bluuebunny/crossref_metadata_2025 huggingface dataset:
Reflections on life and death
Authors: KELLERMAN W.J. PATRICK
Published: April 2008

Patrick began writing a journal in 1998 just before he retired
from paid work as a result of effects of Multiple Sclerosis. He
continued to write irregularly over the subsequent 5 years until he
moved into a long-term care facility. He used the journal as a writing
exercise, but lived with the frustrations of having to rely upon the
computer first to translate his spoken words into written text and then
to speak those words back to him. Although Patrick was legally blind, a
wheelchair user, and lived with debilitating fatigue, he never let
himself be defined by those features. Rather it was his imagination,
humor, and quality of thought that captured those around him. These
journal excerpts document his reflections on “life, the universe,
and everything” in the words of Douglas Adams, a favorite author.
The poems were written with the assistance of scribes while Patrick
lived in a care facility. Patrick died on January 11, 2004 of
pneumonia, having embraced the process of dying as he had his living
over the previous 45 years. His family, including his research and life
partner, Deborah Stienstra, and their children Rebecca and Cailum,
celebrate his life and contributions.
Assessing symptoms of terminally-ill patients by different raters: A prospective study
Authors: ZLOKLIKOVITS SILKE , ANDRITSCH ELISABETH , FRÖHLICH BRIGITTE , VEREBES JULIJANE , DIETMAIER GABRIELE , SAMONIGG HELLMUT
Published: April 2008

Objective: For patients who are terminally ill, the efficiency of symptom management is dependent, among other factors, on an accurate assessment by proxy raters. The aim of this prospective study is to describe differences in symptom severity ratings between patients and their nurses, physicians, and family members during their stay in different departments with acute care, and to identify variables associated with the accuracy of the ratings by others.

Methods: Physical, psychological, social, and functional disorders were assessed for 41 in-patients with a standardized 13-item Symptom List for Quality Assurance in Palliative Care drafted by the Working Group on the Core Documentation for Palliative Care Units in Germany. Symptom assessment was completed by different raters (patient, nurse, physician, family member) within the first four days after admission. Socio-demographic, disease-related, and hospitalization data were taken from patient charts.

Results: Reliability of the symptom list was computed with Cronbach's alpha measures for the present sample. Between-group-comparisons on the individual items and on the sum-score level were analyzed separately for the different rater-pairs: patients-nurses (n= 41), patients-physicians (n= 39), patients-family members (n= 12). Multiple regression analyses calculated predictive variables of the staff's deviation scores.

Significance of results: Significant differences for nurses and physicians were found on the sum-score level for psychological and social symptoms, but not for physical and functional symptoms. Family members rated the intensities of the symptoms generally higher than the patients. Suggestions for further analyses are presented and discussed.
Depression in patients with advanced illness: An examination of Ontario complex continuing care using the Minimum Data Set 2.0
Authors: GRUNEIR ANDREA , SMITH TREVOR FRISE , HIRDES JOHN , CAMERON ROY
Published: April 2008

Objective: In this study, we examined the prevalence of depression, its recognition, and its treatment in continuing care patients with advanced illness (AI).

Methods: All data were obtained from the Ontario (Canada) provincially-mandated MDS 2.0 form for chronic care. Of 3,801 patients, 524 met our empiric definition of AI, which was predicated on a previously validated algorithm. The MDS-embedded Depression Rating Scale (DRS) was used to measure psychological well-being and a score of 3 or greater indicated potential depression.

Results: Twenty-nine percent of patients with AI scored greater than 3, making them nearly twice as likely to be potentially depressed as other patients (OR 1.8, 95% CI 1.5–2.2). Despite this patients with AI were less likely to have received antidepressants (28.9% vs. 38.2%), even among those with a diagnosis (45.3% vs. 58.4%). Using logistic regression, correlates of potential depression were identified and surprisingly patients with cancer were substantially less likely to be depressed (AOR 0.37, 95% CI 0.2–0.6). Further investigation revealed that cancer patients were more likely to be treated for depression and to be recognized as being within the terminal phase of illness.

Significance of results: These findings suggest that a high proportion of terminally ill patients had unmet needs for psychological support. As well, they suggest that cancer patients received better targeted end-of-life care, which resulted in an overall decrease in psychological distress when compared to other patients with similarly advanced illness.
Factors associated with location of death of children with cancer in palliative care
Authors: KURASHIMA ANDRÉA YAMAGUCHI , LATORRE MARIA DO ROSÁRIO DIAS , TEIXEIRA SILVIA APARECIDA DE PAIVA , DE CAMARGO BEATRIZ
Published: April 2008

Objective:The aim of this study was to identify factors associated with location of death of patients receiving palliative care in a pediatric oncology unit.

