Seeking Guidance Research Articles

The Freedom of Being Three: The Art of Architectural Growing Up

Experiential learning and an open, enquiring mind are as integral to the profession of architecture as they are to a child's development. Watching his daughter in her early years, Alex Scott‐Whitby has noticed parallels with the evolution of his practice. Founded in the year she was born, his London architecture and urban design consultancy ScottWhitbyStudio has gone through similar phases: from the seed of an idea, to finding its feet, to seeking guidance from its forebears, to pushing boundaries.

Poem for Children by Allama Iqbal: A Deconstructive Critique

Study aims at deconstructive analysis of the poetry Bachon key nazmen(POEMS FOR CHILDREN) by Allama Muhammad Iqbal. The poems in this collection are of great importance as they do carry moral as well as universal message for the children who are going to lead the nation in upcoming years. These poems are written by Muhammad Iqbal before the partition of India. The time in which the youth was seeking guidance and poets like Iqbal played pivotal role. He made the Muslims of that era realize by addressing the youth and those messages from him are still applicable. The theme of his poetry is mainly to make Muslims realize who they are and how do they share a different heritage from other nation around that are Hindus, Sikhs and Christians. The foundation of this work is laid on the theory of deconstruction in which Jacques Derida suggested three levels of analysis i.e. textual, verbal and linguistic. The logical as well as connotative meanings employed by Iqbal would be unmasked to analyze the hidden meanings.

Ethical considerations in forensic genetics research on tissue samples collected post-mortem in Cape Town, South Africa

BackgroundThe use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa.Main bodyThis article discusses some of the ethical challenges that were encountered in these research projects. Among these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor.ConclusionIt is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa.

Male reproductive health challenges: appraisal of wives coping strategies

BackgroundSystematic studies on the association between men’s sexual dysfunction (low sexual desire, ejaculation disorders, erectile dysfunctions, genital ulcers, testicular disorders, prostate cancer or sexually transmitted infections) and marital conflict are emerging. However, the coping strategies adopted by wives in such circumstances are not commonly reported in the literature. Male sexual functioning is vital to the marital relationship, lack of it can result in intolerable cohabitation or relationship breakdown, and could also cause infertility, infidelity, and arouse stigma in Nigeria. The understanding of coping strategies by female partners could guide in the counselling and treatment of men’s sexual health problems. Effective coping has the potential to lessen or prevent negative outcomes, and thereby could reduce marital conflict.ObjectivesThis study examined the coping strategies adopted by women whose husbands have reproductive health challenges in two of the five states with the highest proportion of divorce/separation in Nigeria.MethodsFour focus group discussions were conducted in two local government areas. The women were recruited from a quantitative couple-study for men with sexual health problems. Focus group responses were transcribed and analysed using systematic-content-analysis with thematic organisation of the summaries and systematic typologies of participants’ responses.ResultsThe results revealed the coping strategies employed by women in this environment: seeking guidance from their religious leaders and family doctors, physical-sexual-therapy, abstinence and concubinage. The participants indicated that they encountered difficulties in discussing their husbands’ sexual health problems with a third party.ConclusionThe study concludes that husband’s sexual ability is crucial to the sustenance of the marital relationship. Religious leaders and family doctors often serve as mediators to husband-wife conflict management. Counselling is recommended in cases of sexual health problems. Husbands should be encouraged to seek treatment and share their sexual challenges with their spouse. The medical officers and religious leaders could also be trained in family-conflict management.

ACHIEVING REGIONAL SUSTAINABILITY

The mayor of Peoria constituted the Peoria Sustainability Commission (PSC) in late 2008 with the mission “To transform Peoria into a community that promotes social equity, green economy, and a healthy environment through policy development, incentives, and initiatives to sustain a quality way of life.” The Commission utilized a unique breakthrough model, which brought together members from diverse backgrounds, functions, expertise, and viewpoints to form a shared vision. The group started with fewer than ten leaders within the community but has now grown to more than 30 members and continues to attract the movers and shakers in the region. The PSC was divided into six subcommittees, which formulated ideas and recommendations targeted towards improving sustainability for their focus areas and enlisting the help of the business community. The Peoria model diverges from traditional models in that it deployed actionable strategy and eliminates silos inherent in most commissions. The core objective was to develop an action plan, commission structure, and seeking feedback and guidance from stakeholders to inspire new ways of thinking. The critical changes identified included moving the PSC focus from a local Peoria-centric model to a regional model and to modify the Commission structure to cross-functional teams to better adapt to future development in the social, environmental and economic areas. The action plan, structure, targets, and PSC achievements are presented in this paper.

