Caring for Fat Patients: Bioethical Considerations Surrounding the Duty of Care

Healthcare providers’ (HCP) duty of care explains what HCPs owe to all their patients, but this thesis will focus on how the duty of care informs the treatment of fat patients. Currently, the foundation of the duty of care is rooted in a set of principles enumerated by the American Medical Association. This current conception of the duty of care fails to provide basic protections against harm to fat individuals, primarily because it is unable to prevent the negative attitudes HCPs have about fat people from permeating healthcare. The negative attitudes HCPs have about fat patients stem from a societal emphasis on framing fatness as an individual moral failing as opposed to a systemic problem. The social narrative around fatness falsely claims that fat people choose to be fat and that they have a personal responsibility to choose otherwise. This framework causes harm to fat patients through the negative attitudes of HCPs. These harms include a decreased quality of healthcare, damaged relationships between providers and patients, mistrust of diagnoses, and much more. After exploring the harms endured by fat patients and the failure of the current duty of care to protect fat patients from these harms it will be clear that a revised duty of care is needed. The revised duty of care will be constructed from a new set of principles combined with increased educational standards for all providers. The new set of principles will rely on Beauchamp and Childress’s Principlism, an account of medical ethics which concentrates on the adoption of four basic principles: respect for autonomy, nonmaleficence, beneficence, and justice (2019). Furthermore, this thesis argues for the need to increase educational requirements for all providers as a means of successfully employing Principlism and guaranteeing fat patients the same protections as others. The revised duty of care will establish a framework that challenges HCPs to ground their attitudes about fat patients in scientific research instead of social narratives and ensure the obligations which stem from the duty of care are applied impartially to all patients

Speech symptoms in Schizophrenia and relationships with working memory, goal maintenance, and processing speed

People with schizophrenia exhibit wide ranging cognitive deficits, including slower processing speed (i.e., speed of executing task components). Speech symptoms, such as disorganized speech and alogia, have been associated with cognitive control deficits, but the exact nature of their relationship to specific cognitive deficits is unclear. In the current study, people with schizophrenia (n = 51) and non-psychiatric controls (n = 26) completed speech interviews allowing for assessment of speech symptoms. Participants also completed two tasks strongly involving working memory and two tasks strongly involving goal maintenance. In addition, measures of processing speed for highly automatic prepotent responses and a measure of general poor task performance were also obtained. For disorganized speech, it was significantly associated with poor performance in all cognitive domains (all r's > -.29), with the largest association found with slower processing speed (r = -.46). Further, disorganized speech was even associated with a non-cognitive control measure of poor general task performance (BY errors on the AX-CPT, r = -.43). In contrast, alogia was not significantly related to any cognitive domain, with the largest association with goal maintenance tasks (r = - .24). Overall, this study suggests that disorganized speech in schizophrenia, but not alogia, is associated with generalized cognitive deficits

Captain Vancouver's Grave

"The soldier who…recently sent back to his home town paper a report that the grave of Captain George Vancouver…was in a state of neglect, must have made a very superficial observation…

Couple Identity Gaps and the Management of Stress and Conflict in Romantic Relationships

