Life-changing Moment Research Articles

Laryngectomy: Phonation Alternatives and Their Impact on the Quality of Life.

Background The decision to consent to surgery is a life-changing moment. This study addresses the impact of total laryngectomy (TL) on phonation and its effect on the quality of life (QoL) of patients. The primary objective of this cohort study is to compare the alternatives in phonation rehabilitation, and the secondary objective is to identify concurrent predictors of vocal outcomes. Methodology To perform a comprehensive analysis, we reviewed data from patients who underwent TL with bilateral radical neck dissection in the Department of Otolaryngology, Head and Neck Surgery at Centro Hospitalar Universitário de Santo António between January 2010 and October 2022.Adult patients who consented to participate in the study and underwent subjective evaluation were included in this study. Data regarding clinical history was primarily collected. Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Different types of vocal rehabilitation formed the subgroups to be compared. An additional analysis was performed for baseline variables collected in the clinical records, and vocal outcomes were measured using the Self-Evaluation of Communication Experiences After Laryngectomy (SECEL) questionnaire. Furthermore, linear models taking SECEL scores as the outcome were developed. Results The first search identified a total of 124 patients operated during the study period. In total, 63 patients were alive at the time of the current follow-up, with 61 deaths (49%). Overall, 26 of the 63 alive patients completed the SECEL questionnaire. All patients were male. The mean age at diagnosis was 62.2 ± 10.6 years. The mean age at the time of subjective vocal assessment with the SECEL questionnaire was 66.3 ± 10.4 years. The mean time of follow-up after the initial diagnosis was 4 ± 3.8 years. A statistically significant difference was observed in esophageal speech (ES), which was inferior to other modalities (mean SECEL total score for ES: 46.6 ± 12.2 vs. mean SECEL total score for all other modalities: 33 ± 15.1; p = 0.03). The follow-up time correlated significantly with vocal function, as measured by the SECEL questionnaire (p = 0.013). Conclusions The SECEL questionnaire can be a valuable tool to evaluate QoL in laryngectomy patients, given its usefulness in assessing the psychological impact derived from vocal functionality in this group. ES appears inferior to other modalities regarding voice-related QoL.

Psychedelic therapies are returning to psychiatry

Psychedelic therapies are returning to psychiatry Professor Erika Dyck, Canada Research Chair in History of Health & Social Justice at the University of Saskatchewan argues that psychedelic drugs and therapies, whether conducted in ceremonial settings or clinical ones, are being touted as life-changing moments for their capacity to efficiently transform an individual's perspective on themselves. The number of people who suffer from mental illness has grown steadily, with the WHO now reporting that 1 in 5 people in the world lives with mental illness. Due to this, numerous psychedelic therapies have also emerged on this landscape as a potential treatment that may improve individual lives while also transforming the way we diagnose and treat mental illness around the world – labelled a "psychedelic renaissance". Initiatives to legalize, decriminalize, and/or regulate psychedelics have taken different legal forms – as the legal landscape is changing quickly – but there are undeniable and unprecedented successes in treating alcoholism and trauma-based disorders with psychedelic therapies, which Professor Dyck recommends to be explored in more depth.

Transitions: Experiences of younger persons recently diagnosed with Alzheimer-type dementia.

Receiving a diagnosis of dementia before the age of 65 has a huge impact on everyday life. Previously, the disease trajectory has mainly been described from the perspective of older persons. However, young persons with dementia are confronted with specific challenges, influencing the type of life-changing events, or 'critical points' that they may experience. The aim of this study was therefore to describe experiences of persons recently being diagnosed with young-onset dementia. In total, 14 participants with dementia due to Alzheimer's disease (10 woman/4 men) with an average age of 59 were included in the study. Interviews were conducted within 2months after receiving the diagnosis and analyzed using qualitative content analysis with an inductive approach, resulting in three categories: (1) A life changing moment, (2) An ongoing process, and (3) Remaining in control. The findings show that receiving such a diagnosis was experienced by participants as a life changing moment, followed by them seeking to come to terms with the diagnosis and reflecting on its meaning, in which various strategies were adopted to remain in control. The current study highlights three critical points considering the diagnosis of young-onset dementia that warrant special attention and provides insight into factors related to delay in healthy transitioning after receiving the diagnosis, as well as factors that may facilitate successful transitions.

