to stereotype bias. Future efforts to evaluate communication skills training for general practitioners may consider gender differences.

  1. Evaluation of a multiple-encounter in situ simulation for orientation of staff to a new paediatric emergency service: a single-group pretest/post-test study. (United States)

    Davison, Michelle; Kinnear, Frances B; Fulbrook, Paul


    To assess the utility of a multiple-encounter in-situ (MEIS) simulation as an orientation tool for multidisciplinary staff prior to opening a new paediatric emergency service. A single-group pretest/post-test study was conducted. During the MEIS simulation, multidisciplinary staff with participant or observer roles managed eight children (mannequins) who attended triage with their parent/guardians (clinical facilitators) for a range of emergency presentations (structured scenarios designed to represent the expected range of presentations plus test various clinical pathways/systems). Participants were debriefed to explore clinical, systems and crisis-resource management issues. Participants also completed a pre-intervention and post-intervention questionnaire comprising statements about role confidence and orientation adequacy. Pre-test and post-test results were analysed using t-test and Wilcoxon signed rank test. Eighty-nine staff participated in the MEIS simulation, with the majority completing the pre-simulation and post-simulation questionnaire. There was a significant improvement in post-intervention versus pre-intervention Likert scores for role confidence and orientation adequacy (p=0.001 and orientation adequacy. Nearly all scenarios resulted in significant increases in participants' confidence levels. The MEIS simulation was of utility in orientation of staff, at least with respect to self-reported role confidence and orientation adequacy. Its effectiveness in practice or compared with other orientation techniques was not assessed, but it did identify several flaws in planned systems allowing remediation prior to opening.

  2. Domestic Violence Encountered among Kurdish Women (United States)

    Ali, Sirwan Kamil


    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…

  3. The Art of the Encounter

    Directory of Open Access Journals (Sweden)

    Éric Vautrin


    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.

  4. Personal Albums and Cultural Encounters

    DEFF Research Database (Denmark)

    Marselis, Randi Lorenz


    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...

  5. Variation in patient-provider communication by patient's race and ethnicity, provider type, and continuity in and site of care: An analysis of data from the Connecticut Health Care Survey. (United States)

    Aseltine, Robert H; Sabina, Alyse; Barclay, Gillian; Graham, Garth


    The purpose of this study is to examine the quality of patient-reported communication with their health care providers using data from a large, statewide survey of patients. We examine the relationship between patient's race and ethnicity, type of health care provider, site of and continuity in care, and the quality of patient-provider communication. We analyze data from the Connecticut Health Care Survey, a representative telephone survey of 4608 Connecticut residents conducted between June 2012 and February 2013. Eight measures of patient-provider communication were analyzed using weighted general linear and logistic regression models. Patients' assessments of the quality of communication with their health care providers were generally positive. Hispanic patients, those who received care in a clinic or hospital setting, and those who did not consistently see the same provider reported significantly poorer communication with their providers. Our data suggest that improving patient-provider communication for Hispanic patients may be a critical step in achieving health equity. However, increased access to health care delivered outside of physician offices where there may not be consistency in providers across encounters may pose challenges to effective health communication.

  6. Patient-provider communication about medication use at the community pharmacy counter. (United States)

    van Dijk, Marloes; Blom, Lyda; Koopman, Laura; Philbert, Daphne; Koster, Ellen; Bouvy, Marcel; van Dijk, Liset


    The objectives of this study were to, first, describe the information exchanged between pharmacy staff and patients about prescribed medication at the community pharmacy counter, and second, to investigate to what extent this met professional medication counselling guidelines. Pharmaceutical encounters were videotaped in four community pharmacies in the Netherlands. Patients were included if they collected a prescription for their own use. An observation protocol, including the MEDICODE checklist, was used to analyse the video recordings. A distinction was made between first and repeat prescriptions. One hundred fifty-three encounters were videotaped. When dispensing first prescriptions, pharmacy staff provided most information on instructions how to use the medication (83.3%), form of the medication (71.4%) and treatment duration (42.9%). Topics for repeat prescriptions (such as the effects of the medication and the incidence of observed adverse effects) were rarely discussed. Pharmacy staff rarely encouraged patients to ask questions. Pharmacy staff members provided little medication-related information at the counter, especially for repeat prescriptions, did not encourage active patient participation, and thereby did not adhere to the guidelines of their professional organisation. Further research is needed to understand the reasons for this. © 2015 Royal Pharmaceutical Society.

  7. Predator-prey encounters in turbulent waters

    DEFF Research Database (Denmark)

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


    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...

  8. Service encounters as bases for innovation

    DEFF Research Database (Denmark)

    Sundbo, Jon; Sundbo, Donna; Henten, Anders


    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...

  9. Adoption and Use of Internet Technologies in Health Communication: Examining Disparities in Diffusion Patterns, Health Information Sources, and Patient-Provider Encounters (United States)

    Massey, Philip Minter


    This dissertation examines the impact of internet technologies on the field of health communication. Access and use of health communication technologies has and will continue to become increasingly important to manage and treat chronic conditions and other ailments, particularly in the context of health care reform that promotes improved quality…

  10. Book Review: Galactic Encounters

    Energy Technology Data Exchange (ETDEWEB)

    Balasis, Georgios, E-mail: [Institute for Astronomy, Astrophysics, Space Applications and Remote Sensing, National Observatory of Athens, Athens (Greece)


    “Galactic Encounters” by Sheehan and Conselice provides a view of galaxies telling the story of how astronomers have pieced together what is known about the modern view of the Universe. The book helps the reader to understand “why” we know what we do, not simply “what,” starting with the development of the telescope that coincides with the modern picture of the Universe. William Sheehan is a noted historian of astronomy but also a Doctor of Medicine, specializing in psychiatry. In this perspective, he has a unique insight into the personalities of the pioneering figures of the history of science. Christopher Conselice is a Professor of Astrophysics at the University of Nottingham, who studies the formation of galaxies, addressing the issue of “how” rather than “when” galaxies form. Reading the book, amateur astronomers would have been able to feel what actually drives them: “it is the desire to participate in this vast universe, in their own small way,…and not let the experts do everything for them.” I have to admit that I have also quite enjoyed the author's remark pertinent to the history and philosophy of science about the distinction, nowadays, between “polymaths” and “monomaths.”.

  11. Book Review: Galactic Encounters

    International Nuclear Information System (INIS)

    Balasis, Georgios


    “Galactic Encounters” by Sheehan and Conselice provides a view of galaxies telling the story of how astronomers have pieced together what is known about the modern view of the Universe. The book helps the reader to understand “why” we know what we do, not simply “what,” starting with the development of the telescope that coincides with the modern picture of the Universe. William Sheehan is a noted historian of astronomy but also a Doctor of Medicine, specializing in psychiatry. In this perspective, he has a unique insight into the personalities of the pioneering figures of the history of science. Christopher Conselice is a Professor of Astrophysics at the University of Nottingham, who studies the formation of galaxies, addressing the issue of “how” rather than “when” galaxies form. Reading the book, amateur astronomers would have been able to feel what actually drives them: “it is the desire to participate in this vast universe, in their own small way,…and not let the experts do everything for them.” I have to admit that I have also quite enjoyed the author's remark pertinent to the history and philosophy of science about the distinction, nowadays, between “polymaths” and “monomaths.”

  12. Moral Relations in Encounters with Nature (United States)

    Andersson, Karin; Öhman, Johan


    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…

  13. Characteristics of electronic patient-provider messaging system utilisation in an urban health care organisation

    Directory of Open Access Journals (Sweden)

    Sean Patrick Mikles


    Full Text Available Introduction Research suggests that electronic messaging can improve patient engagement. Studies indicate that a ‘digital divide’ may exist, where certain patient populations may be using electronic messaging less frequently. This study aims to determine which patient characteristics are associated with different levels of usage of an electronic patient-provider messaging system in a diverse urban population.Methods Cross-sectional electronic health record data were extracted for patients 10 years of age or older who live in New York City and who visited a set of clinics between 1 July 2011 and 30 June 2012. Regression analyses determined which participant characteristics were associated with the sending of electronic messages.Results Older, female, English-speaking participants of white race who received more messages, had any diagnoses, more office visits and a provider who sent messages were more likely to send more messages. Non-Millennial, non-white participants who received fewer messages, had more office visits, any diagnoses, a provider who saw fewer patients with patient portal accounts, lived in a low socioeconomic status neighbourhood, and did not have private insurance were more likely to send zero messages.Conclusion This study found significant differences in electronic messaging usage based on demographic, socioeconomic and health-related patient characteristics. Future studies are needed to support these results and determine the causes of observed associations.

  14. A Lakatosian Encounter with Probability (United States)

    Chick, Helen


    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…

  15. Risk of Guillain-Barré syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study. (United States)

    Kwong, Jeffrey C; Vasa, Priya P; Campitelli, Michael A; Hawken, Steven; Wilson, Kumanan; Rosella, Laura C; Stukel, Therese A; Crowcroft, Natasha S; McGeer, Allison J; Zinman, Lorne; Deeks, Shelley L


    The possible risk of Guillain-Barré syndrome from influenza vaccines remains a potential obstacle to achieving high vaccination coverage. However, influenza infection might also be associated with Guillain-Barré syndrome. We aimed to assess the risk of Guillain-Barré syndrome after seasonal influenza vaccination and after influenza-coded health-care encounters. We used the self-controlled risk interval design and linked universal health-care system databases from Ontario, Canada, with data obtained between 1993 and 2011. We used physician billing claims for influenza vaccination and influenza-coded health-care encounters to ascertain exposures. Using fixed-effects conditional Poisson regression, we estimated the relative incidence of hospitalisation for primary-coded Guillain-Barré syndrome during the risk interval compared with the control interval. We identified 2831 incident admissions for Guillain-Barré syndrome; 330 received an influenza vaccine and 109 had an influenza-coded health-care encounter within 42 weeks before hospitalisation. The risk of Guillain-Barré syndrome within 6 weeks of vaccination was 52% higher than in the control interval of 9-42 weeks (relative incidence 1·52; 95% CI 1·17-1·99), with the greatest risk during weeks 2-4 after vaccination. The risk of Guillain-Barré syndrome within 6 weeks of an influenza-coded health-care encounter was greater than for vaccination (15·81; 10·28-24·32). The attributable risks were 1·03 Guillain-Barré syndrome admissions per million vaccinations, compared with 17·2 Guillain-Barré syndrome admissions per million influenza-coded health-care encounters. The relative and attributable risks of Guillain-Barré syndrome after seasonal influenza vaccination are lower than those after influenza illness. Patients considering immunisation should be fully informed of the risks of Guillain-Barré syndrome from both influenza vaccines and influenza illness. Canadian Institutes of Health Research

  16. Motivational Interviewing Skills in Health Care Encounters (MISHCE): Development and psychometric testing of an assessment tool. (United States)

    Petrova, Tatjana; Kavookjian, Jan; Madson, Michael B; Dagley, John; Shannon, David; McDonough, Sharon K


    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

  17. Provider portrayals and patient-provider communication in drama and reality medical entertainment television shows. (United States)

    Jain, Parul; Slater, Michael D


    Portrayals of physicians on medical dramas have been the subject of research attention. However, such research has not examined portrayals of interactions between physicians and patients, has not compared physician portrayals on medical dramas versus on medical reality programs, and has not fully examined portrayals of physicians who are members of minority groups or who received their education internationally. This study content-analyzes 101 episodes (85 hours) of such programs broadcast during the 2006-2007 viewing season. Findings indicate that women are underrepresented as physicians on reality shows, though they are no longer underrepresented as physicians on dramas. However, they are not as actively portrayed in patient-care interactions as are male physicians on medical dramas. Asians and international medical graduates are underrepresented relative to their proportion in the U.S. physician population, the latter by almost a factor of 5. Many (but certainly not all) aspects of patient-centered communication are modeled, more so on reality programs than on medical dramas. Differences in patient-provider communication portrayals by minority status and gender are reported. Implications for public perception of physicians and expectations regarding provider-patient interaction are discussed.

  18. Patient-provider communication and hormonal therapy side effects in breast cancer survivors. (United States)

    Lin, Jenny J; Chao, Jennifer; Bickell, Nina A; Wisnivesky, Juan P


    Side effects from hormonal therapy (HT) for breast cancer treatment occur frequently and are associated with worse quality of life and HT non-adherence. Whether improved patient-physician communication is associated with patients' reporting of side effects is unknown. We undertook this study to assess factors associated with women's reports of HT side effects. Between December 2012 and April 2013, we conducted a cross-sectional survey of breast cancer patients undergoing HT in an urban medical center. Descriptive statistics, univariate analyses, and multivariate analyses were used to evaluate associations. Of the 100 participants, 67% reported having HT side effects. However, when prompted, an additional 9% reported experiencing specific HT-related symptoms. Despite very high communication scores, one-third of participants reported they had not discussed side effects with providers. Multivariate analysis showed that after controlling for age, education, race, and medication beliefs, women who had difficulty asking providers for more information were more likely to report side effects (odds ratio 8.27, 95% confidence interval 1.01-69.88). Although HT side effects often occur and are bothersome, patient-provider discussions about side effects remain suboptimal. Providers should actively ask patients about medication side effects so that they can be addressed to improve quality of life and potentially, medication adherence.

  19. Patient-provider connectivity and the role of e-health. (United States)

    Holmes, Suzanne C; Kearns, Ellen Hope


    Patient-provider connectivity (PPC) offers innovative approaches to control costs, improve quality, and sustain a healthy workforce. The application of e-commerce to health care is one facet of PPC and provides solutions to educating, informing, and more efficiently using scarce resources to sustain the nation's health. Technology is available to provide real-time access to clinical results, medical records, health-care providers, and other time-sensitive patient information. This is the first article in a series on PPC that explores the application of e-commerce to the health-care industry from the consumers' and providers' points of view and examines and assesses trends and data from various interdisciplinary sources and studies. Two models exemplifying PPC are explored including the Science Business & Education, Inc., proof-of-concept patient demonstration project, and the emerging application of peer-to-peer (P2P) technology. PPC promises to improve efficiency, facilitate communication between physician and patient, monitor compliance with medical regimens, and positively affect the quality of health care provided and the overall health of the patient. Future articles will address the growth of telemedicine, issues of confidentiality and e-risk, and other PPC applications.

  20. Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: a report from the CHANGES study. (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


    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.

  1. Users’ encounter with normative discourses on Facebook

    DEFF Research Database (Denmark)

    Mathieu, David


    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...

  2. Mobbing behaviors encountered by nurse teaching staff. (United States)

    Yildirim, Dilek; Yildirim, Aytolan; Timucin, Arzu


    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'.

  3. Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication. (United States)

    Correa, John B; Brandon, Karen O; Meltzer, Lauren R; Hoehn, Hannah J; Piñeiro, Bárbara; Brandon, Thomas H; Simmons, Vani N


    Smoking tobacco cigarettes after a cancer diagnosis increases risk for several serious adverse outcomes. Thus, patients can significantly benefit from quitting smoking. Electronic cigarettes are an increasingly popular cessation method. Providers routinely ask about combustible cigarette use, yet little is known about use and communication surrounding e-cigarettes among patients with cancer. This study aims to describe patterns, beliefs, and communication with oncology providers about e-cigarette use of patients with cancer. Patients with cancer (N = 121) who currently used e-cigarettes were surveyed in a cross-sectional study about their patterns and reasons for use, beliefs, and perceptions of risk for e-cigarettes, combustible cigarettes, and nicotine replacement therapies. Patient perspectives on provider communication regarding e-cigarettes were also assessed. Most participants identified smoking cessation as the reason for initiating (81%) and continuing (60%) e-cigarette use. However, 51% of patients reported current dual use of combustible cigarettes and e-cigarettes, and most patients reported never having discussed their use of e-cigarettes with their oncology provider (72%). Patients characterized e-cigarettes as less addictive, less expensive, less stigmatizing, and less likely to impact cancer treatment than combustible cigarettes (Ps < .05), and more satisfying, more useful for quitting smoking, and more effective at reducing cancer-related stress than nicotine replacement therapies (Ps < .05). Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation. This study also highlights the need for improved patient-provider communication on the safety and efficacy of e-cigarettes for smoking cessation. Copyright © 2018 John Wiley & Sons, Ltd.

  4. Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency. (United States)

    Laws, Michael Barton; Rose, Gary S; Beach, Mary Catherine; Lee, Yoojin; Rogers, William S; Velasco, Alyssa Bianca; Wilson, Ira B


    Motivational Interviewing (MI) consistent talk by a counselor is thought to produce "change talk" in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior. We applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit ("episodes"), assesses patient concordance with the behavioral goal, and labels providers' counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system. Patient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second. Observations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency. Counseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Psychosocial correlates of patient-provider family planning discussions among HIV-infected pregnant women in South Africa. (United States)

    Rodriguez, Violeta J; Cook, Ryan R; Weiss, Stephen M; Peltzer, Karl; Jones, Deborah L


    Patient-provider family planning discussions and preconception counseling can reduce maternal and neonatal risks by increasing adherence to provider recommendations and antiretroviral medication. However, HIV-infected women may not discuss reproductive intentions with providers due to anticipation of negative reactions and stigma. This study aimed to identify correlates of patient-provider family planning discussions among HIV-infected women in rural South Africa, an area with high rates of antenatal HIV and suboptimal rates of prevention of mother-to-child transmission (PMTCT) of HIV. Participants were N=673 pregnant HIV-infected women who completed measures of family planning discussions and knowledge, depression, stigma, intimate partner violence, and male involvement. Participants were, on average, 28 ± 6 years old, and half of them had completed at least 10-11 years of education. Most women were unemployed and had a monthly income of less than ~US$76. Fewer than half of the women reported having family planning discussions with providers. Correlates of patient-provider family planning discussions included younger age, discussions about PMTCT of HIV, male involvement, and decreased stigma ( p family planning discussions through male involvement ( b = -0.010, bias-corrected 95% confidence interval [bCI] [-0.019, -0.005]). That is, depression decreased male involvement, and in turn, male involvement increased patient-provider family planning discussions. Therefore, by decreasing male involvement, depression indirectly decreased family planning discussions. Study findings point to the importance of family planning strategies that address depression and facilitate male involvement to enhance communication between patients and providers and optimize maternal and neonatal health outcomes. This study underscores the need for longitudinal assessment of men's impact on family planning discussions both pre- and postpartum. Increasing support for provision of mental

  6. Rethinking social identity theory in international encounters:

    DEFF Research Database (Denmark)

    Lauring, Jakob


    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...

