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PubMed1990

Procrastination and cramming: how adept students ace the system.

Clear power differentials between teacher and pupil and the assignment of well-delineated tasks within specified time constraints characterize the academic system. Most university students are supremely adept at working within that structure. Many students who outwardly adapt to the system, however, engage in an intense and private ritual that comprises five aspects: calculated procrastination, preparatory anxiety, climactic cramming, nick-of-time deadline-making, and a secret, if often uncelebrated, victory. These adept students often find it difficult to admit others into their efficient program of academic survival. Although such behaviors are adaptive for school rhythms and expectations, these students may also try to impose them onto personal relationships, including those that are psychotherapeutic. The students' tendency to transfer their longstanding habits of procrastination and cramming to the workplace after graduation is less problematic. The argument is made that school rhythms and expectations shape the workplace, not vice versa. Methods of addressing the troublesome aspects of these work styles are suggested. Rather than attempting to change existing work patterns, the therapist can identify the underlying psychodynamic drama and its attendant manifestations that are becoming problematic.

Humans↗
PubMedDate not supplied

Neural integration at the mesoscopic level: the advent of some ideas in the last half century.

History seen by a professional historian, based only on the documented record, always incomplete and liable to bias, can be unreliable. Modern history seen by a protagonist must surely be among the most unreliable. Yet, I must try, in a limited scope, to show the human drama as well as the flood on which we are floating, unable to dump the baggage of past biases. Our points of view, priorities, and positions on all the controversial issues and even the well established, noncontroversial ones, are not as rational as we would like to think but are strongly conditioned by where we came from. I wil depend on selected vignettes of the way things looked when I was a student, a young postdoctoral fellow and an Assistant Professor, to compare with the way they look now, in each of half a dozen mesoscopic domains--those in between the most basic subcellular or molecular and the higher levels of learning and cognition. The half dozen constitute, of course, anything but a representative fraction of neuroscience. But they add up to a nontrivial segment of the big picture with respect to the integrative aspects of our science. Most of the fronts that grew into today's popular branches are not represented, but a small set of particular interest and probability of further surprises.

History, 20th Century↗
PubMed1998

Cholesterol ester transfer protein: a molecule with three faces?

The pathogenesis of atherosclerosis continues to be a focus of intensive study. One of the more recent players in the atherosclerosis drama is cholesterol ester transfer protein (CETP). CETP is primarily involved in lipid transfer between lipoproteins, for example, from high-density lipoproteins (HDL) to apo B-containing lipoproteins, but CETP has also been found to take up cholesterol directly from cells without the co-participation of lipoproteins, and it is still not clear whether CETP should be classified as a beneficial or as a harmful protein. Some of the important evidence for these conflicting theories is examined here, with special reference to situations where CETP appears to be proatherogenic, instances where CETP seems to assume an antiatherogenic role, and situations where CETP seems to be both proatherogenic and antiatherogenic. In addition, the metabolic context of CETP and the modification of CETP substrates play crucial roles that are not always recognized when judgements about the role of CETP in atherosclerosis are recorded.

Animals↗
PubMedDate not supplied

Communicating HIV and AIDS, what works? A report on the impact evaluation of Soul City's fourth series.

This article describes the evaluation of the HIV/AIDS communication aspect of the multi media Soul City health promotion intervention in South Africa. The intervention consists of a television and radio drama and print material. The evaluation was multifaceted with a before and after national survey and a national qualitative study. In the before and after survey change was measured and then multiple regression analysis was performed to assess the variables associated with the change. The qualitative study consisted of focus group discussions, which were analysed thematically. The studies show that there are numerous instances of community change and how the change is mediated at the community level. The studies also describe the change at a number of levels of the described behaviour change model for individuals.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Measuring the cost-effectiveness of a national health communication program in rural Bangladesh.

In this article we examine the cost-effectiveness of the Smiling Sun multichannel media campaign, which was undertaken in Bangladesh from 2001 to 2003 and involved a nationally broadcast television serial drama supported by radio, television, newspaper, and billboard advertisements and local promotion activities. The goal was to encourage the use of a package of family health services at NGO (nongovernmental organization) Service Delivery Program (NSDP) providers. This analysis relates the costs of the Smiling Sun campaign at the national and local level to measures of change in the use of health services, namely, antenatal care and childhood immunizations. Effectiveness is measured using data from cross-sectional surveys conducted in 2001 and 2003 in NSDP catchment areas in rural Bangladesh. The statistical approach, bivariate probit estimation, controls for nonrandom exposure to the program's media messages, advertisements, and signs. Using national-level data, we find that the Smiling Sun campaign was both effective and cost-effective, inducing higher levels of service utilization for only $0.05 per additional antenatal care (ANC) user and only $0.30 and $0.36 for each additional child vaccinated for measles and DPT3, respectively. With respect to local promotion activities, the cost per attributable behavior change was considerably higher--nearly $8 per new ANC user, $37 per new DPT3 vaccination, and $32 per new measles vaccination.