Methods:A palliative care program was developed in the pediatric department in order to provide specialized attention to the patient and family in end-of-life. The program is coordinated by a nurse, delivering a simultaneous interdisciplinary team approach with focus on identification and training of a family care provider as well as local resources supplemented by support of a social worker and the community. All 87 patients in palliative care were followed by the team. The factors associated with the location of death (home or hospital) were evaluated for the 71 patients who died prior to analysis.

Results: Forty-two (59%) patients died at home. Factors significantly associated with dying at home were: male with an Odds Ratio (OR) = 3.80, 95% Confidence Interval (CI) = 1.26–11.76; public health insurance (OR) = 4.95, 95%[CI] = 1.03–26.75, low educational level of the caregiver (OR) = 11.11 95%[CI] = 1.65–94.66 and low educational level of the mother (OR) = 7.07 95%[CI] = 1.37–40.14. Gender was the only independent factor associated with location of death: a boy had a higher risk of dying at home, (OR) = 4.25, 95%[CI] = 1.37–13.21 when compared to a girl.

Significance of results:In our society we are still not able to provide hospice care or home care for all children, although increasing emphasis has been placed on utilizing local resources. Even though we had increased the number of desired home deaths, it is still a challenge to meet patients and families' requests. A team approach, the recognition of the factors involved, and adequate health and community support have helped us to meet the child and family's needs.
Family decision making at end of life
Authors: MEEKER MARY ANN , JEZEWSKI MARY ANN
Published: April 2008

Objective: To enhance understanding of the phenomenon of family surrogate decision-making at the end of life (EOL) by means of a systematic review and synthesis of published research reports that address this phenomenon.

Methods: Garrard's (1999) methods for conducting a systematic review of the literature were followed. Fifty-one studies focusing on family decision-making experiences, needs, and processes when assisting a dying family member were selected following electronic database searches and ancestry searches.

Results: In studies using hypothetical scenarios to compare patients' choices and surrogates' predictions of those choices, surrogates demonstrated low to moderate predictive accuracy. Increased accuracy occurred in more extreme scenarios, under conditions of forced choice, and when the surrogate was specifically directed to use substituted judgment. In qualitative explorations of their perspectives, family members voiced their desire to be involved and to accept the moral responsibility attendant to being a surrogate. Quality of communication available with providers significantly influenced family satisfaction with decision-making and EOL care. Group or consensual decision-making involving multiple family members was preferred over individual surrogate decision-making. Surrogates experienced long-term physical and psychological outcomes from being decision-makers.

Significance of results: Functioning as a surrogate decision-maker typically places great moral, emotional, and cognitive demands on the family surrogate. Clinicians can provide improved care to both patients and families with better understanding of surrogates' needs and experiences.
The Lease
Authors: Granet Roger B.
Published: April 2008

The Lease.
Does ethnicity matter? Bereavement outcomes in two ethnic groups living in the United Kingdom
Authors: KOFFMAN JONATHAN , DONALDSON NORA , HOTOPF MATTHEW , HIGGINSON IRENE J.
Published: April 2008

Background: Sociologists, anthropologists, and psychologists agree that grief is a universal phenomenon. Reactions to it are, however, socially constructed and patterned.

Objective: To compare the outcomes of bereavement among family or close friends of deceased first-generation black Caribbean and white native-born patients living in the United Kingdom.

Design: Comparative cross-sectional questionnaire survey in three inner London health authorities administered 10 months after the patient's death.

Participants: Family and close friends of 50 deceased first-generation black Caribbean and 50 native-born white patients with advanced disease.

Main outcome measures: 28-item General Health Questionnaire (GHQ-28), Core Bereavement Items scale, a 17-item measure of grief.

Results: The intensity of grief, measured using the Core Bereavement Items was similar between the two groups. Seventy-two respondents had visited their family doctor subsequent to bereavement, and of these, black Caribbean respondents reported more psychological problems. Depression and anxiety measured by the GHQ-28 were significantly higher among black Caribbean respondents (28.00 vs. 21.2) (t-test = −2.28,p= 0.025). Multiple regression analysis revealed this difference was best accounted for by bereavement concerns such as legal and housing problems.

