Secondary Theme Research Articles

Themes and costs underlying avoidable terminal oncology ICU hospitalizations.

6548 Background: ICU admissions in the last 30 days of life are an indicator of poor care. Our prior research found nearly half of terminal oncology ICU hospitalizations are potentially avoidable. Methods: Data were derived from 72 patients consecutively cared for in an academic medical center’s oncology practice who died in an ICU between July 1, 2012 and June 30, 2013. Oncologists, intensivists, and hospitalists used a standardized assessment tool to review each patient’s electronic health record from 3 months prior to hospitalization until death; they made a clinical determination of avoidability. Two investigators, blinded to the specialty, used a grounded theory approach to extract clinical themes associated with the reviewer’s determination of avoidability. Total, direct, and indirect costs were abstracted for each avoidable hospitalization. Results: Thirty-four (47%) of the examined hospitalizations were deemed avoidable. The primary themes associated with avoidability, and the percentage by specialty, were as follows: 1) failure to initiate appropriate advance care planning in the outpatient setting (68% oncologists, 55% intensivists, 65% hospitalists), 2) failure to integrate understanding of limited prognosis (23% oncologists, 24% intensivists, 26% hospitalists), and 3) failure of clinical management (6% oncologists, 21% intensivists, 6% hospitalists). A failure to educate and integrate surrogates into timely medical decision-making was a prominent secondary theme for oncologists (22%), intensivists (18%), and hospitalists (29%). The total cost per patient averaged $44,532 with direct and indirect costs averaging $25,215 and $19,317, respectively. High cost areas were ICU level care (35%) and pharmaceuticals (16%). Conclusions: The themes identified suggest potential preventative interventions, including higher rates of outpatient advance care planning, oncology inpatient communication to promote patient’s prognostic understanding, prevention of failures in clinical management, and better education and integration of surrogates. Given 8% of oncology patients expire in the ICU and 47% were identified as avoidable, the potential national annual cost of these avoidable hospitalizations is $997MM.

The Chinese Road in the Light of Historical Continuity

The Chinese road has deep historical roots. Its most striking feature is that it is marked by historical continuity rather than rupture, and the main force behind this continuity is its intrinsic dynamism and vitality. Unlike the paradigm of Eurocentrism or “Discovering History in China,” the comparative analytical paradigm discovers China through long-term comparisons with corresponding countries in the same time and space in an effort to find positive elements in the history of the Chinese road and to refute the long prevalent theory of Chinese stagnation. Seen over the course of world history, the impetus for the creation of the world’s most brilliant agrarian civilization was endogenous. This impetus was not a momentary “explosive force” but a sustainable institutional drive whose main constituents were the independent farming household, endogenous government capacity and adaptive national governance. In addition to the main theme of “permanent change,” Chinese development had a secondary theme of “cyclical change” which cannot be ignored. The roots of Chinese development are buried deep in the genes of this agrarian nation in the form of sticky institutions, bureaucratic inertia, arbitrary power, etc. Historical continuity provided a foundation for China’s creative revolution and development in modern times, ultimately laying down a socialist development road with Chinese characteristics, although this remains an unfinished relay process.

Qualitative themes underlying potentially avoidable terminal oncology ICU hospitalizations.

101 Background: ICU admissions in the last 30 days of life is a quality measure endorsed by the National Quality Forum. Our prior research has demonstrated that nearly half of terminal oncology ICU hospitalizations are potentially avoidable. Methods: This was a retrospective care series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. Using a standardized assessment tool, an oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months prior to hospitalization until death and made a clinical determination of avoidability. Two investigators, blinded to the specialty of the reviewer, used a grounded theory approach to extract clinical themes associated with avoidability from the reviewers’ assessments. Results: The primary themes for avoidability identified and percent by specialty were as follows: failure to initiate appropriate advance care planning in the outpatient setting (68% oncologists, 55% intensivists, 65% hospitalists), failure to integrate understanding of limited prognosis from underlying cancer within the context of acute hospitalization (23% oncologists, 24% intensivists, 26% hospitalists), failure of clinical management (6% oncologists, 21% intensivists, 6% hospitalists), failure to recognize futility of outside hospital transfer (3% oncologists, 0% intensivists, 0% hospitalists), and failure of care coordination (0% oncologists, 0% intensivists, 3% hospitalists). A failure to educate and integrate surrogates into timely medical decision making was a prominent secondary theme for oncologists (22%), intensivists (18%), and hospitalists (29%). Conclusions: The themes identified suggest potential interventions to prevent avoidable terminal oncology ICU hospitalizations, including improved advance care planning in the outpatient setting, inpatient multidisciplinary communication to gain a better understanding of the patient’s underlying malignancy within the context of the acute hospitalization and prevent failures in clinical management, and better education and integration of surrogates in medical decision making.