Adolescent↗
PubMedDate not supplied

Saint or sinner? Teacher perceptions of a child with traumatic brain injury.

PURPOSE: To examine influences on classroom performance and behaviour following traumatic brain injury (TBI). METHODS: A case-study of one child who suffered a moderate TBI, with frontal brain damage, aged 8, followed up at ages 12 and 13 years. Parents and child were interviewed to establish pre- and post-injury behaviour and functioning. All 19 teachers who taught the child reported on classroom performance, behaviour and educational achievement in each of their subjects. The child completed a comprehensive neuropsychological assessment battery including the Weschler Intelligence Scale for Children (WISC-III(UK)), Children's Memory Scale (CMS) and Vineland Adaptive Behaviour Scales (VABS). RESULTS: This child demonstrated above-average intelligence and good attention/concentration on the CMS. However, he was unable to focus or maintain attention in most classroom situations. His behaviour was erratic and disruptive in class and at home. At 5-year follow-up, his behaviour had deteriorated in both home and school situations, particularly in less structured environments. CONCLUSIONS: Teachers of more structured subjects (maths and science) perceived the child as excitable but performing at average or above-average levels, whereas teachers of less structured subjects (art, drama, music) perceived him to be 'attention-seeking' and very disruptive in class. The influences of environmental factors are discussed.

Accidental Falls↗
PubMedDate not supplied

Barriers to and facilitators for female participation in an HIV prevention project in rural Ethiopia: findings from a qualitative evaluation.

Ethiopian women face complex social and cultural factors that influence their probability of HIV infection. HIV prevention efforts among this population are particularly important; however, female participation in a rural, HIV prevention project has been minimal. This programme evaluation investigated barriers and facilitators influencing women's ability to participate in project activities. Evaluation data were collected through nine focus groups and 20 semi-structured interviews, which were conducted between October and November 2003. The main themes found to negatively influence women's decisions to participate in this HIV prevention activity included: domestic workloads, lack of education and awareness, and cultural norms that have discouraged discussions about HIV and sexuality. Domestic chores, which are labour intensive and limit time and energy, were found to be the primary barrier to participation among women. Respondents also indicated that female illiteracy and limited educational attainment occur within a social context that traditionally supports education for men but discourages formal knowledge among women, including HIV prevention. Lack of education and inability to freely discuss sexuality denies women access to health information, potentially exposing women to adverse consequences such as HIV infection. Identified facilitators of participation included a radio serial drama and the one female peer educator associated with the project.

Adolescent↗
PubMed2002

Persistent dysphonia in two performers affecting the singing and projected speaking voice: a report on a collaborative approach to management.

The projected speaking voice and the singing voice are highly sensitive to external and internal influences, and teachers of spoken voice and singing are in a unique position to identify subtle and more serious vocal difficulties in their students. Persistent anomalies may herald early onset of changes in vocal fold structure, neurophysiological control, or emotional stability. Two cases are presented to illustrate the benefits of a collaborative approach to diagnosis and management. The first, a 21-year-old male drama and singing student with an abnormally high speaking voice and falsetto singing voice was found to have a psychogenic dysphonia referred to as "puberphonia" or "mutational falsetto". The second, a 34-year-old female alto with strained phonation and perceived stutter of the vocal folds was diagnosed with "adductor spasmodic dysphonia" or "focal laryngeal dystonia" of neurological origin.

Adult↗
PubMed2004

Philosophical oncology: on being needed--thoughts of a deathwatcher.

The ultimate bond that connects the patient and the physician requires an understanding of the human drama we call illness. Medical oncology is a specialty filled with the uncomfortable experiences of people facing fear, anxiety, and loss. The caregiver must share in the distress, be troubled by the patient's troubles, but keep a safe distance, so as not to be wounded as well. The physician is not only a deathwatcher for the sickest of patients, but, by necessity, must be self-reflective--a doctorwatcher.