  7. An attribution theory perspective on emotional labour in nurse-patient encounters: a nested cross-sectional study in paediatric settings. (United States)

    Golfenshtein, Nadya; Drach-Zahavy, Anat


    To understand the role of patients' attributions under the attribution theory framework (locus, controllability, stability) in nurses' performance of surface or deep acting, as they unfold in interactions with different patients. Regulation of emotions at work, or emotional labour, has been conceptualized in terms of two main strategies: surface acting and deep acting. Most prior research tested for between-subject variation in the search for the factors evoking these strategies in nurses, assuming them to be trait-like characteristics. Only scant research has examined how nurses modify their emotional labour strategies in different patient-nurse encounters. A nested cross-sectional design (patients within nurses). Data were collected during 2011-2012 through validated questionnaires from the nursing staff (N = 41) of two paediatric hospital wards and their randomly selected patients (N = 239). Questionnaires were administered to nurses multiple times after encounters with different patients. Analyses were conducted using mixed effects models. In accordance with attribution theory, different combinations of locus, controllability and stability attributions were related to the choice of surface or deep acting. Nurses' perceptions of patients' controllability were associated positively with surface acting and negatively with deep acting. Interaction terms of stability and locus and of controllability and stability, were distinctively associated with deep and surface acting. Findings innovatively introduce the attribution process as an explanatory perspective to nurses' emotional labour and highlight its situational nature, providing a potential tool for emotional labour strategy prediction. Raising nurses' awareness of how they perceive patients may increase control of the strategies employed. © 2015 John Wiley & Sons Ltd.

  8. Attributions of Intentions and Fairness Judgments regarding Interracial Peer Encounters (United States)

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


    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…

  9. 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...

  10. Special relativity a first encounter

    CERN Document Server

    Giulini, Domenico


    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

  11. Computational psychotherapy research: scaling up the evaluation of patient-provider interactions. (United States)

    Imel, Zac E; Steyvers, Mark; Atkins, David C


    In psychotherapy, the patient-provider interaction contains the treatment's active ingredients. However, the technology for analyzing the content of this interaction has not fundamentally changed in decades, limiting both the scale and specificity of psychotherapy research. New methods are required to "scale up" to larger evaluation tasks and "drill down" into the raw linguistic data of patient-therapist interactions. In the current article, we demonstrate the utility of statistical text analysis models called topic models for discovering the underlying linguistic structure in psychotherapy. Topic models identify semantic themes (or topics) in a collection of documents (here, transcripts). We used topic models to summarize and visualize 1,553 psychotherapy and drug therapy (i.e., medication management) transcripts. Results showed that topic models identified clinically relevant content, including affective, relational, and intervention related topics. In addition, topic models learned to identify specific types of therapist statements associated with treatment-related codes (e.g., different treatment approaches, patient-therapist discussions about the therapeutic relationship). Visualizations of semantic similarity across sessions indicate that topic models identify content that discriminates between broad classes of therapy (e.g., cognitive-behavioral therapy vs. psychodynamic therapy). Finally, predictive modeling demonstrated that topic model-derived features can classify therapy type with a high degree of accuracy. Computational psychotherapy research has the potential to scale up the study of psychotherapy to thousands of sessions at a time. We conclude by discussing the implications of computational methods such as topic models for the future of psychotherapy research and practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

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

    Directory of Open Access Journals (Sweden)

    Nandakumar Mekoth


    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.

  13. Standardized Patients Provide a Reliable Assessment of Athletic Training Students' Clinical Skills (United States)

    Armstrong, Kirk J.; Jarriel, Amanda J.


    Context: Providing students reliable objective feedback regarding their clinical performance is of great value for ongoing clinical skill assessment. Since a standardized patient (SP) is trained to consistently portray the case, students can be assessed and receive immediate feedback within the same clinical encounter; however, no research, to our…

  14. Initial Encounters : The Lived Experiences of Buyers

    NARCIS (Netherlands)

    G. Wright; J.J. Dekker


    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.

  15. Work week duration, work-family balance and difficulties encountered by female and male physicians: results from the French SESMAT study. (United States)

    Estryn-Behar, M; Fry, C; Guetarni, K; Aune, I; Machet, G; Doppia, M A; Lassaunière, J M; Muster, D; Pelloux, P; Prudhomme, Ch


    France encounters difficulties attracting physicians to work in hospitals. Organisation at work and at home may be at the heart of the problem for female as well as for male physicians. A comprehensive questionnaire was filled out online by a representative sample of 1924 French hospital physicians. We conducted gender bivariate and multivariate analysis of the risk factors for burnout and intent to leave the profession(ITL). ITL was declared by 17.4% of physicians. According to 41.3% of female physicians (FP), their profession was an obstacle to having children (versus 19.3% for male physicians (MP)). Major factors linked with burnout were Effort/Reward imbalance (FP adjOR = 5.09, MP adjOR = 5.93), Work-family conflicts (FP adjOR = 2.97, MP adjOR = 3.04), and Low quality of teamwork (FP adjOR = 1.82, MP adjOR = 2.68). Major factors linked with ITL were Low quality of teamwork (FP adjOR = 4.49, MP adjOR = 3.03), Patient-related burnout (FP adjOR = 2.10, MP adjOR = 2.35) and General burnout (FP adjOR = 1.85, MP adjOR = 1.45). Excessive job demands are linked with burnout and with work-family conflicts, conducting to difficulties in organising one's life in order to have and raise children. Potential solutions include facilitating teamwork in order to reduce departure, which increase workload on those who stay increasing their work family conflict.

  16. Common Factors Among Family Medicine Residents Who Encounter Difficulty. (United States)

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


    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.

  17. Influence of English proficiency on patient-provider communication and shared decision-making. (United States)

    Paredes, Anghela Z; Idrees, Jay J; Beal, Eliza W; Chen, Qinyu; Cerier, Emily; Okunrintemi, Victor; Olsen, Griffin; Sun, Steven; Cloyd, Jordan M; Pawlik, Timothy M


    The number of patients in the United States (US) who speak a language other than English is increasing. We evaluated the impact of English proficiency on self-reported patient-provider communication and shared decision-making. The 2013-2014 Medical Expenditure Panel Survey database was utilized to identify respondents who spoke a language other than English. Patient-provider communication (PPC) and shared decision-making (SDM) scores from 4-12 were categorized as "poor" (4-7), "average" (8-11), and "optimal." The relationship between PPC, SDM, and English proficiency was analyzed. Among 13,880 respondents, most were white (n = 10,281, 75%), age 18-39 (n = 6,677, 48%), male (n = 7,275, 52%), middle income (n = 4,125, 30%), and born outside of the US (n = 9,125, 65%). English proficiency was rated as "very well" (n = 7,221, 52%), "well" (n = 2,378, 17%), "not well" (n = 2,820, 20%), or "not at all" (n = 1,463, 10%). On multivariable analysis, patients who rated their English as "well" (OR 1.73, 95% CI 1.37-2.18) or "not well" (OR 1.53, 95% CI 1.10-2.14) were more likely to report "poor" PPC (both P English proficiency as "not well" (OR 1.31, 95% CI 1.04-1.65, P = .02). Decreased English proficiency was associated with worse self-reported patient-provider communication and shared decision-making. Attention to patients' language needs is critical to patient satisfaction and improved perception of care. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Alien encounter a scientific novel

    CERN Document Server

    Schulze-Makuch, Dirk


    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...

  19. Innovative generativity of digital service encounters

    DEFF Research Database (Denmark)

    Henten, Anders; Sørensen, Jannick Kirk


    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...

  20. Patient-Provider Interactions Affect Symptoms in Gastroesophageal Reflux Disease: A Pilot Randomized, Double-Blind, Placebo-Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Michelle L Dossett

    Full Text Available It is unclear whether the benefits that some patients derive from complementary and integrative medicine (CIM are related to the therapies recommended or to the consultation process as some CIM provider visits are more involved than conventional medical visits. Many patients with gastrointestinal conditions seek out CIM therapies, and prior work has demonstrated that the quality of the patient-provider interaction can improve health outcomes in irritable bowel syndrome, however, the impact of this interaction on gastroesophageal reflux disease (GERD is unknown. We aimed to assess the safety and feasibility of conducting a 2 x 2 factorial design study preliminarily exploring the impact of the patient-provider interaction, and the effect of an over-the-counter homeopathic product, Acidil, on symptoms and health-related quality of life in subjects with GERD.24 subjects with GERD-related symptoms were randomized in a 2 x 2 factorial design to receive 1 either a standard visit based on an empathic conventional primary care evaluation or an expanded visit with questions modeled after a CIM consultation and 2 either Acidil or placebo for two weeks. Subjects completed a daily GERD symptom diary and additional measures of symptom severity and health-related quality of life.There was no significant difference in GERD symptom severity between the Acidil and placebo groups from baseline to follow-up (p = 0.41, however, subjects who received the expanded visit were significantly more likely to report a 50% or greater improvement in symptom severity compared to subjects who received the standard visit (p = 0.01. Total consultation length, perceived empathy, and baseline beliefs in CIM were not associated with treatment outcomes.An expanded patient-provider visit resulted in greater GERD symptom improvement than a standard empathic medical visit. CIM consultations may have enhanced placebo effects, and further studies to assess the active components of this

  1. Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient-provider communication. (United States)

    Lin, Sue C; McKinley, Duane; Sripipatana, Alek; Makaroff, Laura


    Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients. Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening. Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening. The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017

  2. Avoiding humiliations in the clinical encounter. (United States)

    Malterud, Kirsti; Hollnagel, Hanne


    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.

  3. 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....

  4. Understanding metropolitan patterns of daily encounters. (United States)

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


    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.

  5. The Analysis of Curriculum Development Studies Which are Applied For Effective Science Teaching at Primary Level in Turkey and Suggestions to Problems Encountered




    In this study, curriculum development studies for effective science teaching were analyzed in Turkey, solution suggestions were made by determining the confronted problems. The studies for curriculum analysis toward science teaching were done by covering applications of modern science teaching started in 1970s, curriculum of science teaching made in 1990s and applications of science teaching curriculum put into practice in 2000. It was determined that new science teaching studies that will be...

  6. Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions. (United States)

    Brenk-Franz, Katja; Strauß, Bernhard; Tiesler, Fabian; Fleischhauer, Christian; Schneider, Nico; Gensichen, Jochen


    The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases. 209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management. The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence. A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

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


    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.)

  8. Emotions in relation to healthcare encounters affecting self-esteem. (United States)

    Räty, Lena; Gustafsson, Barbro


    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.

  9. Beyond the Embodied Digital Service Encounter

    DEFF Research Database (Denmark)

    Sørensen, Jannick Kirk


    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 ...

  10. A Semiotic Study of Elementary Teachers' Beliefs about Learning and Teaching of Minority and Latino/a Immigrant Students: The Encounter of Different Umwelten (United States)

    Baratta Posada, Ana Elisa


    Semiotic paradigm and Carspecken's (1996) critical ethnography were used in a qualitative research study of elementary teachers' beliefs about minority and Latino/a immigrant students and the role of life experiences, culture and Umwelt in the formation and influence of beliefs. The participants were a kindergarten, first grade, and second grade…

  11. Beyond the interface: Encountering artifacts in use

    DEFF Research Database (Denmark)

    Bødker, Susanne; Bannon, Liam


    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...

  12. Being Disoriented: Uncertain Encounters with Disability

    Directory of Open Access Journals (Sweden)

    Ryan C. Parrey


    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.

  13. Ethics in the bank internet encounter

    DEFF Research Database (Denmark)

    Rendtorff, Jacob Dahl; Mattsson, Jan


    /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...

  14. Controlled, Constrained, or Flexible? How Self-Management Goals Are Shaped By Patient-Provider Interactions. (United States)

    Franklin, Marika; Lewis, Sophie; Willis, Karen; Rogers, Anne; Venville, Annie; Smith, Lorraine


    A person-centered approach to goal-setting, involving collaboration between patients and health professionals, is advocated in policy to support self-management. However, this is difficult to achieve in practice, reducing the potential effectiveness of self-management support. Drawing on observations of consultations between patients and health professionals, we examined how goal-setting is shaped in patient-provider interactions. Analysis revealed three distinct interactional styles. In controlled interactions, health professionals determine patients' goals based on biomedical reference points and present these goals as something patients should do. In constrained interactions, patients are invited to present goals, yet health professionals' language and questions orientate goals toward biomedical issues. In flexible interactions, patients and professionals both contribute to goal-setting, as health professionals use less directive language, create openings, and allow patients to decide on their goals. Findings suggest that interactional style of health professionals could be the focus of interventions when aiming to increase the effectiveness of goal-setting.

  15. Health literacy in the "oral exchange": an important element of patient-provider communication. (United States)

    Nouri, Sarah S; Rudd, Rima E


    Oral communication between health care providers and patients--the "oral exchange"--greatly impacts patient health outcomes; however, only recently have health literacy inquiries been incorporated into this field. This review examines the intersection between oral and aural literacy and the oral exchange. A systematic literature search was carried out. Papers published in English since 2003 that specifically examine oral/aural literacy and oral patient-provider communication were included. The search yielded 999 articles, 12 of which were included in this review. Three tools have been developed to measure either patient or provider oral/aural literacy. There is a discrepancy between patient and provider oral/aural literacy levels, and high literacy demand is associated with reduced patient learning. Low patient oral/aural literacy is associated with poor health outcomes. Two interventions have been developed to reduce literacy demand. This review demonstrates the critical role of oral and aural literacy in the oral exchange, the importance of reducing literacy demand, and the need for future research in this field. Recommendations include the use of plain language and teach-back by providers, as well as incorporation of awareness of oral and aural literacy into community programs and health care provider education and training. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Survivors of intimate partner violence speak out: trust in the patient-provider relationship. (United States)

    Battaglia, Tracy A; Finley, Erin; Liebschutz, Jane M


    To identify characteristics that facilitate trust in the patient-provider relationship among survivors of intimate partner violence (IPV). Semistructured, open-ended interviews were conducted to elicit participants' beliefs and attitudes about trust in interactions with health care providers. Using grounded theory methods, the transcripts were analyzed for common themes. A community advisory group, composed of advocates, counselors and IPV survivors, helped interpret themes and interview excerpts. Together, key components of trust were identified. Eastern Massachusetts. Twenty-seven female survivors of IPV recruited from community-based IPV organizations. Participants' ages ranged from 18 to 56 years, 36% were African American, 32% Hispanic, and 18% white. We identified 5 dimensions of provider behavior that were uniquely important to the development of trust for these IPV survivors: 1) communication about abuse: provider was willing to openly discuss abuse; 2) professional competency: provider asked about abuse when appropriate and was familiar with medical and social histories; 3) practice style: provider was consistently accessible, respected confidentiality, and shared decision making; 4) caring: provider demonstrated personal concern beyond biomedical role through nonjudgmental and compassionate gestures, empowering statements, and persistent, committed behaviors; 5) emotional equality: provider shared personal information and feelings and was perceived by the participant as a friend. These IPV survivors identified dimensions of provider behavior that facilitate trust in their clinical relationship. Strengthening these provider behaviors may increase trust with patients and thus improve disclosure of and referral for IPV.

  17. Disparities in collaborative patient-provider communication about human papillomavirus (HPV) vaccination. (United States)

    Moss, Jennifer L; Gilkey, Melissa B; Rimer, Barbara K; Brewer, Noel T


    Healthcare providers may vary their communications with different patients, which could give rise to differences in vaccination coverage. We examined demographic disparities in parental report of collaborative provider communication and implications for human papillomavirus (HPV) vaccination. Participants were 4,124 parents who completed the National Immunization Survey-Teen about daughters ages 13-17. We analyzed disparities in collaborative communication (mutual information exchange, deliberation, and decision) and whether they mediated the relationship between demographic characteristics and HPV vaccine initiation. Half of parents (53%) in the survey reported collaborative communication. Poor, less educated, Spanish-speaking, Southern, and rural parents, and parents of non-privately insured and Hispanic adolescents, were least likely to report collaborative communication (all pcommunication accounted for geographic variation in HPV vaccination, specifically, the higher rates of uptake in the Northeast versus the South (mediation z=2.31, pcommunication showed widespread disparities, being least common among underserved groups. Collaborative communication helped account for differences-and lack of differences-in HPV vaccination among some subgroups of adolescent girls. Leveraging patient-provider communication, especially for underserved demographic groups, could improve HPV vaccination coverage.

  18. Effects of a Patient-Provider, Collaborative, Medication-Planning Tool: A Randomized, Controlled Trial

    Directory of Open Access Journals (Sweden)

    James F. Graumlich


    Full Text Available Among patients with various levels of health literacy, the effects of collaborative, patient-provider, medication-planning tools on outcomes relevant to self-management are uncertain. Objective. Among adult patients with type II diabetes mellitus, we tested the effectiveness of a medication-planning tool (Medtable™ implemented via an electronic medical record to improve patients’ medication knowledge, adherence, and glycemic control compared to usual care. Design. A multicenter, randomized controlled trial in outpatient primary care clinics. 674 patients received either the Medtable tool or usual care and were followed up for up to 12 months. Results. Patients who received Medtable had greater knowledge about indications for medications in their regimens and were more satisfied with the information about their medications. Patients’ knowledge of drug indication improved with Medtable regardless of their literacy status. However, Medtable did not improve patients’ demonstrated medication use, regimen adherence, or glycemic control (HbA1c. Conclusion. The Medtable tool supported provider/patient collaboration related to medication use, as reflected in patient satisfaction with communication, but had limited impact on patient medication knowledge, adherence, and HbA1c outcomes. This trial is registered with NCT01296633.