Helena Biantovskaya Fedukowicz: An epitome of contagious passion and spirit.

Helena Biantovskaya Fedukowicz: An epitome of contagious passion and spirit.

Study on Integration and Application of Artificial Intelligence and Wireless Network in Piano Music Teaching.

Until 2019, most people had never faced the situation that would be their life-changing moment. Most universities are conducting classes for their students with the help of virtual classrooms indicating massive technological growth. However, this development does not take enough time to reach the students and the teaching person. Within five to six months of successful projects, most application producers have launched their official sites to conduct online classes and test ways for students. The introduction of virtual classes is not the only example of technological advancement; cloud computing, artificial intelligence, and deep learning have collaborated to produce appropriate, fine, and less error-prone results in all such fields of teaching. These technological advancements have given way to design models created with the wireless networks that are being made, particularly for music-related courses. The Quality-Learning (Q-Learning) Algorithm (QLA) is a pillar study for improving the implementation of artificial intelligence in music teaching in this research. The proposed algorithm aids in improving the accuracy of music, its frequency, and its wavelength when it passes. The proposed QLA is compared with the existing K-Nearest Neighbour (KNN) algorithm, and the results show that QLA has achieved 99.23% accuracy in intelligent piano music teaching through wireless network mode.

After Care

After Care

Exploring the relationship between life events, mode preferences and mode use of young adults: A 3-year cross-lagged panel analysis in the Netherlands

This paper examines the impact of life events on transport mode preferences and the frequency of mode use of young adults in the Netherlands, using data from three waves (2014, 2015 and 2016) of the Netherlands Mobility Panel. The database used for this paper contains 1,180 young adults (18–39 years) who participated in all three waves. Cross-lagged structural equation panel models were estimated to examine the longitudinal relationship between life events (childbirth, moving home or a new job) and travel behaviour. We investigated the relationship between frequency of mode use and mode preference over time, and the impact of life events on mode preference and frequency of mode use. Young adults showed very stable behaviour over time: frequency of mode use and mode preference are good predictors of frequency of mode use and mode preference in the future. The results show that changes in the frequency of mode use have a stronger effect on changes in mode preferences than vice versa. In addition, young adults subjected to life events are more likely to change travel behaviour. Car use and car preference are found to increase significantly after childbirth. Bicycle use and preference for the bicycle were more likely to increase for young adults who moved home. Changing jobs showed a negative association with bicycle use. These life-changing moments could offer a window of opportunity for policymakers and other parties to create more awareness of alternative, more sustainable, modes of transport.

The new ‘opt-out’ organ donation English law: Is the NHS ready for this?

In May 2020, the new 'opt-out' organ donation law was passed in England. This law is a crucial step to help battle the long waiting lists of patients awaiting a transplant. This article aims to explore some of the challenges that the transplant teams may face with the new law, as well as raising awareness among the junior doctors, especially with the new COVID-19 transplant guidelines. Successful transplantations require immense training of healthcare professionals, fast retrieval services, pre- and postoperative care of patients, intensive care management, life-long follow-up and management of patients. Organ transplant surgery is a life-changing moment for a patient. Ultimately, commissioning groups, clinicians and managers need to work together, evaluate the changes required and enact thorough business plans to ensure the NHS is not overwhelmed. Together with increasing the awareness of organ donation within the public, the government needs to support the NHS to fund, train and manage transplant centres to welcome this much-awaited 'opt-out' organ donation law in England successfully.

A Life-Changing Moment in a Patient with Type 1 Diabetes: Insulin Holiday

Background: The diagnosis of type 1 diabetes can be a life-changing moment for our patients particularly having to live with the idea of taking insulin all their life and the barriers it can bring about. Case report: We report a patient with ten years of autoimmune type 1 diabetes treated with insulin. He was able to stop insulin in favour of oral diabetes agents after dynamic endocrine tests confirmed micro insulin secretion despite autoimmunity. Our case demonstrates that a detailed history and thorough investigations adopting a holistic approach can sometimes change the course of disease management and can leave a positive impact on the life of our patients. Conclusion: Patients with partial retention of beta-cell function in type 1 diabetes can temporarily stop insulin safely with ongoing surveillance. [GMJ.2020;9:e1769]

