Exploring Surrogates\u27 Experiences Of Polst Discussions For Individuals With Advanced Dementia

The Physician Orders for Life-Sustaining Treatment (POLST) paradigm is widely endorsed as a means to document and honor the care preferences for seriously ill adults, including those with advanced dementia. Critical to the effective use of POLST are open discussions between surrogate decision makers and healthcare providers about patients’ values, current status, goals of care, and treatments. However, little is known about communication between surrogates and providers during POLST discussions for this patient population. Also, minimal evidence about surrogates’ experiences of POLST discussions exists. This dissertation explores surrogate-provider communication during POLST discussions for individuals with advanced dementia (Chapter 2) and describes surrogates’ experiences of providers’ communication (Chapter 3) and the development of a postdoctoral research proposal to design and test a POLST communication training program (Chapter 4). The Torke et al. (2012) conceptual model of Communication and Surrogate Decision Making guided the entire dissertation. For qualitative descriptive studies in Chapters 2 and 3, ten surrogate-provider POLST discussions were observed and audiorecorded, followed by ten interviews with surrogates about their experiences of providers’ communication. Data were analyzed using a directed content analysis approach. Chapter 2 describes a two-way communication process during POLST discussions that includes information disclosure, sense making, emotional support, and consensus. Findings show that POLST discussions rarely included exploration of surrogates’ expectations about treatments or their preferred roles and levels of participation in decision making. Chapter 3 presents how providers’ communication helped or hindered surrogates in processing clinical information and feeling respected and understood. In particular, experiences of one surrogate who had ineffective communication with the provider are presented. The findings from Chapters 2 and 3 serve as the foundation to design a pilot study that will develop a POLST communication training program and test its feasibility. The training program consists of an online didactic session and a Standardized Patient exercise. This body of work adds to the understanding of surrogate-provider communication in the context of POLST discussions for individuals with advanced dementia in nonhospital settings, and informs the development of an educational intervention to improve providers’ POLST communication

Technological novelty profile and invention's future impact

We consider inventions as novel combinations of existing technological capabilities. Patent data allow us to explicitly identify such combinatorial processes in invention activities. Unconsidered in the previous research, not every new combination is novel to the same extent. Some combinations are naturally anticipated based on patent activities in the past or mere random choices, and some appear to deviate exceptionally from existing invention pathways. We calculate a relative likelihood that each pair of classification codes is put together at random, and a deviation from the empirical observation so as to assess the overall novelty (or conventionality) that the patent brings forth at each year. An invention is considered as unconventional if a pair of codes therein is unlikely to be used together given the statistics in the past. Temporal evolution of the distribution indicates that the patenting activities become more conventional with occasional cross-over combinations. Our analyses show that patents introducing novelty on top of the conventional units would receive higher citations, and hence have higher impact.Comment: 20 pages, 7 figure

DEMOGRAPHIC FACTORS ASSOCIATED WITH ORAL CONTRACEPTIVE USE IN KOREAN WOMEN

Objective: We determined the prevalence of oral contraceptive (OC) use and the demographic factors associated with OC use in Korean women.Methods: A descriptive epidemiologic study was conducted using data for women aged 20-54 y collected by the 2005-2009 Korea National Health and Nutrition Examination Surveys. OC use and demographic characteristics were obtained from the participants by questionnaire.Results: During the study period, the prevalence of OC use ranged from 14.8% to 16.0%. Longer duration of OC use was positively associated with age and with increased cigarette smoking and decreased education. However, the use of OCs was not associated with body mass index, household income, alcohol drinking, or regular exercise.Conclusion: Oral contraceptives are used widely by Korean women, and their use is associated with several demographic factors.Keywords: Oral contraceptive, Prevalence, Demographics, KNHANE