In Silico Absorption, Distribution, Metabolism, Excretion, and Pharmacokinetics (ADME-PK): Utility and Best Practices. An Industry Perspective from the International Consortium for Innovation through Quality in Pharmaceutical Development.

In silico tools to investigate absorption, distribution, metabolism, excretion, and pharmacokinetics (ADME-PK) properties of new chemical entities are an integral part of the current industrial drug discovery paradigm. While many companies are active in the field, scientists engaged in this area do not necessarily share the same background and have limited resources when seeking guidance on how to initiate and maintain an in silico ADME-PK infrastructure in an industrial setting. This work summarizes the views of a group of industrial in silico and experimental ADME scientists, participating in the In Silico ADME Working Group, a subgroup of the International Consortium for Innovation through Quality in Pharmaceutical Development (IQ) Drug Metabolism Leadership Group. This overview on the benefits, caveats, and impact of in silico ADME-PK should serve as a resource for medicinal chemists, computational chemists, and DMPK scientists working in drug design to increase their knowledge in the area.

77 Implantable cardioverter-defibrillator in pregnancy- do we know what to do?

IntroductionThe number of women of reproductive age with an implantable cardioverter-defibrillator (ICD) is increasing, many with Adult Congenital Heart Disease or inherited cardiomyopathy. Safe management of these patients during pregnancy,...

Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA)

Article, see p 1481 Myocardial infarction with nonobstructive coronary arteries (MINOCA) is clinically defined by the presence of the universal acute myocardial infarction (AMI) criteria, absence of obstructive coronary artery disease (≥50% stenosis), and no overt cause for the clinical presentation at the time of angiography (eg, classic features for takotsubo cardiomyopathy).1 With the more frequent contemporary use of coronary angiography in AMI, clinicians have been regularly confronted with this puzzling problem and seeking guidance in its management. An article by Lindahl et al2 in this issue of Circulation represents a major step forward in MINOCA and thereby warrants taking stock of the past, present, and future management strategies of this intriguing condition. The pioneering early angiography studies of DeWood et al demonstrated that ST-segment–elevation myocardial infarction was often associated with an occluded epicardial artery, but this occurred less frequently in non–ST-segment–elevation myocardial infarction, although in both conditions obstructive coronary artery disease was evident in >95% of patients.3 These findings underscored the importance of the underlying atherothrombotic process and provided the impetus for major advances in AMI management over the next 35 years. However, when angiography failed to reveal the presence of obstructive atheroma or thrombosis in patients with clinical criteria for ST-segment–elevation myocardial infarction, some clinicians labeled these patients as having a false-positive ST-segment–elevation myocardial infarction diagnosis.4 Such a label implies that an AMI has not occurred (despite the clinical presentation) and therefore no further diagnostic investigation or cardiac therapy is required. To avoid such diagnostic complacency, the diagnosis of MINOCA was coined5 with an emphasis on investigating these patients to identify the underlying cause of their AMI presentation. Providing a label for this clinical syndrome was the first …

Why evidence-based medicine failed in patient care and medicine-based evidence will succeed

Evidence-based medicine (EBM) has succeeded in strengthening the evidence base for population medicine. Where EBM has failed is in answering the practicing doctor's question of what a likely outcome would be when a given treatment is administered to a particular patient with her own distinctive biological and biographical (life experience) profile. We propose Medicine-based evidence (MBE), based on the profiles of individual patients, as the evidence base for individualized or personalized medicine. MBE will build an archive of patient profiles using data from all study types and data sources, and will include both clinical and socio-behavioral information. The clinician seeking guidance for the management of an individual patient will start with the patient's longitudinal profile and find approximate matches in the archive that describes how similar patients responded to a contemplated treatment and alternative treatments.

