A critical realist evaluation of a music therapy intervention in palliative care

BACKGROUND: Music therapy is increasingly used as an adjunct therapy to support symptom management in palliative care. However, studies to date have paid little attention to the processes that lead to changes in patient outcomes. To fill this gap, we examined the processes and experiences involved in the introduction of music therapy as an adjunct complementary therapy to palliative care in a hospice setting in the United Kingdom (UK). METHODS: Using a realistic evaluation approach, we conducted a qualitative study using a variety of approaches. These consisted of open text answers from patients (n = 16) on how music therapy helped meet their needs within one hospice in Northern Ireland, UK. We also conducted three focus groups with a range of palliative care practitioners (seven physicians, seven nursing staff, two social workers and three allied health professionals) to help understand their perspectives on music therapy's impact on their work setting, and what influences its successful implementation. This was supplemented with an interview with the music therapist delivering the intervention. RESULTS: Music therapy contains multiple mechanisms that can provide physical, psychological, emotional, expressive, existential and social support. There is also evidence that the hospice context, animated by a holistic approach to healthcare, is an important facilitator of the effects of music therapy. Examination of patients' responses helped identify specific benefits for different types of patients. CONCLUSIONS: There is a synergy between the therapeutic aims of music therapy and those of palliative care, which appealed to a significant proportion of participants, who perceived it as effective

Moving ideas: an exploration of students’ use of dialogue for writing in history

In this study, we explored how students make use of whole-class interaction in individual writing. Although various studies show the importance of classroom interaction for writing, little is known about how this works, particularly in history. Starting point is the idea that learning can move from the interpersonal level in classroom discourse to the intrapersonal level in subsequent individual writing. We analyzed nine student texts in history (Grade 11) and traced back the origins of the ideas used (documents or discussion). We found that students not only referenced both documents and classroom discussion in their texts but also that they developed additional ideas. We identified two ways in which students used classroom interaction in their texts: reproducing existing ideas or transforming existing ideas into new ones. Examples of both are discussed. Furthermore, we found differences in students’ use of the language of history in the discussion and in writing. When writing, students seemed to use more nominalizations and the language of time was more complex. We conclude that individual writing can benefit from whole-class discussion because students reproduced and transformed ideas in their writing, resulting in knowledge development, and because students’ use of the language of history became more proficient

A Texas Peasantry? Black Smallholders in the Texas Sugar Bowl, 1865–1890

This article examines a small community of former slaves in Texas's leading sugar-producing county and argues that local conditions fostered the growth of a Caribbean-style ‘reconstituted peasantry’. Using local sources to compile a database of 79 African American landowners, it traces the postwar decline of the sugar plantations, the process of black land acquisition and the smallholders' strategies for survival. The smallholders' position, however, was precarious, and most lost their lands at the close of the nineteenth century. The piece concludes by suggesting that more intensive local research into former-slave communities may force a reconsideration of the notion that all American slaves became landless wage labourers. © 2007 Taylor & Francis

Slavery and Plantation Capitalism in Louisiana's Sugar Country

Sugar planters in the antebellum South managed their estates progressively, efficiently, and with a political economy that reflected the emerging capitalist values of nineteenth-century America. By fusing economic progress and slave labor, sugar planters revolutionized the means of production and transformed the institution of slavery. Slaveholders and bondspeople redefined the parameters of paternalism and recast the master-slave relationship along a novel path. Louisiana slaves accommodated the machine, holding no torch for Luddism while concurrently shaping the agro-industrial revolution to achieve modest economic independence and relative autonomy within the plantation quarters

Body-composition changes in the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE)-2 study: A 2-y randomized controlled trial of calorie restriction in nonobese humans

Background: Calorie restriction (CR) retards aging and increases longevity in many animal models. However, it is unclear whether CR can be implemented in humans without adverse effects on body composition.Objective: We evaluated the effect of a 2-y CR regimen on body composition including the influence of sex and body mass index (BMI; in kg/m2) among participants enrolled in CALERIE-2 (Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy), a multicenter, randomized controlled trial.Design: Participants were 218 nonobese (BMI: 21.9-28.0) adults aged 21-51 y who were randomly assigned to 25% CR (CR, n = 143) or ad libitum control (AL, n = 75) in a 2:1 ratio. Measures at baseline and 12 and 24 mo included body weight, waist circumference, fat mass (FM), fat-free mass (FFM), and appendicular mass by dual-energy X-ray absorptiometry; activity-related energy expenditure (AREE) by doubly labeled water; and dietary protein intake by self-report. Values are expressed as means ± SDs.Results: The CR group achieved 11.9% ± 0.7% CR over 2-y and had significant decreases in weight (-7.6 ± 0.3 compared with 0.4 ± 0.5 kg), waist circumference (-6.2 ± 0.4 compared with 0.9 ± 0.5 cm), FM (-5.4 ± 0.3 compared with 0.5 ± 0.4 kg), and FFM (-2.0 ± 0.2 compared with -0.0 ± 0.2 kg) at 24 mo relative to the AL group (all between-group P < 0.001). Moreover, FFM as a percentage of body weight at 24 mo was higher, and percentage of FM was lower in the CR group than in the AL. AREE, but not protein intake, predicted preservation of FFM during CR (P < 0.01). Men in the CR group lost significantly more trunk fat (P = 0.03) and FFM expressed as a percentage of weight loss (P < 0.001) than women in the CR group.Conclusions: Two years of CR had broadly favorable effects on both whole-body and regional adiposity that could facilitate health span in humans. The decrements in FFM were commensurate with the reduced body mass; although men in the CR group lost more FFM than the women did, the percentage of FFM in the men in the CR group was higher than at baseline. CALERIE was registered at clinicaltrials.gov as NCT00427193