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This paper explores narrative literature as a means of inquiry into the sense of self in depression. Described as a disease, an identity and a way of life, depression is influenced by both internal and external factors. Although brain research has provided new insight into the relationship between neurotransmitter function and depression, the symptoms are experienced by individuals whose lives are intertwined with historical and sociocultural interpretations of illness and its manifestations. At the intersection of science and the humanities, narratives aid in the interpretation of lived experiences, provide a window to that experience, and a public medium that engages writers and readers as they interpret the world. Engaging narratives to interpret both experience and medical jargon may reveal for both those experiencing depression and those engaged in their care, a way of mediating that experience. Narratives can help dissect and thus illuminate the official language of medicine and psychiatry and the personal language of depression. Such a window can enhance the opportunities for empathy and care.

Purpose: The purpose of this study was to examine the relationship between self-transcendence and medication adherence among older adults prescribed antihypertensive medication., Design: Descriptive, correlational research design., Method: Forty-six older adults who were prescribed antihypertensive medications from an independent living facility participated in this study. Participants were given a survey that included a demographic questionnaire, the Morisky Medication Adherence Scale, and Reed's Self-Transcendence Scale., Findings: No significant relationship was found between medication adherence and self-transcendence (r = -.20, p = .18). Ninety percent of the participants however, admitted to cutting back or stopping their medication without notifying their providers., Conclusion: Continued investigation is needed to identify reasons why older adults fail to adhere to taking prescribed hypertension medications in order to improve health outcomes in this population., (C)2014Sage Publications

: Most stars and their planets form in open clusters. Over 95 per cent of such clusters have stellar densities too low (less than a hundred stars per cubic parsec) to withstand internal and external dynamical stresses and fall apart within a few hundred million years 1. Older open clusters have survived by virtue of being richer and denser in stars (1,000 to 10,000 per cubic parsec) when they formed. Such clusters represent a stellar environment very different from the birthplace of the Sun and other planet-hosting field stars. So far more than 800 planets have been found around Sun-like stars in the field 2. The field planets are usually the size of Neptune or smaller 3,4,5. In contrast, only four planets have been found orbiting stars in open clusters 6,7,8, all with masses similar to or greater than that of Jupiter. Here we report observations of the transits of two Sun-like stars by planets smaller than Neptune in the billion-year-old open cluster NGC6811. This demonstrates that small planets can form and survive in a dense cluster environment, and implies that the frequency and properties of planets in open clusters are consistent with those of planets around field stars in the Galaxy., (C) 2013 Nature Publishing Group

Objective: The goal of the study was to evaluate the effectiveness of tympanometry and wideband reflectance (WBR) in detecting conductive hearing loss (CHL) in young infants., Methods: Type of hearing loss was determined using auditory brainstem response using air- and bone-conducted tone bursts in 84 ears from 70 infants (median age = 10 weeks). Of these 84 ears, 60 are included in the current analysis: 43 with normal hearing (NH) and 17 with CHL. Tympanometry was measured using probe tone frequencies of 226, 678, and 1000 Hz. Tympanograms were evaluated in two ways: (1) Acoustic middle ear admittance (Ya, in millimhos); and (2) two-category classification (normal/abnormal), as described by Baldwin (2006). Measures of Ya were evaluated in two ways: by admittance-magnitude tympanograms and calculated admittance magnitude from subcomponents (conductance and susceptance). WBR was measured in response to a chirp stimulus after probe calibration. WBR was analyzed into thirteen 1/3 octave bands. Tests for statistical differences for two-category classification were analyzed using Chi-squared and Ya, and WBR were analyzed using repeated-measures analyses of variances. Cohen's d and likelihood ratios were computed for comparison with statistically significant differences., Results: Ya measured with 678- and 1000 Hz probe tones was significantly different between ears with CHL and NH. Two-category classification of tympanograms using a 1000 Hz probe tone was significantly different between ears with CHL and NH. Neither two-category classification nor Ya was significantly different between ears identified with CHL and NH using a 226 Hz probe tone. WBR was significantly higher in the frequency bands 800 to 2500 Hz and in the frequency band centered at 6300 Hz in infants with CHL. Effect sizes (Cohen's d) were greater than 2 for several WBR frequency bands and Ya measured with 1000 Hz probe tones. The results were similar for calculations of Ya from admittance-magnitude and subcomponent tympanograms. Positive likelihood ratios for WBR ranged between 8.1 and 38, and those for Ya using 1000 Hz ranged between 12.5 and 32., Conclusions: CHL in young infants can be detected well with WBR or tympanometry using probe frequencies of 678 and 1000 Hz., (C) 2013 by Lippincott Williams & Wilkins