The Personal Toll Of Practicing Medicine.

A physician and lifelong patient reflects on her truncated career and why the health of experienced doctors needs protection.

THE PHENOMENON LIVED BY WOMEN IN NURSING CONSULTATION IN THE GYNECOLOGICAL BRACHYTHERAPY

ABSTRACT Objective: to understand the phenomenon lived by women in the nursing consultation in gynecological brachytherapy. Method: a qualitative study, with an approach using the Sociological Phenomenology of Alfred Schutz. Thirteen women submitted to brachytherapy treatment participated in two radiotherapy services: one located in Rio de Janeiro and the other in São Paulo, Brazil. The data collection took place between February and November 2012, through a semi-structured interview. Results: two concrete categories emerged: Seeking guidance and Experiencing fear. The experience lived by patients is that people who need guidance, fear the illness and treatment caused by the diagnosis and by the performance of procedures. Conclusion: the nursing consultation for the patient aids the nurse to understand that each patient has a different degree of understanding and that it is effective to personalize this teaching in order to take care of others.

Patient education as a status passage in life – An ethnographic study exploring participation in a Danish group based patient education programme

In this paper, we apply the theory of status passage to the empirical field of group-based patient education. On the basis of ethnographic fieldwork carried out in the context of a local Danish patient education programme aimed at people diagnosed with rheumatoid arthritis, we illustrate how participation in the programme for the recently diagnosed is a regularised status passage symbolising a transition in life from a novice to a more experienced person with chronic illness. We demonstrate how central properties of status passage are at play and how they are shaped by interactions among the different agents: participants, lay experts and health professionals. We highlight how the unique biographical situation of the individual and the individual timing of participation is an important factor affecting whether the patient education programme succeeds in regularising the status passage. We highlight the ambiguity of the role of the health professionals in directing the status passage of the recently diagnosed. On one hand, health professionals empowered the participants by giving them access to professional knowledge and guidance and thereby supporting the status passage. On the other hand, the effort to direct responsibility back to the participants did not consider individual biographical situations, and thereby risked leaving the participants frustrated and unable to pass. Further, we point to the special significance of the socialising process between the participants, with the recently diagnosed being the novices asking questions and seeking guidance and the lay experts and the experienced participants taking the role of coaches, guiding the recently diagnosed managing the status passage into chronic illness.

Guarding Secrets by Patrick Jones, and: Taking Sides by Darby Creek (review)

Reviewed by: Guarding Secrets by Patrick Jones, and: Taking Sides by Darby Creek Elizabeth Bush Jones, Patrick Guarding Secrets. Darby Creek, 2015 89p (Locked Out) Library ed. ISBN 978-1-4677-5801-7 $27.99 Paper ed. ISBN 978-1-4677-6038-6 $9.99 Ad Gr. 6-10 Taking Sides. Darby Creek, 2015 97p (Locked Out) Library ed. ISBN 978-1-4677-5800-0 $27.99 Paper ed. ISBN 978-1-4677-6037-9 $9.99 R Gr. 6-10 Jones’s new urban lit series, Locked Out, focuses on teens whose parents’ crimes and incarceration have sent their children’s lives into a downward spiral. Guarding Secrets, set in Anaheim, California, focuses on high school junior Camila Hernandez, who has spent the past ten years bouncing among relatives and trying to keep her family secret from classmates—her mother, once involved in a Latino gang, is on death row for the fatal shooting of a police officer. Appeals have been abandoned, the execution date is set, and Camila is torn between the fear that she may have inherited her mother’s propensity to crime and the impulse to find her way toward forgiveness before the opportunity is gone forever. The slight page count isn’t robust enough to fully support additional problems and themes, ranging from adoring her model citizen boyfriend, dodging the blackmailing attempts of a gang-banger classmate, shoplifting a new dress for her mother’s funeral, and seeking guidance from a parish priest. Taking Sides is more tightly focused and, consequently, more successful. Narrator Todd and his sister Tina witness their father stab their mother to death, but each attributes culpability to a different parent. Swept into the foster care system and separated from each other in advance of their father’s trial, the pair has a few opportunities for covert communication, and her father pressures his son to convince Tina to change her interpretation of the tragedy in her father’s favor. Both of the titles are quick reads, constructed with plenty of dialogue, controlled vocabulary, and a chronological trajectory that allows less skilled readers to concentrate on content rather than structure. The riveting plots, however, will have appeal well beyond the reluctant reader set. Copyright © 2015 The Board of Trustees of the University of Illinois

