The Intersection Of Image, Rhetoric, And Witnessing: A Rhetorical Analysis Of The Abu Ghraib Prisoner Abuse Scandal

This project looks at the Abu Ghraib Prisoner Abuse Scandal and the ways those figured in the notorious images were named as bad apples to explain the shocking scenes to a mainstream American collective as well as expands more traditional understandings of witnessing through the examination of this complex moment. Beyond the narrowly legal and political issues, the photographs from Abu Ghraib also raise questions about how images of atrocities are received, interpreted, and contested with this project rephrasing the question what do we see when we look at the images from Abu Ghraib? to that of what did we witness? In the case of Abu Ghraib, technology enabled the abuses at Abu Ghraib Prison to be documented, the result being the now infamous photos. However, these images quickly became a site of fierce debate: were we witnessing something anomalous or getting a glimpse of something deeply disturbing about America itself? Varying interpretations have prevailed, and the project explores three of these interpretations: that of Specialist Sabrina Harman, a primary witness attempting to bear witness in the classical sense of the term; the Taguba report, complied before the scandal and argues that the images merely captured the result of policies fostering an anything goes post-9/11 environment related to prisoner treatment; and the Schlesinger Report, commissioned by the Department of Defense, that became the official version whose interpretation is still held by many people. The predominant issue of the study asks, how was the Schlesinger Report able to recast events in this way, and why was it so quickly accepted? The rhetorical analysis unpacks the harnessing of visual rhetoric and discourse to reveal the deft construction of a plausible mainstream understanding of this highly disconcerting instance. By consequence, the naming the scenes captured in the notorious photographs as the work of bad apples rescued America\u27s exceptionalism at the brink of it being critically called into question as the tethering of a bad apples moniker to the infamous pictures forestalled the potential of a national--and perhaps global--sociopolitical crisis, thereby emerging as the most viable alternative at that historical juncture

The on-going care of patients with cancer: what is the appropriate balance of cancer care between specialists and primary care?

Background: Mortality rates have fallen resulting in people living longer with cancer. However, cancer survivors can face significant treatment related physical and psychosocial issues including comorbidities. Treatment related side effects can persist in the long-term or may occur many years later. There is now a focus on the best way to provide appropriate care to people who have survived cancer and its treatment. Aim: The aim of this study is to explore the appropriate balance of cancer care for patients following diagnosis and treatment between specialist and primary care. Methods: Semi-structured interviews with a purposive sample of 40 oncologists, CNSs and GPs across Scotland. Data are analysed in a systematic fashion using constant comparison. Findings: Many patients face significant health care issues after a diagnosis of cancer. Professionals often play a pivotal role during follow-up by identifying and managing patients’ physical and psychosocial needs and by sign posting to address the challenges that arise. Psychosocial needs, long-term and late effects are sometimes not addressed. Oncologists are leaders of the cancer care process. CNSs often play a central role in survivorship both in specialist and primary care. GPs’ roles are seen to span the full spectrum of survivorship care, although this is largely opportunistic in nature. Communication between specialist and primary care is a key issue. Professionals perceived that there is insufficient contact across the interface in terms of understanding others’ viewpoints about the nature of their work. Efforts are needed to improve the timeliness and detail of letters to primary care. Successful primary care follow-up may require development of nurses’ roles in general practice and the community. It is perceived that GPs could attend specialist care for survivorship education or become cancer specialists in general practice. Cancer Care Reviews are considered useful tools in terms of allowing GPs to engage with their patients. Improvements to technology and further research are considered central to optimal cancer care. Conclusion: Considerable barriers exist with the current system of follow-up. After the treatment phase, GP survivorship care is largely opportunistic and driven by patients’ needs. Based on the findings from this study, strategies of care could potentially be planned to facilitate the role of primary care. However, research supporting these practices is needed

The relationship of individual comorbid chronic conditions to diabetes care quality.

ObjectiveMultimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.Research design and methodsThis is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.ResultsThe 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.ConclusionsFuture interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities

The impact of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) on nutritional outcomes