  19. How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study. (United States)

    Lewis, Sophie; Thomas, Samantha L; Blood, R Warwick; Castle, David J; Hyde, Jim; Komesaroff, Paul A


    Obesity stigma exists within many institutions and cultural settings. Most studies suggest that stigmatising experiences have a negative impact on individuals' health and social behaviours and outcomes. However, some studies indicate that obesity stigma can motivate individuals to lose weight. Limited research has examined weight-based stigma from the perspective of obese individuals, including their perceptions of, and responses to, the different types of weight-based stigma they face in their daily lives. This study advances knowledge about weight-based stigma by documenting how obese adults (mostly female) described the different types of obesity stigma that they faced, how they responded to this stigma, and how different types of stigma impact on health and social wellbeing. Semi-structured, qualitative interviews were conducted between April 2008 and March 2009 with a diverse sample of 141 obese Australian adults. Guided by Link and Phelan's (2006) categorisation of different types of discrimination, participants' experiences could be grouped into three distinct types of stigma: 1) Direct (e.g. being abused when using public transport); 2) Environmental (e.g. not being able to fit into seats on planes); and 3) Indirect (e.g. people staring at the contents of their supermarket trolley). Participants described that more subtle forms of stigma had the most impact on their health and social wellbeing. However, it was the interaction between direct, environmental and indirect stigma that created a barrier to participation in health-promoting activities. Participants rarely challenged stigma and often blamed themselves for stigmatising experiences. They also avoided situations where they perceived they would be stigmatised and constantly thought about how they could find a solution to their obesity. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: a cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals. (United States)

    Kim, Chang Eun; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Choi, Areum; Park, Ki Byung; Lee, Ho-Joo; Ha, In-Hyuk


    Treatment effectiveness holds considerable importance in the association between service quality and satisfaction in medical service studies. While complementary and alternative medicine (CAM) use grows more prominent, comprehensive evaluations of the quality of medical service at CAM-oriented hospitals are scarce. This study assesses the quality of medical services provided at a CAM-oriented hospital of Korean medicine using the service encounter system approach and analyzes the influence of treatment effectiveness on patient loyalty. A survey study using one-on-one interviews was conducted using a cross-sectional design in outpatients visiting one of fifteen Korean medicine facilities located throughout Korea. A total of 880 surveys were completed from June to July, 2014, and 728 surveys were included in the final analysis after excluding incomplete or incorrect questionnaires. The reliability and validity of the surveys was confirmed using Cronbach's alpha coefficient and confirmatory factor analysis, and a structural equation modeling analysis was performed to verify causality and association between factors (quality of medical service, treatment effectiveness, patient satisfaction, and intent to revisit). The measured factors of physician performance and quality of service procedures had a positive effect on treatment effectiveness. The impression of the facilities and environment directly impacted satisfaction rates for interpersonal-based medical service encounters, while treatment effectiveness positively affected satisfaction regarding quality of medical service. However, treatment effectiveness had a more significant effect on satisfaction compared to facilities and environment, and it indirectly affected satisfaction and directly influenced intent to revisit. Treatment effectiveness and satisfaction both positively influenced intent to revisit. The importance of treatment effectiveness should be recognized when examining quality of medical services, and

  1. Bringing it all back home: Understanding the medical difficulties encountered by newly released prisoners in New Orleans, Louisiana - a qualitative study. (United States)

    Vail, William Lee; Niyogi, Anjali; Henderson, Norris; Wennerstrom, Ashley


    Formerly incarcerated persons (FIPs) face a disproportionate risk of death and serious illness in the immediate post-release period. Therefore, it is a critical time to initiate community-based care for chronic illnesses and behavioural disorders. Little is known about the unique transitional health and social support needs of FIPs in Louisiana, which has the highest incarceration rate in the world. As the average age of prisoners in the United States rises, the release of older prisoners with chronic conditions will become increasingly common. The aim of this study was to explore the healthcare experiences of FIPs in Louisiana in order to inform delivery of services tailored to this population. This research was done in partnership with a community organisation that advocates for restoration of voting rights to FIPs and helps newly released individuals transition back into society. This organisation identified FIPs in the Greater New Orleans area, and from January to May 2015, we conducted 24 semi-structured, in-person, audio-recorded interviews at the community organisation's transitional living facility. The interviews assessed FIPs' experiences with and barriers to receiving healthcare during and after incarceration. These discussions also explored FIPs' desires for services and attitudes towards health and healthcare. Interviews were transcribed and independently coded by two researchers. Interviewees reported negative experiences with healthcare during incarceration, and limited health guidance during the pre-release process. Post-release concerns included lack of insurance, difficulty accessing care and medication, and interest in learning about healthy lifestyles. Results suggest a need for a formalised system of transitional healthcare for FIPs. Findings are being used to inform a pilot transitional care clinic in New Orleans, Louisiana. © 2017 John Wiley & Sons Ltd.

  2. "I am yet to encounter any survey that actually reflects my life": a qualitative study of inclusivity in sexual health research. (United States)

    Carrotte, Elise R; Vella, Alyce M; Bowring, Anna L; Douglass, Caitlin; Hellard, Margaret E; Lim, Megan S C


    Heteronormativity describes a set of norms and assumptions pertaining to heterosexual identities and binary gender. In 2015, we conducted our annual Sex, Drugs and Rock'n'Roll study, an online health survey of over 1000 Victorians aged 15-29 years. Feedback from participants suggested that our survey contained heteronormative language. In response to this, we aimed to make inclusive changes to our survey via consultation with young gender and sexually diverse (GSD) people. We conducted two semi-structured focus groups in Melbourne with a total of 16 participants (age range: 21-28 years). Participants were mostly cisgender women, and there were two transgender participants and one non-binary participant. Participants also had a range of sexual identities including lesbian, queer, bisexual, pansexual, and asexual. Focus group discussions were transcribed verbatim and analysed thematically. Most participants indicated heteronormativity affects their lives in multiple ways, noting its impacts on access to sexual healthcare, invalidating sexual experiences and miscommunication in forms and surveys. Overall, participants emphasised the need for sexual health research to avoid assumptions about behaviour, to be clear and eliminate question ambiguity and avoiding treating gender as binary. Participants also discussed how the Sex, Drugs and Rock'n'Roll survey could address a range of sexual behaviours and experiences, rather than focusing on penetrative sex, which many participants found invalidating. Our findings have important implications for future health surveys aimed at general populations. We present recommendations that encourage research to be more inclusive to ensure data collection from GSD participants is respectful and rigorous.

  3. “I am yet to encounter any survey that actually reflects my life”: a qualitative study of inclusivity in sexual health research

    Directory of Open Access Journals (Sweden)

    Elise R. Carrotte


    Full Text Available Abstract Background Heteronormativity describes a set of norms and assumptions pertaining to heterosexual identities and binary gender. In 2015, we conducted our annual Sex, Drugs and Rock’n’Roll study, an online health survey of over 1000 Victorians aged 15–29 years. Feedback from participants suggested that our survey contained heteronormative language. In response to this, we aimed to make inclusive changes to our survey via consultation with young gender and sexually diverse (GSD people. Methods We conducted two semi-structured focus groups in Melbourne with a total of 16 participants (age range: 21–28 years. Participants were mostly cisgender women, and there were two transgender participants and one non-binary participant. Participants also had a range of sexual identities including lesbian, queer, bisexual, pansexual, and asexual. Focus group discussions were transcribed verbatim and analysed thematically. Results Most participants indicated heteronormativity affects their lives in multiple ways, noting its impacts on access to sexual healthcare, invalidating sexual experiences and miscommunication in forms and surveys. Overall, participants emphasised the need for sexual health research to avoid assumptions about behaviour, to be clear and eliminate question ambiguity and avoiding treating gender as binary. Participants also discussed how the Sex, Drugs and Rock’n’Roll survey could address a range of sexual behaviours and experiences, rather than focusing on penetrative sex, which many participants found invalidating. Conclusions Our findings have important implications for future health surveys aimed at general populations. We present recommendations that encourage research to be more inclusive to ensure data collection from GSD participants is respectful and rigorous.

  4. Patient-Provider Communication: Experiences of Low-Wage-Earning Breast Cancer Survivors in Managing Cancer and Work. (United States)

    Nichols, Helen M; Swanberg, Jennifer E; Vanderpool, Robin C


    In 2017, there will be more than 250,000 new diagnoses of invasive breast cancer; most cases will occur in working-age women. The goal of this qualitative study was to explore low-wage-earning breast cancer survivors' experiences communicating with their oncology team about cancer and employment issues. Twenty-four low-wage-earning breast cancer survivors in the USA were interviewed in 2012 using a structured interview protocol. Sociodemographic data, cancer history, and patient-provider communication experiences regarding the management of cancer and work were collected. Interviews were analyzed using grounded theory strategy of constant comparative analysis. Low-wage-earning breast cancer survivors' experiences communicating with their oncology team about employment and cancer focused on three dimensions of patient-provider communication: extent, quality, and content. Over 70% of respondents reported no communication or only routine communication with their providers regarding work; three quarters of women reported poor or standard communication quality, and content of work-related communication covered scheduling issues, work absences, continuing to work during treatment, and financial concerns. Communication between oncology care teams and low-wage-earning cancer patients is critical to the successful management of treatment and work responsibilities given the vulnerable employment situation of these women. There is a need for education of oncology team members about how cancer and its treatment can impact employment for all workers, but especially for low-wage workers, thereby allowing the care team to address these issues proactively and help patients successfully manage both cancer treatment and work responsibilities.

  5. First-Year Principal Encounters Homophobia (United States)

    Retelle, Ellen


    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.

  6. Encounter Group Effects of Soccer Team Performance. (United States)

    Magen, Zipora


    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)

  7. Close stellar encounters in globular clusters

    International Nuclear Information System (INIS)

    Bailyn, C.D.


    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)

  8. Patient-provider relationship predicts mental and physical health indicators for HIV-positive men who have sex with men. (United States)

    Bankoff, Sarah M; McCullough, Mary B; Pantalone, David W


    We used secondary data analysis to examine associations among aspects of patient-provider relationships and mental and physical health indicators. Positive patient perceptions of patient-provider relationships were associated with fewer mental health symptoms in this outpatient sample of HIV-positive men who have sex with men (N = 171). Regression analyses revealed the role of anxiety and depression in explaining associations between two aspects of patient-provider relationships (i.e. quality of information offered and provider interactional style) and health-related quality of life. The findings demonstrated the importance of patient-provider relationships to improving physical health and functioning and maintaining engagement in care, among HIV-positive men who have sex with men.

  9. Participants in urban Mexican male homosexual encounters. (United States)

    Carrier, J M


    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.

  10. Special Relativity - A First Encounter

    International Nuclear Information System (INIS)

    Gough, W


    follows. Of particular interest here are sections on the effect of relativity on navigational aids, the 'possibility' of travel to distant stars and astronomical issues including star collapse and dark matter. The last chapter reviews the status of understanding of the speed of light, from Romer's early measurements to mid-20th century experiments to put upper limits on any possible dependence on the motion of the source. The question of whether velocities faster than c are possible is considered. The rest of the chapter has worthy but unrelated topics which could perhaps have been better placed, for example the transformation of momentum, energy and force. The last few pages are rather deep, and too compressed to be very helpful. In this book, where the emphasis is on conciseness, it is unfortunate that the author found no room for exercises and worked examples. Despite this, I would recommend it to a good undergraduate who is studying relativity for the first time, looking for a concise inexpensive book, and prepared to use other sources for exercises. (book review)

  11. 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.

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

    International Nuclear Information System (INIS)

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


    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)

  13. Termite: Emulation Testbed for Encounter Networks

    Directory of Open Access Journals (Sweden)

    Rodrigo Bruno


    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.

  14. Determinants of customer satisfaction with service encounter

    Directory of Open Access Journals (Sweden)

    Ariana Nefat


    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.

  15. Unethical Behaviours Preservice Teachers Encounter on Social Networks (United States)

    Deveci Topal, Arzu; Kolburan Gecer, Aynur


    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…

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

    NARCIS (Netherlands)

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


    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

  17. 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 ...

  18. Difficulties Encountered by Academicians in Academic Research Processes in Universities (United States)

    Yalçin, Sinan; Altun Yalçin, Sema


    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…

  19. 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.

  20. The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus. (United States)

    Marceau, Lisa; McKinlay, John; Shackelton, Rebecca; Link, Carol


    To estimate the relative contribution of patient attributes, provider characteristics and organizational features of the doctors' workplace to the diagnosis and management of diabetes. In a factorial experimental design doctors (n = 192) viewed clinically authentic vignettes of 'patients' presenting with identical signs and symptoms. Doctor subjects were primary care doctors stratified according to gender and level of experience. During an in-person interview scheduled between real patients, doctors were asked how they would diagnosis and manage the vignette 'patients' in clinical practice. This study considered the relative contribution of patient, doctor and organizational factors. Taken together patient attributes explained only 4.4% of the variability in diabetes diagnosis. Doctor factors explained only 2.0%. The vast majority of the explained variance in diabetes diagnosis was due to organizational factors (14.3%). Relative contributions combined (patient, provider, organizational factors) explained only 20% of the total variance. Attempts to reduce health care variations usually focus on the education/activation of patients, or increased training of doctors. Our findings suggest that shifting quality improvement efforts to the area which contributes most to the creation and amplification of variations (organizational influences) may produce better results in terms of reduced variations in health care associated with diabetes. © 2010 Blackwell Publishing Ltd.

  1. Mobile-based patient-provider communication in cancer survivors: The roles of health literacy and patient activation. (United States)

    Jiang, Shaohai; Hong, Y Alicia


    Thanks to rapid penetration of mobile tools, more and more cancer survivors have adopted mobile-based patient-provider communication (MBPPC). The relationship between MBPPC and patients' health outcomes, however, remains unclear; how health literacy and patient activation interact with such relationship is unexplored. Data were drawn from National Cancer Institute's Health Information National Trends Survey 4 Cycle 3. A sample of 459 cancer survivors were included in the analysis. Based on the 3-stage model of health promotion using interactive media, this study empirically tested a moderated mediation model. MBPPC (eg, patient use of email, text message, mobile app, and social media to communicate with providers) had no direct effect on cancer survivors' emotional health. Instead, health literacy completely mediated this path. Patient activation positively moderated the effect of health literacy on emotional health and further increased the indirect effect of MBPPC on emotional health. MBPPC alone does not directly result in better emotional health outcomes; health literacy is the key to realize its health benefits; patient activation significantly strengthens the effects of MBPPC. As we embrace the mHealth movement, innovative programs are needed to promote MBPPC, and improve health literacy and activation of cancer survivors, particularly in underserved communities, to reduce health disparities. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Exploring the Cervical Cancer Screening Experiences of Black Lesbian, Bisexual, and Queer Women: The Role of Patient-Provider Communication. (United States)

    Agénor, Madina; Bailey, Zinzi; Krieger, Nancy; Austin, S Bryn; Gottlieb, Barbara R


    Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, focus group discussions were conducted in Boston and Cambridge, Massachusetts between November and December 2012. Using purposive sampling methods, the authors enrolled 18 black LBQ women who participated in one of four focus groups. Using thematic analysis, patient-provider communication was identified, which consisted of four sub-themes--health care provider communication style and demeanor; heteronormative provider assumptions; heterosexism, racism, and classism; and provider professional and sociodemographic background--as the most salient theme. Participants reported fears and experiences of multiple forms of discrimination and preferred receiving care from providers who were knowledgeable about same-sex sexual health and shared their life experiences at the intersection of gender, race/ethnicity, and sexual orientation. The cervical cancer screening experiences of black LBQ women would be improved by training all health care providers in same-sex sexual health, offering opportunities for clinicians to learn about the effects of various forms of discrimination on women's health care, and increasing the presence of LBQ women of color in health care settings.

  3. Plankton motility patterns and encounter rates

    DEFF Research Database (Denmark)

    Visser, Andre; Kiørboe, Thomas


    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...

  4. Entering a Crack: An Encounter with Gossip (United States)

    Henderson, Linda


    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.…

  5. 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 ...

  6. Avoidance: From threat encounter to action execution

    NARCIS (Netherlands)

    Arnaudova, I.


    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

  7. Encounters on a Shape-changing Bench

    DEFF Research Database (Denmark)

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


    ; 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...

  8. Patient-provider communication about medication use at the community pharmacy counter.

    NARCIS (Netherlands)

    Dijk, M. van; Blom, L.; Koopman, L.; Philbert, D.; Koster, E.; Bouvy, M.; Dijk, L. van


    Objective: The objectives of this study were to, first, describe the information exchanged between pharmacy staff and patients about prescribed medication at the community pharmacy counter, and second, to investigate to what extent this met professional medication counselling guidelines. Methods:

  9. Effects of Patient-Provider Race Concordance and Smoking Status on Lung Cancer Risk Perception Accuracy among African Americans (United States)

    Persky, Susan; Kaphingst, Kimberly A.; Allen, Vincent C.; Senay, Ibrahim


    Background Communication of lung cancer risk information between providers and African-American patients occurs in a context marked by race-based health disparities. Purpose A controlled experiment assessed whether perceived physician race influenced African-American patients’ (n=127) risk perception accuracy following the provision of objective lung cancer risk information. Methods Participants interacted with a virtual reality-based, simulated physician who provided personalized cancer risk information. Results Participants who interacted with a racially discordant virtual doctor were less accurate in their risk perceptions at post-test than those who interacted with a concordant virtual doctor, F(1,94)=4.02, p=.048. This effect was amplified among current smokers. Effects were not mediated by trust in the provider, engagement with the health care system, or attention during the encounter. Conclusions The current study demonstrates that African-American patients’ perceptions of a doctor’s race are sufficient to independently impact their processing of lung cancer risk information. PMID:23389688

  10. Effects of patient-provider race concordance and smoking status on lung cancer risk perception accuracy among African-Americans. (United States)

    Persky, Susan; Kaphingst, Kimberly A; Allen, Vincent C; Senay, Ibrahim


    Communication of lung cancer risk information between providers and African-American patients occurs in a context marked by race-based health disparities. A controlled experiment assessed whether perceived physician race influenced African-American patients' (n = 127) risk perception accuracy following the provision of objective lung cancer risk information. Participants interacted with a virtual reality-based, simulated physician who provided personalized cancer risk information. Participants who interacted with a racially discordant virtual doctor were less accurate in their risk perceptions at post-test than those who interacted with a concordant virtual doctor, F(1,94) = 4.02, p = .048. This effect was amplified among current smokers. Effects were not mediated by trust in the provider, engagement with the health care system, or attention during the encounter. The current study demonstrates that African-American patients' perceptions of a doctor's race are sufficient to independently impact their processing of lung cancer risk information.

  11. Close Encounters of Lymphoid Cells and Bacteria (United States)

    Cruz-Adalia, Aranzazu; Veiga, Esteban


    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. Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review. (United States)

    Voruganti, Teja; Grunfeld, Eva; Makuwaza, Tutsirai; Bender, Jacqueline L


    Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14

  13. Very massive runaway stars from three-body encounters (United States)

    Gvaramadze, Vasilii V.; Gualandris, Alessia


    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.

  14. Adherence to Cardiovascular Disease Medications: Does Patient-Provider Race/Ethnicity and Language Concordance Matter?


    Traylor, Ana H.; Schmittdiel, Julie A.; Uratsu, Connie S.; Mangione, Carol M.; Subramanian, Usha


    BACKGROUND: Patient-physician race/ethnicity and language concordance may improve medication adherence and reduce disparities in cardiovascular disease (CVD) by fostering trust and improved patient-physician communication. OBJECTIVE: To examine the association of patient race/ethnicity and language and patient-physician race/ethnicity and language concordance on medication adherence rates for a large cohort of diabetes patients in an integrated delivery system. DESIGN: We studied 131,277 adul...

