Insights into the impact of clinical encounters gained from personal accounts of living with advanced cancer.

Aim To describe the impact of interactions with health care professionals revealed by people’s accounts of living and dying with cancer; to explore reasons for the observed effects; and thus, to consider the implications for practice. Background The importance of practitioner–patient interactions is enshrined within professional values. However, our understanding of how and why the consultation impacts on outcomes remains underdeveloped. Stories recounted by people living and dying with cancer offer important insights into illness experience, including the impact of contact with health services, framed within the context of the wider social setting in which people live their lives. From our recent study of distress in primary palliative care patients, we describe how people’s accounts revealed both therapeutic and noxious effects of such encounters, and discuss reasons for the observed effects. Method A qualitative study with a purposive sample of 19 primary palliative care patients: (8 men, 11 at high risk of depression). In-depth interviews were analysed using the iterative thematic analysis described by Lieblich. Findings Living with cancer can be an exhausting process. Maintaining continuity of everyday life was the norm, and dependent on a dynamic process of balancing threats and supports to people’s emotional well-being. Interactions with health care professionals were therapeutic when they provided emotional, or narrative, support. Threats arose when the patient’s perception of the professional’s account of their illness experience was at odds with the person’s own sense of their core self and what was important to them. Our findings highlight the need for a framework in which clinicians may legitimately utilize different illness models to deliver a personalized, patient-centred assessment of need and care. The work provides testable hypotheses supporting development of understanding of therapeutic impact of the consultation

Construction of an instrument to assess the service learning model: Establishing concurrent validity and internal reliability

A paper and pencil test was constructed to investigate the existence of phases as identified by the Service Learning Model (Delve, Mintz, & Stewart, 1990). Subjects with no structured exposure to service-learning activities residing in the residence halls at the University of Northern Colorado (URC) (n =70) and subjects involved in service-learning programs coordinated by the Office of Community Service at Colorado State University (CSU) (n=65) participated in the study during the spring of 1992. Research objectives provided guidelines for developing the test format and Writing clear and understandable items that reflected the affective, behavioral and cognitive ways in which students experience and understand what it is to be a responsible citizen. No significant relationship was observed between the phases of the test instrument and parallel learning modes as measured by the Learning-Styles Inventory. It was suggested that learning styles transcend the different ways to experience and understand what it is to be a responsible citizen, and therefore, do not provide an appropriate measure of concurrent validity. The internal reliability tor each phase of the test instrument was lower than desired, however, the coefficients of internal consistency showed promise ranging from r=.5266 for Phase 1 to r=.7582 for Phase 3. Post-hoc tests comparing mean phase scores between colleges and between categories of self-reported duration of involvement in helping activities were conducted to supplement a statement of validity for the test instrument. Differences tor mean phase scores between subjects at UNC and CSU were significant and in the predicted direction. Similar results were observed when mean phase scores tor subjects with eight or fewer contacts over the prior academic year were compared to subjects with nine or more contacts over the same period. However, it was unclear it these differences were influenced by involvement in service-learning activities or personal variables such as age and class status. More research needs to be conducted before the Service-Learning Model can be empirically confirmed or rejected. Recommendations identity several suggestions for further investigating the validity and reliability of the test instrument

Postrum II: a posture aid for trumpet players

While brass pedagogy has traditionally focussed on sound output, the importance of bodily posture to both short-term performance and longer-term injury prevention is now widely recognized. Postrum II is a Linux-based system for trumpet players that performs real-time analysis of posture and uses a combination of visual and haptic feedback to try to correct any posture issues that are found. Issues underpinning the design of the system are discussed, the transition from Mac OS X to Ubuntu detailed, and some possibilities for future work suggested

Systematics and evolutionary relationships among the herons (Ardeidae).

http://deepblue.lib.umich.edu/bitstream/2027.42/56394/1/MP150.pd

Mechanisms of pelvic floor muscle function and the effect on the urethra during a cough

Background: Current measurement tools have difficulty identifying the automaticphysiologic processes maintaining continence, and many questions still remainabout pelvic floor muscle (PFM) function during automatic events.Objective: To perform a feasibility study to characterise the displacement, velocity,and acceleration of the PFM and the urethra during a cough.Design, setting, and participants: A volunteer convenience sample of 23 continentwomen and 9 women with stress urinary incontinence (SUI) from the generalcommunity of San Francisco Bay Area was studied.Measurements: Methods included perineal ultrasound imaging, motion trackingof the urogenital structures, and digital vaginal examination. Statistical analysisused one-tailed unpaired student t tests, and Welch’s correction was applied whenvariances were unequal.Results and limitations: The cough reflex activated the PFM of continent women tocompress the urogenital structures towards the pubic symphysis, which wasabsent in women with SUI. The maximum accelerations that acted on the PFMduring a cough were generally more similar than the velocities and displacements.The urethras of women with SUI were exposed to uncontrolled transverse accelerationand were displaced more than twice as far ( p = 0.0002), with almost twicethe velocity ( p = 0.0015) of the urethras of continent women. Caution regardingthe generalisability of this study is warranted due to the small number of women inthe SUI group and the significant difference in parity between groups.Conclusions: During a cough, normal PFM function produces timely compressionof the pelvic floor and additional external support to the urethra, reducing displacement,velocity, and acceleration. In women with SUI, who have weakerurethral attachments, this shortening contraction does not occur; consequently,the urethras of women with SUI move further and faster for a longer duratio