Conclusions: This study has observed higher psychological morbidity among the bereaved Caribbean individuals. Family doctors are a source of support for three-quarters of respondents, and they may need to focus on the needs of black and minority ethnic minorities.
Outcome expectations and self-regulation in cancer patients: Reliability, initial factor structure, and relationships with benefit finding
Authors: GRAVES KRISTI D. , CARTER CINDY L.
Published: April 2008

Objective:The purpose of this research was to investigate outcome expectation and self-regulation measures within a sample of cancer patients and to explore relationships of these variables with benefit finding. The outcome expectation and self-regulation measures were evaluated for reliability and initial factor structure.

Method:A convenience sample of 141 cancer patients completed study measures while waiting for appointments at a cancer center.

Results:The measures demonstrated good reliability (alphas = .88 and .92, for outcome expectation and self-regulation respectively). Initial factor structure suggested six outcome expectation factors (managing symptoms, expressing emotions, talking about cancer, learning about cancer, managing self-image, and managing needs) and one self-regulation factor. Gender and treatment status were related to outcome expectations but not self-regulation. Outcome expectations and self-regulation were significant predictors of benefit-finding,F(8, 80) = 3.1,p= .005.

Significance of the research:Measures of outcome expectations and self-regulation are reliable, are related to gender and clinical variables, and may be useful as predictors of cancer patients' ability to find benefits in their cancer experience.
Atypical antipsychotics in the management of delirium: A review of the empirical literature
Authors: BOETTGER SOENKE , BREITBART WILLIAM
Published: April 2008

Objectives: To review the existing literature of atypical antipsychotics in the treatment of delirium and make recommendations regarding their use in the treatment of delirium.

Methods: I conducted a literature search in Pubmed, Psychlit, and Embase for studies using atypical antipsychotics in the treatment of delirium. In the absence of studies, case reports were used.

Results: Overall 13 studies examined the use of risperidone, olanzapine, and quetiapine, two cases were reported about ziprasidone, and no publication was found using aripiprazole in the treatment of delirium. Among the existing studies were retrospective and prospective, open label studies in addition to one with a double blind design using risperidone. Risperidone, olanzapine, and quetiapine may be all similarly effective in the treatment of delirium, whereas there may be limited efficacy in the use of olanzapine in the hypoactive subtype of delirium in elderly populations, which may generalize to the other atypical antipsychotics. The use of atypical antipsychotics in the treatment of delirium is safe and carries a low burden of side effects.

Significance of results: Although atypical antipsychotics are widely used in the treatment of delirium, well-designed studies do not exist. Among the existing studies, stronger data supports the use of risperidone and olanzapine, and also quetiapine may be considered in the treatment of delirium. Recommendations are made based on the existing data and literature. The need for well-designed studies to validate the use of atypical antipsychotics in the treatment of delirium continues.
Prayer
Authors: NIEMEYER ROBERT A.
Published: April 2008

Prayer for Cicely.
Milestones for Palliative & Supportive Care
Authors: BREITBART WILLIAM
Published: April 2008

With the publication of Volume 3, Number 4 of our journal,
Palliative & Supportive Care, we have reached several
important milestones that are noteworthy. I am pleased to say that with
this issue, we successfully conclude the third year of publication of our
new journal, whose acceptance in the scientific and academic community was
not a matter of certitude. We had the idealistic mission of providing an
intellectual and journalistic home for that small (but growing) band of
academicians around the world who were focusing their work in palliative
care, with particular emphasis on the psychiatric, existential, and
spiritual aspects of care. We have survived! Our survival is due, in no
small part, to the contributions of researchers all around the world who
have so graciously and generously submitted their work to us for
publication. Palliative & Supportive Care is truly an
international journal, with authors from more than 15 countries
contributing to the journal these past three years. Our thanks also to our
wonderful Editorial Board and dedicated reviewers. I know that I speak on
behalf of my coeditors, Drs. Chochinov and Wein, when I say that these
three years have been extraordinarily challenging, exciting, and extremely
rewarding. However, none of it would be possible without the dedication of
our Managing Editor, Donna Cassetta, and the wonderful support of the
staff at Cambridge University Press, which publishes our journal.
Predictors of death within six months in patients with advanced
AIDS
Authors: BRECHTL JOHN R. , PATRICK PATRICIA A. , VISINTAINER PAUL , BRAND DONALD A.
Published: April 2008

Objectives: This study sought to identify potential
predictive variables of death within 6 months in patients with advanced
AIDS.