  15. Interrelation between Patient Satisfaction and Patient-Provider Communication in Diabetes Management

    Directory of Open Access Journals (Sweden)

    Ayse Basak Cinar


    Full Text Available The present study aims to assess how patient satisfaction with medical provider-patient communication can affect oral health, diabetes, and psychobehavioural measures among type 2 diabetes (T2DM patients. It is part of a prospective intervention study among randomly selected T2DM patients, in Turkey. The data analyzed were Community Periodontal Need Index (CPI, HbA1c, patient satisfaction with communication, and psychobehavioural variables. Data was collected initially and at the end of the intervention. The participants were allocated to either health coaching (HC or health education (HE. At baseline, there were no statistical differences between the HC and the HE groups on any of the measures (P>0.05. Patients in both the HC and the HE groups had low satisfaction with communication. At postintervention, the increase in patient satisfaction with communication in the HC group was significantly higher than that in the HE group (P=0.001. Principal component analysis revealed that patient satisfaction with communication shared the same cluster with clinical measures (CPI and HbA1c and quality of life in the HC group. In conclusion, the present study showed, to our knowledge for the first time, that overall patient satisfaction with medical care provider-patient communication, empowered by HC approach, was interrelated with well-being of T2DM patients, in terms of psychobehavioural and clinical measures.

  16. Predictors of relational continuity in primary care: patient, provider and practice factors. (United States)

    Kristjansson, Elizabeth; Hogg, William; Dahrouge, Simone; Tuna, Meltem; Mayo-Bruinsma, Liesha; Gebremichael, Goshu


    Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of care provided by different models of primary care. This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient's perspective. Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider

  17. Patient-Provider Communication: Does Electronic Messaging Reduce Incoming Telephone Calls? (United States)

    Dexter, Eve N; Fields, Scott; Rdesinski, Rebecca E; Sachdeva, Bhavaya; Yamashita, Daisuke; Marino, Miguel


    Internet-based patient portals are increasingly being implemented throughout health care organizations to enhance health and optimize communication between patients and health professionals. The decision to adopt a patient portal requires careful examination of the advantages and disadvantages of implementation. This study aims to investigate 1 proposed advantage of implementation: alleviating some of the clinical workload faced by employees. A retrospective time-series analysis of the correlation between the rate of electronic patient-to-provider messages-a common attribute of Internet-based patient portals-and incoming telephone calls. The rate of electronic messages and incoming telephone calls were monitored from February 2009 to June 2014 at 4 economically diverse clinics (a federally qualified health center, a rural health clinic, a community-based clinic, and a university-based clinic) related to 1 university hospital. All 4 clinics showed an increase in the rate of portal use as measured by electronic patient-to-provider messaging during the study period. Electronic patient-to-provider messaging was significantly positively correlated with incoming telephone calls at 2 of the clinics (r = 0.546, P electronic patient-to-provider messaging was associated with increased use of telephone calls in 2 of the study clinics. While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change not be based on the idea that it will alleviate clinical workload. © Copyright 2016 by the American Board of Family Medicine.

  18. 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

  19. Patient-provider communication over social media: perspectives of adolescents with psychiatric illness. (United States)

    van Rensburg, Samuel H; Klingensmith, Katherine; McLaughlin, Paige; Qayyum, Zheala; van Schalkwyk, Gerrit I


    Social media is an increasingly dominant platform for communication, especially among adolescents. Statements from professional bodies and a growing body of empirical evidence support a role for social media in improving provider-patient interactions. In psychiatry, particular concerns exist about the suitability of this style of communication. Very limited data are available exploring how patients would like to incorporate social media into their communication with their psychiatric providers. We conducted a qualitative study with 20 adolescents attending the Yale Psychiatric Hospital Intensive Outpatient Programme. Interviews were analysed using inductive thematic analysis. Participants highlighted how social media could allow for constant access to a mental health provider, provide a less anxiety-provoking mode of communication, and allow for them to be monitored in a more on-going fashion. However, participants also identified many potential risks associated with these applications, including the potential for anxiety if a provider was not able to respond immediately, and a sense that online interactions would be less rich overall. Our findings suggest that adolescents are open to the idea of communicating with mental health providers over social media and are able to describe a number of instances where this could be of value. The risks participants described, as well as concerns raised by existing literature, indicate the need for further work and protocol development in order for social media to be a feasible tool for communication between providers and adolescents with psychiatric illness. © 2015 John Wiley & Sons Ltd.

  20. Challenging Obesity: Patient, Provider, and Expert Perspectives on the Roles of Available and Emerging Nonsurgical Therapies (United States)

    Apovian, Caroline M.; Garvey, W. Timothy; Ryan, Donna H.


    Objective Adult obesity is recognized as a chronic disease. According to principles of chronic disease management, healthcare professionals should work collaboratively with patients to determine appropriate therapeutic strategies that address overweight and obesity, specifically considering a patient’s disease status in addition to their individual needs, preferences, and attitudes regarding treatment. A central role and responsibility of healthcare professionals in this process is to inform and educate patients about their treatment options. Although current recommendations for the management of adult obesity provide general guidance regarding safe and proper implementation of lifestyle, pharmacological, and surgical interventions, healthcare professionals need awareness of specific evidence-based information that supports individualized clinical application of these therapies. More specifically, healthcare professionals should be up-to-date on approaches that promote successful lifestyle management and be knowledgeable about newer weight loss pharmacotherapies, so they can offer patients with obesity a wide range of options to personalize their treatment. Accordingly, this educational activity has been developed to provide participants with the latest information on treatment recommendations and therapeutic advances in lifestyle intervention and pharmacotherapy for adult obesity management. Design and Methods This supplement is based on the content presented at a live CME symposium held in conjunction with ObesityWeek 2014. Results This supplement provides an expert summary of current treatment recommendations and recent advances in nonsurgical therapies for the management of adult obesity. Patient and provider perspectives on obesity management are highlighted in embedded video clips available via QR codes, and new evidence will be applied using clinically relevant case studies. Conclusions This supplement provides a topical update of obesity management

  1. Patient-Provider Discussions About Strategies to Limit Air Pollution Exposures. (United States)

    Mirabelli, Maria C; Damon, Scott A; Beavers, Suzanne F; Sircar, Kanta D


    Exposure to air pollution negatively affects respiratory and cardiovascular health. The objective of this study was to describe the extent to which health professionals report talking about how to limit exposure to air pollution during periods of poor air quality with their at-risk patients. In 2015, a total of 1,751 health professionals completed an online survey and reported whether they talk with their patients about limiting their exposure to air pollution. In 2017, these data were analyzed to assess the frequency that health professionals in primary care, pediatrics, obstetrics/gynecology, and nursing reported talking about limiting air pollution exposure with patients who have respiratory or cardiovascular diseases, were aged ≤18 years, were aged ≥65 years, or were pregnant women. Frequencies of positive responses were assessed across categories of provider- and practice-level characteristics. Overall, 714 (41%) respondents reported ever talking with their patients about limiting their exposure to air pollution. Thirty-four percent and 16% of providers specifically reported talking with their patients with respiratory or cardiovascular disease diagnoses, respectively. Percentages of health professionals who reported talking with their patients about limiting air pollution exposure were highest among respondents in pediatrics (56%) and lowest among respondents in obstetrics/gynecology (0%). Despite the well-described health effects of exposure to air pollution, the majority of respondents did not report talking with their patients about limiting their exposure to air pollution. These findings reveal clear opportunities to improve awareness about strategies to limit air pollution exposure among sensitive groups of patients and their health care providers. Published by Elsevier Inc.

  2. Athletic Training Student Core Competency Implementation During Patient Encounters. (United States)

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


      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

  3. 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...

  4. Self. Propagating | a strategy of encounter |

    Directory of Open Access Journals (Sweden)

    Gabrielle Lorraine Fletcher


    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. Correlation between patients' reasons for encounters/health problems and population density in Japan: a systematic review of observational studies coded by the International Classification of Health Problems in Primary Care (ICHPPC) and the International Classification of Primary care (ICPC). (United States)

    Kaneko, Makoto; Ohta, Ryuichi; Nago, Naoki; Fukushi, Motoharu; Matsushima, Masato


    The Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients' reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients' RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system. We conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015. We employed population density as index of accessibility. We calculated Spearman's rank correlation coefficient to examine the correlation between the proportion of "non-internal medicine-related" RFEs and health problems in each study area in consideration of the population density. We found 17 studies with diverse designs and settings. Among these studies, "non-internal medicine-related" RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, "non-internal medicine-related" health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of "non-internal medicine-related" RFEs and health problems. This is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan

  6. Does patient-provider gender concordance affect mental health care received by primary care patients with major depression? (United States)

    Chan, Kitty S; Bird, Chloe E; Weiss, Robert; Duan, Naihua; Meredith, Lisa S; Sherbourne, Cathy D


    We sought to determine whether patient-provider gender concordance influences the detection and care of depression and comorbid anxiety and substance use in patients with major depression Cross-sectional analyses of baseline patient survey data linked with provider data were performed. Data based on routine primary care visits in clinics from a variety of health systems serving diverse patient populations across the United States. Participants all had major depression. Depression care was examined in the Quality Improvement for Depression (QID) Collaboration sample (n patients = 1,428, n providers = 389). In a subanalysis of data solely from 714 patients and 157 providers from Partners-In-Care, one of the projects participating in QID, we also examined detection of anxiety disorder and alcohol or drug problems. Rates of detection and care of mental health problems in primary care were low even among patients with major depression. Except for anxiety counseling in female patients, patient-provider gender concordance did not improve care as hypothesized. However, female providers were more likely to counsel on anxiety and less likely to counsel on alcohol or drug use than male providers. Female patients were less likely to be counseled on alcohol or drug use compared with male patients. Detection and care of mental health and substance use problems for patients with major depression is not influenced by patient-provider gender concordance. However, depressed female patients may have greater unmet needs for alcohol and drug use counseling than their male counterparts.

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

    Directory of Open Access Journals (Sweden)

    Tanawin Nunthaphanich


    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.

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

    Directory of Open Access Journals (Sweden)

    Amanish Singh Shinh


    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.

  9. Multiple Codes, Multiple Impressions: An Analysis of Doctor-Client Encounters in Nigeria (United States)

    Odebunmi, Akin


    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…

  10. Effects of Soundscapes on Perceived Crowding and Encounter Norms (United States)

    Kim, Sang-Oh; Shelby, Bo


    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.

  11. Strengthening student communication through pediatric simulated patient encounters

    Directory of Open Access Journals (Sweden)

    Ryan Whitt


    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.

  12. Scientific misconduct encountered by APAME journals: an online survey. (United States)

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


    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. The Reality of Encounters with Local Life in Other Cultures

    Directory of Open Access Journals (Sweden)

    Jin-Young Kim


    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,, 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.

  14. Encounter Probability of Individual Wave Height

    DEFF Research Database (Denmark)

    Liu, Z.; Burcharth, H. F.


    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....

  15. Brief encounters: Assembling cosmetic surgery tourism. (United States)

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


    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.

  16. Angular distribution of binary encounter electrons

    International Nuclear Information System (INIS)

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


    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

  17. Focus Groups as Transformative Spiritual Encounters

    Directory of Open Access Journals (Sweden)

    Sharon Moloney PhD


    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.

  18. Encountering women veterans with military sexual trauma. (United States)

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


    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.

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

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


    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…

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

    DEFF Research Database (Denmark)

    Sørensen, Jannick Kirk; Henten, Anders


    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...

  1. Innovation from the ICT-based service encounter

    DEFF Research Database (Denmark)

    Henten, Anders


    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...

  2. Association of volume of patient encounters with residents' in-training examination performance. (United States)

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


    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.

  3. 'I am treated well if I adhere to my HIV medication': putting patient-provider interactions in context through insights from qualitative research in five sub-Saharan African countries. (United States)

    Ondenge, Ken; Renju, Jenny; Bonnington, Oliver; Moshabela, Mosa; Wamoyi, Joyce; Nyamukapa, Constance; Seeley, Janet; Wringe, Alison; Skovdal, Morten


    The nature of patient-provider interactions and communication is widely documented to significantly impact on patient experiences, treatment adherence and health outcomes. Yet little is known about the broader contextual factors and dynamics that shape patient-provider interactions in high HIV prevalence and limited-resource settings. Drawing on qualitative research from five sub-Saharan African countries, we seek to unpack local dynamics that serve to hinder or facilitate productive patient-provider interactions. This qualitative study, conducted in Kisumu (Kenya), Kisesa (Tanzania), Manicaland (Zimbabwe), Karonga (Malawi) and uMkhanyakude (South Africa), draws upon 278 in-depth interviews with purposively sampled people living with HIV with different diagnosis and treatment histories, 29 family members of people who died due to HIV and 38 HIV healthcare workers. Data were collected using topic guides that explored patient testing and antiretroviral therapy treatment journeys. Thematic analysis was conducted, aided by NVivo V.8.0 software. Our analysis revealed an array of inter-related contextual factors and power dynamics shaping patient-provider interactions. These included (1) participants' perceptions of roles and identities of 'self' and 'other'; (2) conformity or resistance to the 'rules of HIV service engagement' and a 'patient-persona'; (3) the influence of significant others' views on service provision; and (4) resources in health services. We observed that these four factors/dynamics were located in the wider context of conceptualisations of power, autonomy and structure. Patient-provider interaction is complex, multidimensional and deeply embedded in wider social dynamics. Multiple contextual domains shape patient-provider interactions in the context of HIV in sub-Saharan Africa. Interventions to improve patient experiences and treatment adherence through enhanced interactions need to go beyond the existing focus on patient-provider communication

  4. Assortment of encounters and evolution of cooperativeness. (United States)

    Eshel, I; Cavalli-Sforza, L L


    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. Aging and Osteoarthritis: An Inevitable Encounter?

    Directory of Open Access Journals (Sweden)

    Thomas Hügle


    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.

  6. Thermal fluctuation problems encountered in LMFRs

    International Nuclear Information System (INIS)

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


    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

  7. LHC experiences close encounters with UFOs

    CERN Multimedia

    Mike Lamont for the LHC Team


    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


    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 (United States)

    Pendergrast, Robert A.


    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


    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. 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


    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

  12. The importance of motivation, weapons, and foul odors in driving encounter competition in carnivores. (United States)

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


    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.

  13. The organisational stressors encountered by athletes with a disability. (United States)

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


    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.

  14. A metasynthesis of patient-provider communication in hospital for patients with severe communication disabilities: informing new translational research. (United States)

    Hemsley, Bronwyn; Balandin, Susan


    Poor patient-provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication.

  15. Patient-provider communication and reproductive health among HIV-positive women in Rio de Janeiro, Brazil. (United States)

    Malta, Monica; Todd, Catherine S; Stibich, Mark A; Garcia, Thais; Pacheco, Diego; Bastos, Francisco I


    To qualitatively assess the influence of patient-provider communication on contraceptive choice among HIV-positive women in the context of universal antiretroviral therapy (ART) access. Focus group discussions (FGD; n=3), in-depth (IDI; n=15) and freelist interviews (FLI; n=36) were conducted with HIV-positive women aged 18-40 years recruited from public health units in Rio de Janeiro/Brazil. Of 70 participants, 49 used ART and the median time since HIV diagnosis was 6 years (range: 1-18). The majority of participants (71.4%) reported some degree of dissatisfaction with their health providers (usually lack of open dialogue) and a few reported experiences of stigma/prejudice during appointments. Intra, interpersonal and social factors modulated behaviors and reproductive health decisions, and those issues were rarely addressed by providers during HIV clinical care. Despite dramatic increases in survival and life quality after universal ART implementation in Brazil, reproductive health issues are neglected by multiple cadres of HIV health providers. Communication on reproductive health issues remains fragmented and potentially contradictory, compromising care in these settings. Adequate provider training to address reproductive health-related issues in a comprehensive, culturally sensitive manner and improved integration of HIV and reproductive health care are urgently needed in this setting. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  16. Consumer Health Informatics: The Application of ICT in Improving Patient-Provider Partnership for a Better Health Care. (United States)

    Abaidoo, Benjamin; Larweh, Benjamin Teye


    There is a growing interest concerning the potential of ICT solutions that are customized to consumers. This emerging discipline referred to as consumer health informatics (CHI) plays a major role in providing information to patients and the public, and facilitates the promotion of self-management. The concept of CHI has emerged out of the desire of most patients to shoulder responsibilities regarding their health and a growing desire of health practitioners to fully appreciate the potential of the patient. To describe the role of ICT in improving the patient-provider partnership in consumer health informatics. Systematic reviewing of literature, identification of reference sources and formulation of search strategies and manual search regarding the significance of developed CHI applications in healthcare delivery. New consumer health IT applications have been developed to be used on a variety of different platforms, including the Web, messaging systems, PDAs, and cell phones. These applications assists patients with self-management through reminders and prompts, delivery of real-time data on a patient's health condition to patients and providers, web-based communication and personal electronic health information. New tools are being developed for the purposes of providing information to patients and the public which has enhanced decision making in health matters and an avenue for clinicians and consumers to exchange health information for personal and public use. This calls for corroboration among healthcare organizations, governments and the ICT industry to develop new research and IT innovations which are tailored to the health needs of the consumer.

  17. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes. (United States)

    Jesus, Tiago Silva; Silva, Isabel Lopes


    There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) 'how' rehabilitation outcomes can be improved by communication; and (b) through 'which' elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the '4 Rehab Communication Elements' deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the '4 Rehab Communication Elements'. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes. © The Author(s) 2015.

  18. 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...


    International Nuclear Information System (INIS)

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


    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.

  20. Visuality – Textuality: An Uncanny Encounter

    Directory of Open Access Journals (Sweden)

    Elisabeth Bronfen


    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

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

    Directory of Open Access Journals (Sweden)

    Tim D Smith


    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

  2. Due Regard Encounter Model Version 1.0 (United States)


    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

  3. Patient, Provider, and System Factors Associated With Failure to Follow-Up Elevated Glucose Results in Patients Without Diagnosed Diabetes

    Directory of Open Access Journals (Sweden)

    Michael E. Bowen


    Full Text Available Background: Although elevated glucose values are strongly associated with undiagnosed diabetes, they are frequently overlooked. Patient, provider, and system factors associated with failure to follow-up elevated glucose values in electronic medical records (EMRs are not well described. Methods: We conducted a chart review in a comprehensive EMR with a patient portal and results management features. Established primary care patients with no known diagnosis of diabetes and ≥ 1 glucose value >125 mg/dL were included. Follow-up failure was defined as (1 no documented comment on the glucose value or result communication to the patient within 30 days or (2 no hemoglobin A 1c (HbA 1c ordered within 30 days or resulted within 12 months. Associations were examined using Wilcoxon and χ 2 tests. Results: Of 150 charts reviewed, 97 met inclusion criteria. The median glucose was 133 mg/dL, and 20% of patients had multiple values >125 mg/dL. Only 36% of elevated glucose values were followed up. No associations were observed between patient characteristics, diabetes risk factors, or provider characteristics and follow-up failures. Automated flagging of glucose values ≥140 mg/dL by highlighting them red in the EMR was not associated with improved follow-up (46% vs 32%; P = .19. Even when follow-up occurred (n = 35, only 31% completed gold standard diabetes testing (HbA 1c within 12 months. Of the resulted HbA 1c tests (n = 11, 55% were in the prediabetes range (5.7%-6.4%. Conclusions: Two-thirds of elevated glucose values were not followed up, despite EMR features facilitating results management. Greater understanding of the results management process and improved EMR functionalities to support results management are needed.

