Wilderness state of mind: expanding authenticity

This paper challenges the overuse of existential authenticity as a categorical umbrella encapsulating touristic experience and contributes new insights to the way postmodern authenticity is defined in tourism research. To date, studies associated with postmodern authenticity have focused on the inauthentic and themed, with scholars contending that it speaks more to the consumptive, the superficial, and the trivial than to the substantive and meaningful. By working through a case study focused on nature tourists in pursuit of authentic wilderness experiences, this paper illustrates the ways postmodern authenticity encompasses much more than cynical authenticity, for while the American wilderness may be a hyperreal, and even hypernatural, simulacrum, nature tourists nevertheless report deep, meaningful, and " authentic " engagements with wilderness

Customer effort in value cocreation activities: improving quality of life and behavioral intentions of health care customers

Transformative service research is particularly relevant in health care where the firm and customer can contribute to individual as well as societal well-being. This article explores customer value cocreation in health care, identifying a hierarchy of activities representing varying levels of customer effort from complying with basic requirements (less effort and easier tasks) to extensive decision making (more effort and more difficult tasks). We define customer Effort in Value Cocreation Activities (EVCA) as the degree of effort that customers exert to integrate resources, through a range of activities of varying levels of perceived difficulty. Our findings underscore the importance of viewing health care service as taking place within the customer's service network that extends well beyond the customer-firm dyad to include other market-facing as well as public and private resources. Moreover, we demonstrate the transformative potential of customer EVCA linking customer EVCA to quality of life, satisfaction with service and behavioral intentions. We do so across three prevalent chronic diseasescancer, heart disease, and diabetes. Our findings highlight how an integrated care model has benefits for both customers and providers and can enhance customer EVCA

Sodium Consumption: An Individual's Choice?

Excess intake of dietary salt is estimated to be one of the leading risks to health worldwide. Major national and international health organizations, along with many governments around the world, have called for reductions in the consumption of dietary salt. This paper discusses behavioural and population interventions as mechanisms to reduce dietary salt. In developed countries, salt added during food processing is the dominant source of salt and largely outside of the direct control of individuals. Population-based interventions have the potential to improve health and to be cost saving for these countries. In developing economies, where salt added in cooking and at the table is the dominant source, interventions based on education and behaviour change have been estimated to be highly cost effective. Regardless, countries with either developed or developing economies can benefit from the integration of both population and behavioural change interventions

Complexity of childhood sexual abuse: predictors of current post-traumatic stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with men

Men who have sex with men (MSM) are the group most at risk for HIV and represent the majority of new infections in the United States. Rates of childhood sexual abuse (CSA) among MSM have been estimated as high as 46 %. CSA is associated with increased risk of HIV and greater likelihood of HIV sexual risk behavior. The purpose of this study was to identify the relationships between CSA complexity indicators and mental health, substance use, sexually transmitted infections, and HIV sexual risk among MSM. MSM with CSA histories (n = 162) who were screened for an HIV prevention efficacy trial completed comprehensive psychosocial assessments. Five indicators of complex CSA experiences were created: CSA by family member, CSA with penetration, CSA with physical injury, CSA with intense fear, and first CSA in adolescence. Adjusted regression models were used to identify relationships between CSA complexity and outcomes. Participants reporting CSA by family member were at 2.6 odds of current alcohol use disorder (OR 2.64: CI 1.24–5.63), two times higher odds of substance use disorder (OR 2.1: CI 1.02–2.36), and 2.7 times higher odds of reporting an STI in the past year (OR 2.7: CI 1.04–7.1). CSA with penetration was associated with increased likelihood of current PTSD (OR 3.17: CI 1.56–6.43), recent HIV sexual risk behavior (OR 2.7: CI 1.16–6.36), and a greater number of casual sexual partners (p = 0.02). Both CSA with Physical Injury (OR 4.05: CI 1.9–8.7) and CSA with Intense Fear (OR 5.16: CI 2.5–10.7) were related to increased odds for current PTSD. First CSA in adolescence was related to increased odds of major depressive disorder. These findings suggest that CSA, with one or more complexities, creates patterns of vulnerabilities for MSM, including post-traumatic stress disorder, substance use, and sexual risk taking, and suggests the need for detailed assessment of CSA and the development of integrated HIV prevention programs that address mental health and substance use comorbidities.This study was supported by a Grant from the NIMH (R01 MH095624) PI: O'Cleirigh; Author time (Safren) was supported, in part, by Grant 5K24MH094214. (R01 MH095624 - NIMH; 5K24MH094214)Accepted manuscrip