Methods: Investigators enrolled a consecutive series of
patients with advanced AIDS admitted to a skilled nursing facility in New
York City over a 1-year period. Demographic, clinical, laboratory, and
outcome data were abstracted from medical records using a standardized
data collection instrument.

Results: Of the 152 patients enrolled during the study
period, 61 patients (40%) died within 6 months from date of admission.
Serum albumin, percent deviation from ideal body weight, and number of
comorbidities at the time of admission proved to be the best combination
of predictors of death within 6 months.

Significance of results: The decrease in AIDS mortality over
the past decade, along with an increase in prevalence due to longer
survival, has been attributed primarily to the successful use of highly
active antiretroviral therapy (HAART). HAART regimens, however, can also
produce both short-term adverse effects and long-term complications. The
prognostic model developed by this study may be useful in guiding
treatment decisions in patients with advanced AIDS for whom a more
palliative care plan may be sought.
A pilot examination of the impact of cancer patients' fatigue on their spousal caregivers
Authors: PASSIK STEVEN D. , KIRSH KENNETH L.
Published: April 2008

Objective:In this pilot project we examined the quality of life of spouses of cancer patients who had significant fatigue.

Methods:We assessed both the spouses of cancer patients and the patients who presented with chemotherapy-induced fatigue and anemia. Study endpoints included the impact that cancer patients' fatigue had on their spouses' quality of life, including their own levels of fatigue, depressive symptoms, activity levels, work absenteeism, and marital adjustment. We examined the extent to which changes in patients' fatigue from baseline to one month follow-up were associated with changes in spouses' quality of life indices.

Results:25 couples completed the study. Seven (28%) spousal caregivers reported handling fewer responsibilities at work, 8 (32%) had reduced their work hours, and 8 (32%) felt that they were less effective overall at work. Spousal caregivers also missed a significant amount of time at work during the month long study, missing an average of 2.7 (SD= 2.95) days, with an additional 1.29 (SD= 2.97) sick days and 1.76 (SD= 2.63) vacation days during that time. Spouses reporting greater levels of caregiver strain were more likely to have increased fatigue at baseline (F1,23= 8.11,p< .01), and worse dyadic adjustment at both time points (baseline:F1,23= 7.80,p< .01; follow-up:F1,21= 9.24,p< .01). Also, those with more caregiver strain were less likely to engage in social activity at baseline (F1,23= 6.11,p< .05) and more likely to engage in less work by the one month follow-up (F1,20= 8.36,p< .01).

Significance of results:Spouses who were identified as having elevated burden experienced more personal fatigue, had worse dyadic adjustment, reported poor energy levels, and tended to engage in fewer work and social activities; the impact of patient's fatigue level on these parameters was highly variable in this small pilot study.
Patient desires: A model for assessment of patient preferences for care of severe or terminal illness
Authors: KNOPS KAREN M. , SRINIVASAN MALATHI , MEYERS FREDRICK J.
Published: April 2008

Objective:Patient-centered care is better achieved through a comprehensive understanding of patients' preferences for how they want to live their life and how they want to influence their own death. Though much has been written on identifying goals of care, it is often difficult for clinicians to articulate patient goals to guide care planning. We explored the literature on patient's preferences for their care in chronic or life-limiting illness to develop a model for assessment of patient perspectives. We then illustrated our model with composite patients from our clinics and we provide questions to guide patient discussion.

Methods:We searched MEDLINE from 1986 to 2004 for primary research articles that relate primarily to a patient's preferences for his or her care. We reviewed over 3500 titles, abstracts, and research papers. Hundreds of articles described patients' quality of life, health status, or satisfaction. We excluded consensus guidelines, non-English papers, reviews, and articles focused on medical professional perspectives. Forty-eight studies focused primarily on patient preferences. Using an iterative process, we identified unique issues and broader themes in patients' desires for their care.

Results:Studies focused on patients with cancer, those in hospice or those with terminal disease. Three domains emerged: patient feelings about disease, feelings about suffering, and feelings about the circumstances of death. Attention was given to the differences between patients in terms of the strength and persistence of feelings in each domain.