Attitude to Death↗
PubMed2001

Knowledge held in common. Tales of Luther Burbank and science in the American vernacular.

During the first half of the twentieth century, the horticulturist Luther Burbank was largely considered an irrelevant figure by the scientific community, despite winning acclaim from the public as an eminent scientist. In examining the intellectual, social, and political claims embedded in texts by and about Burbank, this essay argues that consideration of the Burbank stories as they circulated in the vernacular realm can aid historians in understanding the dynamics of science in American life. Among the themes it addresses are how the Burbank stories directly engaged the question of who should legitimately count as a student of nature; the varied philosophical perspectives that derived from siting science within the deomestic sphere; and how these stories played with the possibility of a philosophy of nature based on the concept of "living matter," as opposed to one grounded on mechanistic principles. The essay also discusses how Burbank's views on evolution were mediated by the image of the child and the way in which his convictions regarding the power of the environment to release latent characteristics in physiological material presented a view of the future of the American "race" that was at odds with conventional eugenic thinking and assigned a central role to women in the drama of American evolution.

Biological Evolution↗
PubMed1997

Preferences for different life-sustaining treatments among elderly persons in Israel.

The purpose of this study was to assess elderly persons' wishes regarding the use and choice of different life-sustaining treatments (LST). Data were collected from a random sample of 987 Israeli elderly persons, aged 70+. Interviewees were questioned about their wishes for artificial feeding, mechanical ventilation, and cardiopulmonary resuscitation in five different illness conditions. Results indicate that significantly more of the respondents would want to prolong their life in mild rather than in severe illness conditions. Significant differences are found, however, among subgroups who differ on religiosity, gender, education, and health status. The findings also indicate that in all five illness conditions, elderly persons are more likely to want cardiopulmonary resuscitation than artificial feeding. This is explained by the fact that the public's main source of information is television dramas, and that there is a lack of communication about the use of LST among physicians and patients and their families.

Aged↗
PubMed2002

Quantitative process evaluation of a community-based HIV/AIDS behavioural intervention in rural Uganda.

This paper describes the implementation of a large community-based HIV/AIDS behavioural intervention in rural Uganda and presents 4 years' worth of quantitative process data. The intervention involved 560 field-based workers (57% male, 76% subsistence farmers, mean age 35 years), supervised by six central staff. Intervention channels included drama and video shows, Community Educators (CEs), as well as leaflet and condom distribution. Activities focused on one or more of 16 key topics. In total, 392 000 attendances (51% female) were recorded--a mean of over 6 for each of the 64 000 target adults--at 81 000 activities, with CEs attracting 71% of the total attendance; 164 000 leaflets and 242 000 condoms were also distributed. The annual cost of the intervention per target individual was approximately US$1.76. Our voluntary workforce experienced an annual attrition rate of 11%, with 'stable' workers more likely to be older, married or opinion leaders in their community than those who dropped out. We calculate that even a significant increase in the proportion of female field workers would have made little difference either to the sex ratio of attendees or to overall attendance. In spite of some initial resistance to the intervention, particularly in relation to condoms, we have demonstrated that people in rural Africa can accept and actively participate in the dissemination of HIV/AIDS prevention messages throughout their own communities.

Adolescent↗
PubMed2004

Representing young people's sexuality in the 'youth' media.

This paper reports findings from a content analysis of the main messages about sexuality in media outlets consumed by young people. It examines how sexuality is represented and the level of sexual health information provided in some UK magazines and TV programmes targeted at young people. Our findings show that such outlets included a vast range of useful discussion including information about health concerns and in-depth exploration of issues such as consent and examples of couples exploring whether or not they were 'ready' for sex. In particular, the right of girls to 'say no' was vividly fore-grounded in several teen dramas and magazines. However, coverage was also characterized by certain limitations. A clear pattern was evident whereby contraception and managing 'how far to go' were depicted as women's responsibility. There was a limited range of representations for young men, a lack of positive images of lesbian and gay teenagers, and a failure to represent diversity. There were also no examples of how people might raise concerns such as safer sex. In this context, health educators need to be aware of both the richness and the limitations of current mainstream representations in order to work with and through the media to improve the quality and range of material for young people.

Adolescent↗
PubMed2006

A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme.

