The psychological basis of adolescent worship

Thesis (M.A.)--Boston UniversityFor the basic psychological characteristics that in turn will assist in determining a program of worship, we have considered but five, others of which could be added. Those mentioned are habit, social consciousness, conversion, loyalty and hero-worship. Each of these we feel are essential if we are to properly and adequately construct a worship program

Women’s experiences and reactions when a fetal malformation is detected by ultrasound examination

Background: Second trimester ultrasound examination among pregnant women in Sweden is almost universal. The detection of a fetal malformation on ultrasound puts health care providers and pregnant women in a difficult and precarious situation. What information and how it is communicated is crucial to women’s decision-making about continuing or terminating at pregnancy. The main aim of this thesis was to describe and analyze women’s experiences and reactions following the detection of a fetal malformation on an ultrasound scan. Methods: Two semi-structured in-depth interviews were performed, with women informed of a fetal malformation following an ultrasound scan. A total of 27 women took part in the first round of interviews: women continuing their pregnancy were interviewed, either in gestational week 30 or three weeks after the diagnosis; those terminating their pregnancy were interviewed two to four weeks after termination (Paper I). A second interview with 11 women who terminated their pregnancy was conducted six months after termination (Paper III). Two questionnaires were also administered. The first, answered by 99 women (Paper II) and comprising 22 study- specific questions along with emotional well-being and socio-demographics variables and medical and obstetric history, was conducted at the same time as the first stage of interviews. The other questionnaire, answered by 56 women incorporated common self- report instruments and was performed three times: first in gestational week 30, and then two respectively six months postpartum (Paper IV). Qualitative data were analyzed through content analysis, and quantitative data were analyzed through descriptive statistics. Results: The timing, duration, and manner of women’s initial counseling and ongoing support were shown to be important in the interaction between women and caregivers. Positive interactions improved the women’s ability to understand the information and fostered feelings of trust and safety, which in turn reduced their anxiety. Most of the women who expected a baby with an abnormality expressed their need for information on several occasions to help them make this difficult decision. They also wished for information from different specialists and continuity of care. These needs were even stronger in women who chose to terminate their pregnancy. We found women continuing their pregnancy to be at high risk of depressive symptoms, major worries, and high anxiety levels, both in mid-pregnancy, and at two months and one year postpartum. Despite these findings, the results of the maternal-fetal attachment scale for women who continued their pregnancy with a fetus diagnosed with a malformation indicated a high level of attachment. Conclusions and Clinical Implications: Effective communication, empathy and compassion, and consistent follow-up routines are important to ensure good treatment and care of this group of women. Taking these results into account may improve caregivers’ ability to counsel these vulnerable patients and to ensure that their needs are properly met

Clinical decision support improves physician guideline adherence for laboratory monitoring of chronic kidney disease: a matched cohort study

Sample graph page of relevant test results. (PDF 289 kb

Established and Novel Initiatives to Reduce Crowding in Emergency Departments

Introduction: The American College of Emergency Physicians (ACEP) Task Force on Boarding described high-impact initiatives to decrease crowding. Furthermore, some emergency departments (EDs) have implemented a novel initiative we term “vertical patient flow,” i.e. segmenting patients who can be safely evaluated, managed, admitted or discharged without occupying a traditional ED room. We sought to determine the degree that ACEP-identified high-impact initiatives for ED crowding and vertical patient flow have been implemented in academic EDs in the United States (U.S.). Methods: We surveyed the physician leadership of all U.S. academic EDs from March to May 2010 using a 2-minute online survey. Academic ED was defined by the primary site of an emergency residency program. Results: We had a response rate of 73% (106/145) and a completion rate of 71% (103/145). The most prevalent hospital-based initiative was inpatient discharge coordination (46% [47/103] of respondents) while the least fully initiated was surgical schedule smoothing (11% [11/103]). The most prevalent ED-based initiative was fast track (79% [81/103]) while the least initiated was physician triage (12% [12/103]). Vertical patient flow had been implemented in 29% (30/103) of responding EDs while an additional 41% (42/103) reported partial/in progress implementation. Conclusion: We found great variability in the extent academic EDs have implemented ACEP’s established high-impact ED crowding initiatives, yet most (70%) have adopted to some extent the novel initiative vertical patient flow. Future studies should examine barriers to implementing these crowding initiatives and how they affect outcomes such as patient safety, ED throughput and patient/provider satisfaction