A Code of Ethics for Health Care Ethics Consultants: Journey to the Present and Implications for the Field

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here.

Searching for certainty: Religious beliefs and intolerance toward value-violating groups

Religiosity has been consistently linked to prejudice toward a variety of outgroups. This article proposes that this is the case only when religiosity reflects a specific aspect of seeking guidance and security in daily practices and complex sociocultural norms. Outgroups that challenge the epistemic certainty that belief in God provides are rejected in an effort to protect this certainty. The results from two studies found that uncertainty avoidance was related to belief in God and this belief mediated the relationship between uncertainty avoidance and intolerance within the context of general human rights (Study 1), and the derogation of value-violating groups (e.g., homosexuals or followers of other religions) but not of groups that pose no threat to religious values (old or poor people) (Study 2). The interpretative dimension of religiosity (i.e., the way in which people process religious content) is not connected to security seeking, as reflected in the lack of a correlation with uncertainty avoidance and with different prejudice measures. The results are discussed in relation to past research on religiosity and prejudice, and suggest that for people who avoid uncertainty, only those types of religious beliefs that provide a sense of certainty are linked with intolerance toward value-violating groups.

Influence of personal social network and coping skills on risk for suicidal ideation in Chinese university students.

BackgroundPersonal social network and coping skills have important influences on suicidality of young people and such influences must be understood in the context of other factors. This study aims to assess the influences of social contacts and coping skills on risk for suicidal ideation and to disentangle their possible pathways using a large sample of university students from China.Methods5972 students, randomly selected from 6 universities in China, completed the questionnaire survey for the study. Logistic regression was performed to estimate individual effect of social contacts and coping skills on risk for suicidal ideation. A partial least squares path model (PLSPM) was used to probe possible paths of their effects in the context of psychopathology.ResultsOf the 5972 students, 16.39% reported the presence of suicidal ideation. Poor social contacts were significantly associated with an increased risk for suicidal ideation. The influence of coping skills varied by coping styles adapted toward problems. A high score of skills on seeking guidance and support, problem solving as well as seeking alternative rewards was associated with a reduced risk of suicidal ideation; whereas a high score of acceptance or resignation, emotional discharge as well as logical analysis was associated with a significantly increased risk. Modeling the data with PLSPM indicated that the avoidance coping skills conferred the most important dimensional variable in suicidal ideation prediction, followed by the approach coping skills and social network.ConclusionsPoor social contacts and deficient coping skills are strong risk factors for suicidal ideation in young students. Prevention program focusing on these problems may have an enduring effect on reducing suicidal behavior in this population.

General practitioner attitudes and practices in medical fitness to drive in Ireland

BackgroundIn Ireland, assessing medical fitness to drive (MFTD) is performed by general practitioners (GPs) despite not receiving training in traffic medicine. AimTo investigate current attitudes, resources and practices of GPs towards evaluating MFTD prior to the publication of comprehensive national guidelines. Design and settingQualitative study of GPs registered with the Irish College of General Practitioners. MethodWe mailed a questionnaire-survey to GPs (n=1000) in November 2012. ResultsThe response rate was 52%. A majority of GPs were confident (58%) or very confident (11%) in assessing MFTD. However, they were evenly divided as to whether GPs or practitioners specially trained for assessing MFTD should be primarily responsible (48%, 51%, respectively). Many (71%) expressed concern regarding the liability of such assessments. A significant minority reported pressure from patients and/or their families to reconsider decisions on MFTD. When seeking guidance for assessing MFTD, the majority were found to either use existing rudimentary Irish guidelines or refer to a consultant opinion (69%, 66%, respectively). ConclusionAlthough Irish GPs report high levels of confidence in assessing MFTD, as a group they express ambivalence about who should be primarily responsible for such assessments. This would indicate that some would consider deferring to a consultant opinion or at least recognize limitations of their skill set in this area. Further exploration is needed to determine which aspects of MFTD should be included in information and training for GPs, and to help address concerns regarding liability and patient/family communication issues.