Background: Patients undergoing (chemo) radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) are at high risk of malnutrition during and after treatment. Malnutrition can lead to poor tolerance to treatment, treatment interruptions, poor quality of life (QOL) and potentially reduced survival rate. Human papillomavirus (HPV) is now known as the major cause of OPSCC. However, research regarding its effect on nutritional outcomes is limited. The aim of this study was to examine the relationship between HPV status and nutritional outcomes, including malnutrition and weight loss during and after patients&rsquo; (chemo) radiotherapy treatment for OPSCC. Methods: This was a longitudinal cohort study comparing the nutritional outcomes of HPV-positive and negative OPSCC patients undergoing (chemo) radiotherapy. The primary outcome was nutritional status as measured using the Patient Generated-Subjective Global Assessment (PG-SGA). Secondary outcomes included loss of weight, depression, QOL and adverse events. Results: Although HPV-positive were less likely to be malnourished according to PG-SGA at the beginning of treatment, we found that the difference between malnutrition rates in response to treatment was not significantly different over the course of radiotherapy and 3 months post treatment. HPV-positive participants had significantly higher odds of experiencing &gt;10% weight loss at three months post-treatment than HPV-negative participants (OR = 49.68, 95% CI (2.7, 912.86) p &le; 0.01). Conclusions: The nutritional status of HPV positive and negative patients were both negatively affected by treatment and require similarly intense nutritional intervention. In acute recovery, HPV positive patients may require more intense intervention. At 3- months post treatment, both groups still showed nutritional symptoms that require nutritional intervention so ongoing nutritional support is essential.</jats:p

Prognostic variables and scores identifying the end of life in COPD: a systematic review.

INTRODUCTION: COPD is a major cause of mortality, and the unpredictable trajectory of the disease can bring challenges to end-of-life care. We aimed to investigate known prognostic variables and scores that predict prognosis in COPD in a systematic literature review, specifically including variables that contribute to risk assessment of patients for death within 12 months. METHODS: We conducted a systematic review on prognostic variables, multivariate score or models for COPD. Ovid MEDLINE, EMBASE, the Cochrane database, Cochrane CENTRAL, DARE and CINAHL were searched up to May 1, 2016. RESULTS: A total of 5,276 abstracts were screened, leading to 516 full-text reviews, and 10 met the inclusion criteria. No multivariable indices were developed with the specific aim of predicting all-cause mortality in stable COPD within 12 months. Only nine indices were identified from four studies, which had been validated for this time period. Tools developed using expert knowledge were also identified, including the Gold Standards Framework Prognostic Indicator Guidance, the RADboud Indicators of Palliative Care Needs, the Supportive and Palliative Care Indicators Tool and the Necesidades Paliativas program tool. CONCLUSION: A number of variables contributing to the prediction of all-cause mortality in COPD were identified. However, there are very few studies that are designed to assess, or report, the prediction of mortality at or less than 12 months. The quality of evidence remains low, such that no single variable or multivariable score can currently be recommended

A Focus Group Study of Predictors of Relapse in Electronic Gaming Machine Problem Gambling, Part 1: Factors that ‘Push’ Towards Relapse

This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine problem gambling. In this paper the authors describe part one of a two part, linked relapse process: the ‘push’ towards relapse. In this two-part process, factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behavioural events that ends with relapse when the ‘push’ overcomes ‘pull’ (part one); or as described in part two, continued abstinence when ‘pull’ overcomes ‘push’. In the second paper, the authors describe how interacting factors ‘pull’ the problem gambler away from relapse. Two theories emerged: (1) each relapse episode comprised a sequence of mental and behavioural events, which evolves over time and was modified by factors that ‘push’ this sequence towards relapse and (2) a number of gamblers develop an altered state of consciousness during relapse described as the ‘zone’ which prolongs the relapse

Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study

Objective To explore pressure area related pain as a predictor of category ≥2 pressure ulcer (PU) development. Design Multicentre prospective cohort study. Setting UK hospital and community settings. Participants inclusion Consenting acutely ill patients aged ≥18 years, defined as high risk (Braden bedfast/chairfast AND completely immobile/very limited mobility; pressure area related pain or; category 1 PU). Exclusion Patients too unwell, unable to report pain, 2 or more category ≥2 PUs. Follow-up Twice weekly for 30 days. Primary and secondary outcome measures Development and time to development of one or more category ≥2 PUs. Results Of 3819 screened, 1266 were eligible, 634 patients were recruited, 32 lost to follow-up, providing a 602 analysis population. 152 (25.2%) developed one or more category ≥2 PUs. 464 (77.1%) patients reported pressure area related pain on a healthy, altered or category 1 skin site of whom 130 (28.0%) developed a category ≥2 PU compared with 22 (15.9%) of those without pain. Full stepwise variable selection was used throughout the analyses. (1) Multivariable logistic regression model to assess 9 a priori factors: presence of category 1 PU (OR=3.25, 95% CI (2.17 to 4.86), p<0.0001), alterations to intact skin (OR=1.98, 95% CI (1.30 to 3.00), p=0.0014), pressure area related pain (OR=1.56, 95% CI (0.93 to 2.63), p=0.0931). (2) Multivariable logistic regression model to account for overdispersion: presence of category 1 PU (OR=3.20, 95% CI (2.11 to 4.85), p<0.0001), alterations to intact skin (OR=1.90, 95% CI (1.24 to 2.91), p=0.0032), pressure area related pain (OR=1.85, 95% CI (1.07 to 3.20), p=0.0271), pre-existing category 2 PU (OR=2.09, 95% CI (1.35 to 3.23), p=0.0009), presence of chronic wound (OR=1.66, 95% CI (1.06 to 2.62), p=0.0277), Braden activity (p=0.0476). (3) Accelerated failure time model: presence of category 1 PU (AF=2.32, 95% CI (1.73 to 3.12), p<0.0001), pressure area related pain (AF=2.28, 95% CI (1.59 to 3.27), p<0.0001). (4) 2-level random-intercept logistic regression model: skin status which comprised 2 levels (versus healthy skin); alterations to intact skin (OR=4.65, 95% CI (3.01 to 7.18), p<0.0001), presence of category 1 PU (OR=17.30, 95% CI (11.09 to 27.00), p<0.0001) and pressure area related pain (OR=2.25, 95% CI (1.53 to 3.29), p<0.0001). Conclusions This is the first study to assess pain as a predictor of category ≥2 PU development. In all 4 models, pain emerged as a risk factor associated with an increased probability of category ≥2 PU development

