Higher-order Categories Research Articles

Becoming a patient with heart failure

Objective: The purpose of this study was to gain a better understanding of the process of becoming a patient with heart failure, a process of identity formation. Are there clues in the patients’ stories about heart failure that might give us a better idea of how patients adjust to heart failure and what heart failure means to them? Meanings that individuals attach to events or situations are central to development of identity and subsequent behaviors. Design And Setting: Qualitative methods involving detailed interviews and grounded theory method were used in an outpatient cardiology department of a large health care facility in northeast Ohio. Patients: Twenty-one patients with a diagnosis of heart failure were conveniently selected and interviewed for this research. Patients were selected on the basis of having a left ventricular ejection fraction of 35% or less and New York Heart Association class II, III, or IV. Other possible selection criteria (eg, VO 2Max , walk test, or dyspnea) were not available for all patients and thus did not constitute consistent selection criteria. A broad net was cast for patients with varying characteristics to see if common processes and experiences existed regardless of the differences in clinical indicators. Methods: Patients were interviewed in the examining room as part of a regularly scheduled visit with their cardiologists. All interviews were tape recorded and fully transcribed. Field notes and relevant patient chart data (eg, age, sex, race, marital status, cause of heart failure, comorbidities, history of hospitalization, New York Heart Association functional class, left ventricular ejection fraction) were included in the transcribed interviews. The transcribed interview was read and responses were given initial conceptual codes. These coded passages were categorized according to more abstract categories or concepts and underlying processes that encompass them. This process continues until all relevant passages have been categorized and subsumed under higher-order (more abstract or general) categories. Results: The process of becoming a patient with heart failure involves a gradual process of taking on a new identity. Five distinct phases of this process of identity formation emerged from the data: a crisis event, the diagnosis, the patient’s and family’s response to the diagnosis, their acceptance and adjustment to life with this condition, and making the decision to get on with life. Conclusions: Most research on heart failure has focused on patients or their families farther along in the trajectory of this condition. We know little about the psychosocial experience of the early phases of this condition. Becoming a patient with heart failure is a process of searching for a meaning to this condition (what is it? what does it mean for the future?) and a process of taking on a new identity and appropriate role behaviors. This process takes place over a period of time. This suggests that the formation of individual identities evolve as new information becomes available, as meanings are attached to the new circumstances, and as a process of negotiating new roles among family members (and among patient, family members, and clinicians) takes place. The findings of this study suggest possible interventions that may positively affect the patient’s condition and the quality of family life. (Heart Lung ® 1999;28:284-92.)

Social Discrimination and Tolerance in Intergroup Relations: Reactions to Intergroup Difference

In this article, we present a theoretical approach to social discrimination on the one hand and intergroup relations characterized by tolerance and plurality on the other hand. Central to the analysis is the question of how members deal with intergroup difference. If the outgroup's difference is judged to be non-normative and inferior, devaluation, discrimination, and hostility are likely responses toward the outgroup. Judging the outgroup's difference to be normative or positive leads to acceptance and appreciation of this group. Following self-categorization theory, the criteria being norms and values for judging intergroup differences are derived from the superordinate category that is perceived to include both groups. More specifically, they are derived from the prototype, or representation, of this inclusive category. Social discrimination results from the generalization of ingroup attributes to the inclusive category, which then become criteria for judging the outgroup. Tolerance, on the other hand, is conceptualized as either a lack of inclusion of both groups in a higher order category or as the representation of the inclusive category in such a way as to also include the other group and designate it as normative.

Reply to Lilienfeld: Why Alcoholism is a Disease

Lilenfeld's attack on my conceptual examination of the disease concept of alcoholism suffers from erroneous interpretations, fallacious reasoning, and a lack of fam iliarity with relevant alcoholism research. He offers an alternative nominalist interpretation of the disease concept of alcoholism based on a fuzzy boundary between disease and well ness. He fails to recognize that the basic issue between nominalist and realist accounts of a lower-order concept such as alcoholism is the presence or absence of general principles that may account for the observed signs and symptoms characterizing a specific disease entity, not fuzzy boundaries between higherorder categories. Extensive evidence (which Lilienfeld ignores) of biological bases for the pathognomic signs and symptoms of alcoholism, particularly loss of control, demonstrates that the disease concept of alcoholism refers to a disease entity that has a biological basis. It is not a “mental construct.”

Higher categories, strings, cubes and simplex equations

This survey of categorical structures, occurring naturally in mathematics, physics and computer science, deals with monoidal categories; various structures in monoidal categories; free monoidal structures; Penrose string notation; 2-dimensional categorical structures; the simplex equations of field theory and statistical mechanics; higher-order categories and computads; the (v,d)-cube equations; the simplex equations as cubical cocycle equations; and, cubes, braids and higher braids.

A qualitative study of situations turning a hearing disability into a handicap

ABSTRACT The aim of this study was to gain a deeper understanding of the handicap creation process. Twelve hearing-impaired middle-aged subjects were interviewed monthly for 5 months. The interviews focused on the subjects' own descriptions of stressful situations related to their impaired hearing. The analysis of the interviews was influenced by the constant comparative method for grounded theory described by Glaser & Strauss. The primary aim of this inductive method is to generate a theory, models, or concepts from the data rather than to verify an existing theory. Eight categories were grunded in the present data, describing potential situations for a handicap to arise. These formed two higher order categories or concepts: situations related to environmental factors and situations related to life habits. The results of the study fitted in well with the proposed revision of the World Health Organisation definition of handicap, as well as with a Swedish version of an environmentally-related definition. I...

Classification of suicidal behavior: a review and step toward integration.

The many forms of suicidal phenomena, including contemplated, attempted, and completed suicide, present significant problems to both researchers and practitioners. Although many attempts have been made to develop categories, agreement among the proposed systems has been more the exception than the rule. This article reviews theoretical and empirical efforts to define types of suicidal individuals and attempts to integrate them by means of higher-order categories of variables. These categories or "dimensions" are as follows: (1) descriptive, (2) situational, (3) psychological/behavioral, and (4) teleological. Implications for research and practice are discussed.

The effects of category generalizations and instance similarity on schema abstraction.

Abstract : Three experiments were designed to differentiate two models of schema abstraction. One model, called the generalization model, proposes that category generalizations, defined as feature combinations which occur frequently across study items, are abstracted during learning and used to classify transfer items. According to the other model, called the instance-only model, transfer items are classified according to their similarity to studied items. Study materials were constructed which either yielded category generalizations (generalize condition) or did not (control condition). Transfer items differed on whether they were classifiable by category generalizations and on their similarity to study items. In Experiments I and III, accuracy and confidence on transfer items was better in the generalize condition than in the control condition. Experiment II manipulated the order in which generalizable study items were presented for study: Items were either blocked, so that items contributing to a category generalization occurred close in the study sequence, or randomly ordered. Study items were learned faster and transfer performance was better with blocked presentation than with random presentation. In all three experiments, there was an effect for the similarity of transfer items to study material. There was some evidence suggesting an advantage for partially matching a category generalization. The results support a schema abstraction model in which transfer is a function of similarity to both specific category instances and to higher-order category information. (Author)