Assessment of Premarital Sexual Practices and Determinant Factors Among High School Students in West Shoa Zone, Oromia Regional State, Ethiopia

Background: Adolescents face fears, concerns and lack of understanding about their needs, thus asking for or seeking guidance and service is very difficult. Most of youth lack basic knowledge of reproductive anatomy, physiology, how pregnancy or STI/HIV occurs, how to prevent them or where to obtain information and services. Most adults fear that informing young adolescents about sex and teaching them how to protect them was make them sexually active. Objective: the objective of the study was to assess premarital sexual behavior and determinant factors among high school students in west shoa zone. Methodology: the study was conducted in West Shoa Zone Oromia Regional state by using cross sectional study design with structured self-administered questionnaire which supplemented by 3 focus group discussion. The collected data entered and analyzed by using EPinfo and SPSS software. Result: From a total of 843 students who were selected for the study, 828 were participated. One hundred thirty eight (16.7%) of the respondents were reported chat chewing, 552(66.7%) of the respondents were reported alcohol consumption and 322(38.9%) of the students were attended video. The majority of the respondents, 552 (66.7%) had ever sexual partner. Among those who had sexual partner, 506 of the students had ever sexual practice. Of the respondents who had sexual practice, 186(36.8%), 230(45.4%) of the respondents were less than 15 years and between 15 and 19 years of age at their first sexual exposure respectively. Among the socio-demographic variables, sex of the respondents (female), the respondent’s parent educational status and participants who have no pocket money as well as from the behavioral variables, students who did not talk with parent about sexual issues, students who drinking alcohol, participants who attending video/ movies, students who have no information about sexual issues were significantly associated with pre-marital sexual practice of the students. Conclusion and recommendation-In this study the premarital sexual practice and associated factors were assessed. Based on the finding of both qualitative and quantitative studies premarital and early sexual practice was commonly practiced by most school adolescents. Open discussion about sexual related issues and provide adequate and updated reproductive health related information through school health education, establishing reproductive health club in the school should be promoted.

Classical Rabbinic Literature and the Making of Jewish Ethics

Classical Rabbinic Literature and the Making of Jewish Ethics

Adolescent attachment and substance use: Concurrent and prospective links

In Ireland, assessing medical fitness to drive (MFTD) is performed by general practitioners (GPs) despite not receiving training in traffic medicine.To investigate current attitudes, resources and practices of GPs towards evaluating MFTD prior to the publication of comprehensive national guidelines.Qualitative study of GPs registered with the Irish College of General Practitioners.We mailed a questionnaire-survey to GPs (n=1000) in November 2012.The response rate was 52%. A majority of GPs were confident (58%) or very confident (11%) in assessing MFTD. However, they were evenly divided as to whether GPs or practitioners specially trained for assessing MFTD should be primarily responsible (48%, 51%, respectively). Many (71%) expressed concern regarding the liability of such assessments. A significant minority reported pressure from patients and/or their families to reconsider decisions on MFTD. When seeking guidance for assessing MFTD, the majority were found to either use existing rudimentary Irish guidelines or refer to a consultant opinion (69%, 66%, respectively).Although Irish GPs report high levels of confidence in assessing MFTD, as a group they express ambivalence about who should be primarily responsible for such assessments. This would indicate that some would consider deferring to a consultant opinion or at least recognize limitations of their skill set in this area. Further exploration is needed to determine which aspects of MFTD should be included in information and training for GPs, and to help address concerns regarding liability and patient/family communication issues.