Parabens Promote Protumorigenic Effects in Luminal Breast Cancer Cell Lines With Diverse Genetic Ancestry

Context One in 8 women will develop breast cancer in their lifetime. Yet, the burden of disease is greater in Black women. Black women have a 40% higher mortality rate than White women, and a higher incidence of breast cancer at age 40 and younger. While the underlying cause of this disparity is multifactorial, exposure to endocrine disrupting chemicals (EDCs) in hair and other personal care products has been associated with an increased risk of breast cancer. Parabens are known EDCs that are commonly used as preservatives in hair and other personal care products, and Black women are disproportionately exposed to products containing parabens. Objective Studies have shown that parabens impact breast cancer cell proliferation, death, migration/invasion, and metabolism, as well as gene expression in vitro. However, these studies were conducted using cell lines of European ancestry; to date, no studies have utilized breast cancer cell lines of West African ancestry to examine the effects of parabens on breast cancer progression. Like breast cancer cell lines with European ancestry, we hypothesize that parabens promote protumorigenic effects in breast cancer cell lines of West African ancestry. Methods Luminal breast cancer cell lines with West African ancestry (HCC1500) and European ancestry (MCF-7) were treated with biologically relevant doses of methylparaben, propylparaben, and butylparaben. Results Following treatment, estrogen receptor target gene expression and cell viability were examined. We observed altered estrogen receptor target gene expression and cell viability that was paraben and cell line specific. Conclusion This study provides greater insight into the tumorigenic role of parabens in the progression of breast cancer in Black women

The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors

Participation in physical play and leisure : developing a theory- and evidence-based intervention for children with motor impairments

Peer reviewedPublisher PD

Aligning Retrograde Nuclear Cluster Orbits with an Active Galactic Nucleus Accretion Disc

Stars and stellar remnants orbiting a supermassive black hole (SMBH) can interact with an active galactic nucleus (AGN) disc. Over time, prograde orbiters (inclination $i<90^{\circ}$) decrease inclination, as well as semi-major axis ($a$) and eccentricity ($e$) until orbital alignment with the gas disc ("disc capture"). Captured stellar-origin black holes (sBH) add to the embedded AGN population which drives sBH-sBH mergers detectable in gravitational waves using LIGO-Virgo-KAGRA (LVK) or sBH-SMBH mergers detectable with LISA (Laser Interferometer Space Antenna). Captured stars can be tidally disrupted by sBH or the SMBH or rapidly grow into massive 'immortal' stars. Here, we investigate the behaviour of polar and retrograde orbiters ($i \geq 90^{\circ}$) interacting with the disc. We show that retrograde stars are captured faster than prograde stars, flip to prograde ($i<90^{\circ}$) during capture and decrease $a$ dramatically towards the SMBH. For sBH, we find a critical angle $i_{\rm ret} \sim 113^{\circ}$, below which retrograde sBH decay towards embedded prograde orbits ($i \rightarrow 0^{\circ}$), while for $i_{\rm o}>i_{\rm ret}$ sBH decay towards embedded retrograde orbits ($i \rightarrow 180^{\circ}$). sBH near polar orbits ($i \sim 90^{\circ}$) and stars on nearly embedded retrograde orbits ($i \sim 180^{\circ}$) show the greatest decreases in $a$. Whether a star is captured by the disc within an AGN lifetime depends primarily on disc density, and secondarily on stellar type and initial $a$. For sBH, disc capture time is longest for polar orbits, low mass sBH and lower density discs. Larger mass sBH should typically spend more time in AGN discs, with implications for the embedded sBH spin distribution.Comment: 10 pages, 7 figures, 1 table; submitted to MNRA