Defining forgiveness: Christian clergy and general population perspectives.

The lack of any consensual definition of forgiveness is a serious weakness in the research literature (McCullough, Pargament &amp; Thoresen, 2000). As forgiveness is at the core of Christianity, this study returns to the Christian source of the concept to explore the meaning of forgiveness for practicing Christian clergy. Comparisons are made with a general population sample and social science definitions of forgiveness to ensure that a shared meaning of forgiveness is articulated. Anglican and Roman Catholic clergy (N = 209) and a general population sample (N = 159) completed a postal questionnaire about forgiveness. There is agreement on the existence of individual differences in forgiveness. Clergy and the general population perceive reconciliation as necessary for forgiveness while there is no consensus within psychology. The clergy suggests that forgiveness is limitless and that repentance is unnecessary while the general population suggests that there are limits and that repentance is necessary. Psychological definitions do not conceptualize repentance as necessary for forgiveness and the question of limits has not been addressed although within therapy the implicit assumption is that forgiveness is limitless.</p

Variation and appropriateness of antipsychotic use in long-term care facilities across Newfoundland and Labrador

Objective: The use of antipsychotics to treat seniors in long-term care facilities (LTC Fs) has raised concern because of health consequences (i.e., increased risk of falls, stroke, death) in this vulnerable population. This study measured geographic patterns of antipsychotic utilization among seniors living in LTC Fs in Newfoundland and Labrador (NL) and assessed potential inappropriateness. Method: We analyzed prescription records among adults 66 years and older with provincial prescription drug coverage admitted to LTC Fs in NL between April 1, 2011, and March 31, 2014. Patterns of use were analyzed across the 4 regional health authorities (RHAs) in NL and LTC Fs. Logistic, Poisson and linear regression models were used to test variations in prevalence, rate and volume of antipsychotic utilization. To assess potential inappropriateness of antipsychotic use, we analyzed data from Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0 forms from NL LTC Fs between January 1, 2016, and December 31, 2018. Pearson chi-squared analysis was performed at the RHA and LTC F levels to determine changes in percentage of total prescriptions or antipsychotic prescriptions without psychosis. Results: Between 2011 and 2014, 2843 seniors were admitted to LTC Fs across NL; of these, 1323 residents were prescribed 1 or more antipsychotics. Within the 3-year period, the percentage of antipsychotic use across facilities ranged from 35% to 78%. Using data from 27,260 RAI-MDS 2.0 assessments between 2016 and 2018, 71% (6995/9851) of antipsychotic prescriptions were potentially inappropriate. Discussion: There is substantial variation across NL regions concerning the utilization of antipsychotics for senior in LTC Fs. Facility size and management styles may be reasons for this. Conclusion: With nearly three-quarters of antipsychotic prescriptions shown to be potentially inappropriate, systematic interventions to assess indications for antipsychotic use are warranted

Penetrance of HNPCC-related cancers in a retrolective cohort of 12 large Newfoundland families carrying a MSH2 founder mutation: an evaluation using modified segregation models

<p>Abstract</p> <p>Background</p> <p>Accurate risk (penetrance) estimates for associated phenotypes in carriers of a major disease gene are important for genetic counselling of at-risk individuals. Population-specific estimates of penetrance are often needed as well. Families ascertained from high-risk disease clinics provide substantial data to estimate penetrance of a disease gene, but these estimates must be adjusted for possible specific sources of bias.</p> <p>Methods</p> <p>A cohort of 12 independently ascertained HNPCC families harbouring a founder MSH2 mutation was identified from a cancer genetics clinic in St. John's, Newfoundland, Canada. Carrier status was known for 247 family members but phenotype information on up to 85 additional relatives with unknown carrier status was available; using modified segregation models these additional individuals could be included in the analyses. Three HNPCC-related phenotypes were evaluated as age at diagnosis of: any HNPCC cancer (first cancer), colorectal cancer (CRC), and endometrial cancer (EC) for females.</p> <p>Results</p> <p>Lifetime (age 70) risk estimates for male and female carriers were similar for developing any HNPCC cancer (Males = 98.2%, 95% Confidence Interval (CI) = (93.8%, 99.9%); Females = 92.8%, 95% CI = (82.4%, 99.1%)) but female carriers experienced substantially reduced lifetime risk for developing CRC compared to male carriers (Females = 38.9%, 95% CI = (24.2%, 62.1%); Males = 84.5%, 95% CI = (67.3%, 91.3%)). Female non-carriers had very low lifetime risk for these two outcomes while male non-carriers had lifetime risks intermediate to the female carriers and non-carriers. Female carriers had a lifetime risk of developing EC of 82.4%. Relative risks for developing any HNPCC cancer (carriers relative to non-carriers) were substantially greater for females compared to their male counterparts (Females = 54.8, 95%CI = (4.4, 379.8); Males = 9.7, 95% CI = (0.3, 23.8)). Relative risks for developing CRC at age 70 were substantially greater for females compared to their male counterparts (Females = 23.7, 95%CI = (5.6, 137.9); Males = 6.8%, 95% CI = (2.3, 66.2)). However, the risk of developing CRC decreased with age among both genders.</p> <p>Conclusion</p> <p>The proposed modified segregation-based models used to estimate age-specific risks for HNPCC phenotypes can reduce bias due to ascertainment and missing genotype information as well as provide estimates of absolute and relative risks.</p

Decisional and emotional forgiveness scales: Psychometric validity and correlates with personality and vengeance.

Forgiveness is an internal process to overcome negative aspects (e.g., anger, bitterness, resentment) towards an offender, being associated to a range of variables (e.g., well-being, quality of loving relationships, resilience). Forgiveness can happen through two different types: (1) decisional, which is a behavioural modification to reduce direct hostility; and (2) emotional, which is a transformation of negative emotions into positive. The current research aimed to gather psychometric evidences for the Decisional Forgiveness Scale (DFS) and the Emotional Forgiveness Scale (EFS), using a Brazilian sample. Two studies were conducted. In Study 1 (n = 181), the bifactorial structures were replicated, also providing satisfactory reliability levels. Through Item Response Theory, results indicated good discrimination, difficulty levels, and considerable information to all the items from both measures. In Study 2 (n = 220), confirmatory factor analyses confirmed their structure, presenting good model fit. The measures were also invariant regarding participants’ gender. Finally, the measures presented significant results when correlated to personality and vengeance. In sum, the instruments demonstrated satisfactory psychometric properties, evidencing the possibility of their use in the respective context.The authors acknowledge financial support from the CAPES Foundation (Brazil, http://www.capes.gov.br/) for the Ph.D. scholarship to the second author. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Inter-regional comparisons in the pattern of use and needs for institutional care

As the percentage of elderly people increases so does the demand for long-term care services. To ensure that the elderly will be properly cared for in the future, the efficiency of resource utilization needs to be maximized. As a result, the current study looked at the appropriateness of client placement and the annual demands for long-term care in both Western and Labrador health care regions of Newfoundland and Labrador. Comparisons were then made to findings in the St. John's region. -- The appropriateness of client placement, the efficiency of the single entry system and an estimate of the annual demands for long-term care were determined for both Western and Labrador using study populations of 178 and 51 respectively. A tendency to recommend clients for a higher level of care than they required was consistent with previous findings in the St. John's region. The percentage of clients suffering from impaired cognition was also high and Labrador had long waiting times for placement and a high occupancy rate of acute care beds by clients awaiting placement. -- To overcome the issue of inappropriate placement, minimal criteria for placement into supervised care and nursing home care facilities may need to be established. Alternate housing facilities for those with low to modest disability and those suffering from impaired cognition may also reduce the number of inappropriate nursing home placements. To reduce waiting list sizes and time to placement, waiting lists must follow some management scheme, such as placement based on assessed need, and target times for placement must be developed

The impact of screening on the clinical course of lynch syndrome

Background & Aims: Lynch syndrome (LS) is an autosomal dominant disorder and is caused by mutations in one of the DNA mismatch repair (MMR) genes, in particular, MLH1, MSH2, MSH6 and PMS2. Lynch syndrome mutation carriers are at a high risk of developing colorectal cancer (CRC) and gynecological cancers, and as such, targeted screening programs have been developed. The primary objective of this thesis was to determine the phenotypic expression of three different MSH2 mutations causing LS in Newfoundland and to examine the impact of screening in this group of MSH2 mutation earners. -- Methods: Age to onset of first CRC, first extracolonic cancers and death were compared for those with an intron 5 splice site mutation, an exon 8 deletion and an exon 4-16 deletion. To determine the impact of colonoscopic screening in male and female MSH2 mutation carriers, CRC incidence and survival in the screened group was compared to that expected, derived from the non-screened group. To correct for survivor bias controls were matched for age at entry into screening and also for gender. Compliance with screening recommendations of colonoscopy every 1-2 years was also addressed. Gynecological cancer incidence and overall survival was compared in females who received gynecological screening and in matched controls. Controls were randomly selected from non-screened mutation carriers who were alive and disease-free at the age the case entered the screening program. One matched control was selected for each case. -- Results: For all three mutations males had a higher age-related risk of CRC and death compared to females. For the intron 5 splice site mutation carriers, the number of transitional cell cancers of the urinary tract was significantly lower and time to first ovarian cancer was significantly higher than in the carriers of the genomic deletions. Median age to CRC was 58 years in males who received colonoscopic screening whereas expected was 47 years (P<.0001), and median survival in screened males was 66 years compared to expected of 62 years (P=.034). In females, median age to CRC in the colonoscopic screened group was 79 years, whereas in the non-screened group it was 57 years (P=.000), and median survival was 80 years in the screened group compared to expected of 63 years (P=.001). Eight of 41 (20%) males and five of 68 (7%) females who had serial screening colonoscopies developed an interval CRC within 2 years of previous colonoscopy. Endometrial or ovarian cancer occurred in 14 of 54 (26%) women in the gynecological screened group. Median age to diagnosis of gynecological cancer was 54 years in the screened group compared to 56 years in matched controls (P=.50). Stage I or II cancer was diagnosed in 92% of screened patients compared to 71% in the control group (P=.17). Mean survival in the screened group was 79 years compared to 69 years in the matched control group (P=.11), likely associated with concomitant colonoscopic screen mg. -- Conclusions: The incidence of CRC in MSH2 mutation carriers, exposed to the same environment, is not modified by the specific mutation, although there is a suggestion that type of mutation may influence development of some extracolonic cancers. For both males and females, colonoscopic screening was associated with decreased CRC risk, later age of onset, and better survival than expected if non-screened; however, CRCs continued to occur. CRC development may be further reduced by decreasing the screening interval to one year in MSH2 mutation carriers and improving compliance and quality of colonoscopic examination. Gynecological screening did not result in earlier gynecologic cancer detection and despite screening two young women died from ovarian cancer suggesting that prophylactic hysterectomy with bilateral salpingo-oophorectomy be considered in female mutation carriers who have completed childbearing

GEOCHEMISTRY OF THE CENOZOIC VOLCANIC ROCKS OF ROSS ISLAND AND VICINITY, ANTARCTICA

The Cenozoic volcanic rocks of Ross Island and vicinity, Antarctica, are surface flows, tuffs, breccias, and small intrusives. The prominent rock is basanitoid. Alkali-basalt magma reached the surface over an appreciable length of time and was differentiated to produce a rock series: basanitoid → trachybasalt → phonolite. The alkalic, silica-undersaturated rocks are part of a larger petrologic province composed of volcanic centers in a belt nearly 2,000 km long roughly parallel to the Transantarctic Mountains. Two trends of magmatic differentiation are apparent. At depth the fractional crystallization of olivine, clinopyroxene, and opaque oxide minerals, all of which are abundant as phenocrysts in the basanitoid flows, produced trachybasalt magma. At crustal levels, fractional crystallization of clinopyroxene, apatite, opaque oxides, kaersutite, plagioclase, and anorthoclase developed the phonolitic rocks. Alkali enrichment is marked, and the end-member phonolites contain 11% Na2O, 5.6% K2O, and 57% SiO2. The basanitoids contain relatively large amounts of Ba (~ 400 ppm), Sr (~ 1,000 ppm), and Rb (~ 30 ppm). The concentrations of these and other trace elements in the various rock types support the model of small degrees of partial melting of peridotitic mantle for the derivation of the basanitoid magma, and of magmatic differentiation for the subsequent development of the rock series