  4. 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.

  5. Modifications in children's goals when encountering obstacles to conflict resolution. (United States)

    Troop-Gordon, Wendy; Asher, Steven R


    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.

  6. Key components of effective collaborative goal setting in the chronic care encounter. (United States)

    Bigi, Sarah


    Collaborative goal setting in patient-provider communication with chronic patients is the phase in which--after collecting the data regarding the patient's health--it is necessary to make a decision regarding the best therapy and behaviors the patient should adopt until the next encounter. Although it is considered a pivotal phase of shared decision making, there remain a few open questions regarding its components and its efficacy: What are the factors that improve or impede agreement on treatment goals and strategies?; What are the 'success conditions' of collaborative goal setting?; How can physicians effectively help patients make their preferences explicit and then co-construct with them informed preferences to help them reach their therapeutic goals? Using the theoretical framework of dialogue types, an approach developed in the field of Argumentation Theory, it will be possible to formulate hypotheses on the success conditions' and effects on patient commitment of collaborative goal setting.

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

    NARCIS (Netherlands)

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


    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

  8. High-velocity runaway stars from three-body encounters (United States)

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


    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.

  9. Creating illusions of past encounter through brief exposure. (United States)

    Brown, Alan S; Marsh, Elizabeth J


    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.

  10. Value creation and knowledge development in tourism experience encounters

    DEFF Research Database (Denmark)

    Sørensen, Flemming; Jensen, Jens Friis


    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....

  11. The space of togetherness--a caring encounter. (United States)

    Holopainen, Gunilla; Kasén, Anne; Nyström, Lisbet


    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.

  12. Researching Africa : Explorations of everyday African encounters

    NARCIS (Netherlands)

    Bruijn, de M.E.; Merolla, D.


    The studies in this volume are the result of research carried out by students of the Research Masters in African Studies (RMAS) at Leiden University who graduated in 2008. The studies cover such areas as conflict, democracy, migration, urban and rural studies, language, communication and youth. An

  13. Role of Self-Efficacy in the Relationship Between Patient-Provider Relationships and Psychological Insulin Resistance Among Patients with Type 2 Diabetes


    Nam, Soohyun; Nam, Soohyun; Song, Youngshin


    Psychological insulin resistance (PIR) affects patients’ self-care behaviors and quality of life due to the delay of insulin treatment for optimal glycemic control. Although effective patient-provider communication and relationships have been shown to improve patients’ overall treatment adherence and attitude toward treatment, little is known about the potential mechanisms by which effective patient-provider communication and relationships decrease PIR and whether these relationships are medi...

  14. Spatial capture-recapture models for search-encounter data (United States)

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


    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.

  15. Switches to English during French Service Encounters: Relationships with L2 French Speakers' Willingness to Communicate and Motivation (United States)

    McNaughton, Stephanie; McDonough, Kim


    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…

  16. Problems Encountered by Religious Vocational Secondary School and Other Secondary School Students in Physical Education and Sports Activities (United States)

    Bar, Mustafa; Yaman, Menzure Sibel; Hergüner, Gülten


    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"…

  17. Large-Scale Survey Findings Inform Patients’ Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment (United States)

    Patel, Nitin R; Lind, Jason D; Antinori, Nicole


    Background Secure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users’ experiences in using secure email messaging. Objective To quantitatively assess veteran patients’ experiences in using secure email messaging in a large patient sample. Methods A cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations’ Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance. Results The majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy

  18. Large-Scale Survey Findings Inform Patients' Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment. (United States)

    Haun, Jolie N; Patel, Nitin R; Lind, Jason D; Antinori, Nicole


    Secure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users' experiences in using secure email messaging. To quantitatively assess veteran patients' experiences in using secure email messaging in a large patient sample. A cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations' Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance. The majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy-to-use (P≤.001) communication tool, compared

  19. Brain systems underlying encounter expectancy bias in spider phobia. (United States)

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


    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.

  20. Encountering a cartwheeling princess: relational psychoanalytic ...

    African Journals Online (AJOL)

    Objective: This study was conducted to demonstrate the use and process of contemporary relational psychoanalytic child therapy to address the interpersonal implications of attention deficit hyperactivity disorder and interlinked insecure attachment processes. Method: This therapy case study explicates the seven-month ...

  1. Language Policy, Multilingual Encounters, and Transnational Families (United States)

    King, Kendall A.


    The study of what has come to be known as family language policy has evolved and expanded significantly over the last hundred years, from its early beginnings in the diary studies of Ronjat and Leopold, to the interdisciplinary and transnational research found in this thematic issue of the "Journal of Multilingual and Multicultural…


    Directory of Open Access Journals (Sweden)

    Sangeeta MALIK


    Full Text Available This study explores; the rapid growth of the adult learner population is increasing the demand of distance learning techniques. The demographic study of the learners will help target the adult learner population and proper training will help organizations to develop course materials and techniques appropriately.

  3. Stereotype threat and racial differences in citizens' experiences of police encounters. (United States)

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


    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).

  4. 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.


    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...

  5. AIDS: Problems encountered in anthropological research

    Directory of Open Access Journals (Sweden)

    G. Boulogne


    Full Text Available Medical science has up to now not discovered a means to fight HIV and it is obvious that the epidemic can only be controlled by prevention. Those disciplines from the humanities that could make the most meaningful contribution in this regard would be those that study, or ought to study sexuality, namely, psychology, sociology and anthropology. The communication sciences and nursing belong here as well and ought to play a crucial role.

  6. The spacecraft encounters of Comet Halley (United States)

    Asoka Mendis, D.; Tsurutani, Bruce T.


    The characteristics of the Comet Halley spacecraft 'fleet' (VEGA 1 and VEGA 2, Giotto, Suisei, and Sakigake) are presented. The major aims of these missions were (1) to discover and characterize the nucleus, (2) to characterize the atmosphere and ionosphere, (3) to characterize the dust, and (4) to characterize the nature of the large-scale comet-solar wind interaction. While the VEGA and Giotto missions were designed to study all four areas, Suisei addressed the second and fourth. Sakigake was designed to study the solar wind conditions upstream of the comet. It is noted that NASA's Deep Space Network played an important role in spacecraft tracking.

  7. Engineering Encounters: Elephant Trunks and Dolphin Tails (United States)

    Hefty, Lukas


    This article describes how one class at Douglas Jamerson Elementary School in St. Petersburg, Florida, a center for engineering and mathematics, incorporated an Engineering Design Process into its curriculum. At Jamerson Elementary, all students in kindergarten through fifth grade engage in teacher-created, integrated engineering units of study,…

  8. Pulmonary venous abnormalities encountered on pre ...

    African Journals Online (AJOL)

    Multidetector computed tomography (MDCT) elegantly renders pulmonary venous anatomy. With increasing numbers of radiofrequency ablation procedures being performed, there is now a greater emphasis on pre-procedure imaging to delineate this anatomy. Pulmonary venous mapping studies can be performed with or ...

  9. The Therapeutic Stage Encounters the Virtual World (United States)

    Imholz, Susan


    Clinical research in expressive therapies, psychodrama in particular, offer education researchers and software designers descriptive analyses and evidence-based impact studies on attitudinal shifts and enhanced problem solving abilities for patients and students who participate in psychodrama role-play. Gaming environments and virtual worlds that…

  10. The Historian Encounters Film: A Historiography. (United States)

    Toplin, Robert Brent; Eudy, Jason


    Provides a historiography of the articles and books that focuses upon studying history through film. Reviews topics such as: censorship, the film industry's use and interpretations of history in films, and the lack of material on documentaries in the scholarship. (CMK)

  11. Membrane trafficking: ER export encounters dualism. (United States)

    Barlowe, Charles


    Cytoplasmic coat protein complexes perform central roles in sorting protein constituents within the endomembrane system. A new study reveals that the COPII coat operates through dual recognition of signals in a sorting receptor and its bound cargo to promote efficient export from the endoplasmic reticulum. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Investigating Effect of Service Encounter, Value, and Satisfaction on Word of Mouth: An Outpatient Service Context. (United States)

    Hsu, Li-Chun


    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.

  13. 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


    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.

  14. Web-based versus face-to-face interprofessional team encounters with standardized patients. (United States)

    Lempicki, Kelly A; Holland, Christine S


    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.

  15. An intimate encounter: negotiating subtitled cinema


    Flynn, Niall


    The question of subtitling has received little attention in Film Studies, despite being the primary means by which foreign-language cinema is experienced. Current literature focuses on important matters of language and translation, but there are other aspects that exceed these matters when we watch subtitled films, aspects which are able to affect and move viewers without relying on explanation through translation. My paper shows how viewers have to negotiate these affective elements in order...

  16. Problems Encountered during the Scientific Research Process in Graduate Education: The Institute of Educational Sciences (United States)

    Akyürek, Erkan; Afacan, Özlem


    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…

  17. High pregnancy intentions and missed opportunities for patient-provider communication about fertility in a South African cohort of HIV-positive women on antiretroviral therapy. (United States)

    Schwartz, Sheree R; Mehta, Shruti H; Taha, Taha E; Rees, Helen V; Venter, Francois; Black, Vivian


    High fertility intentions amongst HIV-positive women have been reported elsewhere. Less is known about how clinical and HIV treatment characteristics correlate with fertility intentions. We use cross-sectional baseline data from a prospective cohort study to assess pregnancy intentions and patient-provider communication around fertility. Non-pregnant, HIV-positive women aged 18-35 on ART were recruited through convenience sampling at Johannesburg antiretroviral (ART) treatment facilities. Among the 850 women in this analysis, those on efavirenz had similar fertility intentions over the next year as women on nevirapine-based regimens (33% vs. 38%). In multivariate analysis, recent ART initiation was associated with higher current fertility intentions; there was no association with CD4 cell count. Forty-one percent of women had communicated with providers about future pregnancy options. Women on ART may choose to conceive at times that are sub-optimal for maternal, child and partner health outcomes and should be routinely counseled around safer pregnancy options.

  18. Storyboard GALILEO CRUISE SCIENCE OPPORTUNITIES describes asteroid encounters (United States)


    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.

  19. 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


    ...) 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...

  20. Availability and Usability of BHO Encounter Data in MAX 2009 (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,...

  1. Penguin head movement detected using small accelerometers: a proxy of prey encounter rate. (United States)

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


    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.

  2. Dental case manager encounters: the association with retention in dental care and treatment plan completion. (United States)

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


    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.

  3. Patient expectations for radiology in noninteractive encounters

    International Nuclear Information System (INIS)

    Altmaier, E.; Smith, W.L.; Ross, R.; Johnson, B.; Berberoglu, L.


    One hundred seven patients who underwent procedures not involving direct interaction with a radiologist were interviewed regarding their experience. The 545 responses divided clearly into items regarding the physical facility (parking, room temperature, etc) and items directly under control of radiology. The latter were twofold: waiting time and technologist behavior. Specific behaviors judged critical for technologists included ability to impart clear instructions, interpersonal behaviors, concern for physical comfort, and skill in procedure performance. A final question involved the role of the ''unseen'' radiologist. Patients desired a high level of skill in study interpretation and that the radiologist possess several positive personality traits even though they never anticipated direct contact


    Directory of Open Access Journals (Sweden)

    Alessandra Martins


    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.

  5. An Intimate Encounter: Negotiating Subtitled Cinema

    Directory of Open Access Journals (Sweden)

    Niall Flynn


    Full Text Available The question of subtitling has received little attention in Film Studies, despite being the primary means by which foreign-language cinema is experienced. Current literature focuses on important matters of language and translation, but there are other aspects that exceed these matters when we watch subtitled films, aspects which are able to affect and move viewers without relying on explanation through translation. My paper shows how viewers have to negotiate these affective elements in order to apprehend foreign-language films, with special attention on their indeterminate characteristics that escape representation. It considers the negotiation of subtitled cinema from numerous theoretical perspectives. Gilles Deleuze’s film-philosophy is popular in Film Studies for its theoretical flows and lines of flight, but this paper engages another Deleuzian thread—one of gaps and fissure—in order to explore the indeterminate negotiations of subtitled films. But in thinking about subtitling, we also have to reconsider the constitution of media. Cinema is not just made up of individual parts; rather, it is made of many interacting media, which cannot be separated. I argue that subtitled cinema consists of multiple affective elements that go beyond the interpretive methods of language and translation, and that the practice of negotiation is one way to apprehend them. In conclusion, this article, by exploring non-linguistic issues, argues that subtitling is not simply supplementary to cinema.

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

    International Nuclear Information System (INIS)

    Young, D.T.


    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

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


    Reimer, Jennifer Andrea


    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...

  8. Internet advertisements for public sexual encounters among men who have sex with men: are safe behaviors communicated? (United States)

    Downing, Martin J


    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.

  9. Geology Before Pluto: Pre-encounter Considerations (United States)

    Moore, J. M.


    Pluto, its large satellite Charon, and its four small known satellites represent the first trans-Neptunian Kuiper Belt objects populating the outer-most solar system beyond the gas giant planets to be studied in detail from a spacecraft (New Horizons). A complete picture of the solar nebula and solar system formation cannot be confidently formulated until representatives of this group of bodies at the edge of solar space have been examined. The Pluto system is composed of unique, lunar- and intermediate-sized objects that can tell us much about how objects with volatile icy compositions evolve. Modeling of the interior suggests that geologic activity may have been significant to some degree, and observations of frost on the surface could imply the need for a geologic reservoir for the replenishment of these phases. However, these putative indicators of Pluto's geologic history are inconclusive and unspecific. Detailed examination of Pluto's geologic record is the only plausible means of bridging the gap between theory and observation. In this talk I will examine the potential importance of these tentative indications of geologic activity and how specific spacecraft observations have been designed and used to constrain the Pluto system's geologic history. The cameras of New Horizons will provide robust data sets that should be immanently amenable to geological analysis of the Pluto system's landscapes. In this talk, we begin with a brief discussion of the planned observations by the New Horizons cameras that will bear most directly on geological interpretability. Then I will broadly review major geological processes that could potentially operate on the surfaces of Pluto and its moons. I will first survey exogenic processes (i.e., those for which energy for surface modification is supplied externally to the planetary surface): impact cratering, sedimentary processes (including volatile migration), and the work of wind. I will conclude with an assessment of the

  10. Geology Before Pluto: Pre-Encounter Considerations (United States)

    Moore, Jeffrey M.


    Pluto, its large satellite Charon, and its four known satellites represent the first trans-Neptunian Kuiper Belt objects populating the outer-most solar system beyond the gas giant planets to be studied in detail from a spacecraft (New Horizons). A complete picture of the solar nebula, and solar system formation cannot be confidently formulated until representatives of this group of bodies at the edge of solar space have been examined. The Pluto system is composed of unique lunar- and intermediate-sized objects that can tell us much about how objects with volatile icy compositions evolve. Modeling of the interior suggests that geologic activity may have been to some degree, and observations of frost on the surface could imply the need for a geologic reservoir for the replenishment of these phases. However, the putative indicators of Pluto's geologic history are inconclusive and unspecific. Detailed examination of Pluto's geologic record is the only plausible means of bridging the gap between theory and observations. In this talk I will examine the potential importance of these tentative indications of geologic activity and how specific spacecraft observations have been designed and used to constrain the Pluto system's geologic history. The cameras of New Horizons will provide robust data sets that should be immanently amenable to geological analysis of the Pluto System's landscapes. In this talk, we begin with a brief discussion of the planned observations by New Horizons' cameras that will bear most directly on geological interpretability. Then I will broadly review major geological processes that could potentially operate of the surfaces of Pluto and its moons. I will first survey exogenic processes (i.e., those for which energy for surface modification is supplied externally to the planetary surface): impact cratering, sedimentary processes (including volatile migration) and the work of wind. I will conclude with an assessment of prospects for endogenic activity

  11. Smart City: Utilization of IT resources to encounter natural disaster (United States)

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


    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.

  12. Drug-related police encounters across the globe: How do they compare? (United States)

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


    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

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

    Alrawashdeh, Ayah Isam; Al-zayed, Norma Nawaf


    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. Difficulties EFL Jordanian University Students Encounter in Translating English Idioms into Arabic (United States)

    Alrishan, Amal; Smadi, Oqlah


    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…

  15. Barriers Encountered in the Transfer of Educational Training to Workplace Practice in Saudi Arabia (United States)

    Almannie, Mohamed


    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…

  16. Glucosa-Insulin-Potassium (GIK) solution used with diabetic patients provides better recovery after coronary bypass operations. (United States)

    Straus, Slavenka; Gerc, Vjekoslav; Kacila, Mirsad; Faruk, Custovic


    Tight blood glucose control has become a therapeutical goal for anesthetic management for patients scheduled for cardiac surgery, especially if they are diabetic patients. This study was created to confirm the benefits of intraoperative GIK solution usage during coronary bypass operation of diabetic patients. Patients with type 1 and 2 diabetes mellitus (DM) referred for coronary artery bypass grafting (CABG) were randomized to receive GIK solution (GIK--study group) in the first 24 hours intraoperatively or to receive official Clinical protocol without GIK solution (non GIK - control group). The primary clinical outcome was the cardiac index (CI) since it represents the most sensitive measure of cardiac work in the immediate postoperative period, and the secondary clinical outcomes were the glycemic control, insulin consumption, duration of mechanical ventilation (MV), potassium level and atrial fibrillation (AF) appearance. One hundred diabetic patients, divided into two groups, were included in the study. The cardiac index did not show a significant difference, although the study group had CI with only minor variations than those of the controlled group, hence the reason we considered the study group as the more stable. The atrial fibrillation showed a difference between two groups, with 14 (28%) patients with postoperative AF in the control group compared with 3 (6%) patients with postoperative AF in the study group. As potassium values were stable in study group, we concluded that it can be one of the reasons for less postoperative AF in this group. The duration of MV showed a significant difference (0,003) between the two groups as well. In the study group the average MV time was 534,38 minutes, compared with the control group with 749,20 minutes. The average value of glucose was 11.1 mmol/l in the control group vs. 9.8 mmol/l in the study group. The study group had less insulin consumption in order to maintain target glycemia (p = 0.001). In the non GIK

  17. Daily Encounter Cards—Evaluating the Quality of Documented Assessments (United States)

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


    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

  18. Daily Encounter Cards-Evaluating the Quality of Documented Assessments. (United States)

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


    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.