The purpose of this study was to investigate the role of couple identity (or the degree to which one's partner and relationship are central to one's personal identity; Acitelli, Rogers, & Knee, 1999) in romantic partners' communicative and physiological management of stress associated with relational conflict. The current study extends the research on couple identity by introducing the concept of identity gaps (Hecht, 1993) into relational contexts as a way to explain why couples vary in their ability to manage stress. With assumptions that perceptions of couple identity are beneficial to stress management and that perceptions of couple identity gaps are detrimental to stress management, it was hypothesized that these variables would predict romantic partners' a) perceptions of anxiety, stress, and negativity associated with a conflict-inducing discussion and b) their salivary alpha-amylase (sAA) and salivary cortisol reactivity and recovery in response to a conflict-inducing discussion. One hundred eighteen couples participated in a laboratory study, in which they engaged in a discussion about conflict-inducing topic and provided saliva samples to assess biological stress markers. The couples were also randomly assigned to one of three conditions (couple identity prime, individual identity prime, or control) to test whether priming partners' sense of couple identity (compared to individual identity) prior to the conflict-inducing discussion influenced the results. The results showed that perceptions of couple identity predicted perceptions of conflict negativity, but not anxiety or stress. Overall, perceptions of couple identity gaps emerged as a stronger predictor in this study than perceptions of couple identity. Perceptions of couple identity gaps were associated with greater conflict anxiety, stress, and negativity, as well as heightened cortisol and sAA reactivity. Intriguing results emerged when testing the possibility of interaction effects between the type of prime (couple identity or individual identity) and individuals' pre-existing perceptions of couple identity (and couple identity gaps) on conflict and stress outcomes. The interaction effect patterns suggest that for some outcomes, priming couple identity for those who have weak perceptions of couple identity or have high couple identity gap perceptions increases stress associated with conflict (self-reported and physiological). On the other hand, the interaction effects revealed some evidence that priming individual identity for those who have strong perceptions of couple identity or those with low couple identity gap perceptions increases stress associated with conflict (self-reported and physiological). The current study contributes to the existing research on couple identity by highlighting its role in the romantic partners' experiences and management of stress associated with relational conflict. The study also is the first known to the author to translate identity gaps from the individual context to a dyadic context. Furthermore, the predictive power of couple identity gaps in this study was noteworthy and further supports the viability of this concept in future relationship research. Finally, the study integrated multiple approaches to studying stress (cognitive, behavioral, and physiological) in a novel and theoretically-rich way

Feasibility and Acceptability of a Wrist-worn Transdermal Alcohol Biosensor to Collect Data in the Field

Transdermal alcohol monitoring allows for continuous, non-invasive, objective, and remote measurement of alcohol consumption. We evaluated feasibility and acceptability of participant use of the BACtrack Skyn biosensor bracelet in daily life. Heavy drinkers (n=20) wore the Skyn and self-reported drinking behavior for 7 days, followed by an individual interview. Recruitment and retention benchmarks were met, supporting feasibility. Participants provided both positive and constructive feedback on the Skyn during interviews, and usability of the bracelet was deemed “good”. Most missing data were inconsequential (<5 mins), with data available 85% of the time participants were asked to wear it. Missing data was largely expected and due to bracelet removal during bathing or charging. Overall, results indicate promise in our ability to integrate this tool into research and/or clinical practice, passively and objectively monitoring alcohol use in participants and/or patients with minimal burden

Exile Vol. XVII No. 2

POETRY Grammer lesson by Julie Lockwood 5 Hunter by J. Barmeier 10 (rare) by Alice Merrill 13 November Leaf by J. Barmeier 13 In retrospect by Julie Lockwood 14 Weaving by Alice Merrill 16 SPETSE by Cary Anne Spear 17 View From A Garret To Infinity J. Barmeier 18 Morning after Reflection by J. Barmeier 19 A MINOR CHANGE AT DENISON U.? by Pete Porteous 30 Snowflak by J. Barmeier 32 LOVING by Curtis Hutchens 34 IRISH CONVERSATION by Cary Anne Spear 36 On This Planet by yasue aoki 39 FICTION Visiting Before The Mirror by Holly Battles 8-9, 31 Cypher by Keith McWalter 22-28 ART by Sandy Adams: Cover, 31 by Beth Newman 4 by Jill Harris 6, 13 by Ned Bittinger 7 by Bill Musgrave 12, 20 by Gail Lutsch 15, 18, 26, 29 by M. A. Albert 31 by Charlie Greacen 35 by Diane Ulmer 38 PHOTOGRAPHY by Jill Harris 19 all others by Tim Het

Risco frente ao HIV/Aids entre mulheres trabalhadoras do sexo que usam crack no sul do Brasil

