Students Connecting with the University Community: The Learning Community as Bridge

The purpose of this piece is to call attention to learning conversations—to bring forth an understanding of the power of storytelling, and how it functions to make communicative connections possible, thus helping students learn. I want to highlight the value of an embodied way of engaging students during service learning. I begin this perspective by telling the story behind the story of this “learning conversation.” Following that, I provide a rationale for building a communicative connection—a relationship—between the classroom and the community through service learning. Kolb’s (1984) “Experiential Learning Theory” is introduced as a means of building this relationship or bridge to connect the instructional environment of the classroom and the practices of the community through conversational learning. The final section describes a pedagogical praxis grounded in the experience of the learning community, its service learning initiative, and the power of organizing conversations through story. Christina L. McDowell Marinchak is an Assistant Professor of Business Communication at University of Alaska, Anchorage

The Learning Community Experience: Cultivating a Residual Worldview

In this essay, we conceptualize first-year learning communities as worldviews that, during the first year and residually in subsequent years, allow students to recognize and engage difference and acknowledge and articulate their biases. Students who take part in a learning community have an opportunity to develop the biases and presuppositions of the community, as well as a position that is present throughout life. Using the first-year learning communities at Duquesne University as an example, we contend that inclusion in a learning community upholds a given worldview – as narrative, philosophical or theological system, or shaper of individuals. This, in turn, fosters the biases and presuppositions of the community’s members, a residual outcome that stays with students for the rest of their lives. Christina L. McDowell Marinchak is an Assistant Professor of Business Communication at University of Alaska, Anchorage. David DeIuliis is a Ph.D. candidate in the Department of Communication & Rhetorical Studies at Duquesne University in Pittsburgh, PA

From the Voice of the President: Advancing the Discipline through Communication Leadership

College and university presidents hold significant leadership positions not only in an administrative capacity, but also in their respective academic disciplines. This summary report presents results from a study of college and university presidents who hold an academic degree in communication at any level (BA, MA, and/or Ph.D.). The interview findings are organized according to the following major themes: Disciplinary identity, Ethical communication, Communication leadership, and Advocacy within the discipline. The summary report concludes by highlighting responses to the interview findings from top leaders within the communication discipline

Quality of Life and Clinical Outcomes in Elderly Patients Treated with Ventricular Pacing as Compared with Dual-Chamber Pacing

ABSTRACT Background Standard clinical practice permits the use of either single-chamber ventricular pacemakers or dual-chamber pacemakers for most patients who require cardiac pacing. Ventricular pacemakers are less expensive, but dual-chamber pacemakers are believed to be more physiologic. However, it is not known whether either type of pacemaker results in superior clinical outcomes. Methods The Pacemaker Selection in the Elderly study was a 30-month, single-blind, randomized, controlled comparison of ventricular pacing and dualchamber pacing in 407 patients 65 years of age or older in 29 centers. Patients received a dual-chamber pacemaker that had been randomly programmed to either ventricular pacing or dual-chamber pacing. The primary end point was health-related quality of life as measured by the 36-item Medical Outcomes Study Short-Form General Health Survey. Results The average age of the patients was 76 years (range, 65 to 96), and 60 percent were men. Quality of life improved significantly after pacemaker implantation (P0.001), but there were no differences between the two pacing modes in either the quality of life or prespecified clinical outcomes (including cardiovascular events or death). However, 53 patients assigned to ventricular pacing (26 percent) were crossed over to dual-chamber pacing because of symptoms related to the pacemaker syndrome. Patients with sinus-node dysfunction, but not those with atrioventricular block, had moderately better quality of life and cardiovascular functional status with dual-chamber pacing than with ventricular pacing. Trends of borderline statistical significance in clinical end points favoring dual-chamber pacing were observed in patients with sinus-node dysfunction, but not in those with atrioventricular block. Conclusions The implantation of a permanent pacemaker improves health-related quality of life. The quality-of-life benefits associated with dualchamber pacing as compared with ventricular pacing are observed principally in the subgroup of patients with sinus-node dysfunction. (N Engl J Med 1998;338:1097-104.