Significance of results:Based on existing data, there are three fundamental domains of patient perspective that influence preferences for care. These domains can be assessed by the care team to guide the development of a plan of care and to identify areas of conflict. Our review identifies gaps in the end-of-life literature and areas for future work in patient preferences.
Methadone in the treatment of pain and terminal delirum in advanced
cancer patients
Authors: MORYL NATALIE , KOGAN MARIA , COMFORT CHRISTOPHER , OBBENS EUGENIE
Published: April 2008

Objective: This prospective study documents the use of
methadone as part of an opioid rotation strategy in patients with
uncontrolled pain and severe delirium admitted for terminal care to a
tertiary cancer palliative care hospital.

Methods: We reviewed the treatment of 20 patients with severe
pain and delirium at the end of life who's delirium did not improve
24 h or longer after starting a neuroleptic medication.

Results: Ten male and 10 female patients, 47 to 77 years old,
were rotated or “switched” to methadone due to uncontrolled
pain in the setting of delirium, limiting further opioid dose escalation.
At 2 weeks, a total of 10 patients had expired. Of the 10 patients who
were alive 2 weeks after starting methadone, 7 patients were stable on an
average of 1.1 mg/h methadone, 2 patients were restarted on morphine
IV and one on Percocet. The calculated average equianalgesic dose of
methadone was 9% (2%–17%) of the previous morphine-equivalent dose.
Of the 20 patients who were switched to methadone for what appeared to be
terminal delirium, the pain control was significant in 15, moderate in 3,
and unchanged in 2 patients. Average analgesia was good to excellent
(average Numeric Analog Scale rating [NAS] decreased from 8.2 to
2.5). Sedation had decreased from 1.65 to 0.55 on a scale of 0 to 3. Of
the 20 patients, improvement of cognitive status was significant in 9,
moderate in 6, partial in 2, and none in 3 patients. The Memorial Delirium
Assessment Scale (MDAS) showed improvement from an average of 23.6 prior
to the switch to 10.6 3 days after. Decreased alertness on methadone was
devoid of agitated features.

Significance of results: Our study suggests that methadone
can be effective in the treatment of both refractory pain and what appears
to be terminal delirium. Most patients in our group had at least a
short-term improvement in mental status as well as significant and lasting
improvement in analgesia.
Clinical assessment of depression in terminally ill cancer patients:
A practical guide
Authors: PESSIN HAYLEY , OLDEN MEGAN , JACOBSON COLLEEN , KOSINSKI ANNE
Published: April 2008

Depression is commonly experienced by cancer patients at the end of
life. The identification of patients suffering from depression is
essential to provide clinicians with an opportunity to relieve
considerable suffering. However, the assessment of depressive symptoms is
complex and often challenging in a terminally ill cancer population. This
article offers practical guidelines to assist clinicians with the
diagnosis of depression, reviews the defining symptoms of depression and
their unique presentation in patients at the end of life, suggests
modifications of the standard diagnostic interview, and provides examples
of specific assessment questions to target depressive symptoms at the end
of life.
Caring for those who care for the dying: Coping with the demands on palliative care workers
Authors: ROKACH AMI
Published: April 2008

The article reviews the complex and demanding field of palliative care, noting the sources of the stresses and strains that the health care workers often encounter. It illustrates the multidimensional needs of patients, the reasons why they and/or their families may hamper palliative care, and, mostly, what can be done to deal with and—better yet—prevent palliative workers' burnout.
The Goals of Palliative Care: Beyond Symptom Control
Authors: BREITBART WILLIAM
Published: April 2008

My father died a basically “good death.” He died,
comfortably, at home, in his own bed, clean shaven, surrounded and
embraced by his family. My father lived with widely metastatic prostate
cancer for 5 years. In those 5 years, he had minimal pain and no episodes
of infection or hospitalizations. He did extremely well for 4 years and 6
months, even working. The last 6 months were marked by progressive weight
loss and weakness, requiring him to slow down. But up until the day before
he died, he was ambulatory, showered and dressed himself, argued with my
mother, and was pain free. On a Tuesday morning, for the first time in his
long illness, he did not get out of bed. He was drowsy and not completely
responsive. My mother called to tell me of the change. I left morning
rounds at the hospital, collected a few essential medications, and went
straight to their home (the home I grew up in). I spent the next and last
24 hours of his life sitting in a chair at the side of his bed, feeding
him drops of liquid morphine and haloperidol to keep him comfortable, free
of pain, free of confusion and agitation. My mother slept beside him that
entire night. When the hospice nursing aide arrived on Wednesday morning
it was clear that my father was very near death. We both bathed my father,
and I insisted on shaving him. He had about 4 days worth of beard growth,
and I knew he would want to die clean shaven. After shaving the left side
of his face, he stopped breathing. I kissed him, thanked him for giving me
life, and then I completed shaving the right side of his face.
Brief psychotic disorder mimicking the symptoms of cerebrovascular
attack evoked by symptoms that symbolized death in a patient with terminal
stage stomach cancer: Case report and review of the literature
Authors: ONISHI HIDEKI , OKUNO SHIGEKO , YAE SUZU , SAIRENJI MOTONORI , ONOSE MASANARI , MIZUNO YASUHIRO , KAWANISHI CHIAKI
Published: April 2008

