Timbre, Genre, and Polystylism in Sonic the Hedgehog 3

In the soundtrack for the Sega Genesis game Sonic the Hedgehog 3 (1992), the genres represented include calypso, funk, carnival, new wave, prog rock, and more. Soundtracks for video games frequently shift genres this way, to create aesthetic themes for different levels or characters. Turning toward an account of the game’s soundtrack as a unified and continuous work, I posit that the music of Sonic the Hedgehog 3 might be understood as analogous to a series of “samples” within a polystylistic whole, following Leydon 2010. Leydon notes that instrumentation “bears the bulk of the semiotic burden” in communicating genre, but stops short of detailing how different instrumental timbres themselves might signify these genres. In my close analysis of two specific levels from Sonic the Hedgehog 3—Ice Cap Zone and Marble Garden Zone—I detail how timbre, as a musical parameter separate from instrumentation, can evoke specific inter-textual and extramusical associations from a listener, based on implied genres in the soundtrack. In doing this, I will show how timbre, a musical parameter that remains overlooked in a great deal of music analysis, might inform and en-hance dialogue in music analyses of genre within video game music and more broadly

Preconception care by family physicians and general practitioners in Japan

BACKGROUND: Preconception care provided by family physicians/general practitioners (FP/GPs) can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan. METHODS: A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents. RESULTS: Two hundred and sixty-eight of 347 (77%) eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%), and the least was about folic acid supplementation (12%). Many participants reported providing smoking cessation in their practice (60%), though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10%) or folic acid supplementation (4%). About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care. CONCLUSION: FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education

Prevalence of Hepatitis B Virus (HBV) Infection Among Hmong Immigrants in the San Joaquin Valley

Chronic hepatitis B infection (HBV) is the major cause of primary liver cancer worldwide and Asians are disproportionately affected. The prevalence of HBV among most Asian American groups has been well documented, except in Hmong immigrants in the United States. The aim of this study was to determine the prevalence of HBV among Hmong immigrants in the San Joaquin Valley of California. A convenient sample of 534 Hmong age ≥18 years was recruited at various locations throughout Fresno County. Blood samples from study participants were collected and tested for hepatitis B surface antigen (HBsAg) by enzyme-immunoassay. Two hundred and eighty-nine females and 245 males of Hmong descent (mean age, 43.93) were screened. Eighty-nine (41 males and 48 females) were positive for HBsAg, which accounts for a prevalence of 16.7% (95% C.I. 13.5–19.9). The majorities of HBsAg positive patients were ≥40 years (64.2%), married (66.7%), born in Laos (87.3%), and had lived in the United States ≥20 years (62.5%). Only 37.5% of the participants reported having a primary care physician. Our study revealed that approximately one out of every six Hmong immigrants screened was infected with HBV. Based on our findings, more than one-third of these infected patients have no primary care physician to provide further treatment, surveillance for liver cancer, or vaccination of their families. This supports the Institute of Medicine’s recent recommendations to the Center for Disease Control to engage in a national Hepatitis B surveillance system

Implementing a stepped-care approach in primary care: results of a qualitative study

Contains fulltext : 108260.pdf (publisher's version ) (Open Access)BACKGROUND: Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC) was initiated in the Netherlands. METHODS: Alongside the QIC, an intervention study using a controlled before-and-after design was performed. Part of the study was a process evaluation, utilizing semi-structured group interviews, to provide insight into the perceptions of the participating clinicians on the implementation of stepped care for depression into their daily routines. Participants were primary care clinicians, specialist clinicians, and other healthcare staff from eight regions in the Netherlands. Analysis was supported by the Normalisation Process Theory (NPT). RESULTS: The introduction of a stepped-care model for depression to primary care teams within the context of a depression QIC was generally well received by participating clinicians. All three elements of the proposed stepped-care model (patient differentiation, stepped-care treatment, and outcome monitoring), were translated and introduced locally. Clinicians reported changes in terms of learning how to differentiate between patient groups and different levels of care, changing antidepressant prescribing routines as a consequence of having a broader treatment package to offer to their patients, and better working relationships with patients and colleagues. A complex range of factors influenced the implementation process. Facilitating factors were the stepped-care model itself, the structured team meetings (part of the QIC method), and the positive reaction from patients to stepped care. The differing views of depression and depression care within multidisciplinary health teams, lack of resources, and poor information systems hindered the rapid introduction of the stepped-care model. The NPT constructs 'coherence' and 'cognitive participation' appeared to be crucial drivers in the initial stage of the process. CONCLUSIONS: Stepped care for depression is received positively in primary care. While it is difficult for the implementation of a full stepped-care approach to occur within a short time frame, clinicians can make progress towards achieving a stepped-care approach, particularly within the context of a QIC. Creating a shared understanding within multidisciplinary teams of what constitutes depression, reaching a consensus about the content of depression care, and the division of tasks are important when addressing the implementation process