Asymptotic problems for stochastic processes and related differential equations

It is well known that solutions of classical initial--boundary problems for second order parabolic equations depend continuously on the coefficients if the coefficients converge to their limits in a strong enough topology. In case of one spatial variable, we consider the question of the weakest possible topology providing convergence of the solutions. Convergence of solutions of PDE's is equivalent to weak convergence of corresponding diffusion processes. In general, continuous Markov processes corresponding to the generalized second order differential operators introduced by W. Feller can appear as limiting processes. In other words, the infinitesimal generator of limiting processes need not be a classical second order elliptic differential operator but instead can be a generalized in the sense of W. Feller \cite{WF1}. Following Freidlin and Wentzell's paper \cite{FW2}, where processes in open intervals were considered, we study the necessary and sufficient conditions for the weak convergence of one dimensional Markov processes in closed intervals. We provide conditions that guarantee the convergence of solutions of initial--boundary value problems for parabolic equations. Furthermore, necessary and sufficient conditions of weak convergence can be easily verified. In a number of articles, it was proved that the solution of reaction diffusion equations with a certain nonlinearity term is close for large $t$ to a running wave solution. However, in general, one cannot always give a simple formula for the asymptotic speed as was done in the Kolmogorov, Petrovskii and Piskunov (KPP) case in $R^1$. We apply our results to wave front propagation in narrow, of width $\varepsilon\ll 1$, domains. Especially, we consider the wave front propagation problem in a narrow periodic domain of width $\varepsilon \ll 1$ with the reaction term of KPP type. We focus on how a smooth or non--smooth periodic boundary of a narrow tube can affect the asymptotic speed of wave front propagation. In particular, under a non--smooth periodic boundary, the limit of solutions of initial--boundary problems is expected to satisfy a parabolic equation with a generalized second order operator, instead of a classical second order elliptic one

The Role of Trust in Rumor Suppression on Social Media: A Multi-Method Approach Applying the Trust Scores in Social Media (TSM) Algorithm

University of Minnesota Ph.D. dissertation. August 2019. Major: Mass Communication. Advisor: Jisu Huh. 1 computer file (PDF); viii, 196 pages.Commercial rumor about an organization or brand, especially on social media, presents a special challenge for marketers and communication practitioners because of the fast flow and exchange of information among peers. Despite the importance of refuting rumors quickly and effectively, research on the effects and effectiveness of refuting rumor messages has been limited. To advance the literature in this emerging research area, the current project examines the impact of an interpersonal relational factor on the dissemination and effectiveness of rumor-refutation communication. The role of interpersonal relational factors is particularly important given that rumors spread through word-of-mouth (WOM) communication. Rumor-refutation communication should also utilize the same communication conduit for rapid and effective refutation. To advance rumor-refutation research and address the rising problem of commercial rumors, this dissertation project aimed to examine 1) how interpersonal influence among peers affects the belief and retransmission of rumors and rumor-refutation messages, and 2) potentially influential message characteristics that could help enhance interpersonal influence on readers’ belief of the rumors and rumor refutation messages, and the retransmission of rumor-refutation messages. To achieve these research goals, this study adopted a multi-method approach. Study 1 is a between-subjects repeated-measures experiment with a 2 (high-trustworthy vs. low-trustworthy source) x 2 (presence vs. absence of a trust cue) design that examines how the trustworthiness of the message source and a trust cue designed to induce message trustworthiness affect the belief and retransmission intention of rumors and rumor-refutation messages. Study 2 utilizes a computational research approach using the Trust Scores in Social Media (TSM) algorithm to test how mathematically captured trustworthiness scores of the sources of rumor-refutation messages influence actual message retransmission and how such an effect is moderated by the presence of trust cues included in the messages. The key findings in Study 1 revealed that a high-trustworthy source compared to a low-trustworthy source led to higher levels of rumor-refutation message belief and retransmission intention, but source trustworthiness did not affect the extent of reduction in the rumor belief and retransmission intention. Inclusion of a trust cue also did not moderate the impact of source trustworthiness on the belief and retransmission intention for both the rumor and rumor-refutation messages. Instead, it showed main effects in increasing the rumor-refutation message belief and retransmission intention, and a decreasing rumor belief and retransmission intention. The findings in Study 2 further confirmed the effects of the trustworthiness of the source on rumor-refutation message retransmission. However, inclusion of trust cues did not augment the source trustworthiness effects. The results indicated that the influence of source trustworthiness was stronger when the rumor-refutation message had no embedded trust cue. This study advances the rumor and electronic word-of-mouth research field by revealing how interpersonal influence among peer social media users can contribute to the effects and effectiveness of rumor-suppression communication. The findings also offer useful practical implications for identifying effective rumor-refutation dissemination hubs and refutation message-crafting strategies for a successful rumor-suppression campaign