Objective: We report here a terminally ill patient with
stomach cancer who developed a brief psychotic disorder mimicking
cerebrovascular attack after a short episode of nasal bleeding. Close
examination of the patient revealed that nasal bleeding was an event that
symbolized deterioration of the general condition leading to death for the
patient.

Methods: A 77-year-old male, who was diagnosed as having
stomach cancer and was receiving palliative care, presented with tremor
and insomnia just after a short episode of nasal bleeding and showed
reduced response to stimuli mimicking cerebrovascular attack. Laboratory
data were unremarkable. The next day, catatonic behavior developed. He had
no history of psychiatric illness or drug or alcohol abuse. After
receiving haloperidol, psychiatric symptoms disappeared and he returned to
the previous level of functioning within 3 days. The patient explained
that he had seen a patient whose general condition deteriorated after
nasal bleeding and regarded nasal bleeding as a symptom of deteriorating
general condition leading to death and thereafter became afraid of the
nasal bleeding.

Results and Significance of results: Although, nasal bleeding
is common and usually not severe in medical settings, for the patient, it
was an event that symbolized deterioration of the general condition
leading to death. Brief psychotic disorder in cancer patients is rare in
the literature, although patients receiving terminal care share various
kinds of psychological burden. Medical staff in the palliative care unit
should be aware of the psychological distress experienced by each patient
and consider brief psychotic disorder as part of the differential
diagnosis when patients show unexplained neurological-like and/or
psychiatric symptoms.
Narratives of grief and their potential for transformation
Authors: BERZOFF JOAN
Published: April 2008

This article examines narratives of grief and loss and how, under the best of circumstances, they may lead to transformation and growth, even contributing to the greater social good. Using psychodynamic and narrative theories, and examples drawn from mourners who have used their grief in powerful and political ways, I make the case that even grief that has been highly appropriated and contested, as in the case of Terri Schiavo, may ultimately serve important functions. Grief may mobilize mourners by helping them to turn passivity into activity. Grief may mobilize higher-level defenses such as altruism. Grief and loss may lead to a mourner's desire to do for others what was not done for him or her. A necessary part of turning grief into social action is the creation of a coherent grief narrative—first personal and then political. This coherent narrative can be developed using clinical interventions as well. Hence I discuss the clinical implications of helping those who are grieving to create coherent narratives out of shattered assumptions in a process of personal and social change.
Can we know what Terri Schiavo would have wanted?
Authors: SCHWARZ JUDITH , COYLE NESSA
Published: April 2008

What would Terri Schiavo have wanted? That remains an unanswered
question for many who followed the media frenzy that attended the
extraordinary court and legislative battles that preceded her death 13
days after her feeding tube was removed for the last time. What would she
have directed her physicians to do if she had “miraculously”
regained capacity and awareness of the consequences of her cardiac arrest
that left her in a persistent vegetative state? Who would she have wanted
to make that decision for her if she were unable to do so? How are we to
understand the meaning of statements that she purportedly made about
life-sustaining treatments approximately 20 years ago, and how can we
apply them to the current situation? This article reflects on those
questions from the perspective of two small exploratory studies. These
studies considered the meanings and interpretation of statements by
terminally ill patients concerning desire for hastened death and the
relevance of previously made statements to their current clinical
situation.
“A Rose for Emily,” a rose for Terri: The lifeless body as love object and the case of Theresa Marie Schindler Schiavo
Authors: SZASZ THOMAS
Published: April 2008

The precise circumstances of Theresa Schiavo's disability, the reasons advanced for preserving and ending her life and the covert personal agendas and unacknowledged political-economic forces that may have significantly affected the outcome were investigated and are presented.
Caring for the spiritual pain of patients with advanced cancer: A phenomenological approach to the lived experience
Authors: TAMURA KEIKO , KIKUI KAZUKO , WATANABE MICHIYO
Published: April 2008

Objective: The aim of this research was to reveal, from the perspective of the “lived experience” shared by cancer patients and their nurses, how patients facing death create lived experience in the context of palliative care. This research also aims to elucidate the meaning nurses find in patients' experiences while caring for their patients.