A cross-sector collaboration among a community-based organization, a prison arts program, and state departments of Public Health, Education, and Correction was established to address critical health education prevention efforts for at-risk high school-aged youth. The Tell Me What You See initiative utilizes artwork and poetry created by incarcerated youth to promote sexually transmitted disease (STD), HIV, and hepatitis prevention with students in public high schools and juvenile justice facilities. This innovative intervention integrates functional health knowledge and skills-based education through an art-based interdisciplinary approach reaching various populations of youth in multiple settings across a state. Evaluation results indicated that the materials effectively engage youth and open up a critical dialogue among peers and adults by addressing the role personal behavior can have in the prevention of STDs, hepatitis, and HIV. Lessons learned and recommendations are provided., (C)2021Sage Publications

Background: Adolescents with obesity are less likely to flourish and be academically engaged in comparison to their healthy weight peers. However, it is unknown how participation in physical activity influences flourishing and academic engagement in adolescents with obesity. The current study examined engagement in varying levels of physical activity and the likelihood of flourishing and academic engagement in adolescents with obesity. Methods: Analyses included 26 764 adolescents, ages 10–17 years, from the parent-reported, combined 2016–2017 National Survey of Children's Health. Participants were grouped by physical activity levels (none, low, moderate, daily). Outcome variables included flourishing (finishing tasks, staying calm when faced with a challenge and showing interest in new things) and academic engagement (completing all required homework and caring about doing well in school). Logistic regression models, adjusted for age, sex, race, household income, highest level of education in the household, behavioural conduct problems and depression assessed the likelihood of each outcome comparing physical activity levels among adolescents with obesity. Results: Adolescents with obesity who participated in any amount of physical activity (low, moderate and daily) or sports had significantly greater likelihood of flourishing and academic engagement compared those that did not engage in any physical activity (p's ¡ 0.05). Conclusions: Participation in even low amounts of physical activity or participation in sports increases the likelihood of flourishing and academic engagement in adolescents with obesity, which expands on previous findings that adolescents with obesity are less likely to flourish and be academically engaged in comparison to their healthy weight peers. © 2021 World Obesity Federation

Humans are rapidly transforming the structural configuration of the planet's ecosystems, but these changes and their ecological consequences remain poorly quantified in underwater habitats. Here, we show that the loss of forest-forming seaweeds and the rise of ground-covering 'turfs' across four continents consistently resulted in the miniaturization of underwater habitat structure, with seascapes converging towards flattened habitats with smaller habitable spaces. Globally, turf seascapes occupied a smaller architectural trait space and were structurally more similar across regions than marine forests, evidencing habitat homogenization. Surprisingly, such habitat convergence occurred despite turf seascapes consisting of vastly different species richness and with different taxa providing habitat architecture, as well as across disparate drivers of marine forest decline. Turf seascapes contained high sediment loads, with the miniaturization of habitat across 100s of km in mid-Western Australia resulting in reefs retaining an additional ~242 million tons of sediment (four orders of magnitude more than the sediments delivered fluvially annually). Together, this work demonstrates that the replacement of marine forests by turfs is a generalizable phenomenon that has profound consequences for the ecology of temperate reefs., (C) 2021 John Wiley & Sons, Ltd

Due to steep declines in charitable support and reduced demand for traditional hospital services, economic goals are increasingly important to not-for-profit hospitals. Effects of efficient management and effective pursuit of not-for-profit status (for example, levels of Medicare, indigent patients, and unprofitable services) on financial viability are explored. While previous research compared hospitals of different ownership status, not-for-profit hospital operations before acquisition by for-profit hospital chains are investigated--"neutral ground" relative to ownership. Results suggest minor links between efficiency and long-term profitability despite effectiveness in pursuit of non taxable status.

