Toward developing a model of responsive pastoral care for adult children of divorce

Reports on consequences of parental divorce identify a crucial need for involvement with caring adults in recovery and healing. The literature review includes reports of research and anecdotal surveys of adult children of divorce. The literature review stimulates questions for qualitative research with a pastoral care focus. The thesis incorporates discussion about the church\u27s role in helping individuals recover from divorce pain. It addresses contemporary concerns in group function, particularly in issues of pastoral care. An underlying assumption is a personal understanding that providing a healing community and participating in healing process is at the core of Christian mission. The thesis addresses basic theological and pastoral care assumptions. The central organizing questions informing and shaping literary review and qualitative research for this thesis are: How has the church/community of faith provided a healing community and participated in the healing process for adult children of divorce? and, How do adult children of divorce want the church/community of faith to respond to their need for healing? The research component surveys respondents about their experience of parental divorce and needs for pastoral care. Participants in this project identified inner resources as primary coping resources. Abandonment, isolation and loss of trust recurred as themes in their responses. Each respondent articulated an ideal for pastoral care within the context of their experience. Drawing from their input, this project envisions and describes a responsive model for pastoral care within communities of faith. The responsive model for care is portrayed in images of piece work quilts. A trampoline as symbol of a relational network of support conveys the communal aspect of relational healing. A Slinky depicts the dynamic cycle of change through CARE

In Sickness and in Health: The Influence of State and Federal Health Insurance Coverage Mandates on Marriage of Young Adults in the USA

We study the effects of state and federal dependent health insurance mandates on marriage rates of young adults, ages 19 to 25. Motivated by low rates of coverage among this age group, state governments began mandating health insurers in the 1970s to allow adult children to stay on their parents’ insurance plans. These state level efforts successfully increased insurance coverage rates, but also came with unintended implications for the marriage decisions of young adults. Almost all state mandates explicitly prohibited marriage as a condition of eligibility, thereby directly discouraging marriage. Additionally, by making access to health insurance through parents easier, the mandates made access through spouses’ employers relatively less attractive. To the extent that young adults were altering their marriage plans to gain access through potential spouses, they no longer needed to do so under the mandates, thereby implicitly discouraging marriage. When the dependent coverage mandate of the Affordable Care Act (ACA) was enacted, it effectively ended the state-based marriage restrictions, thereby encouraging marriage among young adults previously eligible for state mandates. On the other hand, for those who were not eligible for state mandates, the ACA represented an attractive new path to obtain coverage, thereby discouraging marriage for these young adults, just as the state mandates had implicitly done previously for others. Thus, the separate efforts at the state and federal level to address low coverage rates for young adults ended up interacting and influencing incentives for marriage in opposite directions. We study these interaction effects on marriage empirically using a new dataset we compiled on state-level dependent coverage mandates. Consistent with theoretical arguments, we find that, before the implementation of the ACA, state mandates lowered marriage rates by about 2 percentage points, but this pattern reversed upon the passage of the ACA. We also find that state mandates increased the probability of out-of-wedlock births among state-mandate-eligible women as compared to ineligible ones, but the ACA reversed this trend as well. Our study provides an important example where fundamental understanding of the effects of the ACA dependent coverage mandate can only be had with full consideration of the pre-existing state laws

Phosphorylation of androgen receptors at serine 515 is a potential prognostic marker for triple negative breast cancer

1.7 million cases of breast cancer are diagnosed every year with 522,000 deaths. Molecular classifications of breast cancer have resulted in improved treatments. However, treatments for triple negative breast cancer (TNBC) are lacking. Analysis of molecular targets for TNBC is a priority. One potential candidate is androgen receptor (AR) phosphorylation. This study assessed the role of AR phosphorylation at ser81/ser515 and their two upstream effectors, cyclin-dependent kinase 1 (pCDK1) and extracellular-regulated kinase 1/2 (pERK1/2) in 332 ductal breast cancer patients by immunohistochemistry. pERK1/2 combined with AR-515 associated with improved cancer-specific survival (CSS, p = 0.038), decreased size (p = 0.001), invasive grade (p < 0.001), necrosis (p = 0.003), b-lymphocytes (p = 0.020), molecular subtype (p < 0.001) and estrogen receptor (ER)/progesterone receptor (PR)-status (p < 0.001). The cohort was therefore stratified into ER+ve and ER-ve patients. In ER+ve tumours, pERK1/2 combined with AR-515 associated with improved CSS (p = 0.038), smaller size (p = 0.004), invasive grade (p = 0.001), decreased b-lymphocytes (p = 0.013) and increased plasma cells (p = 0.048). In contrast, in TNBC patients, phosphorylation of AR-515 associated with poorer CSS (p = 0.007). pERK1/2 combined with AR-515 associated with decreased inflammation (p = 0.003), increased tumour stroma (p = 0.003) and tumour budding (p = 0.011), with trends towards decrease CSS (p = 0.065) and macrophage levels (p = 0.093). In Conclusions, AR-515 may be an important regulator of inflammation in breast cancer potential via ERK1/2 phosphorylation. AR-515 is a potential prognostic marker and therapeutic target for TNBC