Methods: The participants in this study were cancer patients who were given opportunities to discuss events and concerns in their daily lives, with the interactions guided by the researchers. Transcriptions of conversations with the patients were analyzed using the method for empirical data classification set forth by Giorgi (1985) with appropriate modification.

Results: This study found that when the nurse correctly interprets the meaning of the concerns (Heidegger, 1962) of the patient facing death and shares that meaning with the patient, fundamental questions naturally arise for the patient. Answering these questions becomes possible only through interactions that require the reexamination of the values of the patient and the nurse.

Significance of research: This research elucidates the spiritual pain experienced by cancer patients and discusses opportunities for nurses to address the spiritual care of these patients.
REPARATIONS: Justice and Greed in Black and
White
Authors: Dawson Michael C. , Popoff Rovana
Published: April 2008

Proponents and opponents of reparations for Blacks vociferously
disagree. Conservative opponents argue that reparations for Black
slavery are a disastrous idea and that proponents are motivated by
either greed or the desire to do harm to the republic. Liberal and left
opponents of reparations argue that the advocacy on this issue will
lead to great racial divisions and do potentially irreparable harm to
progressive movements. Supporters of reparations argue that it is a
case of simple justice. That during the colonial, slavery, and Jim Crow
eras Blacks were systematically oppressed and exploited with the active
support of the state. They also argue that both domestic and
international precedents strengthen the case for Black reparations.
This paper shows that there is a tremendous divide between Blacks and
Whites on questions of both an apology to Blacks as well as monetary
reparations. The racial divide extends to support for the reparations
to Japanese-Americans who were victims of official incarceration during
World War II. Finally, multivariate analyses demonstrates that for both
Blacks and Whites, racialized views of politics are best predictors of
support for or opposition to reparations.
EMBEDDING THE COLOR LINE: The Accumulation of Racial Advantage and the Disaccumulation of Opportunity in Post-Civil Rights America
Authors: Brown Michael K. , Wellman David
Published: April 2008

This article investigates why deeply entrenched racial inequality persists into the post-civil rights era in the United States. It challenges individual-level explanations that assume persistent racial inequality is the result of either White bigotry, which is diminishing, or the failure of Blacks to take advantage of the opportunities opened up by the civil rights legislation of the 1960s. We propose an alternative explanation for durable racial inequality. Contemporary color lines, we argue, result from the cumulative effect of racial discrimination and exclusion, a process in which Whites accumulate racial advantages to the detriment of African Americans and Latinos. These cumulative inequalities are produced and sustained by competition between racial groups to acquire and control jobs and other resources, and by institutional practices and public policies. Individual choice in the form ofintentional racismhas little to do with the persistence of racial inequality. Our analysis suggests that Americans' current understanding of the concept of equality of opportunity is out of sync with the realities of durable racial inequality, and needs to be revised.
BLACK, TRIGUEÑO, WHITE … ? Shifting Racial
Identification among Puerto Ricans
Authors: Vargas-Ramos Carlos
Published: April 2008

The use of U.S.-oriented racial categories in the 2000 decennial
census conducted by the Census Bureau in Puerto Rico provided results that
may not accurately reflect social dynamics in Puerto Rico, more generally,
and inequality based on race, in particular. This work explores how
variations in racial typologies used for the collection of data in Puerto
Rico and the methodology used to collect such data produce widely ranging
results on racial identification that in turn affect the measurement of
the impact of “race” on social outcomes. Specifically, the
analysis focuses on how the omission of locally based and meaningful
racial terminology from census questionnaires leads to results on racial
identification that differ markedly from those found in survey data that
include such terminology. In addition, differing strategies to record the
racial identification of Puerto Ricans on the island (i.e.,
self-identification versus identification by others), lead to variations
that highlight the changing effect of race on socioeconomic status. Who
identifies a person's race affects analyses of how race affects the
life chances of individuals in Puerto Rico.
AFTER THE STORM: In the Wake of Katrina
Authors: Dawson Michael C. , Bobo Lawrence D.
Published: April 2008

