An Ethnographic Study of Homelessness in Memphis During the COVID-19 Pandemic

Abstract This dissertation is an ethnographic study that examines the health beliefs of persons experiencing homelessness in Mid-town Memphis. It considers participants\u27 social practices and environmental circumstances and analyzes how the global pandemic may have informed their health beliefs. Social determinants such as neighborhood safety, unemployment, racism, and transportation exacerbate issues of absenteeism, poor dietary/health-related habits, and further mistrust in health systems and public aid. Low “compliance,” a term used in health care to describe patient behaviors of non-adherence to prescribed medical treatments, is problematic in its connotation of intent or deliberateness without consideration of socioeconomics and other sociocultural matters. Therefore, the term is used in this text interchangeably with “non-adherence” with reluctance and with the understanding that such industry terminology does not account for health beliefs, psychosocial, or cultural factors. Moreover, the terms are restrictive and are at odds with the notions of health beliefs and the narrative paradigm. Nonetheless, non-compliance highlights issues of health literacy, which may also complicate matters of patient adherence and the production of socially constructed health beliefs. Vulnerable populations, such as persons experiencing homelessness, have long suffered from the systems that exclude them from society and almost entirely from the scientific literature that may shed light on the barriers they experience daily and pathways that might affect policy change to improve their health and wellness. By Privileging the voices and experiences of persons affected by homelessness, this study seeks to identify social and structural barriers impacting the health of this population group and make their struggles visible to policymakers, health promoters, and the lay public. Secondly, this community-based participatory action research invites participants to discuss pathways to impact health equity and become potential catalysts for social change. The participants are the recorders, collectors, and tellers of stories expressing their needs to inform systemic or policy change. The study data was collected over eighteen months post- COVID-19 lock-down. This ethnomethodological study demonstrates that the cohort\u27s mixed sociocultural, socioeconomic, and psychohistories affect individual and communal health beliefs. The narratives serve as the primary data and basis for answering questions about the formulation, exchange, and communication of health beliefs and behaviors as they may be affected by socio-environmental conditions

Causes of death and survival analysis for patients with retinoblastoma in Jordan

PurposeTo analyze causes and prognostic factors for death among Retinoblastoma (Rb) patients treated at a single specialized tertiary cancer center in Jordan.MethodsWe reviewed the mortality causes for all Rb patients who have been treated at the King Hussein Cancer Center between 2003 and 2019 and were followed for at least 3 years after diagnosis. The main outcome measures included demographics, laterality, tumor stage, treatment modalities, metastasis, survival, and causes of death.ResultsTwenty-four (5%) of the 478 patients died from retinoblastoma and 5-year survival was 94%. The mean age at diagnosis was 15 months (median, 18 months; range, 4–38 months); eight (33%) received diagnoses within the first year of life. Eleven (46%) were boys, 16 (67%) had bilateral disease, and 3 (13%) had a positive family history. The stage for the worst eye was C for 1 (4%) patient, D in 6 (25%) patients, and E (T3) in 15 (63%) patients. Two patients had extraocular Rb at diagnosis, and four of the patients who had intraocular Rb at diagnosis refused treatment and then came back with extraocular Rb. In total, extraocular disease was encountered in six eyes (six patients). After a 120-month median follow-up period, 24 patients (5%) died of second neoplasms (n = 3) or metastases (n = 21). Significant predictive factors for metastasis and death included advanced IIRC tumor stage (p < 0.0001), the presence of high-risk pathological features in the enucleated eyes (p = 0.013), parental refusal of the recommended primary treatment plan (p < 0.0001), and extraocular extension (p < 0.0001).ConclusionThe 5-year survival rates of Rb patients in Jordan are as high as those in high-income countries. However, 5% are still dying from metastatic disease, prompting the need for awareness campaigns to educate the public about the high cure rates and to prevent treatment abandonment

Communication around palliative care principles and advance care planning between oncologists, children with advancing cancer and families

BACKGROUND: In medical oncology, palliative care principles and advance care planning are often discussed later in illness, limiting time for conversations to guide goal-concordant care. In pediatric oncology, the frequency, timing and content of communication about palliative care principles and advance care planning remains understudied. METHODS: We audio-recorded serial disease re-evaluation conversations between oncologists, children with advancing cancer and their families across the illness trajectory until death or 24 months from last disease progression. Content analysis was conducted to determine topic frequencies, timing and communication approaches. RESULTS: One hundred forty one disease re-evaluation discussions were audio-recorded for 17 patient-parent dyads with advancing cancer. From 2400 min of recorded dialogue, 119 min (4.8%) included discussion about palliative care principles or advance care planning. Most of this dialogue occurred after frank disease progression. Content analysis revealed distinct communication approaches for navigating discussions around goals of care, quality of life, comfort and consideration of limiting invasive interventions. CONCLUSIONS: Palliative care principles are discussed infrequently across evolving illness for children with progressive cancer. Communication strategies for navigating these conversations can inform development of educational and clinical interventions to encourage earlier dialogue about palliative care principles and advance care planning for children with high-risk cancer and their families

She Embodied: A Materialized Collective

This collaboratively written piece materializes the collective experiences of 14 students and an instructor in a graduate-level feminist research methods class in the United States. Instead of writing a traditional seminar paper, the class decided to continue our weekly discussions, during which we wrestled with both theory and practice, in text in a final paper. It just seemed like the best way to end our time together. In so doing, the she embodied collective furthers feminist writing practices that embrace uneasy collectives of varying viewpoints. This particular collective acknowledges our she, but recognizes, listens to, and celebrates all the powerful pronouns that create a collective. The collective offers a brief introduction and lengthy appendix to situate the piece. We do not adhere to a singular feminism in the piece. Consequently, our collective is a way of doing unity differently, of attending to and residing with the frictional thought within feminisms and finding that frictional thought as generative. We invite readers to join our collective, to think together across differences without reducing those differences to similarities