The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease

BACKGROUND: Chronic Kidney Disease (CKD) is associated with alterations in phosphorus excretion, and increases in fibroblast growth factor (FGF23) and parathyroid hormone (PTH). Plant protein-based phytate-bound phosphorus, is less bioavailable than that from animal sources. Our one-week study that was conducted previously showed that a nearly 100% plant protein-based diet benefits mineral metabolism in CKD; however, this diet may not be acceptable to patients. Here we hypothesize that a diet containing 70% protein from plants has similar efficacy and is tolerated by CKD patients. METHODS: Thirteen subjects with CKD 3-4 received an omnivorous diet containing 70% protein from plants for 4 weeks. The primary outcome was change in 24 h urine phosphorus. Secondary outcomes were changes in serum phosphorus, FGF23, PTH, urine sodium excretion, grip strength and fat free mass. Repeated measures analysis of variance (ANOVA) was used to test differences in parameters over the 4 weeks. RESULTS: Mean age of subjects was 54.8 years. Median eGFR was 26 (IQR 14.7) ml/min/1.73 m(2). Over the 4-week period, urine phosphorus significantly decreased by 215 ± 232 mg/day (p < 0.001). No significant changes in serum FGF23, phosphorus or PTH were noted. Urine sodium and titratable acid decreased significantly on the diet. Hand grip strength and fat-free mass did not change. There were two hyperkalemia events both 5.8 mEq/l, corrected by food substitutions. No other adverse events were observed. CONCLUSIONS: A 70% plant protein diet is safe, tolerated, and efficacious in lowering urine phosphorus excretion and may be an alternative to phosphate binders

Rockfall and snow avalanche impact dynamics for road protection design at Svarthola, Senja. A hazard evaluation aided by numerical models and physical formulas

Rockfalls and snow avalanches are a major natural hazard and common phenomenon in mountainous areas in Norway, endangering people and infrastructure. Svarthola, on Fv 862, Senja, is a 100 m long unprotected stretch of road that experiences a high frequency of mass movements. The road is situated at a tunnel portal, between a 100 m high cliff and the fjord. As such, it is the only short access route between the northern and western parts of the island, and frequent road closures have created safety and access issues. It is therefore classified by Troms and Finnmark County as one of the most dangerous roads in the region, and the installation of a protection structure is considered necessary. This study focuses on the impact dynamics from rockfalls (kinetic energy, velocity, jump height) and snow avalanches (snow pressure, velocity, flow height) at Svarthola for protection design. An analysis of the hazard at the site was performed through fieldwork and desktop mapping in order to estimate the size of the mass movements relevant for the design. This data were used in numerical modelling to obtain the impact dynamics. The road experiences frequent rock fall inundation, with boulders up to 2 m3 causing damage and road closures. Rockfall analysis shows variable impact dynamics for the different event scenarios, ranging from 1,700 kJ for annual events up to 7,100 kJ for a 100-year event. The analysis showed impact velocities between 22 and 50 m/s. The median jump heights were 0.9-1.2 m, where some rock blocks can jump >20 m if they hit the lower cliff part above the road. The fall height of a block can be up to 100 m. The road experiences a lower frequency of snow avalanches but they are often leading to road closures. Impact dynamics were obtained through numerical modelling and physical formulas. The impact dynamics for a 100-year dry-slab avalanche event with a volume of 16,900 m3 is estimated as follows: snow pressure of 130-270 kPa, impact velocity between 20 and 37 m/s and flow height of 2-3.7 m in the northern part of the road and up to 1.2 m in the southern part. Finally, an analysis of the relationship between the rockfall and avalanche history and climate factors were done with the aim to propose the implications of climate change. Svarthola will most likely experience more rockfall events in the future due to the projected increase in rainfall intensity and frequency. The dry-snow avalanche hazard may disappear completely due to the rarity of snow cover in these low coastal areas, but the likelihood of wet-snow avalanches and slushflows may increase in a wetter climate

Synthetic Studies toward Gold(I)-catalyzed preparation of Trifluoromethyl Compounds

In this project gold(I)-catalyzed reactions on triple bonds has been investigated, with the trifluoromethyl group incorporated. Initially the goal was to develop a new gold(I)-catalyzed trifluoromethylation reaction, as shown below. This goal has not been reached. Several attempts in order to prepare a trifluoromethylated di-hydropyran derivate, both by direct trifluoromethylation and via trifluoromethylated precursors. A study of the reactivity of a trifluoromethylated alkyne in regard to gold(I)-catalysis has been performed in order to obtain a better understanding of reactions on similar substrates. The study has been performed by GLC analysis of a range of small scale reactions, as shown below, performed under different conditions. The study showed that the nucleophilic attack on the gold activated \ce{CF3}-alkyne triple bond is highly favored towards generating a vinyl compound. While terminal alkynes react further to form unsaturated products, the trifluoromethyl substrate is fairly stable at the alkene stage, although it will react further given tougher conditions. NMR has been essential for the structure elucidation and monitoring of reactions throughout the project

Wasted Intuitions: New York City’s Solid Waste Management System and the Ambiguous Effects of Traditional Collective Good Provision Analysis

Refuse Collection services\u27 status as a public good has been highly contested. As it is both rivalrous and excludable, basic theory predicts that private provision of solid waste management services will be more efficient. Private trash carters are able to specialize in a way that municipality-run services simply cannot. New York City is unique in that its solid waste management system is rigidly split: residential trash is managed by the city; commercial trash is managed by private businesses. This thesis explores how New York City\u27s public and private solid waste management systems complicate these initial intuitions through a welfare analysis. Price, wage, and operating efficiency are used to measure consumer, employee, and employer welfare respectively. New York City’s private refuse collection industry is characterized by weak unions, systemic bloat, and poor safety standards. Furthermore, they offer higher prices, lower wages, and are less efficient in comparison to their public counterpart. The city hopes to assuage some of these problems by creating Commercial Waste Zones