Sacred moments in Guided Imagery and Music

This theoretical article reviews a range of current views on spiritual experiences in Guided Imagery and Music (GIM) and includes my personal assessment of the theme with a range of case vignettes illustrating the concept of ‘sacred moments’. Sacred moments occurring in psychotherapy have been described as specific life-changing moments of trust and boundlessness that can be remembered years after, and that positively influence health and the effectiveness of therapy. Deep listening to music in music therapy seems to provide an opportunity to create and embrace spirituality. This article explores the phenomenology of sacred moments as they appear in GIM seen in the light of case examples: how does the client experience a sacred moment, how can it be understood and integrated, and what impact does it have in the life of the client? It is also discussed whether practices of Music and Imagery can be applied in education and pedagogics.

Online Reviews of Specialized Drug Treatment Facilities-Identifying Potential Drivers of High and Low Patient Satisfaction.

Despite the importance of high-quality and patient-centered substance use disorder treatment, there are no standardized ratings of specialized drug treatment facilities and their services. Online platforms offer insights into potential drivers of high and low patient experience. We sought to analyze publicly available online review content of specialized drug treatment facilities and identify themes within high and low ratings. This was a retrospective analysis of online ratings and reviews of specialized drug treatment facilities in Pennsylvania listed within the 2016 National Directory of Drug and Alcohol Abuse Treatment Facilities. Latent Dirichlet Allocation, a machine learning approach to narrative text, was used to identify themes within reviews. Differential Language Analysis was then used to measure correlations between themes and star ratings. Online reviews of Pennsylvania's specialized drug treatment facilities posted to Google and Yelp (July 2010-August 2018). A total of 7823 online ratings were posted over 8years. The distribution was bimodal (43% 5-star and 34% 1-star). The average weighted rating of a facility was 3.3 stars. Online themes correlated with 5-star ratings were the following: focus on recovery (r = 0.53), helpfulness of staff (r = 0.43), compassionate care (r = 0.37), experienced a life-changing moment (r = 0.32), and staff professionalism (r = 0.29). Themes correlated with a 1-star rating were waiting time (r = 0.41), poor accommodations (0.26), poor phone communication (r = 0.24), medications given (0.24), and appointment availability (r = 0.23). Themes derived from review content were similar to 9 of the 14 facility-level services highlighted by the Substance Abuse and Mental Health Services Administration's National Survey of Substance Abuse Treatment Services. Individuals are sharing their ratings and reviews of specialized drug treatment facilities on online platforms. Organically derived reviews of the patient experience, captured by online platforms, reveal potential drivers of high and low ratings. These represent additional areas of focus which can inform patient-centered quality metrics for specialized drug treatment facilities.