Parenthetic Aside in a 1789 Analysis of Mozart’s K. 284

In a 1789 treatise, the Darmstadt musician J.G. Portmann presents what amounts to a multi-level harmonic analysis of Mozart’s Sonata for Piano in D, K. 284, I. Portmann’s interpretation of the movement’s exposition is in line with concepts expressed by other eighteenth-century theorists, but suggestively differs from standard modern conceptions of the form, especially in its understanding of what nowadays is labeled as the secondary theme.

Bakhtin, Pushkin e a cocriatividade daqueles que compreendem

RESUMO Do início (1919) até o final de suas publicações (1972), Mikhail Bakhtin escreveu frequentemente a respeito da força da criatividade. Isso foi um tema secundário, mas também uma variante livre e valorativa de seus grandes temas, como dialogismo, cronotopo, carnaval, grande tempo. A definição de Bakhtin que colabora para distinguir o dado, que já existe, do recentemente criado, ajuda-nos, em 2015, a resgatar a criatividade de seus usos desgastados na esfera pública. Uma finalidade deste ensaio é retificar uma expressão valiosa: mostrar o que Bakhtin quer dizer com a cocriatividade daqueles que compreendem1. Outra finalidade é especificar, com o auxílio de Bakhtin, o tipo de criatividade que Alexandr Pushkin realiza nos poemas líricos, narrativos e meditativos em seu momento histórico. Na medida em que formos bem-sucedidos, continuamos um projeto de estudos bakhtinianos cujo objetivo é mostrar como seu pensamento contribui para a interpretação da poesia como uma arte verbal.

A qualitative description of successful aging through different decades of older adulthood

ABSTRACTObjective: To qualitatively examine factors that contribute to successful aging during different decades of older adulthood.Methods: Fundamental qualitative description was adopted as the methodological framework. Through purposeful sampling, 42 community dwelling older adults (mean age = 79.6 years, age range = 65–97 years; 19 males) were recruited. Focus groups (6) segmented by decade of life were conducted with participants 65–74 (n = 17) and 75–84 (n = 17) years of age. Semi-structured interviews (16) were conducted with four participants from each decade, as well as participants 85 years of age and older (n = 8). Data analyses were conducted independently for each decade of life and included inductive analysis of textual data through continuous comparisons of meaning units.Results: Three primary themes related to successful aging were identified across all decades of older adulthood: (1) staying healthy (secondary themes: genetics and lifestyle choices), (2) maintaining an active engagement in life (secondary themes: social engagement and cognitive engagement), and (3) keeping a positive outlook on life. Participants in specific decades of older adulthood identified three additional secondary themes related to maintaining an active engagement in life: finances (65–74 and 85+ years), social support (75+ years), and successful marriage (75+ years). Similarly, only adults 65–84 years of age identified a secondary theme for keeping a positive outlook on life: acceptance and adaptation.Conclusion: Primary themes related to successful aging were agreed upon by participants in all decades of older adulthood, while age-based differences existed among secondary themes. Thus, what it means to age successfully may be age-dependent.