  19. Low sustainability, poor governance, and other challenges encountered by grassroots non-governmental organizations targeting HIV prevention for men who have sex with men in China - a nation-wide study. (United States)

    Lau, Joseph T F; Wang, Zixin; Kim, Yoona; Li, Jinghua; Gu, Jing; Mo, Phoenix K H; Wang, Xiaodong


    Grassroots non-governmental organizations (NGOs) played pivotal roles in HIV prevention among men who have sex with men (MSM) in China. Their governance and sustainability issues were under-studied. This nation-wide study surveyed leaders of 202 of the HIV related NGOs in China.58.4% of the leaders believed that their NGO would last for ≤5 years; which was negatively associated with perceived good relationship with CDC. 65.3% mentioned ≥3 non-sustainability issues; associated factors included perceived inadequacies in prevention skills, management skills, policy support, technical support, operational support, and CDC's support; a reverse association was found for frequent collaboration with organizations in China. 30.6% of the leaders mentioned ≥7 governance issues; a stepwise model found a positive association with having no office and negative associations with number of full-time staff and core volunteers. These problems would severely limit the effectiveness of HIV prevention among MSM. Related improvements and support are warranted.

  20. ‘You try to play a role in her pregnancy’ - a qualitative study on recent fathers’ perspectives about childbearing and encounter with the maternal health system in Kigali, Rwanda

    Directory of Open Access Journals (Sweden)

    Jessica Påfs


    Full Text Available Background: Rwanda has raised gender equality on the political agenda and is, among other things, striving for involving men in reproductive health matters. With these structural changes taking place, traditional gender norms in this setting are challenged. Deeper understanding is needed of men's perceptions about their gendered roles in the maternal health system. Objective: To explore recent fathers’ perspectives about their roles during childbearing and maternal care-seeking within the context of Rwanda's political agenda for gender equality. Design: Semi-structured interviews were conducted with 32 men in Kigali, Rwanda, between March 2013 and April 2014. A framework of naturalistic inquiry guided the overall study design and analysis. In order to conceptualize male involvement and understand any gendered social mechanisms, the analysis is inspired by the central principles from relational gender theory. Results: The participants in this study appeared to disrupt traditional masculinities and presented ideals of an engaged and caring partner during pregnancy and maternal care-seeking. They wished to carry responsibilities beyond the traditional aspects of being the financial provider. They also demonstrated willingness to negotiate their involvement according to their partners’ wishes, external expectations, and perceived cultural norms. While the men perceived themselves as obliged to accompany their partner at first antenatal care (ANC visit, they experienced several points of resistance from the maternal health system for becoming further engaged. Conclusions: These men perceived both maternal health system policy and care providers as resistant toward their increased engagement in childbearing. Importantly, perceiving themselves as estranged may consequently limit their engagement with the expectant partner. Our findings therefore recommend maternity care to be more responsive to male partners. Given the number of men already taking

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

    Karnieli-Miller, Orit; Eisikovits, Zvi


    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


    Directory of Open Access Journals (Sweden)



    on several directions: when filling out the application form, the technical-financial reporting, at the contracting phase of the projects, problems of partners. The article deals with the first two, and from the respondents’ answers, the phase with the greatest number of problems was that of filling out the application form, followed by the technical and financial reporting. Regarding the usefulness of the results, it should be noted that the information obtained from the conducted research supplies, theoretically speaking, the studied field and brings an important contribution not only to possible beneficiaries of European funds (public, private organisations, NGOs, the state, etc., but to the entire Romanian society through the economic growth it generates The authors’ main contribution is to integrate this study into the logical thread of the thesis entitled “Strategic management in European project funding”. The research conducted in the project management specialty literature emphasises the uniqueness and originality of the proposed and researched theme, which meets a current and pressing requirement of the Romanian society.

  3. Gravitational wave bursts from Primordial Black Hole hyperbolic encounters

    CERN Document Server

    Garcia-Bellido, Juan


    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...

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

    International Nuclear Information System (INIS)

    Parmenter, B.M.


    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

  5. Protoplanetary disc response to distant tidal encounters in stellar clusters (United States)

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


    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.

  6. Humor During Clinical Practice: Analysis of Recorded Clinical Encounters. (United States)

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


    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.

  7. 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


    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.

  8. Patient-provider communication and low-income adults: age, race, literacy, and optimism predict communication satisfaction. (United States)

    Jensen, Jakob D; King, Andy J; Guntzviller, Lisa M; Davis, LaShara A


    To assess whether literacy, numeracy, and optimism are related to low-income adults' satisfaction with their healthcare provider's communication skills. Low-income adults (N=131) were recruited from seven counties in Indiana through University extension programs. To achieve research triangulation, participants were surveyed and interviewed about their communication satisfaction with health providers. Survey data revealed that four variables significantly predicted satisfaction: age, race, literacy, and optimism. Low-income adults in the current study were more critical of their healthcare provider's communication skills if they were younger, White, functionally literate, and pessimistic. Follow-up interviews confirmed this pattern and suggested it was a byproduct of patient activism. In low-income populations, communication satisfaction may be lower for groups that are traditionally active in doctor-patient interactions (e.g., younger patients, patients with higher literacy skills). Healthcare providers should be aware that older, non-White, optimistic, and literacy deficient patients report greater communication satisfaction than their younger, White, pessimistic, and functionally literate peers. Both groups may be coping with their situation, the former by withdrawing and the latter by actively pushing for a higher standard of care. Healthcare providers should continue to seek out ways to facilitate dialogue with these underserved groups. 2009 Elsevier Ireland Ltd. All rights reserved.

  9. The development and preliminary testing of a multimedia patient-provider survivorship communication module for breast cancer survivors. (United States)

    Wen, Kuang-Yi; Miller, Suzanne M; Stanton, Annette L; Fleisher, Linda; Morra, Marion E; Jorge, Alexandra; Diefenbach, Michael A; Ropka, Mary E; Marcus, Alfred C


    This paper describes the development of a theory-guided and evidence-based multimedia training module to facilitate breast cancer survivors' preparedness for effective communication with their health care providers after active treatment. The iterative developmental process used included: (1) theory and evidence-based content development and vetting; (2) user testing; (3) usability testing; and (4) participant module utilization. Formative evaluation of the training module prototype occurred through user testing (n = 12), resulting in modification of the content and layout. Usability testing (n = 10) was employed to improve module functionality. Preliminary web usage data (n = 256, mean age = 53, 94.5% White, 75% college graduate and above) showed that 59% of the participants accessed the communication module, for an average of 7 min per login. The iterative developmental process was informative in enhancing the relevance of the communication module. Preliminary web usage results demonstrate the potential feasibility of such a program. Our study demonstrates survivors' openness to the use of a web-based communication skills training module and outlines a systematic iterative user and interface program development and testing process, which can serve as a prototype for others considering such an approach. Copyright © 2012. Published by Elsevier Ireland Ltd.

  10. PReSaFe: A model of barriers and facilitators to patients providing feedback on experiences of safety. (United States)

    De Brún, Aoife; Heavey, Emily; Waring, Justin; Dawson, Pamela; Scott, Jason


    The importance of involving patients in reporting on safety is increasingly recognized. Whilst studies have identified barriers to clinician incident reporting, few have explored barriers and facilitators to patient reporting of safety experiences. This paper explores patient perspectives on providing feedback on safety experiences. Patients (n=28) were invited to take part in semi-structured interviews when given a survey about their experiences of safety following hospital discharge. Transcripts were thematically analysed using NVivo10. Patients were recruited from four hospitals in the UK. Three themes were identified as barriers and facilitators to patient involvement in providing feedback on their safety experiences. The first, cognitive-cultural, found that whilst safety was a priority for most, some felt the term was not relevant to them because safety was the "default" position, and/or because safety could not be disentangled from the overall experience of care. The structural-procedural theme indicated that reporting was facilitated when patients saw the process as straightforward, but that disinclination or perceived inability to provide feedback was a barrier. Finally, learning and change illustrated that perception of the impact of feedback could facilitate or inhibit reporting. When collecting patient feedback on experiences of safety, it is important to consider what may help or hinder this process, beyond the process alone. We present a staged model of prerequisite barriers and facilitators and hypothesize that each stage needs to be achieved for patients to provide feedback on safety experiences. Implications for collecting meaningful data on patients' safety experiences are considered. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  11. Connection between encounter volume and diffusivity in geophysical flows (United States)

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


    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.

  12. Binary encounter electron production in ion-atom collisions

    International Nuclear Information System (INIS)

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


    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

  13. 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...

  14. Encounters of The Solar System With Molecular Clouds

    International Nuclear Information System (INIS)

    Wickramasinghe, J. T.


    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

  15. Households' Stories of Their Encounters with a Plug-In Hybrid Electric Vehicle (United States)

    Caperello, Nicolette D.; Kurani, Kenneth S.


    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…

  16. Concentrated Language Encounter Approach in Practice for Global Teaching of Literacy: Lighthouse Strategy Implementation (United States)

    Rattanavich, Saowalak


    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…

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

    DEFF Research Database (Denmark)

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


    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...

  18. Commognitive Analysis of Undergraduate Mathematics Students' First Encounter with the Subgroup Test (United States)

    Ioannou, Marios


    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…

  19. Identifying the Ethical Challenges Encountered by Information Technology Professionals Working within the Nevada Casino Industry (United States)

    Essig, Michael R.


    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…

  20. Encountering Heidi: meeting others as a central aspect of the river experience (United States)

    Lilian Jonas; Kevin Larkin


    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...

  1. The Autobiography of Intercultural Encounters through Visual Media: Exploring Images of Others in Telecollaboration (United States)

    Lindner, Rachel; Méndez Garcia, Maria del Carmen


    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"…

  2. 2. A Study to Assess Problems Encountered by Immediate Family ...

    African Journals Online (AJOL)


    probability sampling method. A total number of 145 .... the health workers. The above ... health workers, media, peer, books, family friends .... distributed in every province in Zambia , therefore there is ... D.(1993). Psychological Adjustment of.

  3. Studying the clinical encounter with the Adaptive Leadership framework. (United States)

    Bailey, Donald E; Docherty, Sharron L; Adams, Judith A; Carthron, Dana L; Corazzini, Kirsten; Day, Jennifer R; Neglia, Elizabeth; Thygeson, Marcus; Anderson, Ruth A


    In this paper we discuss the concept of leadership as a personal capability, not contingent on one's position in a hierarchy. This type of leadership allows us to reframe both the care-giving and organizational roles of nurses and other front-line clinical staff. Little research has been done to explore what leadership means at the point of care, particularly in reference to the relationship between health care practitioners and patients and their family caregivers. The Adaptive Leadership framework, based on complexity science theory, provides a useful lens to explore practitioners' leadership behaviors at the point of care. This framework proposes that there are two broad categories of challenges that patients face: technical and adaptive. Whereas technical challenges are addressed with technical solutions that are delivered by practitioners, adaptive challenges require the patient (or family member) to adjust to a new situation and to do the work of adapting, learning, and behavior change. Adaptive leadership is the work that practitioners do to mobilize and support patients to do the adaptive work. The purpose of this paper is to describe this framework and demonstrate its application to nursing research. We demonstrate the framework's utility with five exemplars of nursing research problems that range from the individual to the system levels. The framework has the potential to guide researchers to ask new questions and to gain new insights into how practitioners interact with patients at the point of care to increase the patient's ability to tackle challenging problems and improve their own health care outcomes. It is a potentially powerful framework for developing and testing a new generation of interventions to address complex issues by harnessing and learning about the adaptive capabilities of patients within their life contexts.

  4. Building a Unique Scenario to Support Cross-Mission Science with SPICE: The Siding-Spring comet encounter with Mars (United States)

    Costa, M.; Witasse, O.; Sánchez-Cano, B.


    On October 2014, Mars experienced a close encounter with Comet Siding Spring. This contribution outlines a SPICE scenario built to assist studies combining MEX, MAVEN, Mars Odyssey, MSL, and Siding-Spring data focused on a Cosmographia 3D scenario.

  5. Value Encounters - Modeling and Analyzing Co-creation of Value (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.

  6. Y. Laberge on Raphael-Hernadez and Steen’s AfroAsian encounters: Culture, History, Politics.

    Directory of Open Access Journals (Sweden)


    Full Text Available Heike Raphael-Hernadez and Shannon Steen,  Eds. AfroAsian encounters: Culture, History, Politics. New York: New York University Press, 2006.  xxiii + 342 p. An overlooked, interdisciplinary, often innovative book, Afroasian encounters: Culture, History, Politics offers a collection of seventeen new essays related to the African-Asian intersections, cosmopolitanism and cross-cultural theories. In terms of emerging disciplines, we already had Atlantic studies (or "Trans-Atlantic studies", an i...

  7. The third person in the room: frequency, role, and influence of companions during primary care medical encounters. (United States)

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


    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.

  8. Examining the spatial distribution of law enforcement encounters among people who inject drugs after implementation of Mexico's drug policy reform. (United States)

    Gaines, Tommi L; Beletsky, Leo; Arredondo, Jaime; Werb, Daniel; Rangel, Gudelia; Vera, Alicia; Brouwer, Kimberly


    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.

  9. Encounter success of free-ranging marine predator movements across a dynamic prey landscape. (United States)

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


    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.

  10. Appraisal Skills, Health Literacy and the Patient-Provider Relationship: Considerations as the Health Care Consumer Turns to the Internet to Inform their Care. (United States)

    O'Dell, Rosann


    Health care consumers increasingly obtain health information from the Internet to inform their health care; the health care consumer, who also has the role of patient, maintains the right to access information from sources of their choosing for this purpose. However, noteworthy considerations exist including information appraisal skills, health literacy and the patient-provider relationship. Awareness and education are warranted to assist the health care consumer in achieving proficiency as they turn to the Internet for health information.

  11. Ulysses at jupiter: an overview of the encounter. (United States)

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


    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. (United States)

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


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

    NARCIS (Netherlands)

    Sobecki, Sebastian


    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 ... 2.Murray, Alan V.

  15. Exploring Festival Performance as a State of Encounter (United States)

    O’Grady, Alice; Kill, Rebekka


    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…

  16. Fabricated Childhoods: Uncanny Encounters with the More-than-Human (United States)

    Blaise, Mindy


    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…

  17. Room with a View: Ethical Encounters in Room 13 (United States)

    Grube, Vicky


    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…

  18. Live Aircraft Encounter Visualization at FutureFlight Central (United States)

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


    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.

  19. 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.

  20. Grassroots Leadership: Encounters with Power Dynamics and Oppression (United States)

    Kezar, Adrianna


    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…

  1. 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.

  2. Reconsidering Children's Encounters with Nature and Place Using Posthumanism (United States)

    Malone, Karen


    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…

  3. 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 ...

  4. '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 ...

  5. Translational neonatology research: transformative encounters across species and disciplines. (United States)

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


    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.

  6. Nurses' use of pliable and directed strategies when encountering children in child and school healthcare. (United States)

    Harder, Maria; Enskär, Karin; Golsäter, Marie


    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.

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

    Directory of Open Access Journals (Sweden)

    Herman Meininger


    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.

  8. Research on the influence that communication in psychiatric encounters has on treatment. (United States)

    Cruz, Mario; Pincus, Harold Alan


    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.

  9. Primo Levi and Franz Kafka: an Unheimlich Encounter

    Directory of Open Access Journals (Sweden)

    Stefano Bellin


    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

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


    Chen, Ning; Zhao, Qi; Ardley, Barry


    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...

  11. An Analysis of the Interaction Effect between Employee Technical and Emotional Competencies in Emotionally Charged Service Encounters


    Delcourt, Cécile; Gremler, Dwayne; De Zanet, Fabrice; van Riel, Allard


    Purpose—Customers often experience negative emotions during service experiences. The ways that employees manage customers’ emotions and impressions about whether the service provider is concerned for them in such emotionally charged service encounters (ECSEs) is crucial, considering the criticality of the encounter. Drawing on cognitive appraisal theory, this study proposes that two key competencies—employee emotional competence (EEC) and employee technical competence (ETC)—affect negative cu...

  12. Social Workers' Reflections on the Therapeutic Encounter With Elder Abuse and Neglect. (United States)

    Goldblatt, Hadass; Band-Winterstein, Tova; Alon, Sara


    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.

  13. Learned Helplessness Encountered by Michael Oher in the Blind Side Movie




    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...

  14. The prevalence of two ‘commonly’ encountered synthetic target fibres within a large urban environment


    Palmer, Ray; Burnett, Elisabeth; Luff, Natalie; Wagner, Craig; Stinga, Georgia; Carney, Clare; Sheridan, Kelly


    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), ...

  15. Formation of massive clouds and dwarf galaxies during tidal encounters (United States)

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


    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.

  16. Estimating the encounter rate variance in distance sampling (United States)

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


    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.

  17. 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...

  18. Beyond cultural competency: Bourdieu, patients and clinical encounters. (United States)

    Lo, Ming-Cheng M; Stacey, Clare L


    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.

  19. Reproductive encounters: Negev bedouin women’s lay encounters at childbirth in an Israeli hospital

    NARCIS (Netherlands)

    Kisch, S.


    Though hospital studies have often focused on the vertical relationships between patients and medical staff, the interactions between patients have received much less attention. Whereas interaction with staff members is episodic, patients often spend long hours sharing intimate space and daily

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


    Todres, Jonathan


    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...

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


    Barras Arnaud


    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...

  2. Elucidating Dynamical Processes Relevant to Flow Encountering Abrupt Topography (FLEAT) (United States)


    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

  3. 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.


    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)

  4. Hotspots on Io During the Ganymede 2 Encounter (United States)


    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

  5. 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



    Vilaça, Aparecida


    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...

  7. HIV-positive migrants’ encounters with the Swedish health care system

    DEFF Research Database (Denmark)

    Mehdiyar, Manijeh; Andersson, Rune; Hjelm, Katarina


    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...

  8. An expression of love--midwives' experiences in the encounter with lesbian women and their partners. (United States)

    Spidsberg, Bente Dahl; Sørlie, Venke


    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.

  9. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters. (United States)

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


    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

  10. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters (United States)


    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

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

    Directory of Open Access Journals (Sweden)

    Chang Ching-Sheng


    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

  12. Encounters with service professionals experienced by children from families with alcohol problems

    DEFF Research Database (Denmark)

    Werner, Anne; Malterud, Kirsti


    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...

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

    Directory of Open Access Journals (Sweden)

    Hossein Gazor


    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.

  14. Problems Encountered by Primary School Teachers in the Teaching of Music

    Directory of Open Access Journals (Sweden)

    Ilgım KILIÇ


    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.

  15. Undesirable Behaviors Elementary School Classroom Teachers Encounter in the Classroom and Their Reasons


    E.G. Balcik; S. Gulec


    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...



    Dr. Wachyudi.N.*


    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...