Offline: A story of discrimination against women

Utako Okamoto (1918–2016) is not a name widely known, let alone celebrated, in medicine and global health. Yet this remarkable Japanese scientist deserves international recognition for her heroic struggle to advance women's and children's health. She discovered the drug tranexamic acid in the 1950s and believed that its powerful haemostatic properties might offer decisive benefits for women who suffered post-partum haemorrhage. Ian Roberts, in his inaugural UK Faculty of Public Health Bazalgette Lecture delivered last week in London, described the story of a medical scientist with an astonishing vision. But it was a vision that was repeatedly crushed by endemic discrimination. The credit for rediscovering the work of Utako Okamoto lies with Ian Roberts and Ayumi Naito. The story he uncovered is emblematic of the difficulties faced today by scientists seeking to translate their discoveries into practice. On March 10, 2010, Ian had a rare life-changing moment. Leading a randomised trial of over 20 000 adult trauma patients (CRASH-2), he and his collaborators found that intravenous tranexamic acid reduced the risk of death from bleeding by 15%. The effect was greatest if tranexamic acid was given within 3 h of the trauma. Calculations showed that the widespread use of this cheap generic medicine could save 130 000 lives annually. The trial cost £2·5 million. With such a stunning result, Ian asked England's Department of Health for £500 000 to help implement the findings. He received a paltry £15 000. Implementation of research results was not a priority for the UK Government. Still, he was able to get tranexamic acid onto WHO's list of essential medicines. And he devised innovative ways—eg, animated videos—to spread the message that this neglected drug had life-saving properties. But the obstacles proved formidable. The pharmaceutical company that made tranexamic acid, Pfizer, was not interested in promoting it since they saw no likely profit accruing, despite the medicine's cost-effectiveness. Civil society organisations and the British military proved more helpful. Eventually, dogged persistence, combined with powerful imagery (showing the number of graves that could have been eliminated from Arlington National Cemetery if tranexamic acid had been used by US armed forces), enabled the drug to gain wide acceptance. But this success was only the beginning of a larger and more revealing narrative. Ian became intrigued about the origins of tranexamic acid. Although Pfizer held the licence for the drug, the company was not responsible for its discovery. Utako Okamoto, working with her husband Shosuke near Kobe, Japan, deserved that accolade. Ian travelled to Japan with his partner, Ayumi Naito, a Japanese paediatrician, and found Utako's home, which doubled as a laboratory where she continued her research. She had a clear vision for her work. She wanted to deliver results that outperformed global standards. She sought to be truly innovative by avoiding the currently fashionable trends in research. And she was driven by wanting to find an effective treatment for post-partum haemorrhage. Ian saw Utako's journey as a story of perseverance. Together with his colleague, Haleema Shakur, he embarked on the second phase of his research—this time to fulfil the hopes of Utako by launching a trial (WOMAN; World Maternal Antifibrinolytic trial) to test if tranexamic acid could indeed reduce deaths from post-partum bleeding. Haemorrhage is the commonest cause of maternal mortality. If WOMAN could repeat the success of CRASH-2, Haleema and Ian's team would have discovered one of the most important interventions to save the lives of women during pregnancy. The result beat all expectations. Deaths due to bleeding when tranexamic acid was given within 3 h were reduced by 31%. The result was little short of a global sensation—over 800 separate news reports, cited on over 2500 radio stations, and reaching 80 million people via social media. Utako died just 2 weeks before the WOMAN trial ended. And it was this result that changed the way Ian thought about Utako's story. It was not a story of perseverance. It was a story of discrimination against women. Discrimination that Utako had endured her entire life. And discrimination that continues today as governments, development agencies, and international organisations continue to fail to implement one of the most safe and cost-effective tools ever discovered to save women's lives.

Women's pathways to prison in Kenya: Violence, poverty, familial caretaking and barriers to justice

Studies undertaken on women incarcerated in African countries are limited. In this article we explore Kenyan women's (n = 49) narratives of their journeys into prison using life history interviews and a feminist pathways approach. Results show the life stories of imprisoned women in Kenya reflect those of female prisoners elsewhere. In particular, victimisation, disordered familial and intimate relationships, low levels of education, poverty and motherhood (often in teen years) characterised many women's lives. Some also struggled with addiction (usually to alcohol but sometimes illicit drugs) and poor physical health due to HIV infection. Barriers to justice were a generic problem. In addition to these broad categorical findings six different pathway experiences were identified: 1) the economically motivated pathway; 2) domestic violence pathway, 3) harmed and harming pathway, 4) deviant women pathway, 5) pathway of negligible culpability and justice inaccessibility, 6) pathway of one life changing moment.

When the Stars Lead to You by Ronni Davis

Reviewed by: When the Stars Lead to You by Ronni Davis Alaine Martaus Davis, Ronni When the Stars Lead to You. Little, 2019 [400p] Trade ed. ISBN 978-0-316-49070-2 $17.99 E-book ed. ISBN 978-0-316-49068-9 $9.99 Reviewed from galleys Ad Gr. 9-12 Their first romantic round ended in her getting ghosted, but now eighteen-year-old Devon has fallen for Ashton all over again. Their love heats up fast, and Devon has faith that this time she's older and wiser. She soon finds herself navigating Ashton's struggles with depression and his parents' race- & class-based disapproval (Devon is biracial), all while keeping her own future on track. Then a close call with tragedy forces her to decide: is love strong enough to keep them together or can she be strong enough to let him go? Whether it's love, lust, school stress, or family drama, this novel of first loves, first times, and first heartbreaks plays up the emotional intensity. With so much going on, the story is sometimes cluttered and unfocused, but the mess also lends an air of realness to Devon's experiences. Unfortunately, the narrative style is more tell than show, including a few descriptive sex scenes, distancing readers from the emotion and undermining the chemistry between the leads. Meanwhile, characters face the many life-changing moments with an unfailing maturity that belies their years, ultimately giving the novel the vibe of a very special episode about depression. Still, readers who love a good soapy drama-romance may find their hearts a-flutter from the twists and turns of Devon and Ashton's love. Copyright © 2019 The Board of Trustees of the University of Illinois