Sonata Theory, Secondary Themes and Continuous Expositions: Dialogues with Form‐Functional Theory

ABSTRACTWith regard to the definition of secondary (or subordinate) themes within Classical‐style expositions, Sonata Theory and form‐functional theory proceed from different understandings of the style, role and structural purpose of such themes. From the more integrative standpoint of Sonata Theory, the form‐functional understanding, while logically tight, is insufficiently attentive to rhetorical, punctuational and thematic factors that also lie at the core of expositional practice in the second half of the eighteenth century. This article updates my thoughts on secondary‐theme definition in this era, underscoring once again the need for flexibility and musical sensitivity in the application of the ‘no MC, no S’ guideline. Along the way, I outline a broader historical argument to suggest that, beginning around 1750, the strategic introduction of an emphatic medial caesura (or punctuational ‘hard break’) into the centre of what we now call sonata expositions effectively and immediately divided any such exposition into two separate parts. Each of the two parts is usually subdivisible into two separate action‐zones, resulting in a de facto {P TR}’{S/C} pattern, each zone of which soon came to call for its own generically appropriate harmonic and thematic/rhetorical treatment. Under the zonal concept of expositional formatting (precipitated by the presence of an MC), the secondary theme is best construed as that characteristic, new theme that marks the post‐MC onset of the second part. Expositions without an interior MC present us with a different situation, one in which it can be counterintuitive – or at least analytically unnecessary – to posit the presence of a subordinate theme in the zonal sense: one need not presume that all mid‐expositional V:PACs are preceded by a subordinate theme. The article also considers how most productively to interpret a transition‐ending dominant‐lock leading to an MC and concludes by discussing how and why it is possible for a transition‐ending V:PAC to articulate an MC that then gives way to the onset of a characteristic secondary theme.

Crossing Boundaries: Ethnicity, Race, and National Belonging in a Transnational World ed. by Brian D. Behnken, Simon Wendt, and: At the Border of Empires: The Tohono O’odham, Gender, and Assimilation, 1880–1934 by Andrae M. Marak, Laura Tuennerman

Reviewed by: Crossing Boundaries: Ethnicity, Race, and National Belonging in a Transnational World ed. by Brian D. Behnken, Simon Wendt, and: At the Border of Empires: The Tohono O’odham, Gender, and Assimilation, 1880–1934 by Andrae M. Marak, Laura Tuennerman Benjamin H. Johnson Crossing Boundaries: Ethnicity, Race, and National Belonging in a Transnational World. Edited by Brian D. Behnken and Simon Wendt. New York: Lexington Books, 2013. 330pp. $85 (cloth). At the Border of Empires: The Tohono O’odham, Gender, and Assimilation, 1880–1934. By Andrae M. Marak and Laura Tuennerman. Tucson: University of Arizona Press, 2013. 232pp. $55 (cloth). Contemporary maps divide the world into territories controlled by discrete nation-states, the very entities that have structured the modern discipline of history. Yet social and political reality is also characterized by transnational flows of people, goods, and ideas. Paradoxically, these exchanges—the raison d’être of the burgeoning field of transnational history—include nationalist ideas and mobilizations. “Transnationalized concepts of national belonging” are the focus of the wide-ranging and provocative anthology Crossing Boundaries. Its editors endeavor to show how such concepts have been “forced and adopted, borrowed and compelled, adapted and coopted, and, ultimately how they can be accepted and rejected by local people” (p. 2). The volume consists of fourteen brief essays, of about twenty pages each, which range over the twentieth century. Half of the essays examine transnational dynamics in the Americas; four are set primarily in Asia; and the rest describe transnational relationships rooted primarily in Africa and Europe. The center of gravity lies in the study of political movements, but transnational cultural history is a strong secondary theme, particularly in Brian Behnken’s discussion of music and hair-style in his essay on connections between the U.S. Chicano movement and Mexican student unrest and in Pablo Dominguez Andersen’s examination of Chinese American movie star Anna May Wong and her fame in Weimar Germany. The last essay, Kevin Amidon’s superb and wonderfully theorized “Beyond the Straight State: On the Borderlands of Sexuality, Ethnicity, and Nation in the United States and Europe,” is more comparative than explicitly transnational. The individual essays have their particular ambitions and historiographic interventions, but the editors conclude that the volume’s most fundamental revelation is that “transnational and transcultural processes impeded political elites’ efforts to create ethnically and racially homogenous national communities, while they also produced a hybrid sense of national belonging that frequently transcended traditional forms of ethnic nationalism as well as national boundaries” (p. 6). This revelation is pursued in a particularly compelling fashion in several of the essays. [End Page 414] Charles Reed makes a convincing case for the importance of “imperial citizenship,” which allowed early twentieth-century South African activists to struggle for dignity and autonomy within the British Empire and to thereby escape the distinctions that later scholars often drew between civic and ethnic nationalisms. His subjects, Reed observes, “imagined themselves as British citizen-subjects (civic) and ‘natives’ (ethnic) without contradiction and without such distinctions in mind” (p. 104). Similarly, Charlton Yingling’s recreation of Dominican exile networks from the 1930s to 1950s traces the joining of notions of pan– Latin Americanism with Dominican nationalism, concluding with a forceful articulation of the importance of exile “as a decisive site of nation-building” (p. 54). Karen Morris points to debates over Ivoirité in the Cote d’Ivoire in recent decades as illustrative of the wider tensions “inherent in equations of post–World War II national citizenship with ancestry-based pre-colonial territoriality” in postcolonial Africa and beyond (p. 173). The similarities in themes link together essays that are diverse in empirical terms. Examining different national projects on five continents over the course of a century necessarily draws on an enormous range of historical developments and historiographies. The fact that the essays speak so well to one another reflects a strong editorial hand and the sweeping importance of the questions about ethnicity, race, and nationalism that lie at the heart of the volume. The anthology’s success in terms of thematic unity, however, raises questions that it does not answer or even substantially address. Taken as a whole, Crossing Boundaries offers very little sense...