Coping strategies of women with postpartum depression symptoms in rural Ethiopia: a cross-sectional community study

Background: Most women with postpartum depression (PPD) in low- and middle-income countries remain undiagnosed and untreated, despite evidence for adverse effects on the woman and her child. The aim of this study was to identify the coping strategies used by women with PPD symptoms in rural Ethiopia to inform the development of socio-culturally appropriate interventions. Methods: A population-based, cross-sectional study was conducted in a predominantly rural district in southern Ethiopia. All women with live infants between one and 12 months post-partum (n = 3147) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those scoring five or more, ‘high PPD symptoms’, (n = 385) were included in this study. The Brief Coping with Problems Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis. Results: Confirmatory factor analysis of the brief COPE scale supported the previously hypothesized three dimensions of coping (problem-focused, emotion-focused, and dysfunctional). Emotion-focused coping was the most commonly employed coping strategy by women with PPD symptoms. Urban residence was associated positively with all three dimensions of coping. Women who had attended formal education and who attributed their symptoms to a physical cause were more likely to use both problem-focused and emotion-focused coping strategies. Women with better subjective wealth and those who perceived that their husband drank too much alcohol were more likely to use emotion-focused coping. Dysfunctional coping strategies were reported by women who had a poor relationship with their husbands. Conclusions: As in high-income countries, women with PPD symptoms were most likely to use emotion-focused and dysfunctional coping strategies. Poverty and the low level of awareness of depression as an illness may additionally impede problem-solving attempts to cope. Prospective studies are needed to understand the prognostic significance of coping styles in this setting and to inform psychosocial intervention development

Individual and contextual covariates of burnout: a cross-sectional nationwide study of French teachers

<p>Abstract</p> <p>Background</p> <p>Limited information on the covariates of burnout syndrome in French teachers is available. The aim of this study was to evaluate the relative contributions of individual and contextual factors on the three burnout dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment.</p> <p>Methods</p> <p>The source data come from an epidemiological postal survey on physical and mental health conducted in 2005 among 20,099 education workers (in activity or retired) selected at random from the health plan records of the national education system. The response rate was 52.4%. Teachers in activity currently giving classes to students who participated in the survey (n = 3,940) were invited to complete a self-administered questionnaire including the Maslach Burnout Inventory. 2,558 teachers provided complete data (64.9%). Variables associated with high emotional exhaustion (highest quartile of score), high depersonalization (highest quartile), and reduced personal accomplishment (lowest quartile) were evaluated using multivariate logistic regression. Studied variables referred to demographic characteristics, socio-professional environment, job dissatisfaction, experienced difficulties at work, and teaching motivations.</p> <p>Results</p> <p>Different variables were associated with each burnout dimension. Female teachers were more susceptible to high emotional exhaustion and reduced personal accomplishment, whereas male teachers were more susceptible to high depersonalization. Elementary school teachers were more susceptible to high emotional exhaustion, but less susceptible to high depersonalization and reduced personal accomplishment than their higher school level counterparts. Experienced difficulties with pupils were associated with all three dimensions. A socio-economically underprivileged school neighbourhood was also related to high emotional exhaustion and high depersonalization.</p> <p>Conclusion</p> <p>Programs to enhance teaching environment might be an interesting approach to try to prevent burnout. It would be useful to take the different dimensions into account in planning the intervention.</p