Captivated by Gaze. Sculpture as Witness at the Lausanne Cathedral's Porch

The sculptures of the Lausanne cathedral's painted porch (1225–1235) are unique testimonies to a fully adorned and painted liminal zone. Focusing on the notions of movement and iconic presence, this article explores the potential liturgical and social functions of this space in relation to its sculptural imagery. It focuses particularly on circulation and threshold as experienced by pilgrims and other believers. Further, it deals with the notion of images' capturing viewers' attention by analyzing the Lausanne porch sculptures' most striking features: their position, their polychrome decoration, and their gaze. This study contributes to understanding the role of medieval images, how they could accompany daily events, and how such images became witnesses to a believer's once-in-a-lifetime, life-changing moment.

When Children Participate in the Death Ritual of a Parent: Funerary Photographs as Mnemonic Objects

When children lose a parent during childhood this offers emotional and life changing moments. It is important for them to be included in the death ritual and to be recognized as grievers alongside adults. Recent research has shown that children themselves consider it relevant to be part of the ‘communitas’ of grievers and do not like to be set aside because they are considered to be too young to participate. In this case study, I describe how a Dutch mother encouraged her three children, aged 12, 9 and 6, to participate in the death rituals of their father. She asked a funeral photographer to document the rituals. In that way, later on in their life, the children would have a visual report of the time of his death in addition to their childhood memories. The objective of my case study research was first, to explore in detail hów children are able to participate in death rituals in a carefully contemplated manner and in accordance with their age and wishes, and second, to examine the relevance of funeral photographs to them in later years. The funeral photographs will be presented as a visual essay of how and when the children took part in the rituals and which ritual objects, such as the coffin and the grave, but also letters, poems and drawings were important in creating an ongoing bond with their deceased father. The conclusion of this case study presentation is that funeral photographs of death rituals may function as mnemonic objects later on in the life of children who lost a parent in their childhood. These photographs enable children, when necessary, to materialize how they participated in the death ritual of their father or mother. In this respect they can be seen as functional means of continuing bonds in funeral culture, linking the past with the present, in particular when young children are involved.

Spring after Spring: How Rachel Carson Inspired the Environmental Movement by Stephanie Roth Sisson

Reviewed by: Spring after Spring: How Rachel Carson Inspired the Environmental Movement by Stephanie Roth Sisson Elizabeth Bush Sisson, Stephanie Roth Spring after Spring: How Rachel Carson Inspired the Environmental Movement; written and illus. by Stephanie Roth Sisson. Roaring Brook, 2018 [34p] ISBN 978-1-62672-819-6 $17.99 Reviewed from galleys R 5-8 yrs Following naturalist Rachel Carson from observant child to scientist, writer, and activist, Sisson fashions a picture book that is laudably thorough and informative, and it’s a visual treat as well. Opening scenes linger over Carson’s early years in Pennsylvania, allowing viewers to experience the birdsong and animals calls that changed with the seasons, to join her in investigating the “wonders big . . . and small” around her home, and to share her expectation that she would become a writer of nature stories. The life-changing moment, in which she’s captivated by a microscope view of aquatic life, emerges as a delightful plot twist, as it leads to her overcoming her fear of water to do underwater research, which in turn informed her observations of drastic change in the environment and the pesticide research that led to publication of Silent Spring. Mixed-media illustrations add a tactile dimension to a text replete with nature’s chatter; smooth surfaces of stones and clothing and breaking dawn contrast with the rough paper texture beneath vibrant blue waterscapes, and negative space denoting animals increasingly conspicuous by their absence practically invite viewers to poke their fingers into the sad little voids. A graphic of the path of pesticide poisoning throughout several food chains rivals science textbook presentations for clarity, an author note remarks on Carson’s connection to Earth Day, and endnotes offer extended annotations on the text. Bibliography and source notes are also included. Copyright © 2018 The Board of Trustees of the University of Illinois

The Eternal Present: The Untold and Short Cuts series, BBC Radio 4.