Group sandplay characteristic and mental health status of 518 military pilots

Objective To analyse characteristics of military pilot group sandplay work and reveal their psychological status. Methods Using the self-reporting 90-item Symptom Checklist (SCL-90) to test the validity of group sandplay work made by 87 groups of military pilots. Statistical analysis was used to analyse the characteristics of code data in group sandplay work. Results Positive and negative themes in group sandplay work showed negative and positive correlations(r=-0.59, 0.59) with symptom factors of SCL-90, respectively. Positive and negative themes scores were 5.37±2.25 and 2.36±1.85, respectively. The secondary theme scores in the positive theme were entirely higher than those in the negative theme. Scores of energy, connection, cooperation, integration, relaxation, and spirituality in the positive theme and threat, limitation, and aggression in the negative theme were relatively high. The overall evaluations of the work include power, integration, enrichment, and fluency. The theme names of the work include life, military, natural and abstract. Conclusion Group sandplay is an effective method in the study of military pilots' psychological health and military pilots are in good mental health. These pilots have strong intrinsic energy, teamwork and communication.However, some pilots have symptoms of anxiety, tension and insecure. Key words: Group Sandplay; Military pilots; Sandplay themes; Mental evaluation

The Nature and Impact of Late Imperial Chinese Academies: A Review of Some Recent Publications in China

This review essay analyzes the historiography of Confucian academies (shuyuan) in imperial China, focusing on five representative books published in China between 2008 and 2014, including two new editions of books originally published in 1995 and 2004. The five authors share a deep concern about the nature of academies, particularly their relationship with the state. A secondary theme that these books address is the impact that academies had on late imperial Chinese culture and society. Read together, these five works show how research on academies in imperial China has evolved over the past two decades.