This study is a process evaluation of the school component of the adolescent sexual health programme MEMA kwa Vijana (MkV), which was implemented in 62 primary schools in rural Mwanza, Tanzania from 1999 to 2001. The MkV curriculum was a teacher-led and peer-assisted programme based on the Social Learning Theory. Process evaluation included observation of training sessions, monitoring and supervision, annual surveys of implementers, group discussions and 158 person-weeks of participant observation. Most teachers taught curriculum content well, but sometimes had difficulty adopting new teaching styles. Peer educators performed scripted dramas well, but were limited as informal educators and behavioural models. The intervention appeared successful in addressing some cognitions, e.g. knowledge of risks and benefits of behaviours, but not others, e.g. perceived susceptibility to risk. MkV shared the characteristics of other African school-based programmes found to be successful, and similarly found significant improvements in self-reported behaviour in surveys. However, a substantial proportion of MkV survey self-reports were inconsistent, there was no consistent impact on biological markers and extensive process evaluation found little impact on several key theoretical determinants of behaviour. Improvements in self-reported survey data alone may provide only a very limited-and perhaps invalid-indication of adolescent sexual health programme success.

Adolescent↗
PubMed1996

Case manager-physician collaboration: implications for professional identity, roles, and relationships.

The backdrop for this article is the continuing drama of changing roles and relationships among health care professionals. This article reports the results of a study of the professional identities, roles, and relationships of case managers in nine demonstration sites around the United States. Funded by the John A. Hartford Foundation, the demonstration projects use diverse personnel to enhance the role of primary care physicians in practice with elderly people. Implications for health care social workers, educators, and community-based providers are presented.

Aged↗
PubMed1992

Intention-to-treat analysis: implications for quantitative and qualitative research.

Intention-to-treat analysis is an important aspect of randomized controlled trials of health care interventions. The concept is now widely accepted in theory, but not always implemented in practice. Failure to analyse by intention-to-treat can give misleading and indeed life-threatening interpretations. In some studies, a case is put for estimating the effect that would have been observed if all patients had received the allocated treatment. Situations where this is valid are rare, but an example is given of such an exceptional study. The relevance of the intention-to-treat concept is not always taken into account in qualitative research. Interviews with new mothers who delivered their babies at home in a hypothetical controlled trial of home versus hospital confinement would provide fascinating accounts of the pleasure of successful delivery at home. But by definition the interviews would exclude the hazard and drama of necessary transfers to hospital due to complications in late pregnancy and early labour. The intention-to-treat approach would avoid this bias.

Cohort Studies↗
PubMed2002

A tale of two experts: thalidomide and political engagement in the United States and West Germany.

The physicians, Widukind Lenz and Frances Kelsey, played crucial roles in the thalidomide drama of the early 1960s. Widespread use of the drug in West Germany was only halted when the paediatrician, Lenz, publicized its association with the birth of nearly 4,000 children exhibiting abnormal limb growth. Few cases were reported in the United States because Kelsey, a medical officer at the US Food and Drug Administration, repeatedly delayed thalidomide's marketing approval. Experts in both countries were expected to demonstrate publicly the professional 'objectivity' of medicine and the institutional 'disinterestedness' of regulatory bodies. These norms were invoked both by industry representatives seeking to undermine the two experts and by critics desiring stronger regulatory controls. Comparing Lenz and Kelsey demonstrates how institutional structures shape an expert's social and scientific roles. While the United States provided important protection from external pressure for Kelsey through her regulatory position at the FDA, Lenz was open to sharp criticism, especially when giving expert testimony during a lengthy court trial. The degree of exposure to politically motivated attacks differed for these two experts; they nevertheless faced similar threats to their professional credibility and personal integrity when they publicized links between thalidomide and birth defects.

Abnormalities, Drug-Induced↗
PubMed2005

The English patient in post-colonial perspective, or practising surgery on the poms.

Drawing on interviews with Australasian surgeons who trained in the 1950s and 1960s, this article discusses where, and on whom, they practised the manual skills involved in surgery, In the twentieth century, elite Australasian surgeons emphasized the importance of the science of surgery and the lengthy experience needed to acquire surgical judgement, and these concerns are reflected in the accreditation procedures adopted by the Royal Australasian College of Surgeons. However, trainee surgeons also ha to acquire th manual skills that they needed in the operating theatre. The rhetoric of training emphasized the intellectual skills needed in surgery, but in reality the manual skills remained important, and there was also a fascination with the drama and stress involved in operating. In this era, British and Australasian surgical training were closely linked and many Australasian surgeons gained significant cutting experience in Britain.

Australasia↗