  17. Isolated Femoral Muscle and Bone Metastases Rarely Encountered in Testicular Seminoma

    Directory of Open Access Journals (Sweden)

    Serkan Degirmencioglu


    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.

  18. Uncorrelated Encounter Model of the National Airspace System, Version 2.0 (United States)


    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

  19. Cross-cultural care encounters in paediatric care: minority ethnic parents' experiences. (United States)

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


    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.

  20. Nature and frequency of exchanges on medications during primary care encounters. (United States)

    Richard, Claude; Lussier, Marie-Thérèse


    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

  1. Imaging Obsearvations of Jupiter's Sodium Magneto-Nebula During the Ulysses Encounter. (United States)

    Mendillo, M; Flynn, B; Baumgardner, J


    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.

  2. Dealing with Moms and Dads: Family Dilemmas Encountered by Youth Program Leaders

    Directory of Open Access Journals (Sweden)

    Aisha Griffith


    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.

  3. Biographical Narratives of Encounter: The Significance of Mobility and Emplacement in Shaping Attitudes towards Difference (United States)

    Sadgrove, Joanna


    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

  4. Prospects for asteroid mass determination from close encounters between asteroids: ESA's Gaia space mission and beyond (United States)

    Ivantsov, Anatoliy; Hestroffer, Daniel; Eggl, Siegfried


    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

  5. Environmental Catastrophes in the Earth's History Due to Solar Systems Encounters with Giant Molecular Clouds (United States)

    Pavlov, Alexander A.


    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.

  6. Assessment of the Gaussian Covariance Approximation over an Earth-Asteroid Encounter Period (United States)

    Mattern, Daniel W.


    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.

  7. An examination of the role of perceived support and employee commitment in employee-customer encounters. (United States)

    Vandenberghe, Christian; Bentein, Kathleen; Michon, Richard; Chebat, Jean-Charles; Tremblay, Michel; Fils, Jean-François


    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.

  8. Astrometry of 2014MU69 for New Horizons encounter (United States)

    Buie, Marc


    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.

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

    DEFF Research Database (Denmark)

    Paggio, Patrizia


    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...

  10. Doing Research in a Conflict Situation Encounters and Experiences

    Directory of Open Access Journals (Sweden)

    Suresh Dhakal


    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: Journal of Sociology and Anthropology Vol. 8, 2014; 87-98

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


    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.

  12. Trailing Vortex-Induced Loads During Close Encounters in Cruise (United States)

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


    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.

  13. The joy of discovery great encounters along the way

    CERN Document Server

    Thirring, Walter


    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

  14. Challenges Encountered Using Ophthalmic Anesthetics in Space Medicine (United States)

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


    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.

  15. How superdiffusion gets arrested: ecological encounters explain shift from Lévy to Brownian movement. (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


    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.

  16. How superdiffusion gets arrested: ecological encounters explain shift from Lévy to Brownian movement (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


    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

  17. Universities as spaces for engaging the other: A pedagogy of encounter for intercultural and interreligious education (United States)

    Gill, Scherto


    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.

  18. Analysis of the relationships among perceived service encounter quality, service value, satisfaction and behavioral intention for physical therapy patients. (United States)

    Ko, Min-Seok; Lee, Won-Hwee


    [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.

  19. Encounters between degenerate stars and extrasolar comet clouds

    International Nuclear Information System (INIS)

    Pineault, S.; Poisson, E.


    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

  20. Protoplanetary disc truncation mechanisms in stellar clusters: comparing external photoevaporation and tidal encounters (United States)

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


    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.

  1. The Proposed MACRA/MIPS Threshold for Patient-Facing Encounters: What It Means for Radiologists. (United States)

    Rosenkrantz, Andrew B; Hirsch, Joshua A; Allen, Bibb; Wang, Wenyi; Hughes, Danny R; Nicola, Gregory N


    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

  2. Variation of the binary encounter peak energy as a function of projectile atomic number

    International Nuclear Information System (INIS)

    Sanders, J.M.


    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

  3. Analyzing communication skills of Pediatric Postgraduate Residents in Clinical Encounter by using video recordings. (United States)

    Bari, Attia; Khan, Rehan Ahmed; Jabeen, Uzma; Rathore, Ahsan Waheed


    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.

  4. Encounters With Health-Care Providers and Advance Directive Completion by Older Adults. (United States)

    Koss, Catheryn


    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.

  5. Crowdsourcing for Context: Regarding Privacy in Beacon Encounters via Contextual Integrity

    Directory of Open Access Journals (Sweden)

    Bello-Ogunu Emmanuel


    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.

  6. Patients' experiences of healthcare encounters in severe irritable bowel syndrome: an analysis based on narrative and feminist theory. (United States)

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


    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

  7. Experiences of Latinos with limited English proficiency with patient registration systems and their interactions with clinic front office staff: an exploratory study to inform community-based translational research in North Carolina


    Calo, William A.; Cubillos, Laura; Breen, James; Hall, Megan; Rojas, Krycya Flores; Mooneyham, Rachel; Schaal, Jennifer; Hardy, Christina Yongue; Dave, Gaurav; Jolles, M?nica P?rez; Garcia, Nacire; Reuland, Daniel S.


    Background Health services research of Latinos with limited English proficiency (LEP) have largely focused on studying disparities related to patient-provider communication. Less is known about their non-provider interactions such as those with patient registration systems and clinic front office staff; these interactions precede the encounter with providers and may shape how comfortable patients feel about their overall health services experience. This study explored Latino patients with LEP...

  8. The encounter with God in myth and madness. (United States)

    Doerr, Otto; Velásquez, Oscar


    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

  9. The encounter with God in myth and madness

    Directory of Open Access Journals (Sweden)

    Doerr Otto


    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

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

    International Nuclear Information System (INIS)

    Gladkikh, V.; Burshtein, A.I.


    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

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

    International Nuclear Information System (INIS)

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


    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

  12. Motility of copepod nauplii and implications for food encounter

    DEFF Research Database (Denmark)

    Titelman, Josefin; Kiørboe, Thomas


    (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...

  13. 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)


    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.

  14. Physician Encounters with Human Trafficking: Legal Consequences and Ethical Considerations. (United States)

    Todres, Jonathan


    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.

  15. 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...

  16. Encounter times of chromatin loci influenced by polymer decondensation (United States)

    Amitai, A.; Holcman, D.


    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.

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

    DEFF Research Database (Denmark)

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


    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...


    Directory of Open Access Journals (Sweden)

    Aura CODREANU; Alina DEBU


    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.

  19. Collisionless encounters and the origin of the lunar inclination. (United States)

    Pahlevan, Kaveh; Morbidelli, Alessandro


    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.

  20. 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.


    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,

  1. Encounters with immigrant customers: perspectives of Danish community pharmacy staff on challenges and solutions. (United States)

    Mygind, Anna; Espersen, Sacha; Nørgaard, Lotte Stig; Traulsen, Janine M


    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

  2. Designing the Self: The Transformation of the Relational Self-Concept through Social Encounters in a Virtual Immersive Environment (United States)

    Knutzen, K. Brant; Kennedy, David M.


    This article describes the findings of a 3-month study on how social encounters mediated by an online Virtual Immersive Environment (VIE) impacted on the relational self-concept of adolescents. The study gathered data from two groups of students as they took an Introduction to Design and Programming class. Students in group 1 undertook course…

  3. Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight. (United States)

    Washington Cole, Katie O; Gudzune, Kimberly A; Bleich, Sara N; Cheskin, Lawrence J; Bennett, Wendy L; Cooper, Lisa A; Roter, Debra L


    To examine the association of women's body weight with provider communication during prenatal care. We coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication. Compared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44-0.99, p=0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32-0.82, p=0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51-0.91, p=0.01) and concern statements (IRR 0.68, 95% CI 0.53-0.86, p=0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19-0.84 p=0.02). Less lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care. Interventions to increase use of patient-centered communication - especially for women with overweight and obesity - may improve prenatal care quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Understanding interprofessional education as an intergroup encounter: The use of contact theory in programme planning. (United States)

    Carpenter, John; Dickinson, Claire


    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.

  5. 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 ...

  6. Strange Encounter: Depicting An “Other” Reality for Young Readers

    Directory of Open Access Journals (Sweden)

    YOU Chengcheng


    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

  7. Influence of alcohol on condom use pattern during non-spousal sexual encounter in male migrant workers in north India. (United States)

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


    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.

  8. Difficulties that Students who Learn Turkish as a Foreign Language Encounter During Listening Skills

    Directory of Open Access Journals (Sweden)

    Abdullah KALDIRIM


    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.

  9. 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)


    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

  10. Volcanic Ash -Aircraft Encounter Damages: in Volcanological Point of View (United States)

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


    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

  11. Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors. (United States)

    Palmer, Nynikka R A; Kent, Erin E; Forsythe, Laura P; Arora, Neeraj K; Rowland, Julia H; Aziz, Noreen M; Blanch-Hartigan, Danielle; Oakley-Girvan, Ingrid; Hamilton, Ann S; Weaver, Kathryn E


    We examined racial and ethnic disparities in patient-provider communication (PPC), perceived care quality, and patient activation among long-term cancer survivors. In 2005 to 2006, survivors of breast, prostate, colorectal, ovarian, and endometrial cancers completed a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic white (white) survivors who had seen a physician for follow-up care in the past 2 years (n = 1,196) composed the analytic sample. We conducted linear and logistic regression analyses to identify racial and ethnic differences in PPC (overall communication and medical test communication), perceived care quality, and patient activation in clinical care (self-efficacy in medical decisions and perceived control). We further examined the potential contribution of PPC to racial and ethnic differences in perceived care quality and patient activation. Compared with white survivors (mean score, 85.16), Hispanic (mean score, 79.95) and Asian (mean score, 76.55) survivors reported poorer overall communication (P = .04 and P Asian survivors (mean score, 79.97) reported poorer medical test communication (P = .001). Asian survivors were less likely to report high care quality (odds ratio, 0.47; 95% CI, 0.30 to 0.72) and reported lower self-efficacy in medical decisions (mean score, 74.71; P Asian disparities remained significant. Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors. © 2014 by American Society of Clinical Oncology.

  12. Adrenal lesions encountered in current medical practice − a review of their radiological imaging

    Directory of Open Access Journals (Sweden)

    Vanesha Naidu


    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. An Analysis of the Last Clinical Encounter before Outpatient Mortality among Children with HIV Infection and Exposure in Lilongwe, Malawi.

    Directory of Open Access Journals (Sweden)

    Chris A Rees

    Full Text Available Human immunodeficiency virus (HIV contributes to nearly 20% of all deaths in children under five years of age in Malawi. Expanded coverage of antiretroviral therapy has allowed children to access treatment on an outpatient basis. Little is known about characteristics of the final outpatient encounter prior to mortality in the outpatient setting.This retrospective cohort study assessed clinical factors associated with mortality among HIV-exposed infants and HIV-infected children less than 18 years of age at the Baylor College of Medicine Abbott Fund Children's Center of Excellence in Lilongwe, Malawi. We compared clinical indicators documented from the final outpatient encounter for patients who died in the outpatient setting versus those who were alive after their penultimate clinical encounter.Of the 8,546 patients who were attended to over a 10-year period at the Baylor Center of Excellence, 851 had died (10%. Of children who died, 392 (46% were directly admitted to the hospital after their last clinical encounter and died as inpatients. Of the remaining 459 who died as outpatients after their last visit, 53.5% had a World Health Organization (WHO stage IV condition at their last visit, and 25% had a WHO stage III condition. Multivariate regression analysis demonstrated that poor nutritional status, female gender, shorter time as a patient, more clinical encounters in the prior month, if last visit was an unscheduled sick visit, and if the patient had lost weight since their prior visit independently predicted increased mortality in the outpatient setting after the final clinical encounter.Clinical indicators may assist in identifying children with HIV who have increased risk of mortality in the outpatient setting. Recognizing these indicators may aid in identifying HIV-infected children who require a higher level of care or closer follow-up.

  14. An Automated System to Quantify Convectively induced Aircraft encounters with Turbulence over Europe and North Atlantic (United States)

    Meneguz, Elena; Turp, Debi; Wells, Helen


    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

  15. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. (United States)

    Poteat, Tonia; German, Danielle; Kerrigan, Deanna


    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

  16. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

    Directory of Open Access Journals (Sweden)

    Rasmussen Finn


    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

  17. Measuring Perceived Procedural Justice and Coercion among Persons with Mental Illness in Police Encounters: The Police Contact Experience Scale (United States)

    Watson, Amy C.; Angell, Beth; Vidalon, Theresa; Davis, Kristin


    Despite increased recent attention to improving the quality of encounters between police officers and people with serious mental illness, there are no measures available for assessing how consumers perceive their interactions with police officers. Drawing upon conceptual frameworks developed within social psychology, this study reports the…

  18. Examining Activities Concerning the Use of Words Encountered in Content Area Courses in Writing by Children with Hearing Loss (United States)

    Karasu, H. Pelin


    Improvement of vocabulary constitutes an important part of the literacy practices. Children with hearing loss experience difficulties in using newly encountered words in verbal and written languages due to the delay they experience in linguistic skills. The objective of the present study is to investigate the course of applying a balanced literacy…

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

    Directory of Open Access Journals (Sweden)

    Sara Soncini


    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.

  20. Managing the bank service encounter: A conceptual model

    Directory of Open Access Journals (Sweden)

    K. K. Govender


    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.

  1. An encounter between 4e cognition and attachment theory (United States)

    Petters, Dean


    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.

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

    International Nuclear Information System (INIS)

    Hastings, Robert L.


    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.

  3. 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...

  4. Complications encountered in contrast roentgenography of the colon

    International Nuclear Information System (INIS)

    Vogel, H.; Steinkamp, U.


    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

  5. The substance of love when encountering suffering: an interpretative research synthesis with an abductive approach. (United States)

    Thorkildsen, Kari Marie; Eriksson, Katie; Råholm, Maj-Britt


    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.

  6. Analysing the problems of science teachers that they encounter while teaching physics education

    Directory of Open Access Journals (Sweden)

    Cihat Demir


    Full Text Available Even though physical science is very important in our daily lives, it is insufficiently understood by students. In order for students to get a better physical education, the teachers who have given physics lesson should first eliminated the problems that they face during the teaching process. The aim of this survey is to specify the matters encountered by science teachers during the teaching of physics and to provide them with solutions. The study group consisted of 50 science teachers who worked in Diyarbakır and Batman over the period of 2014 - 2015. This research is a descriptive study carried out by content analysis. In this study, semi-structured interview have been used along with qualitative research methods. According to the research findings, the top problems that the physics teachers encountered in physics lesson while processing the topics were laboratory problems. Some solutions have been introduced for science teachers in order to help them provide a better physics education.

  7. Adverse Situations Encountered by Adolescent Students Who Return to School Following Suspension

    Directory of Open Access Journals (Sweden)

    Cheng-Fang Yen


    Full Text Available This study aimed to investigate the adverse personal, family, peer and school situations encountered by adolescent students who had returned to school after being suspended. This was a large-scale study involving a representative population of Taiwanese adolescents. A total of 8,494 adolescent students in Southern Taiwan were recruited in the study and completed the questionnaires. The relationships between their experiences of suspension from school and adverse personal, family, peer, and school situations were examined. The results indicated that 178 (2.1% participants had been suspended from school at some time. Compared with students who had never been suspended, those who had experienced suspension were more likely to report depression, low self-esteem, insomnia, alcohol consumption, illicit drug use, low family support, low family monitoring, high family conflict, habitual alcohol consumption, illicit drug use by family members, low rank and decreased satisfaction in their peer group, having peers with substance use and deviant behaviors, low connectedness to school, and poor academic achievement. These results indicate that adolescent students who have returned to school after suspension encounter numerous adverse situations. The psychological conditions and social contexts of these individuals need to be understood in depth, and intervention programs should be developed to help them to adjust when they return to school and to prevent school dropouts in the future.

  8. Using public health detailing and a family-centered ecological approach to promote patient-provider-parent action for reducing childhood obesity. (United States)

    Sealy, Yvette M; Zarcadoolas, Christina; Dresser, Michelle; Wedemeyer, Laura; Short, Leslie; Silver, Lynn


    This paper describes the research and development of the Obesity in Children Action Kit, a paper-based chronic disease management tool of the Public Health Detailing Program (PHD) at the New York City (NYC) Department of Health and Mental Hygiene (DOHMH). It also describes PHD's process for developing the Obesity in Children detailing campaign (targeting healthcare providers working with children aged 2-18) and its results, during which the Action Kit materials were a focal point. The campaign goals were to impact healthcare provider clinical behaviors, improve the health literacy of parents and children, instigate patient-provider-parent dialogue, and change family practices to prevent obesity. Qualitative research methods consisted of healthcare provider in-depth interviews and parent focus groups to aid campaign development. Evaluation of the Obesity in Children campaign included self-reported data on uptake and usage of clinical tools and action steps of matched assessments from 237 healthcare provider initial and follow-up visits, material stock counts, and DOHMH representative qualitative visit excerpts. Key themes identified in parent focus groups were concerns about childhood diabetes and high blood pressure, awareness of cultural pressure and our "supersize" culture, frustration with family communication around overweight and obesity, lack of knowledge about food quality and portion size, economic pressures, and the availability of healthy and nutritious foods. During the Obesity in Children campaign, six representatives reached 161 practices with 1,588 one-on-one interactions, and an additional 461 contacts were made through group presentations. After these interactions, there was a significant increase in the percentage of physicians self-reported use of key recommended practices: Use of BMI percentile-for-age to assess for overweight or obesity at every visit increased from 77% to 88% (p families to set realistic goals increased from 64% to 86% (p

  9. Medical device development: managing conflicts of interest encountered by physicians. (United States)

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


    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

  10. Hildegard Peplau’s Theory and the Healthcare Encounters of Survivors of Sexual Violence (United States)

    Courey, Tamra J.; Martsolf, Donna S.; Draucker, Claire B.; Strickland, Karen B.


    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

  11. Modeling Fuel Treatment Leverage: Encounter Rates, Risk Reduction, and Suppression Cost Impacts

    Directory of Open Access Journals (Sweden)

    Matthew P. Thompson


    Full Text Available The primary theme of this study is the cost-effectiveness of fuel treatments at multiple scales of investment. We focused on the nexus of fuel management and suppression response planning, designing spatial fuel treatment strategies to incorporate landscape features that provide control opportunities that are relevant to fire operations. Our analysis explored the frequency and magnitude of fire-treatment encounters, which are critical determinants of treatment efficacy. Additionally, we examined avoided area burned, avoided suppression costs, and avoided damages, and combined all three under the umbrella of leverage to explore multiple dimensions with which to characterize return on investment. We chose the Sierra National Forest, California, USA, as our study site, due to previous work providing relevant data and analytical products, and because it has the potential for large, long-duration fires and corresponding potential for high suppression expenditures. Modeling results generally confirmed that fire-treatment encounters are rare, such that median suppression cost savings are zero, but in extreme years, savings can more than offset upfront investments. Further, reductions in risk can expand areas where moderated suppression response would be appropriate, and these areas can be mapped in relation to fire control opportunities.