Civil religious contention in Cairo, Illinois: priestly and prophetic ideologies in a “northern” civil rights struggle

We argue that analyses of civil religious ideologies in civil rights contention must include the interplay of both movement and countermovement ideologies and must recognize the ways in which such discourse amplifies conflict as well as serves as a basis for unity. Based on in-depth interviews, archival research, and content analysis of civil religious language, this article examines how priestly and prophetic civil religious discourses, and the infusion of Black power ideologies, provided significant and dynamic resources for both movement and countermovement ideologies during periods of civil rights contention in Cairo, Illinois, especially from 1969 to 1972. We compare the ways in which Cairo’s civil rights leaders mobilized prophetic versions of civil religion, and concomitantly, how white countermovement organizations used a priestly civil religion. On the prophetic side the themes of “equality,” “freedom,” “justice,” and the “right to revolt” against worldly socio-political arrangements were employed. On the priestly side, the theme of “law” and “order” was played up, with a secondary theme that connected religious acquiescence to worldly power with God’s will. The former rhetoric saw calls for economic and employment integration within God’s will and the nation’s destiny. The latter rhetoric contrasted civil rights claims as essentially “un-American.”

The Story of Helium and the Birth of Astrophysics

Helium is unusual among the elements, as it is the only one which was first discovered in an extraterrestrial environment. The yellow spectral emission line of hot helium gas was first seen by Jules Janssen, the celebrated French astrophysicist, at the time of the 1868 total solar eclipse of the Sun, when he observed the hot outer atmosphere of the Sun later known as the chromosphere. The eclipse occurred on the morning of 18 August and was observable from southern India as well as Singapore.Janssen believed the line was coincident with the yellow D lines of sodium, so did not suspect that a new element was involved. He is remembered, however, for his discovery of how to observe the solar chromosphere spectroscopically even outside of the time of eclipse, by placing his spectroscope slit tangential to and slightly above the solar limb.Norman Lockyer in England independently discovered that technique in October 1868 and noted that the bright yellow line was several angstroms to the short wavelength side of the sodium D doublet and therefore was not due to sodium. He suggested that a new element may be responsible. Norman Pogson in India also suspected that the yellow chromospheric line may not be coincident with the D lines, and was the first to make this remark but did not speculate on what its implications might be.Much of the emphasis of Nath's book is based on debunking the oft-repeated myth that Janssen discovered helium. Janssen himself never made such a claim. The Nobel committee, when it awarded the chemistry prize to William Ramsay for his work on noble gases in 1904, which included the terrestrial discovery of helium, referred to Janssen as the original discoverer and the myth since then has remained in the literature.Nath was not the first to point out that Janssen did not discover helium. Francoise Launay, in her recent biography of Janssen (Vuibert 2008), was the first to set the record straight, a point not adequately acknowledged by Nath. Nevertheless, this is a very readable account aimed at the general reader rather than professional historian. It vividly tells the story of the various eclipse expeditions in India in August 1868, notably those of James Tennant, Lt John Herschel, Jules Janssen, and Norman Pogson (the last being based in Madras as government astronomer). This part of the book is particularly well researched, and the trials and tribulations of all the observers are narrated in a lively and informative way. Other notable astronomers are also brought to life, especially Norman Lockyer, who would have observed the eclipse from India in August if only his Browning spectroscope has been ready in time, and William Huggins and Angelo Secchi, noted early stellar spectroscopists of the 1860s and later.The book less satisfactorily covers its secondary theme, namely, the birth of astrophysics. …

Nursing patients with chronic critical illness and their families: a qualitative study.

chronic critical illness (CCI) is a complex syndrome with a high risk of dying in hospital. Intensive care unit nurses are well-positioned to lead conversations integrating palliative and end-of-life care, yet have reported limited involvement. To generate further understanding of nurses' experiences of patients with CCI and their families. This qualitative study followed Thorne's interpretive description methods. In 2012, 16 intensive care unit nurses from one academic hospital participated in interviews. Our primary theme was that of internal tension generated through participants' knowledge of patients' anticipated and protracted dying, while wanting to shield families from suffering. This internal tension resulted from responsibilities to preserve hope for patients and families, while at the same time wanting to provide them prognostic information. Participants experienced challenges of: (i) preserving family trust, (ii) determining when and how to engage families in discussions and (iii) providing possibilities of a 'good' death. A secondary theme described constraints to acting on their insights because of interprofessional team dynamics or limited communication, within the team and with the family. Internal tension, as experienced by participants reflects the challenges of transition from acute to palliation and end-of-life care, made more complex in CCI, because of its poorly defined terminal stage. Nurses' ability to manage the complex process of supporting hope while gradually providing information to build family understanding of CCI highlights their central role in facilitating what and how prognostic information is given, while managing the emotional implications and family response. To better support nurses do this, we advocate for formal structures enabling nurses to participate in decision-making regarding timing of transitions using palliation and end-of-life care.