Illness Perceptions and Self-management in Late-life Chronic Disorders

Background: As chronic disorders become increasingly prevalent among persons 50 years of age and older, understanding how an individual perceives an illness in the context of disease characteristics (physical vs. mental), and what self-management strategies are adopted in response to these perceptions becomes an important issue. Purpose: The aims of this study were 1) to examine the associations between illness perceptions, self-efficacy, and self-management, and 2) to identify similarities and differences among persons (≥ 50 years of age) with type 2 diabetes (T2DM) and those with mild cognitive impairment (MCI), treating the conditions as exemplars of late-life physical and mental disorders. Methods: This cross-sectional study used secondary analyses of existing datasets. The coherence and causality subscales of the Revised Illness Perception Questionnaire, Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease, Risk Evaluation and Education for Alzheimer’s disease health behavior measure, and four-item Morisky Medication Adherence Scale, were used. In Aims 1 and 2, we performed hierarchical linear and logistic regression analyses while controlling for covariates to examine the associations between illness perceptions, self-efficacy, and self-management among persons with MCI and those with T2DM. In Aim 3, we conducted multivariate analysis of covariance (MANCOVA) and hierarchical linear regression to compare illness perceptions between the T2DM and MCI groups. Results: Regardless of the disease characteristics (physical [T2DM] or mental [MCI]), illness perceptions or its interactions with covariates were associated with either self-efficacy or self-management behaviors (p < .05) among participants with chronic disorders. Coherence was an important factor of self-management in both T2DM (b = .306, p = .035) and MCI (b = .051, p = .089) groups when the interactions terms were added to the models. With the exception of the consequences dimension, each dimension of illness perception was significantly different between the T2DM and MCI groups. Conclusion: Future research should incorporate illness perceptions in the context of disease characteristics (physical vs. mental), sociodemomegraphics, and comorbid conditions into development of interventions aimed at improving both self-efficacy and self-management among older adults with chronic disorders, which may result in one’s positive health outcomes such as quality of life

Přenos paměti, stezka kulturního dědictví a vzpoura na ostrově Jeju

a klíčová slova Přenos paměti: Stezka dědictví a povstání na ostrově Jeju Tato práce si klade za cíl osvětlit příběhy jednotlivců při přenosu vzpomínek pomocí Stezky dědictví jako média paměti. Práce tedy zkoumá, jak Stezka dědictví funguje jako ztělesnění paměti a dále, jaká je její role při přenosu paměti. Výzkumné místo, ostrov Jeju v Korejské republice, bylo vybráno kvůli nedostatečnému uznání jeho kulturního i přírodního dědictví ve vztahu k historii povstání na ostrově. Tato událost se nazývá různými způsoby: "incident 3. dubna", "povstání na Jeju", "vraždy na Jeju" nebo jednoduše 4,3 (Sasam), což představuje datum ozbrojeného povstání na ostrově Jeju v roce 1943. Stezka dědictví povstání Jeju zvaná Stezka 4,3 byla zkoumána empiricky jako případová studie. Terénní práce probíhala na ostrově od 22. září do 10. října 2020. Data byla sbírána z rozhovorů a pozorování účastníků a poté narativně analyzována. Ve stejném diskurzu existují polysemické vzpomínky a příběhy, protože názvy události se liší od kontextu ke kontextu. K prozkoumání více dimenzí vzpomínek obklopujících Stezku, byli dotazováni strážci paměti a studována praxe chůze. Práce dospěla k závěru, že na Stezce dědictví se zkušenost chodců stává zralejší a rozmanitější prostřednictvím zapojených kulturních, narativních a komunikačních...Transmission of memory: the Heritage Trail and Jeju Uprising This thesis aims to shed light on the stories of individuals in transmitting memories using the heritage trail as a medium. Thus, this thesis examines how the heritage trail works as memory embodiment and, further, its role in transmitting memory. The research site, Jeju Island of the Republic of Korea, was selected due to its little recognition as both cultural and natural heritage concerning the history of Jeju Uprising. This event is called in different ways, including the April 3rd Incident, Jeju Killings, Jeju Rebellion, and simply 4.3 (Sasam), representing the date of the armed uprising in Jeju Island in 1943. The heritage trail of the Jeju Uprising called the 4.3 trail was examined empirically as a case study. Fieldwork was conducted from 22 September to 10 October 2020 in Jeju Island. The data was collected from interviews and participant observation and then narratively analyzed. There are polysemic memories and narratives within the same discourse because the names of calling the Uprising vary from context to context. The memory workers were interviewed, and the practice of walking as a component of the trail was studied to examine multiple dimensions of the memories surrounding the trail. Finally, this thesis concludes that in...Institute of General HistoryÚstav světových dějinFaculty of ArtsFilozofická fakult