Over the last decade, investor-owned hospital corporations have grown primarily by acquiring other for-profit hospital chains or stand-alone for-profit institutions. Between 1990 and 1995, however, these corporations also acquired nearly 50 not-for-profit hospitals and converted them to for-profit status. An examination of the long-term financial condition of 39 not-for-profit hospitals acquired by various investor-owned hospital corporations between 1992 and 1996 was conducted using free-cash-flow accounting valuation. The results suggest that, initially, only not-for-profit hospitals in dire financial straits were candidates for acquisition and conversion to for-profit status. More recent acquisitions increasingly have involved more successful not-for-profit hospitals.

This paper will discuss Internet based data collection and analysis utilizing a Windows 95 and a UNIX hosted system. Forms on the World Wide Web (WWW) that illustrate the use of this technology in medical research, conference registration, and. patient care will be highlighted. Some of the details involved with creating data collection forms will be presented. The paper concludes with the recommendation that the Health Telematics curricula should include a unit on creating Internet based data collection forms.

Research on receptive language development in typical children, especially as explicated in a classic paper by Robin Chapman, is reviewed. These findings raise three challenges for clinicians assessing comprehension in children with language disorders: (1) contrary to popular wisdom, comprehension does not always precede production in a simple step-by-step way; (2) comprehension is a private event; indicators of comprehension must be used to assess it, and these indicators can be misleading; and (3) children with subtle comprehension deficits may do well on standardized tests that are not sensitive to their difficulties with real-time discourse. Some strategies for addressing these challenges, as well as a framework for assessing comprehension, are offered.

PURPOSE: As the United States health care model progresses towards medical teams and the country's population continues to diversify, the need for health professional education programs to develop and implement culturally specific interprofessional education (IPE) becomes increasingly imperative. A wide range of models exists for delivering and implementing IPE in health education, but none have included the cultural components that are vital in educating the health professional., METHODS: A cross-cultural decentralized IPE model for physician assistant (PA) and physical therapy (PT) students was developed. This three-part IPE series was created using an established cultural curricular model and began with the exploration of self, continued with the examination of various dimensions of culture, and concluded with the exploration of the intersection between health and culture. We assessed student satisfaction of the IPE experiences and students' engagement and attitudes towards IPE using a three-item open-ended questionnaire administered after each cross-cultural activity and the Interprofessional Education Series Survey (IESS) upon the completion of the series., RESULTS: IESS responses showed that PA and PT students reported benefits in interprofessional collaboration and cultural awareness and expressed overall satisfaction with the series. Qualitative analysis revealed growth in student response depth consistent with the scaffolded focus of each IPE module in the series., CONCLUSION: The trends in this three-part series suggest that institutions looking to develop culturally inclusive IPE educational initiatives may have success through a decentralized model mirroring the effective cultural progression focused on addressing exploration of self, examination of various dimensions of culture, and exploration of the intersection between health and culture.