Disquietude: A Sonata-Form Inquiry into Multiliteracies Practices in an EAL Classroom

This narrative case study describes an English as an Additional Language teacher’s struggle to understand her young adult learners’ apparent resistance toward multiliteracies pedagogical practices in a college setting. Multiliteracies Pedagogy (New London Group, 1996) advocates the use of digital media, and home languages and culture, to engage diverse youth in designing personally meaningful multimodal texts that can significantly impact learner identity, voice, and agency. This arts-based study uses an innovative sonata-style format to document the making of a class documentary, accompanied by teacher reflections on the video project in the form of poetry, journal excerpts, and classroom dialogue. The sonata form provides a unique methodology for teacher inquiry, allowing the teacher-researcher to explore the ways in which curriculum, pedagogy, and sociocultural influences intersect in the classroom. The study does not end with a clear resolution of the problem; instead, the process of inquiry leads to deeper understandings of what it means to teach in the complex worlds of diverse learners. Chapter One: Theoretical Preface This narrative case study describes my undertaking, as an EAL (English as an Additional Language) teacher, to better understand my young adult English language learners’ apparent resistance toward multiliteracies practices in my classroom. This has been a recurring issue for the 5 years that I (and my colleagues) have been teaching in this program. It is not supposed to happen; multiliteracies pedagogy, as envisioned by the New London Group (1996), should motivate, engage, and empower all students, especially diverse and marginalized learners. Department of Graduate and Undergraduate, Studies in Education, Faculty of Education, Brock University, St. Catharines, Ontario 60 International Journal of Language and Literature, Vol. 2(4), December 2014 It builds on students’ proficiency with digital technology and taps their home cultures and languages through collaborative and creative project work. It is a dynamic, innovative pedagogy that is supposed to have a profound effect on English language learners. And it does—for some, but not for others. It seems there is an undercurrent of tension in our classroom, a resistance to multiliteracies practices, that is difficult to comprehend and challenging to address. This narrative inquiry involves reflection on transformative theories of language and literacy education, personal history, and living in that uncomfortable space in which pedagogy and real world application come into conflict. The study is written in a sonata-style format, a creative framework for arts-based inquiry. The sonata begins with an exposition, which introduces the primary theme: the making of a class documentary. This is followed by a contrasting secondary theme, which explores teacher reflections on classroom events and conversations. The exploration uses poetry, journal notes, and reconstructions of classroom dialogue. Through these reflections, the conflict between pedagogy and practice, between curricular imperatives and meeting broader student needs, is exposed. While the study examines the tension in the classroom, it does not attempt to resolve it; rather it is grounded in the understanding that not all teacher practical knowledge is about clear solutions to specific pedagogical problems. The case study is told from the perspective of a fictional English as an Additional Language teacher, whose story is based on my own teaching experiences. The inquiry uses arts-based representations of real classroom experiences to problematize idealistic conceptions of literacy pedagogy and to offer more complex ways of viewing English language teaching and learning. My hope is that the presentation of an alternative view of multiliteracies pedagogy will lead to further avenues for research and will facilitate more respectful, responsive, and ultimately more effective pedagogical practices.