Case study: using PebblePad to enhance the effectiveness of personal tutoring and improve student engagement

It is widely recognised that there has been an increase in the proportion of students accessing a university education, in particular from groups who would not traditionally enter higher education (HE). With widening participation (WP) comes some key challenges, and pressure on institutions to retain students is ever growing. Therefore, the need for increasing achievement and reducing attrition requires an effective support mechanism for students through a university personal tutoring process (Stuart, Willock & Browning, 2019)

A legacy of lingering uncertainty: the experience of long-term cancer survivorship: a multiple-case study

More people are surviving cancer, and for longer. As a result, ‘cancer survivorship’ is a key policy and research issue. This exploratory study aimed to describe, and further understanding of, the cancer experience of individuals living five years or more post-treatment. A multiple-case study design was adopted. A narrative interview and semi-structured follow-up interview were held with thirteen participants and their ‘significant others’. ‘Restorying’ of narratives was followed by a cross-case analysis to explore similarities and differences across cases. The utility of liminality as a framework for understanding cancer survivorship was then explored. Little et al. (1998) argue individuals live in a state of ‘sustained’ liminality that persists until end-of-life. However, some individuals may ‘transcend’ the liminal phase. Individuals diagnosed with breast, gynaecological, prostate, testicular and colorectal cancer, five to sixteen years post-treatment, took part. A legacy of lingering uncertainty was evident across cases. The most common manifestation was fear of recurrence. A typology of the place of cancer was developed. Cancer was situated in the past, past-present or present-future. However, the place of cancer is not static; it oscillates between the past, present and future, and foreground and background of participants’ lives as a result of the lingering uncertainty and various ‘reality checks’ experienced. Most, but not all, participants live in a state of ‘sustained’ liminality. Perceiving the five-year survival marker as a ‘milestone’ is key to transitioning out of the liminal state. Some participants have put cancer (the disease) in the past, but consequences of treatment result in them living in an on-going state of physical liminality. Others perceive they are living with cancer within them and experience liminality existentially. However, whilst liminality is often construed negatively, it can be a catalyst for positive change to self. Implications for practice are positioned within the context of new models of ‘aftercare’ implemented in England. Holistic needs assessments at key transition points along the survivorship trajectory are crucial to providing tailored care within the context of individuals’ wider lives

Interprofessional collaboration to improve professional practice and healthcare outcomes

BackgroundPoor interprofessional collaboration (IPC) can adversely affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes.ObjectivesTo assess the impact of practice-based interventions designed to improve interprofessional collaboration (IPC) amongst health and social care professionals, compared to usual care or to an alternative intervention, on at least one of the following primary outcomes: patient health outcomes, clinical process or efficiency outcomes or secondary outcomes (collaborative behaviour).Search methodsWe searched CENTRAL (2015, issue 11), MEDLINE, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform to November 2015. We handsearched relevant interprofessional journals to November 2015, and reviewed the reference lists of the included studies.Selection criteriaWe included randomised trials of practice-based IPC interventions involving health and social care professionals compared to usual care or to an alternative intervention.Data collection and analysisTwo review authors independently assessed the eligibility of each potentially relevant study. We extracted data from the included studies and assessed the risk of bias of each study. We were unable to perform a meta-analysis of study outcomes, given the small number of included studies and their heterogeneity in clinical settings, interventions and outcomes. Consequently, we summarised the study data and presented the results in a narrative format to report study methods, outcomes, impact and certainty of the evidence.Main resultsWe included nine studies in total (6540 participants); six cluster-randomised trials and three individual randomised trials (1 study randomised clinicians, 1 randomised patients, and 1 randomised clinicians and patients). All studies were conducted in high-income countries (Australia, Belgium, Sweden, UK and USA) across primary, secondary, tertiary and community care settings and had a follow-up of up to 12 months. Eight studies compared an IPC intervention with usual care and evaluated the effects of different practice-based IPC interventions: externally facilitated interprofessional activities (e.g. team action planning; 4 studies), interprofessional rounds (2 studies), interprofessional meetings (1 study), and interprofessional checklists (1 study). One study compared one type of interprofessional meeting with another type of interprofessional meeting. We assessed four studies to be at high risk of attrition bias and an equal number of studies to be at high risk of detection bias.For studies comparing an IPC intervention with usual care, functional status in stroke patients may be slightly improved by externally facilitated interprofessional activities (1 study, 464 participants, low-certainty evidence). We are uncertain whether patient-assessed quality of care (1 study, 1185 participants), continuity of care (1 study, 464 participants) or collaborative working (4 studies, 1936 participants) are improved by externally facilitated interprofessional activities, as we graded the evidence as very low-certainty for these outcomes. Healthcare professionals’ adherence to recommended practices may be slightly improved with externally facilitated interprofessional activities or interprofessional meetings (3 studies, 2576 participants, low certainty evidence). The use of healthcare resources may be slightly improved by externally facilitated interprofessional activities, interprofessional checklists and rounds (4 studies, 1679 participants, low-certainty evidence). None of the included studies reported on patient mortality, morbidity or complication rates.Compared to multidisciplinary audio conferencing, multidisciplinary video conferencing may reduce the average length of treatment and may reduce the number of multidisciplinary conferences needed per patient and the patient length of stay. There was little or no difference between these interventions in the number of communications between health professionals (1 study, 100 participants; low- certainty evidence).Authors’ conclusionsGiven that the certainty of evidence from the included studies was judged to be low to very low, there is not sufficient evidence to draw clear conclusions on the effects of IPC interventions. Neverthess, due to the difficulties health professionals encounter when collaborating in clinical practice, it is encouraging that research on the number of interventions to improve IPC has increased since this review was last updated. While this field is developing, further rigorous, mixed-method studies are required. Future studies should focus on longer acclimatisation periods before evaluating newly implemented IPC interventions, and use longer follow-up to generate a more informed understanding of the effects of IPC on clinical practice