The present tense is THE powerful first lesson in radio grammar. But so is telling the truth. What happens then, when these two butt up against one another and call each other’s bluff? ‘The Untold’ is a half-hour BBC radio series dedicated to ‘documenting the untold dramas of 21st century Britain’. The episode, Songs of the Bothy Balladeer, like all the stories in this series, is personal. This whole production can only be made with a high degree of cooperation from all its subjects. Indeed some of them nominate themselves. It means that we, the audience, are granted seemingly unimpeded access to a life-changing moment as it happens. We are with the subject behind the scenes. This is reality radio. In real time. Pre-recorded. Throughout the whole series ‘time’ is critical. The untold story must happen in a sort of ‘suspended’ real time. For the idea to work, the audience must feel it is living moment by moment alongside a particular dramatic event in the subject’s life. The idea fits perfectly with our ‘selfie stick’ age. The second series, Short Cuts, is another BBC Radio 4 production, assembled by an independent company, Falling Tree Productions. The slot is also 28 minutes, but this program is made up of short documentaries and ‘adventures in sound’. Each episode is produced and curated around a particular theme by the inventive Eleanor McDowall. McDowall seeks out and plays documentaries from everywhere, mixing experienced, professional program makers up with student and community radio first-timers. What she is seeking are sound paintings that look at the world in a way you haven’t seen before. She stresses a compositional approach, often with found sound. ‘The End of the Story’ episode is made up of three features about things drawing to a close. The first, by noted Danish producer Rikke Houd, is about ancient Inuit culture in Greenland. The story is told in three different epochs, each cut into fragments and layered over one another. The earliest is an evocative and mysterious archival recording. This sound of a man’s voice from the past desperately shouting to us in the present, so that all it represents – people, culture, language, land, will not be forgotten and destroyed – has huge emotional power. The words are incomprehensible but the meaning is plain. The second, two and a half minutes piece, is called ‘Too Many Miles’. It is an imaginary audio film inspired by a Robert Frost poem. The producer of the third piece, ‘Power of Bare’, is former Third Coast Artistic Director, Sarah Geis. It is an interview with an American artist, Harold Stevenson, from the Warhol generation, who is best known for his paintings of the male nude. In comparing these shows, it could be said that the program with the more artifice is actually the more honest. Not that it matters, because one program The Untold, simply proceeds by asking us to suspend our disbelief in the idea of real time being real, and the other, Short Cuts, doesn’t.

“Passing as Normal”

This autoethnography presents a narrative account of the author’s experience of living and coping with the stigma of deafness. First, the autoethnographic stories explore the author’s experience of face-to-face encounters with hearing people in which he attempts to pass himself off as normal. The stories illustrate how stigma played a central role in the framing of social interactions inside and outside of school. Second, the article draws on Erving Goffman’s theories on stigma and identity management in an attempt to illuminate an understanding of what the author was coming to terms with. Finally, the author offers his own reflections on the stories including details of some life-changing moments that provided the impetus to transform the stigma of deafness into a positive attribute.

Popular Music and Jazz, 1900–1950

On the evening of March 8, 2014, I became the most envied person in the Lancaster, Pennsylvania, Marriott Heritage Ballroom (perhaps the whole of Lancaster County). For my own part, I snoozed. But there on the nightstand, my cell phone danced with texts of more energetic colleagues: “Sherrie, you won the Grove! Where the @#! are you?” It seemed I had hit the jackpot in the SAM 2.0 raffle. In (quite literally) the blink of an eye, I had gone from a run-of-the-mill scholar of American music with pretty much the same books on the shelf as others with my particular set of research interests, to one of the few people on the planet to own the entire eight-volume AmeriGrove II. In that same life-changing moment—as I learned the next morning—I had also become the person least able to politely decline John Koegel's invitation to contribute to this multipart review.