‘The midwives aren't allowed to tell you’: Perceived infant feeding policy restrictions in a formula feeding culture – The Feeding Your Baby Study

Objectiveto explore the expectations and experiences of postnatal mothers in relation to infant feeding, and to identify how care could be improved. Designthis study used a qualitative, exploratory, descriptive design. Data were collected through one to one in-depth semi-structured interviews and focus groups. SettingTayside area of Eastern Scotland. Participantsseven focus group interviews (n=38 participants) and 40 semi-structured one-to-one interviews with mothers with a range of infant feeding experiences i.e. exclusively breast fed; started breast feeding but changed to formula milk before 16 weeks; exclusively formula fed; or who concurrently breast and formula fed their infant. Findingsa principal theme of ‘Mixed and missing messages’ emerged, incorporating ‘Conflicting advice’, ‘Information gaps’ and ‘Pressure to breast feed’ with a secondary theme of ‘Emotional costs’. Several problems were identified with how women were given information, how infant feeding discussions were held, and the type of support available after the infant is born. Key conclusionsthere was a strong perception that some midwives are not ‘allowed’ to discuss or provide information on formula feeding, and the women reported feeling pressurised to breast feed. Current interpretation of guidance from the UNICEF UK Baby Friendly Initiative may be restricting antenatal discussions about infant feeding. The combination of this partial preparation antenatally and postnatal support that was often inconsistent seems to incur a counter-productive emotional cost. Implications for practiceat strategic, policy and practice levels the infant feeding message needs to change to encourage a more woman-centred focus including discussions about the realities of all types of infant feeding. It is important that health providers continue to promote and support breast feeding; and that effective services are provided to women who wish to breast feed to help them to do so. However provision of information about all aspects of feeding is needed as well as support for women who do not wish to breast feed.

What does coping mean to the worker with pain-related disability? A qualitative study

Purpose: Pain coping is important in health outcomes. In the current literature, pain coping usually means those goal-directed strategies to manage pain. The study goal was to explore what personal meaning “coping” has for work-disabled individuals in pain. Method: Qualitative, in depth interviews with follow-up verification interviews were conducted with 13 volunteers who were off work and in rehabilitation for chronic pain from a musculoskeletal injury. The two main questions were: (1) How did participants understand the term “coping with pain”; and (2) how did they come to this understanding of coping. The theoretical approach was social phenomenology and data were analyzed using thematic analysis. Results: The dominant theme was that pain coping is an intrinsic and life-defining attitude and belief. This understanding primarily arose through early modeling by parents and significant others. Secondary theme was that coping is practical strategies to manage or eliminate pain. This arose through more current interactions with health care providers and others in the social network. Conclusions: Researchers’ and clinicians’ view of coping may not always match the views held by individuals with chronic pain. This might impact on the effectiveness of interventions designed to modify coping behaviors, and alternative ways of intervening may be needed.Implications for RehabilitationCoping has an important impact on health recovery after musculoskeletal injuries but interventions to modify pain coping strategies in those with chronic pain have met with modest success.The dominant model for coping in the research literature defines coping as a behavioral and/or cognitive response to a stressful situation.A qualitative study to examine what personal meaning “coping” holds for work-disabled persons with chronic pain suggests that coping is primarily conceptualized as an intrinsic and life-defining attitude/belief learned early in life.The above incongruence between the dominant research model of coping and the views of workers with chronic pain might impact on the effectiveness of interventions designed to modify coping behaviors for this population, and alternative ways of intervening may be needed.

Chinese older adults’ resilience to the loneliness of living alone: A qualitative study

Objective: The purpose of this study was to investigate resilience factors that help Chinese older adults living alone cope with senses of loneliness. Method: Qualitative in-depth interviews were conducted on 13 older adults living alone in the community who did not show severe loneliness. Trained research assistants conducted interviews guided by semi-structured interview guidelines. The analysis followed a five-step interpretive approach. Results: The primary theme of resilience was found in cognitive competence, self and personality, and social relations. The secondary theme of resilience showed a family-oriented, relationship-focused resilience coping, which is in line with Chinese culture. Conclusion: This study demonstrated that family-oriented and relationship-focused resilience at the cognitive, self and personality, and social relations levels played significant roles in helping the Chinese older adults overcome their high risk of loneliness. Developing and maintaining dynamic daily rhythms that can integrate family-oriented and relationship-focused coping strategies at the cognitive and social levels are recommended.