We study the problem of partially ordered phases with periodically arranged disordered (paramagnetic) sites on the pyrochlore lattice, a network of corner-sharing tetrahedra. The periodicity of these phases is characterized by one or more wave vectors k={1/21/21/2}. Starting from a general microscopic Hamiltonian including anisotropic nearest-neighbor exchange, long-range dipolar interactions, and second- and third-nearest neighbor exchange, we use standard mean-field theory (SMFT) to identify an extended range of interaction parameters that support partially ordered phases. We demonstrate that thermal fluctuations ignored in SMFT are responsible for the selection of one particular partially ordered phase, e.g., the "4-k" phase over the "1-k" phase. We suggest that the transition into the 4-k phase is continuous with its critical properties controlled by the cubic fixed point of a Ginzburg-Landau theory with a four-component vector order parameter. By combining an extension of the Thouless-Anderson-Palmer method originally used to study fluctuations in spin glasses with parallel-tempering Monte Carlo simulations, we establish the phase diagram for different types of partially ordered phases. Our results elucidate the long-standing puzzle concerning the origin of the 4-k partially ordered phase observed in the Gd2Ti2O7 dipolar pyrochlore antiferromagnet below its paramagnetic phase transition temperature.

We extrapolate to the perturbative triples (T)/complete basis set (CBS) limit using double zeta basis sets without polarization functions (Wesleyan-1-Triples-2zeta or "Wes1T-2Z") and triple zeta basis sets with a single level of polarization functions (Wesleyan-1-Triples-3zeta or "Wes1T-3Z"). These basis sets were optimized for 102 species representing the first two rows of the Periodic Table. The species include the entire set of neutral atoms, positive and negative atomic ions, as well as several homonuclear diatomic molecules, hydrides, rare gas dimers, polar molecules, such as oxides and fluorides, and a few transition states. The extrapolated Wes1T-(2,3)Z triples energies agree with (T)/CBS benchmarks to within +/-0.65 mEh, while the rms deviations of comparable model chemistries W1, CBS-APNO, and CBS-QB3 for the same test set are +/-0.23 mEh, +/-2.37 mEh, and +/-5.80 mEh, respectively. The Wes1T-(2,3)Z triples calculation time for the largest hydrocarbon in the G2/97 test set, C6H5Me(+), is reduced by a factor of 25 when compared to W1. The cost-effectiveness of the Wes1T-(2,3)Z extrapolation validates the usefulness of the Wes1T-2Z and Wes1T-3Z basis sets which are now available for a more efficient extrapolation of the (T) component of any composite model chemistry.

U.S. SEER (Surveillance Epidemiology and End Results) data for age-adjusted mortality rates for all cancers combined for all races show only a modest overall 13% decline over the past 35 years. Moreover, the greatest contributor to cancer mortality is treatment-resistant metastatic disease. The accepted therapeutic paradigm for the past half-century for the treatment of advanced cancers has involved the use of systemic chemotherapy drugs cytotoxic for cycling cells (both normal and malignant) during DNA synthesis and/or mitosis. The failure of this therapeutic modality to achieve high-level, consistent rates of disease-free survival for some of the most common cancers, including tumors of the lung, colon breast, brain, melanoma, and others is the focus of this paper. A retrospective assessment of critical milestones in cancer chemotherapy indicates that most successful therapeutic regimens use cytotoxic cell cycle inhibitors in combined, maximum tolerated, dose-dense acute treatment regimens originally developed to treat acute lymphoblastic leukemia and some lymphomas. Early clinical successes in this area led to their wholesale application to the treatment of solid tumor malignancies that, unfortunately, has not produced consistent, long-term high cure rates for many common cancers. Important differences in therapeutic sensitivity of leukemias/lymphomas versus solid tumors can be explained by key biological differences that define the treatment-resistant solid tumor phenotype. A review of these clinical outcome data in the context of recent developments in our understanding of drug resistance mechanisms characteristic of solid tumors suggests the need for a new paradigm for the treatment of chemotherapy-resistant cancers. In contrast to reductionist approaches, the systemic approach targets both microenvironmental and systemic factors that drive and sustain tumor progression. These systemic factors include dysregulated inflammatory and oxidation pathways shown to be directly implicated in the development and maintenance of the cancer phenotype. The paradigm stresses the importance of a combined preventive/therapeutic approach involving adjuvant chemotherapies that incorporate anti-inflammatory and anti-oxidant therapeutics.