    Directory of Open Access Journals (Sweden)

    Zeki Doğan


    Full Text Available Agricultural sector, from past to present, had assumed very important duties on economic and social development of societies. It became a globally indispensable and strategic sector due to its various attributes such as: direct/indirect contributions to population nourishment, national income, employment, capital transfers, raw material supply for industry, exportation, biological diversity and ecological balance. Since the dawn of humankind, agricultural sector had gone through a variety of phases in terms of production activities and land proprietorship. Agricultural activities that emerged in the period of hunter-gatherer societies have been superseded by today’s specialized and planned agricultural enterprises utilizing information and technology. Agricultural accounting has also experienced a significant change in parallel with those improvements. This study aims to investigate historical development of agricultural accounting and difficulties encountered during its implementation. Research studies indicate that agricultural assets were initially recorded and inventory controls were performed by Sumerians. Until the Middle Ages, agricultural accounting did not experience any development, whereas it still encounters various difficulties eve

  13. The structure of service quality perceptions for multiple-encounter services. (United States)

    Andaleeb, Syed Saad; Kara, Ali


    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.

  14. Technical problems encountered during certification of a Type B (plutonium) package (U)

    International Nuclear Information System (INIS)

    Gromada, R.J.; Opperman, E.K.


    Westinghouse Savannah River Company is responsible for maintaining the 5320 Plutonium Shipping Cask. The 5320 Cask was originally designed over 15 years ago to transport plutonium and americium. Since then the 5320 Cask has been redesigned numerous times to meet changing packaging regulations. During the current certificate renewal process, four of the 5320 Casks were subjected to hypothetical accident condition drop, puncture and thermal tests. This paper will discuss the technical problems encountered as well as the experiences gained from performing the accident test sequence. The first two sequential tests, the drop and puncture tests, were performed satisfactorily and immediately met the intent of the regulations. The third sequential test, a 1475degF thermal test, was performed in an electric furnace and did not meet regulations. Problems were encountered with oxygen deficiency and radiation attenuation during the test. An evaluation of the problems associated with furnace testing and their solutions will be discussed. The thermal test was repeated in a pool fire at the Sandia National Laboratory Lurance Canyon Burn Site. Unexpected problems from extremely high (1900degF) flame temperatures resulted in secondary vessel containment failure. From the results of a failure study, a heat shield was added to the 5320 Cask and a subsequent fire test determined that the packaging finally met the intent of the regulations. The failure study as well as the subsequent design solution will be discussed. (author)

  15. An autoethnographic exploration of the use of goal oriented feedback to enhance brief clinical teaching encounters. (United States)

    Farrell, Laura; Bourgeois-Law, Gisele; Ajjawi, Rola; Regehr, Glenn


    Supervision in the outpatient context is increasingly in the form of single day interactions between students and preceptors. This creates difficulties for effective feedback, which often depends on a strong relationship of trust between preceptor and student. Building on feedback theories focusing on the relational and dialogic aspects of feedback, this study explored the use of goal-oriented feedback in brief encounters with learners. This study used autoethnography to explore one preceptor's feedback interactions over an eight-month period both in the ambulatory setting and on the wards. Data included written narrative reflections on feedback interactions with twenty-three learners informed by discussions with colleagues and repeated reading of feedback literature. Thematic and narrative analyses of data were performed iteratively. Data analysis emphasized four recurrent themes. (1) Goal discussions were most effective when initiated early and integrated throughout the learning experience. (2) Both learner and preceptor goals were multiple and varied, and feedback needed to reflect this complexity. (3) Negotiation or co-construction of goals was important when considering the focus of feedback discussions in order to create safer, more effective interactions. (4) Goal oriented interactions offer potential benefits to the learner and preceptor. Goal oriented feedback promotes dialogue as it requires both preceptor and learner to acknowledge and negotiate learning goals throughout their interaction. In doing so, feedback becomes an explicit component of the preceptor-learner relationship. This enhances feedback interactions even in relatively brief encounters, and may begin an early educational alliance that can be elaborated with longer interactions.

  16. Fecal glucocorticoid metabolite response of captive koalas (Phascolarctos cinereus) to visitor encounters. (United States)

    Webster, Koa; Narayan, Edward; de Vos, Nicholas


    Physiological responses of wildlife species to zoo visitors should be studied to better understand how wildlife perceive human encounters. We conducted an experimental test of the effect of changes in zoo visitor encounter experiences on the glucocorticoid (GC) response of koalas (Phascolarctos cinereus) in a Sydney zoo. Koalas were housed in a multiple-bay enclosure (two to three koalas per bay) for photography sessions with zoo visitors (no touching of koalas permitted by visitors). Following a one-week no-photography baseline period, photography sessions were rotated between three enclosure bays for four weeks (Intensive photography), then between five enclosure bays for an additional four weeks (Standard photography). A sixth enclosure bay was never included in the photography sessions (control bay); koalas in this bay showed no significant change in fecal cortisol metabolites (FCMs) during the course of the study. In the five experimental bays differences were seen between male and female koalas. Males had higher mean FCMs than females, and individual FCM traces showed that two male koalas that were related and of similar age responded strongly to the experimental manipulation. These two males showed a peak in FCMs at the beginning of the Intensive photography period, then a decline when photography sessions returned to the Standard protocol. No systematic pattern in response to photography sessions was observed in females. Our results demonstrate successful application of a non-invasive endocrinology tool for assessing the stress biology and welfare of captive zoo wildlife. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Administrative encounters in general practice: low value or hidden value care? (United States)

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


    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.

  18. Thriving on Pressure: A Factor Mixture Analysis of Sport Performers' Responses to Competitive Encounters. (United States)

    Brown, Daniel J; Arnold, Rachel; Standage, Martyn; Fletcher, David


    Although considerable research exists on performers' responses to sporting encounters, little is known about thriving in sport contexts. The current study examined if distinct response patterns existed between sport performers who thrived in competitive encounters compared with those who did not. Participants were 535 sport performers (134 women; M age  = 23.60 years, SD age  = 8.08; M competing  = 11.84 years, SD competing  = 7.11). Results of factor mixture analysis supported a four-profile solution comprising a thriving group (n = 146), a low-functioning group (n = 38), and two groups characterized by scores marginally above (n = 131) and below (n = 209) the sample mean. Profile membership was found to be predicted by personal enablers (viz., personal resilient qualities, psychological skills use) and process variables (viz., basic psychological need satisfaction and frustration, challenge appraisal). This examination of thriving in sport performers offers significant implications for research and practice.

  19. Modulation of Pleurodeles waltl DNA polymerase mu expression by extreme conditions encountered during spaceflight.

    Directory of Open Access Journals (Sweden)

    Véronique Schenten

    Full Text Available DNA polymerase µ is involved in DNA repair, V(DJ recombination and likely somatic hypermutation of immunoglobulin genes. Our previous studies demonstrated that spaceflight conditions affect immunoglobulin gene expression and somatic hypermutation frequency. Consequently, we questioned whether Polμ expression could also be affected. To address this question, we characterized Polμ of the Iberian ribbed newt Pleurodeles waltl and exposed embryos of that species to spaceflight conditions or to environmental modifications corresponding to those encountered in the International Space Station. We noted a robust expression of Polμ mRNA during early ontogenesis and in the testis, suggesting that Polμ is involved in genomic stability. Full-length Polμ transcripts are 8-9 times more abundant in P. waltl than in humans and mice, thereby providing an explanation for the somatic hypermutation predilection of G and C bases in amphibians. Polμ transcription decreases after 10 days of development in space and radiation seem primarily involved in this down-regulation. However, space radiation, alone or in combination with a perturbation of the circadian rhythm, did not affect Polμ protein levels and did not induce protein oxidation, showing the limited impact of radiation encountered during a 10-day stay in the International Space Station.

  20. Influence of temporal context on value in the multiple-chains and successive-encounters procedures. (United States)

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


    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.

  1. Critical elements of culturally competent communication in the medical encounter: a review and model. (United States)

    Teal, Cayla R; Street, Richard L


    Increasing the cultural competence of physicians is one means of responding to demographic changes in the USA, as well as reducing health disparities. However, in spite of the development and implementation of cultural competence training programs, little is known about the ways cultural competence manifests itself in medical encounters. This paper will present a model of culturally competent communication that offers a framework of studying cultural competence 'in action.' First, we describe four critical elements of culturally competent communication in the medical encounter--communication repertoire, situational awareness, adaptability, and knowledge about core cultural issues. We present a model of culturally competent physician communication that integrates existing frameworks for cultural competence in patient care with models of effective patient-centered communication. The culturally competent communication model includes five communication skills that are depicted as elements of a set in which acquisition of more skills corresponds to increasing complexity and culturally competent communication. The culturally competent communication model utilizes each of the four critical elements to fully develop each skill and apply increasingly sophisticated, contextually appropriate communication behaviors to engage with culturally different patients in complex interactions. It is designed to foster maximum physician sensitivity to cultural variation in patients as the foundation of physician-communication competence in interacting with patients.

  2. The difficulties encountered in conversion from classic pancreaticoduodenectomy to total laparoscopic pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Muharrem Battal


    Full Text Available Background: Recently, total laparoscopic pancreatectomy has been performed at many centres as an alternative to open surgery. In this study, we aimed to present the difficulties that we have encountered in converting from classic open pancreaticoduodenectomy to total laparoscopic pancreatectomy. Materials and Methods: Between December 2012 and January 2014, we had 100 open pancreaticoduodenectomies. Subsequently, we tried to perform total laparoscopic pancreaticoduodenectomy (TLPD in 22 patients. In 17 of these 22 patients, we carried out the total laparoscopic procedure. We analysed the difficulties that we encountered converting to TLPD in three parts: Preoperative, operative and postoperative. Preoperative difficulties involved patient selection, preparation of operative instruments, and planning the operation. Operative difficulties involved the position of the trocars, dissection, and reconstruction problems. The postoperative difficulty involved follow-up of the patient. Results: According to our experiences, the most important problem is the proper selection of patients. Contrary to our previous thoughts, older patients who were in better condition were comparatively more appropriate candidates than younger patients. This is because the younger patients have generally soft pancreatic texture, which complicates the reconstruction. The main operative problems are trocar positions and maintaining the appropriate position of the camera, which requires continuous changes in its angles during the operation. However, postoperative follow-up is not very different from the classic procedure. Conclusion: TLPD is a suitable procedure under appropriate conditions.

  3. 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


    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

  4. Examining the Spatial Distribution of Law Enforcement Encounters among People Who Inject Drugs after Implementation of Mexico’s Drug Policy Reform


    Gaines, Tommi L.; Beletsky, Leo; Arredondo, Jaime; Werb, Daniel; Rangel, Gudelia; Vera, Alicia; Brouwer, Kimberly


    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) ...

  5. Acquisition of an Underway CTD System for the Flow Encountering Abrupt Topography DRI (United States)


    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

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


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


    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...

  7. Quantifying the Effects of Gas-Rich Flyby Encounters on Galaxy Evolution (United States)

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


    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.

  8. Undesirable Behaviors Elementary School Classroom Teachers Encounter in the Classroom and Their Reasons

    Directory of Open Access Journals (Sweden)

    E.G. Balcik


    Full Text Available 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 measurement tool was applied to a total of 54 teachers at 5 schools in Gölcük district of the Kocaeli province. The data collection tool is composed of three sections. The first section is for establishing teachers’ personal information. In this study, as a data collection tool, a questionnaire was used. When preparing questions for the questionnaire, following the examination of resources available, the questionnaire prepared by Aksoy (1999 and used in the thesis study entitled “Classroom Management and Student Discipline in Elementary Schools of Ankara” and also used in the thesis study by Boyraz (2007 entitled “Discipline Problems that Candidate Teachers Servicing at Elementary Schools Encounter in the Classroom” was employed. Although the validity and reliability of the questionnaire was tested by Aksoy (1999 and Boyraz (2007, the reliability study for the questionnaire was retested and found to be 0,9. The questionnaire include 42 items. 19 of them are related to the reasons of undesirable behaviors observed in the classroom and 23 of them are related to undesirable behaviors observed in the classroom.

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

    Directory of Open Access Journals (Sweden)

    Amalia L. Cabezas


    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

  10. The Germans revisiting Gakovo: Encounters, cooperation and reconciliation of the former and present local populations

    Directory of Open Access Journals (Sweden)

    Krel Aleksandar


    Full Text Available This paper presents a case study about a reunion of the evicted members of the German national minority in Vojvodina, who after almost five decades came to visit their homeland, and the local population in Gakovo. The case study attests about lengthy and very complicated process in resolving post-conflict situations. The process’ launch is dependent on the willingness of the individuals involved to face not only one’s own pain caused by the enemy, but also on ability to comprehend, during an encounter with “the dark side of one’s past”, sufferings and humiliation experienced by the adversary. Awareness and acceptance of one’s own responsibility in the conflict are a prerequisite for forgiveness and reconciliation of the opposing parties. The outcome of this process is uncertain to the very end and conditioned upon the entire network of interlocking political, economic and cultural factors.

  11. Encountering Spaces of Resistance When Implementing Research-Based Strategies for English Language Learners (ELLs

    Directory of Open Access Journals (Sweden)

    Xaé Alicia Reyes


    Full Text Available This article discusses research findings from follow-up studies on the effects of purposeful programming designed to prepare educators who participated in either of two professional development federal grants funded by the U.S. Department of Education (REALL 2007 and LEAD 2012 to address the needs of English Language Learners (ELLs. The qualitative data gleaned through focus group interviews and responses to questionnaires collected in these studies describe both educators’ sense of self-efficacy (Bandura, 1994 and their students’ transformations as they experience success. The longitudinal data collected over a 6-year period include narratives of resistance encountered by the grant participants in spaces such as schools, districts, and the broader community, and how these challenges were approached.

  12. Molecular systematics in the genus Mucor with special regards to species encountered in cheese. (United States)

    Hermet, Antoine; Méheust, Delphine; Mounier, Jérôme; Barbier, Georges; Jany, Jean-Luc


    The genus Mucor, a member of the order Mucorales, comprises different species encountered in cheeses. Although fungi play a fundamental role in cheese manufacturing and ripening, the taxonomy of many fungal species found in cheese is poorly defined; indeed, this is the case for Mucor spp. In the present study, we assessed the phylogenetic relationships among 70 Mucor strains, including 36 cheese isolates, by using a five gene phylogenetic approach combined with morphological analyses. Overall, at least six species of Mucor were identified among the cheese isolates including a possible new taxon. The present study also suggests that the genus Mucor comprises undescribed taxa and needs to be properly defined. Copyright © 2012 The British Mycological Society. Published by Elsevier Ltd. All rights reserved.

  13. Difficulties encountered by the teachers in fifth grade applications of mathematics course

    Directory of Open Access Journals (Sweden)

    Fatma Nur Çoban


    Full Text Available The purpose of this study was to determine the teachers’ practices and the difficulties encountered by the teachers in 5th grade optional ‘mathematics applications’ course, which came into effect with the new 4+4+4 educational system.  The study was conducted in 2012-2013 academic year using the qualitative research method of semi-structured interview with 8 mathematics teachers who were teaching this course. The teachers were from four schools situated in socioeconomically average quarters of Eskişehir. The interview consisted of questions under three categories; aims and contents of the course, teachers’ practices and assessment of the course.Key Words:    Mathematics applications course, curriculum, teaching resources, teacher views

  14. Genetic Polymorphisms Associated with Hearing Threshold Shift in Subjects during First Encounter with Occupational Impulse Noise. (United States)

    Grondin, Yohann; Bortoni, Magda E; Sepulveda, Rosalinda; Ghelfi, Elisa; Bartos, Adam; Cotanche, Douglas; Clifford, Royce E; Rogers, Rick A


    Noise-induced hearing loss (NIHL) is the most significant occupational health issue worldwide. We conducted a genome-wide association study to identify single-nucleotide polymorphisms (SNPs) associated with hearing threshold shift in young males undergoing their first encounter with occupational impulse noise. We report a significant association of SNP rs7598759 (p hearing loss, we tested down-regulation of nucleolin in cochlear sensory cells HEI-OC1 under oxidative stress conditions and report increased sensitivity to cisplatin, a chemotherapeutic drug with ototoxic side effects. Additional SNPs were found with suggestive association (p < 5 x 10(-4)), of which 7 SNPs were located in genes previously reported to be related to NIHL and 43 of them were observed in 36 other genes previously not reported to be associated with NIHL. Taken together, our GWAS data and in vitro studies reported herein suggest that nucleolin is a potential candidate associated with NIHL in this population.

  15. Encountering local inhabitants' perspectives in terms of authenticity: The example of rural tourism in southern Germany

    Directory of Open Access Journals (Sweden)

    T. Weidinger


    Full Text Available Effects of globalisation and various standardisation processes in everyday life are currently reflected through individuals’ quests for encountering authenticity. The paper interrogates in which particular ways local inhabitants evaluate rural localities with regard to authenticity by means of local architectural styles and filmic representations. Empirical findings from two qualitative studies carried out in rural Southern Germany are presented. The studies were comprised of qualitative interviews with local inhabitants and representatives in tourism, politics and heritage conservation together with a film analysis of a popular Heimat film shot in the Bavarian forest. Results reveal locals’ critique of modern architectural styles such as “Tuscan houses” as inauthentic, whereby a link between architecture and regional identity (“archidentity” cannot be established. However, the film analysis brings forth locals’ congruities between filmic representations and their lived spaces. In sum, locals’ perspectives on authentication processes can contribute to re-evaluate localities that are mainly shaped by idealised images for tourism purposes.

  16. Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care. (United States)

    Pelto-Piri, Veikko; Engström, Karin; Engström, Ingemar


    Psychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients' opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity. All staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives. The majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.•Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.•Autonomy; 1) respecting the patient's right to self-determination and information, 2) respecting the patient's integrity and 3) protecting human rights.•Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients. Paternalism clearly appeared to be the dominant

  17. Common Ground in Cross Cultural Communication: Sequential and Institutional Contexts in Front Desk Service Encounters. (United States)

    Kidwell, Mardi


    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…

  18. 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....

  19. BodyHeat Encounter: Performing Technology in Pedagogical Spaces of Surveillance/Intimacy (United States)

    Fels, Lynn; Ricketts, Kathryn


    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…

  20. Intercultural Reflection through the "Autobiography of Intercultural Encounters": Students' Accounts of Their Images of Alterity (United States)

    Méndez García, María del Carmen


    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…