A National Survey about Human Papillomavirus Vaccination: What We Didn't Ask, But Physicians Wanted Us to Know

Study ObjectiveThe current study presents findings from a qualitative examination of free text comments from a national survey of U.S. physicians on human papillomavirus vaccine recommendation beliefs and practices. Qualitative analyses of free text physician responses may offer a more complete and physician-driven description of influences on human papillomavirus vaccine recommendation. Design and ParticipantsIn 2009, a survey assessing physicians' knowledge, attitudes, and human papillomavirus vaccination practices was conducted among a national sample of U.S. physicians practicing Family Medicine, Pediatrics, or Obstetrics/Gynecology (response rate 67.8%). Qualitative comments were analyzed using a Grounded Theory approach. ResultsOf 1008 completed surveys, 112 participants provided comments, which were organized into three primary HPV vaccine-related themes: (a) comments about cost of the vaccine, (b) comments about institutional policies and procedures, and (c) physicians' personal views and one secondary theme related to survey methodology: the parent study's use of an upfront cash incentive. Many comments pertained to issues that were queried in the closed-end survey items; however, some comments provided insight into understudied areas (e.g., physician attitudes regarding survey methodology). ConclusionPhysician respondents used the free text space to reemphasize issues that were most important to them and to offer insight about aspects of the vaccine and the survey process.

Exploration of the family’s role and strengths after a young woman is diagnosed with breast cancer: Views of women and their families

PurposeThis exploratory descriptive study examined the role and strengths of the family when supporting the younger woman (<50 years) after a diagnosis of breast cancer. The perspectives of women and family members were sought. MethodParticipants were recruited from oncology outpatient units in Australia. Semi-structured interviews guided by the Family Resiliency Framework were undertaken with 14 young women with breast cancer and 11 family members who reflected on the roles of family. Transcripts were analysed individually and in family groupings. ResultsWomen with breast cancer and their family members experienced a range of emotions during the treatment period. Roles within the family changed as members responded to their circumstances. Analysis of interview transcripts identified the following primary themes; ‘just being there’, ‘paradox of help’ and ‘buffer from society’. A secondary theme related to support, specifically ‘the changing role of support for family members’, highlighting the strengths and experiences of family. ConclusionRecognition needs to be given to the complexity of changing roles experienced by young women with breast cancer and their families. Young women with breast cancer require unique forms of support because of the nature of their experience. Family roles were shaped through a shared sense of commitment and open communication amongst members. Families may demonstrate a range of strengths but are also vulnerable during this stressful period. Health professionals need to be aware of the possible needs of families, assess their adaptation to changing circumstances, and intervene through the provision of information, and counselling to enhance coping.

“I have tried to capture you …”: Rethinking the “Alma” Theme from Mahler's Sixth Symphony

Abstract Since the 1940s, Mahler's Sixth Symphony has been transmitted with an informal “domestic” program centered on several claims first made in Alma Mahler's Erinnerungen. In the work, she writes, Gustav meant to depict their children (in the Scherzo), himself (in the Finale), and finally her, in the first movement's swooning secondary theme. Though critics have almost universally accepted Alma's anecdote, few have seriously asked the important question of what such a portrait would be doing in Mahler's most expressly tragic symphony. In this study I offer a hermeneutic perspective on the Sixth that concedes the possible truth of Alma's anecdote but which challenges the conventional assumption that such a spousal tribute should best be understood as a one-sided testament to Mahler's newfound nuptial bliss. After examining the theme's reception history and Mahler's domestic circumstances during the symphony's composition, I explore the ways in which the first movement's sonata narrative—a protracted conflict between (and reconciliation of) its two gendered subjects—suggestively mirrors the prevailing psychodynamics of Mahler's strained marriage. At the end of the essay I propose how this revised hearing of the opening movement might prompt a reimagining of the entire Sixth as a projected or imagined “domestic tragedy,” with special focus on the intertextual links between the work's outer movements and also between the cataclysmic finale and the penitentially anguished portions of the Third Symphony's “Armer Kinder Betterlied.”