A Focus Group Study of Predictors of Relapse in Electronic Gaming Machine Problem Gambling, Part 2: Factors that ‘Pull’ the Gambler Away from Relapse

This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine (EGM) problem gambling (PG) by describing the processes and factors that ‘pull’ the problem gambler away from relapse contrasted with the ‘push’ towards relapse. These conceptualisations describe two opposing, interacting emotional processes occurring within the problem gambler during any relapse episode. Each relapse episode comprises a complex set of psychological and social behaviours where many factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behaviour events that end (1) with relapse where ‘push’ overcomes ‘pull’ or (2) continued abstinence where ‘pull’ overcomes ‘push’. It was established that vigilance, motivation to commit to change, positive social support, cognitive strategies such as remembering past gambling harms or distraction techniques to avoid thinking about gambling to enable gamblers to manage the urge to gamble and urge extinction were key factors that protected against relapse. Three complementary theories emerged from the analysis. Firstly, a process of reappraisal of personal gambling behaviour pulls the gambler away from relapse. This results in a commitment to change that develops over time and affects but is independent of each episode of relapse. Secondly, relapse may be halted by interacting factors that ‘pull’ the problem gambler away from the sequence of mental and behavioural events, which follow the triggering of the urge and cognitions to gamble. Thirdly, urge extinction and apparent ‘cure’ is possible for EGM gambling. This study provides a qualitative, empirical model for understanding protective factors against gambling relapse

Exploration of potential triggers for self-directed behaviours and regurgitation and reingestion in zoo-housed chimpanzees

The unique challenges faced by animals living in zoos can lead to the production of anxiety-related behaviours. In this study we aimed to understand what specific factors may cause chimpanzees to display these behaviours. In non-human primates, displacement behaviours, such as self-scratching and yawning, are considered markers of anxiety and stress, and Regurgitation and Reingestion (R/R) is considered an abnormal behaviour with negative consequences for physical health. We examined the possible triggers of R/R, scratching, and yawning in a group of zoo-housed chimpanzees and followed this up with an analysis of long-term data to examine further aspects of R/R behaviour. In the first study we conducted focal observations on 18 adult chimpanzees at Edinburgh Zoo, UK, in addition to all occurrence sampling of visitors using flash photography, screaming and banging on the glass in the exhibit. 158 h of data were analysed and Generalised Linear Mixed Models revealed that yawning was significantly more likely if there was a long period of time since the last feed and when there were moderate numbers of visitors in the zoo. There were trends that yawning was more likely to occur if children screamed and that scratching was more likely to occur if visitors used flash photography. R/R occurred most often within 40 min of a feed, but was not affected by the inter-feed interval preceding that feed, positive or negative social interactions, or visitor numbers or behaviour. As there was no obvious daily trigger for R/R, an analysis of long-term data (2009 to 2015) was conducted to investigate if social or dietary factors affected rates of R/R over a larger timescale. It was found that R/R rates in the months before a significant diet change were not different from R/R rates in the months after, but it was found that R/R rates decreased over the five-year period. Lastly, we found no evidence that the introduction of individuals engaging in R/R lead to resident chimpanzees habitually adopting the behaviour, despite considerable opportunities to observe it. These findings have implications for welfare interventions aimed to reduce R/R and/or anxiety behaviours in captive populations and for the translocation of individuals that are known to engage in R/R between groups.Peer reviewe