The Application of A Risk-Resilience Model in Pediatric Chronic Pain

Children with chronic pain are vulnerable to adverse outcomes, such as impaired quality of life and poor functioning. Recent risk and resilience models for adult chronic pain have aimed to conceptualize the complexity of pain, which may prove useful for pediatric populations. The purpose of this study was to examine the unique predictive value of prominent pain-related risk factors, investigate optimism’s role as a resilience factor, and explore protective mechanisms through which optimism exerts its benefits. Participants included 58 8-17 year-old children and adolescents with chronic pain. Pain intensity remained the best predictor of disability, but pain-related fear and optimism were unique predictors of well-being. Optimism contributed to adaptation by reducing pain-related fear and catastrophizing. Findings suggest that the predictive value of related risk factors is inconsistent across functioning outcomes, and optimism is an applicable resilience factor in pediatric pain through its minimization of pain-related risk factors

Exploring Resilience and Adaptation in Adolescents with Sickle Cell Disease

Living with sickle cell disease (SCD) can be a significant adversity due to disease-related symptoms and complications. Compounding these challenges, SCD predominantly affects ethnic minority populations already vulnerable to societal stigmatization, discrimination, and health disparities. It is important to recognize the negative impact of this chronic illness on psychosocial functioning; however, there is value in utilizing a strengths-based approach to determine how to promote adaptation to a challenging life-long disease. The current study explored the association among pain characteristics, adolescent, caregiver, and family protective factors, and functioning outcomes. Another primary aim of this study was to apply the protective factor model of resilience based in resilience theory to pediatric SCD by evaluating the moderating effect of adolescent, caregiver, and family protective factors on the relation between SCD pain burden and functioning outcomes. 93 12- to 18-year-olds with SCD and their caregivers were recruited from a large Southeastern children’s hospital. Adolescents completed measures assessing pain intensity and frequency, general and pain-specific protective factors, and functional outcomes. Caregivers completed measures assessing demographic and disease variables, psychological flexibility, and family functioning. Correlation analyses revealed that the majority of variables were related in expected directions and supported previous research. Adolescent protective factors were generally associated with one another and increased functional ability and quality of life. With the exception of family functioning, caregiver and family variables were not related to primary outcomes. After controlling for demographic, pain, and disease variables, moderation analyses showed that adolescent pain acceptance buffered the relation between SCD pain burden and quality of life. Contrary to hypotheses, moderating effects were not significant for the remaining adolescent, caregiver, and family protective factors. Findings highlight the importance of continuing to identify individual, caregiver, family, and broader environmental protective factors and evaluate resilience mechanisms among adolescents with SCD. Pain acceptance may also be a critical variable to target in future pain-focused interventions. Utilizing a strengths-based approach might lead to novel clinical avenues to empower youth to positively adapt to a chronic illness characterized by pain

Self-report of disordered eating and psychological symptoms by women with ovulatory and unexplained infertility compared with women receiving routine health care

Thesis advisor: Barbara E. WolfeStudies suggest that eating disorder (ED) pathology may be linked to ovulatory and unexplained infertility in women who present to reproductive treatment centers. Specifically, studies have linked hypothalamic amenorrhea, oligomenorrhea, and anovulatory cycles to disordered eating. Advances in Assisted Reproductive Technology can lead to successful conception for women with ED; however, they have a higher risk for poor maternal and fetal outcomes. This descriptive, comparative, quantitative study examined disordered eating and psychological symptoms in women with ovulatory and unexplained infertility compared with women receiving routine health care from their primary care providers. Women ages 20 to 44 were recruited. After providing verbal consent, a study packet was mailed to the study participant's home. The Eating Disorder Inventory-3-Referral Form and Herman and Polivy Restraint Scale measured disordered eating symptoms. The Speilberger Anxiety Inventory and Beck Depression Inventory-II examined psychological symptoms. Provisional DSM IV TR diagnoses were ascertained using the Eating Disorder Inventory-3-Symptom Checklist, along with other scale items. Multivariate analysis of covariance (MANCOVA) confirmed that women with ovulatory and unexplained infertility had significantly higher Desire for Thinness (p = .001) and Bulimia (p = .007) subscale scores putting them at risk for Anorexia Nervosa or Bulimia. Women receiving routine care had significantly higher Body Dissatisfaction (p = .000) subscale scores consistent with their higher weight and tendency toward overeating. Women receiving routine care also had significantly higher Restraint (p = .000) scale scores, leaving them at risk for dietary disinhibition. The groups did not differ on psychological symptoms. Women with infertility had lifetime ED diagnoses many times the national ED prevalence rate, similar to the research findings of Freizinger et al. (2010). The study results support that women with ovulatory and unexplained infertility are at risk for having an occult ED. The critical import of integrating ED assessment into infertility evaluation, reproductive and primary care was implicated. Further study to isolate biobehavioral markers to better identify women at risk for ED and improve their maternal and fetal outcomes was recommended.Thesis (PhD) — Boston College, 2010.Submitted to: Boston College. Connell School of Nursing.Discipline: Nursing