Ventricular pacing or dual-chamber pacing for sinus-node dysfunction

BACKGROUND Dual-chamber (atrioventricular) and single-chamber (ventricular) pacing are alternative treatment approaches for sinus-node dysfunction that causes clinically significant bradycardia. However, it is unknown which type of pacing results in the better outcome. METHODS We randomly assigned a total of 2010 patients with sinus-node dysfunction to dual-chamber pacing (1014 patients) or ventricular pacing (996 patients) and followed them for a median of 33.1 months. The primary end point was death from any cause or nonfatal stroke. Secondary end points included the composite of death, stroke, or hospitalization for heart failure; atrial fibrillation; heart-failure score; the pacemaker syndrome; and the quality of life. RESULTS The incidence of the primary end point did not differ significantly between the dual-chamber group (21.5 percent) and the ventricular-paced group (23.0 percent, P=0.48). In patients assigned to dual-chamber pacing, the risk of atrial fibrillation was lower (hazard ratio, 0.79; 95 percent confidence interval, 0.66 to 0.94; P=0.008), and heart-failure scores were better (P CONCLUSIONS In sinus-node dysfunction, dual-chamber pacing does not improve stroke-free survival, as compared with ventricular pacing. However, dual-chamber pacing reduces the risk of atrial fibrillation, reduces signs and symptoms of heart failure, and slightly improves the quality of life. Overall, dual-chamber pacing offers significant improvement as compared with ventricular pacing

Treating a Mother's Accommodation Behaviors of Her Adult Son's OCD: The Case of "Brianne" and "Charlie"

Obsessive-compulsive disorder (OCD) is an anxiety disturbance in which distress and impairment extend beyond the patient to their immediate family members. Many family members become involved in their loved one’s compulsions by engaging in accommodation behaviors, which ultimately make it easier to perform compulsions or avoid obsession-invoking triggers, frequently exacerbating the severity of the OCD symptoms and decreasing motivation for treatment. Also, accommodation behaviors can indirectly result in negative consequences for the family member engaging in them and for other non-OCD members of the family, reducing their quality-of-life.  The current case study documents and discusses a 3-month, 10-session, cognitive-behavioral treatment designed to help "Brianne," a married Caucasian mother of two in her 40s, reduce her accommodation behaviors with her 19-year-old son, "Charlie," who was unmotivated to accept treatment for his diagnosed OCD and who was living at home. In line with the above, the treatment was premised on the hypothesis that reducing Brianne's accommodation behaviors would  have a positive impact not only on Charlie and Brianne, but also on the other two members of Brianne's nuclear family: her husband "Jack," and her older son "Shane." The therapy focused on (a) providing Brianne with psychoeducation regarding the nature of OCD and the negative impact of accommodation behaviors, (b) developing Brianne's alternative coping behaviors in response to Charlie's rituals, (c) offering Brianne communication training, and (d) promoting Brianne's self-care behaviors. Results indicate that the treatment was effective in reducing Brianne's accommodation and improving her quality of life as well as her husband's and other son's within the household, but that more treatment was likely necessary in order to consolidate therapeutic gains. The treatment did not appear to impact Charlie's OCD treatment-seeking motivation nor his levels of anxiety or aggressive outbursts by the end of therapy. Factors contributing to the results of the treatment are discussed. Overall, the case results suggest that family members living with OCD-diagnosed adults not currently seeking treatment can derive benefit from a brief intervention designed to reduce accommodation behaviors, improve family communication, and promote self-care

Considerations for Modifying Exposure and Response Prevention: The Cases of Mr. H and Angela

Exposure and response prevention (ERP) is considered the gold standard treatment for obsessive-compulsive disorder (OCD). However, when comorbidity or other clinically relevant issues arise, the standard ERP protocol may require modification. Golden and Holaway's (2013) case of "Mr. H" and Pontes and Pereira's (2013) case of "Angela" offer excellent examples of clients presenting with these clinical challenges.  Our commentary addresses some of the concerns raised by these authors by bringing in the emerging field of Distress Tolerance (DT) research.  Using examples from the authors’ cases, along with relevant research, we suggest that clinicians who wish to modify ERP consider the proposed alterations carefully by simultaneously thinking more broadly and more specifically about the psychopathology present. In addition, we stress the necessity of various forms of continual outcome monitoring