OBJECTIVE: To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study. ANALYSIS OF RESULTS: Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care. CONCLUSIONS: Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.OBJETIVO: Comprender el contexto social en el cual están insertadas trabajadoras del sexo que usan crack y su impacto en la adopción de comportamientos de riesgo frente al HIV/Sida. MÉTODOS: Se realizó estudio cualitativo en Foz de Iguacu (Sur de Brasil), en 2003. Se realizaron 26 encuestas con profundidad y dos grupos focales con trabajadoras del sexo que utilizan crack frecuentemente. También se realizaron encuestas con profundidad con profesionales de la salud, líderes comunitarios y gerentes de políticas públicas, además de observaciones de campo. Los datos transcritos fueron codificados con ayuda del software Atlas.ti y el método grounded theory (teoría fundamentada en datos) fue utilizada para analizar los datos y desarrollar un modelo conceptual como resultado de estudio. ANÁLISIS DE LOS RESULTADOS: Las trabajadoras del sexo que utilizan crack presentaron baja autopercepción del riesgo frente al HIV, a pesar de estar relacionadas con comportamientos de riesgo, como sexo desprotegido con múltiples parejas. Experiencias de violencia física y sexual con clientes, parejas ocasionales y estables fueron bastante frecuentes entre estas mujeres, perjudicando la negociación y el uso consistente de preservativos. Según los profesionales de la salud, los líderes comunitarios y los gerentes de políticas públicas, diversas trabajadoras del sexo usuarias de crack, viven en las calles o en barrios, raramente tienen acceso a los servicios de salud, de consejos y exámenes anónimos, de apoyo social y de salud reproductiva y pre-natal. CONCLUSIONES: Las profesionales del sexo que utilizan crack experimentaron varios problemas sociales y de salud que parecen influenciar sobre el riesgo a la infección por el HIV. Intervenciones de bajo umbral, amigables y dirigidas para cuestiones de género deben ser implementadas buscando facilitar el acceso a servicios de salud y de apoyo social en esa población. Tales iniciativas podrán también facilitar el acceso de ese grupo a servicios dirigidos a la salud reproductiva en general y estrategias específicamente dirigidas a la prevención del HIV/Sida y otras infecciones sexualmente transmisibles.OBJETIVO: Compreender o contexto social no qual estão inseridas trabalhadoras do sexo que usam crack e seu impacto na adoção de comportamentos de risco frente ao HIV/Aids. PROCEDIMENTOS METODOLÓGICOS: Estudo qualitativo realizado em Foz do Iguaçu (PR), em 2003. Foram realizadas 26 entrevistas em profundidade e dois grupos focais com trabalhadoras do sexo que utilizam crack freqüentemente. Também foram realizadas entrevistas em profundidade com profissionais de saúde, líderes comunitários e gerentes de políticas públicas, além de observações de campo. Os dados transcritos foram codificados com auxílio do software Atlas.ti e a metodologia grounded theory (teoria fundamentada em dados) foi utilizada para analisar os dados e desenvolver um modelo conceitual como resultado do estudo. ANÁLISE DOS RESULTADOS: As trabalhadoras do sexo que utilizam crack apresentaram baixa autopercepção de risco frente ao HIV, apesar de estarem envolvidas em comportamentos de risco, como sexo desprotegido com múltiplos parceiros. Experiências de violência física e sexual com clientes, parceiros ocasionais e estáveis foram bastante freqüentes entre estas mulheres, prejudicando a negociação e o uso consistente de preservativos. Segundo profissionais de saúde, líderes comunitários e gerentes de políticas públicas, diversas trabalhadoras do sexo usuárias de crack, são moradoras de rua ou favelas, raramente acessam serviços de saúde, de aconselhamento e testagem anônimos, de apoio social e de saúde reprodutiva e pré-natal. CONCLUSÕES: As profissionais do sexo que utilizam crack vivenciam vários problemas sociais e de saúde que parecem influenciar o risco à infecção pelo HIV. Intervenções de limiar baixo, amigáveis e voltadas para questões de gênero devem ser implementadas objetivando facilitar o acesso a serviços de saúde e de apoio social nessa população. Tais iniciativas poderão também facilitar o acesso deste grupo a serviços voltados para saúde reprodutiva em geral e estratégias especificamente voltadas para prevenção do HIV/Aids e demais infecções sexualmente transmissíveis