Hunting for Life on Mars by Studying Life on Earth

Modern-day Mars is a dry, harsh environment with no surface water, but billions of years ago it might have been water-rich, like Earth. Scientists believe that, as water was lost on Mars, the remaining water would have become increasingly salty and rich in sulphur. By researching environments on Earth with a similar chemistry, we can develop hypotheses about whether life could have existed on Mars. In our research, we studied Colour Peak, a sulphur-rich, salty spring system in the Canadian High Arctic. This environment contains bacteria that use sulphur to get their energy. By studying water and sediment samples from this region, we confirmed that bacteria that used sulphur as an energy source could potentially have lived on Mars. These results can help scientists who are analysing data from Mars missions to identify evidence of former life on Mars

The changing climates of global health.

The historical trajectories of three crises have converged in the 2020s: the COVID-19 pandemic, rising inequality and the climate crisis. Global health as an organising logic is being transformed by the COVID-19 pandemic. We point to an emerging consensus that the triple threats of global heating, zoonoses and worsening, often racialised inequalities, will need to be met by models of cooperation, equitable partnership and accountability that do not sustain exploitative logic of economic growth. Health governance is challenged to reconsider sustainability and justice in terms of how local and global, domestic and transnational, chronic and infectious, human and non-human are interdependent. In this article, we discuss their intersection and suggest that a new set of organising ideals, institutions and norms will need to emerge from their conjunction if a just and liveable world is to remain a possibility for humans and their cohabitants. Future health governance will need to integrate pandemic preparedness, racial justice, inequality and more-than-human life in a new architecture of global health. Such an agenda might be premised on solidarities that reach across national, class, spatial and species divisions, acknowledge historical debts and affirm mutual interdependencies

Politics at the Cutting Edge: Intergovernmental Policy Innovation in the Affordable Care Act

In the eight years since the passage of the Patient Protection and Affordable Care Act (ACA), state governments have remained critical sites of contention over the law. Intense partisan conflict over ACA implementation has raised questions about traditional theories of intergovernmental relations, which posit that federal–state cooperation depends largely on policy design. Yet, few studies have examined how partisanship, as well as other important factors, shape state policy innovations under the ACA. This article examines the ACA’s State Innovation Models (SIM) initiative. SIM is specifically geared towards incentivizing states to experiment with new models of payment and delivery that can improve health outcomes and/or reduce health-care costs. Drawing on a combination of quantitative and qualitative evidence, we find that states’ participation in SIM is shaped by partisanship, administrative capacity, and state policy legacies. Our findings have implications for future efforts at intergovernmental health reforms

The legend about sailing ship effects – Is it true or false? The example of cleaner propulsion technologies diffusion in the automotive industry

The global automotive industry is faced with major technological change in the field of propulsion systems. Due to low carbon emission regulations and a rising societal demand for sustainability, original equipment manufacturers (OEMs) are forced to innovate either in the conventional technology or in the technological alternatives such as electric drives or fuel cells. However, OEMs are only marginally switching to electromobility so far, but rather incrementally innovating traditional technologies. This behaviour can be described as sailing ship effect which contains the reaction of an old technology to a new technology by fostering innovation in the old technology. Firstly, the present study contributes to the discussion in literature on the sailing ship effect by combining its underlying ideas and consequences with the rationales of path dependence to demonstrate that such a behaviour may be individually economical rational. Based on these considerations, we respond to the call for further empirical investigation of the sailing ship effect. We show patent-based evidence that there has been a temporary sailing ship effect in the automotive industry concerning traditional and emerging propulsion systems and discuss implications for corporate technology strategy and policy

Responsible management: Engaging moral reflexive practice through threshold concepts

YesIn this conceptual paper we argue that, to date, principles of responsible management have not impacted practice as anticipated because of a disconnect between knowledge and practice. This disconnect means that an awareness of ethical concerns, by itself, does not help students take personal responsibility for their actions. We suggest that an abstract knowledge of principles has to be supplemented by an engaged understanding of the responsibility of managers and leaders to actively challenge irresponsible practices. We argue that a form of moral reflexive practice drawing on an understanding of threshold concepts is central to responsible management, and provides a gateway to transformative learning. Our conceptual argument leads to implications for management and professional education

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI