The Casualization of Intimacy: Consensual Non-Monogamy and the New Sexual Ethos

This dissertation explores the discursive construction of consensually non-monogamous (CNM) relationships. The focus is limited to non-monogamists involved in primary, committed dyadic relationships who also pursue secondary, more casual partners. Using the framework of casualization, the dissertation carries out a discourse analysis of 25 in-depth interviews with straight and LGBT individuals and couples involved in CNM relationships. The term casualization of intimacy makes an analogy between the evolving norms of private life and the casualization of labor. For scholars of work in a global economy, the casualization of labor refers to decreasing job security for workers, coupled with increasing productivity and the demand for new skills. The casualization of intimacy means that our personal lives, like our work lives, are characterized by precarity, the need for flexibility, the feminization of communication, and the valorization of individual hard work. Analysis of interviews with non-monogamists demonstrates a construction of CNM in line with casualization. Non-monogamists portray their lifestyle as protective of partners\u27 autonomy and uniquely accommodating of change; individual adaptability to changing expectations is construed as a necessary virtue. The feminization of communication norms is demonstrated in interview subjects\u27 construction of verbal communication, particularly self-disclosure, as central to and distinctive of CNM relationships. Frequent communication about emotionally-fraught topics - jealousy, desire, insecurity - is considered essential to the success of CNM partnerships; interview participants often argued communication was more important than sex in distinguishing CNM and monogamous partnerships. This emphasis on communication suggests one reason CNM appeals to some women; it also disrupts an understanding of non-monogamy as inevitably sexist. Additionally, by framing the self-disclosure required by CNM as hard work, interview subjects align their lifestyle with the ethos of casualization. In sum, non-monogamists contrast an image of traditional, rigid, hierarchal, and monologic relationships with their construction of non-monogamy as a modern ethic of intimacy, one that is flexible, egalitarian, and dialogic, while also deemphasizing the instability and insecurity inherent in CNM. In trading predictability for excitement and security for freedom, the discourse of consensual non-monogamy highlights the promise and peril offered by the casualization of intimate life

Predictors of Urinary and Fecal Continence Status After Stroke

Urinary incontinence (UI) and fecal incontinence (FI) commonly occur after stroke. The causes are multifactorial. Both conditions can negatively impact recovery, care needs, and health-related quality of life. This study examined if clinical characteristics assessed within two weeks after stroke (baseline) predicted continence at 6 months. The Kansas City Stroke Study, a prospective cohort of 459 subjects examined longitudinally for 6 months using validated functional assessment tools, was used for this analysis. Baseline predictor variables were compared to final continence outcomes assessed with the Barthel Index. Of the 321 eligible subjects who were continent of bladder and bowel pre-stroke, 64 had UI, 48 had FI, and 28 had both at 6 months. Multiple logistic regression models showed age and UI at baseline to be independent predictors for UI. Age, stroke severity, visual impairment, and lack of independence for dressing at baseline were independent predictors for FI at 6 months

Essential Elements for Preparing Future Teachers in Early Childhood Education Using Common Core Standards--RESEARCH

The purpose of this paper is to discuss suggestions on what pre-service teachers need to know in order to be ready to teach in today’s kindergartens where the implementation of the Common Core State Standards reflects best practice. The introduction of the Common Core State Standards in Kentucky has ushered a new culture in kindergarten. Kindergarten used to be seen as a preparation year in which children could be equipped in listening, walking in lines, getting along with others and learning letters. Today, children in kindergarten are expected to begin reading, writing, adding and subtracting. Rigor begins early in the school year as kindergarten children are screened and assessed to determine groupings and which children will need additional supports to meet the CCSS expectations. Teacher education programs, in turn, need to ascertain how to resolve the challenges of this new culture. The teacher candidates will need to be prepared for what they will experience or face in schools. In this paper, the authors will provide suggestions on what pre-service teachers need to know in order to be ready to teach in today’s kindergartens where the implementation of the Common Core State Standards reflects best practice. lines, getting along with others and learning lette rs. Today, children in kindergarten are expected to begin reading, writing, adding and subtracting. Rigor begins early in the school year as kindergarten children are sc reened and assessed to determine groupings and which children will need additional supports to meet the CCSS expe ctations. Teacher education programs, in turn, need to ascert ain how to resolve the challenges of this new cultu re. The teacher candidates will need to be prepared for what they w ill experience or face in schools. In this paper, t he authors will provide suggestions on what pre-service teachers ne ed to know in order to be ready to teach in today’s kindergartens where the implementation of the Common Core State S tandards reflects best practice

Using Wikis to Promote Reflective Teaching and Collaboration among Higher Education Institutions

The purpose of this article is to describe how teacher educators from different higher education institutions used Web 2.0 technology to facilitate collaboration in a small pedagogy group. Faculty from three different institutions participated in monthly face-to-face group meetings. They used technology to facilitate reflection on practice and scholarship. In addition, they were engaged in interactive journaling and collaborative writing activities. Wikis provided useful supports, and enhanced their learning. The group used a hybrid format that allowed increased opportunities to meet group and individual goals and extend benefits to students. Some themes emerged from the qualitative analysis of reflections in response to prompts regarding the impact of using Wikis. These included co-ownership, communication, organization, sharing resources, accessibility, and community. The authors offered some suggestions for facilitating the successful use of this technology in collaborative efforts. Each member of a Wiki must clearly understand the purpose of his or her involvement. Wiki communities participate in social negotiation. This means that each individual should have a clear role, and a sense of belonging. The group used Wikis as extensions and supports that assist group members to reach shared goals. Wiki selfefficacy, or how capable members feel while using wikis, depend on perceived ease of use and decreased sense of user anxiety

Perception, knowledge, and interest of urologic surgery: A medical student survey

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background Although only a limited number of medical schools require a formal educational rotation in urologic surgery, urology as a medical specialty continues to attract a large number of students into the match each year. The purpose of this study was to describe medical student awareness, perception, and knowledge of urology, to determine factors influencing students’ consideration of urology as a career, and to determine if prior urology clerkship experience is associated with differences in these variables. Methods In this cross-sectional study, medical students were electronically surveyed in 07/2016. Self-reported and question-based knowledge of urology were determined. A total of 25 factors were assessed with a five-point Likert scale to determine their influence on students’ consideration of urology as a career. Data analysis was performed using R. Results The survey was completed by 114 students (13.5% of all medical students). A total of 11(9.65%)students had previously participated in a urology clerkship. All students reported awareness of urology; however, only 74 students (64.9%) correctly identified the training pathway and job duties of urologists. Self-perceived knowledge of urology was poor but improved with increased medical school training. Question-based assessment also demonstrated increased knowledge with advanced medical school training (27% per year; p < 0.01). Prior urology clerkship experience appeared to be associated with increased urologic knowledge; however, this was confounded by year in medical school training. When assessing factors impacting students’ consideration of a career in urology, ‘combination of medicine and surgery’ was the most positively influential and ‘competitiveness of the specialty’ was the most negatively influential. Conclusions Although medical students are aware of urology as a specialty, they perceive their knowledge of urology as poor. However, knowledge of urology increases throughout medical school training. Multiple factors influence students’ consideration of urology as a career choice. Additional studies are needed to further explore how participation in a formal urology experience alters students’ perceptions and influences their consideration of urology as a career choice

Informing the surgical workforce pathway: how rural community characteristics matter

Introduction: Rural areas worldwide face a general surgeon shortage, limiting rural populations&#039; access to surgical care. While individual and practice-related factors have been well-studied in the US, we need a better understanding of the role of community characteristics in surgeons&#039; location choices. This study aimed to understand the deeper meanings surgeons associated with community characteristics in order to inform efforts spanning the rural surgeon workforce pathway, from early educational exposures, and undergraduate and graduate medical education, to recruitment and retention. Methods: We conducted a qualitative, descriptive interview study with general surgeons in the Midwestern US about the role and meaning of community characteristics, exploring their backgrounds, education, practice location choices, and future plans. We focused on rural surgeons and used an urban comparison group. We used convenience and snowball sampling, then conducted interviews in-person and via phone, and digitally recorded and professionally transcribed them. We coded inductively and continued collecting data until reaching code saturation. We used thematic network analysis to organize codes and draw conclusions. Results: A total of 37 general surgeons (22 rural and 15 urban) participated. Interviews totaled over 52 hours. Three global themes described how rural surgeons associated different, often deeper, meanings with certain community characteristics compared to their urban colleagues: physical environment symbolism, health resources&#039; relationship to scope of practice, and implications of intense role overlap (professional and personal roles). All interviewees spoke to all three themes, but the meanings they found differed importantly between urban and rural surgeons. Physical landscapes and community infrastructure were representative of autonomy and freedom for rural surgeons. They also shared how facilities, equipment, staff, staff education, and surgical partners combined to create different scopes of practice than their urban counterparts experienced. Often, rural surgeons found these resources dictated when they needed to transfer patients to higher-acuity facilities. Rural surgeons experienced role overlap intensely, as they cared for patients who were also friends and neighbors. Conclusion: Rural surgeons associated different meanings with certain community characteristics than their urban counterparts. As they work with prospective rural surgeons, educators and rural communities should highlight how health resources can translate into desired scopes of practice. They also should share with trainees the realities of role overlap, both how intense and stressful it can be but also how gratifying. Educators should include the rural social context in medical and surgical education, looking for even more opportunities to collaborate with rural communities to provide learners with firsthand experiences of rural environments, resources, and role overlap

Development, acceptability, appropriateness and appeal of a cancer clinical trials implementation intervention for rural- and minority-serving urology practices

This work is licensed under a Creative Commons Attribution 4.0 International License.Background Few community urologists offer cancer patients the opportunity to participate in cancer clinical trials, despite national guidelines that recommend it, depriving an estimated 260,000 urological cancer patients of guideline-concordant care each year. Existing strategies to increase urologists’ offer of clinical trials are designed for resource-rich environments and are not feasible for many community urologists. We sought to design an implementation intervention for dissemination in under-resourced community urology practices and to compare its acceptability, appropriateness and adoption appeal among trial-naïve and trial-experienced urologists. Methods We used a design-for-dissemination approach, informed by the Theoretical Domains Framework and Behavior Change Wheel, to match determinants of the clinical trial offer to theoretically informed implementation strategies. We described the implementation intervention in evaluation workshops offered at urology professional society meetings. We surveyed participants to assess the implementation intervention’s acceptability and appropriateness using validated instruments. We also measured adoption appeal, intention to adopt and previous trial offer. Results Our design process resulted in a multi-modal implementation intervention, comprised of multiple implementation strategies designed to address six domains from the Theoretical Domains Framework. Evaluation workshops delivered at four meetings, convened five separate professional societies. Sixty-one percent of those offered an opportunity to participate in the implementation intervention indicated intention to adopt. Average implementation intervention acceptability and appropriateness ratings were 4.4 and 4.4 (out of 5), respectively. Acceptability scores were statistically significantly higher among those offering trials compared to those not (p = 0.03). Appropriateness scores did not differ between those offering trials and those not (p = 0.24). After urologists ranked their top three innovation attributes, 43% of urologists included practice reputation in their top three reasons for offering clinical trials; 30% listed practice differentiation among their top three reasons. No statistically significant differences were found between those who offered trials and those who did not among any of the innovation attributes. Conclusions LEARN|INFORM|RECRUIT is a promising implementation intervention to address low accrual to clinical trials, poised for implementation and effectiveness testing. The implementation intervention is appealing to its target audience and may have equal uptake among trial-naïve and trial-experienced practices

A person-time analysis of hospital activity among cancer survivors in England

BACKGROUND: There are around 2 million cancer survivors in the UK. This study describes the inpatient and day case hospital activity among the population of cancer survivors in England. This is one measure of the burden of cancer on the individual and the health service. METHODS: The national cancer registry data set for England (1990-2006) is linked to the NHS Hospital Episode Statistics (HES) database. Cohorts of survivors were defined as those people recorded in the cancer registry data with a diagnosis of breast, colorectal, lung or prostate cancer before 2007. The person-time of prevalence in 2006 for each cohort of survivors was calculated according to the cancer type, sex, age and time since diagnosis. The corresponding HES episodes of care in 2006 were used to calculate the person-time of admitted hospital care for each cohort of survivors. The average proportion of time spent in hospital by survivors in each cohort was calculated as the summed person-time of hospital activity divided by the summed person-time of prevalence. The analysis was conducted separately for cancer-related episodes and non-cancer-related episodes. RESULTS: Lung cancer survivors had the highest intensity of cancer-related hospital activity. For all cancers, cancer-related hospital activity was highest in the first year following diagnosis. Breast and prostate cancer survivors had peaks of cancer-related hospital activity in the relatively young and relatively old age groups. The proportion of time spent in hospital for non-cancer-related care was much lower than that for cancer-related care and increased gradually with age but was generally constant regardless of time since diagnosis. CONCLUSION: The person-time approach used in this study is more revealing than a simple enumeration of cancer survivors and hospital admissions. Hospital activity among cancer survivors is highest soon after diagnosis. The effect of age on the amount of hospital activity is different for each type of cancer

The structure of the PapD-PapGII pilin complex reveals an open and flexible P5 pocket

P pili are hairlike polymeric structures that mediate binding of uropathogenic Escherichia coli to the surface of the kidney via the PapG adhesin at their tips. PapG is composed of two domains: a lectin domain at the tip of the pilus followed by a pilin domain that comprises the initial polymerizing subunit of the 1,000-plus-subunit heteropolymeric pilus fiber. Prior to assembly, periplasmic pilin domains bind to a chaperone, PapD. PapD mediates donor strand complementation, in which a beta strand of PapD temporarily completes the pilin domain's fold, preventing premature, nonproductive interactions with other pilin subunits and facilitating subunit folding. Chaperone-subunit complexes are delivered to the outer membrane usher where donor strand exchange (DSE) replaces PapD's donated beta strand with an amino-terminal extension on the next incoming pilin subunit. This occurs via a zip-in-zip-out mechanism that initiates at a relatively accessible hydrophobic space termed the P5 pocket on the terminally incorporated pilus subunit. Here, we solve the structure of PapD in complex with the pilin domain of isoform II of PapG (PapGIIp). Our data revealed that PapGIIp adopts an immunoglobulin fold with a missing seventh strand, complemented in parallel by the G1 PapD strand, typical of pilin subunits. Comparisons with other chaperone-pilin complexes indicated that the interactive surfaces are highly conserved. Interestingly, the PapGIIp P5 pocket was in an open conformation, which, as molecular dynamics simulations revealed, switches between an open and a closed conformation due to the flexibility of the surrounding loops. Our study reveals the structural details of the DSE mechanism

Kinetics of Uropathogenic Escherichia coli Metapopulation Movement during Urinary Tract Infection

The urinary tract is one of the most frequent sites of bacterial infection in humans. Uropathogenic Escherichia coli (UPEC) strains are the leading cause of urinary tract infections (UTIs) and are responsible for greater than 80% of uncomplicated cases in adults. Infection of the urinary tract occurs in an ascending manner, with colonization of the bladder leading to possible kidney infection and bacteremia. The goal of this study was to examine the population dynamics of UPEC in vivo using a murine model of ascending UTI. To track individual UPEC lineages within a host, we constructed 10 isogenic clones of UPEC strain CFT073 by inserting unique signature tag sequences between the pstS and glmS genes at the attTn7 chromosomal site. Mice were transurethrally inoculated with a mixture containing equal numbers of unique clones. After 4 and 48 h, the tags present in the bladders, kidneys, and spleens of infected mice were enumerated using tag-specific primers and quantitative real-time PCR. The results indicated that kidney infection and bacteremia associated with UTI are most likely the result of multiple rounds of ascension and dissemination from motile UPEC subpopulations, with a distinct bottleneck existing between the kidney and bloodstream. The abundance of tagged lineages became more variable as infection progressed, especially after bacterial ascension to the upper urinary tract. Analysis of the population kinetics of UPEC during UTI revealed metapopulation dynamics, with lineages that constantly increased and decreased in abundance as they migrated from one organ to another