Live Intermediality: A New Mode of Intermedial Praxis

This Practice as Research thesis is a contribution to and intervention in the fields of intermedial performance studies and live media practice. Its arguments are formulated through live intermediality, a mode of practice whereby the solo performer activates image, sound, object and body in the presence of and sometimes with the ‘experiencers’ (Nelson 2010), in order to compose a series of shifting intermedial combinations. The thesis interrogates current discourses around intermediality in performance, the role and actions of the live media performer and the generation of events in intermedial and live media practice, arguing that each can be productively re-­-viewed through live intermedial practice. In positioning the practice clearly within the various lineages from which it draws and positing the particular ‘knowings’ it produces, live intermediality is formulated as distinctive ‘praxis’ or ‘doing-thinking’ (Nelson 2013). In addition, the specific characteristics of live intermediality – the dualities, discourses and collisions it generates - are presented both as form of new knowledge through practice and employed as the tools to pierce existing thinking from an ‘insider’ perspective. Working from a Practice as Research methodology, live intermediality is placed in dialogue with resonant conceptual frameworks, such as the work of intermedial theorists, Kattenbelt (2008) and Lavender (2006), new media theorists, Bolter and Grusin (2000), as well as broader paradigms of presence (Power 2008), autopoiesis (Fischer-­-Lichte 2008, Maturana and Varela 1987) and event (Derrida 1978, Deleuze 2006). The praxis, through its dialogue with such frame works, reconfigures current theories around the activation, operation and experience of intermediality in live media forms. In addition, through its distinctive features and the ‘knowings’ they generate, live intermediality is proposed as new mode of praxis within these fields

The Effect of TITAN Evo (TE) Chair on Muscle Stiffness, Player Perceptions and Performance

PURPOSE: To examine the difference of an Aeron chair and a TITAN Evo (TE) chair on muscle stiffness, gaming performance, and gamers perceptions during a 2-hour League of Legends gaming session. METHODS: All subjects signed written consent to participate in this mixed-method randomized cross-over design trial. Each subject performed 2 testing days. Prior to each gaming session, subjects were fitted to each chair according to manufacturer guidelines and shown all the adjustable features of each chair. Instructions were “please adjust the chair to your preference”. Prior to gaming, subjects sat for 15 minutes in the chair. Dynamic muscle stiffness [N/m] was tested using oscillation frequency [Hz]. Measurements were taken bilaterally on the upper trapezius, mid trapezius, lower trapezius and erector spinae muscles pre and post 2 hours of game play. Surveys were administered following each day on chair preference. Total Wins and Kills were recorded. A paired t-test was used to compare the difference in muscle stiffness pre- and post-game play between chairs and for wins and kills, as well as descriptive statistics. RESULTS: Thirty-three subjects (men 85%, age 23 ± 4.9) were analyzed. No significant differences were found in muscle stiffness measures except upper trapezius. After 2 hours of gameplay, the left erector spinae in the TE was 4.8% less than the Aeron chair (p=0.1), and 3.8% less on the right (p=0.29). In the TE chair, the left lower trapezius was 1.7% less (p=0.64), and 4.4% less on the right (p=0.44). The left mid trapezius was 15.6% lower (p=0.94), and 13.7% less on the right (p=0.36). The left upper trapezius was 7.7% higher (p=0.03), and 2.8% higher on the right. No significant difference was found in the left upper trapezius between groups (p= 0.71). Although not significant, subjects showed 25% more wins in the TE chair(p=0.27) and 15% more kills in the TE chair (p=0.32). Chair preference showed 58% of subjects preferred the TE chair over 42% who preferred the Aeron chair. CONCLUSION: This study found minimal differences in muscle stiffness between the TE chair and the Aeron chair. However, the data suggests that the TE chair is the preferred choice among this group of gamers and is associated with enhanced performance