By the time you read this issue of the Du Bois Review, it
will be nearly a year after the disaster caused by Hurricane Katrina swept
the Gulf Coast and roiled the nation. While this issue does not
concentrate on the disaster, (the next issue of the DBR will be
devoted solely to research on the social, economic, and political
ramifications of the Katrina disaster), the editors would be amiss if we
did not comment on an event that once again exposed the deadly fault lines
of the American racial order. The loss of the lives of nearly 1500
citizens, the many more tens of thousands whose lives were wrecked, and
the destruction of a major American city as we know it, all had clear
racial overtones as the story unfolded. Indeed, the racial story of the
disaster does not end with the tragic loss of life, the disruption of
hundred of thousands of lives, nor the physical, social, economic, and
political collapse of an American urban jewel. The political map of the
city of New Orleans, the state of Louisiana (and probably Texas), and the
region is being rewritten as the large Black and overwhelmingly Democratic
population of New Orleans was dispersed out of Louisiana, with states such
as Texas becoming the perhaps permanent recipients of a large share of the
evacuees.
Lernförderung durch Anregung der Selbstregulation im naturwissenschaftlichen Unterricht
Authors: Labuhn Andju Sara , Bögeholz Susanne , Hasselhorn Marcus
Published: April 2008

In einer quasi-experimentellen Interventionsstudie wurde die Wirksamkeit einer Verzahnung von selbstreguliertem Lernen mit naturwissenschaftlichem Fachunterricht untersucht. In enger Kooperation mit Lehrkräften wurde eine Unterrichtseinheit zum Thema Ernährung konzipiert und entweder mit oder ohne zusätzliche Anregungen zum selbstregulierten Lernen mit 199 Schülern der siebten Jahrgangsstufe einer Gesamtschule durchgeführt. Die Resultate des Prätest-Posttest-Vergleichs zeigen, dass die zusätzlichen Selbstregulationsanregungen zu einem Anstieg selbstregulierten Lernens führen. Trotz reduzierter Unterrichtszeit für fachbezogene Inhalte wurde unter der Bedingung mit Selbstregulationsanregungen fachlich ebenso viel gelernt wie in der Vergleichsgruppe. In einer anschließenden neuen und für beide Gruppen identischen Unterrichtseinheit konnte darüber hinaus ein Vorteil der Trainingsgruppe bezüglich des Lernerfolgs nachgewiesen werden.
Die Bedeutung der wahrgenommenen Unterstützung motivationsrelevanter Bedürfnisse und des Alltagsbezugs im Mathematikunterricht für die selbstbestimmte Motivation
Authors: Rakoczy Katrin , Klieme Eckhard , Pauli Christine
Published: April 2008

Die vorliegende Studie beschäftigt sich mit der Bedeutung der wahrgenommenen Unterstützung motivationsrelevanter Bedürfnisse und des wahrgenommenen Alltagsbezugs im Mathematikunterricht für die selbstbestimmte Motivation von Schülerinnen und Schülern. Die Zusammenhänge der individuellen und geteilten Wahrnehmungen mit der selbstbestimmten Motivation im Mathematikunterricht werden unter Berücksichtigung des kulturellen Hintergrunds und des Geschlechts der Schüler/innen anhand von Mehrebenenanalysen untersucht. Sie werden in zwei mathematischen Inhaltsbereichen (Textaufgaben und Satzgruppe des Pythagoras) vergleichend ermittelt. Die empirische Umsetzung erfolgt in einer deutsch-schweizerischen Studie, an der 20 schweizer und 20 deutsche Klassen der achten und neunten Jahrgangsstufe (N = 1015 Schüler/innen) teilnahmen. Die Ergebnisse zeigen, dass die individuelle Wahrnehmung der Unterstützung und der Alltagsrelevanz in beiden mathematischen Inhaltsbereichen einen wichtigen Beitrag zur Erklärung selbstbestimmter Motivation leistet. Dagegen scheint die Bedeutung der geteilten Wahrnehmung unterrichtlicher Bedingungen vom Lerngegenstand abzuhängen.
Lernen mit Texten und Bildern
Authors: Rummer Ralf , Fürstenberg Anne , Schweppe Judith
Published: April 2008

Liegt der Modalitätseffekt beim Lernen mit Texten und Bildern darin begründet, dass Bild und visueller Text gleichzeitig im visuell-räumlichen Arbeitsgedächtnissystem verarbeitet werden und dieses dadurch überfordert ist? Das in diesem Artikel vorgestellte Experimentalparadigma erlaubt die Überprüfung einer alternativen Erklärung, die sich aus der Grundlagenforschung zum verbalen Behalten ergibt. Als Material dienten Items, die aus jeweils einem kurzen Text zu einem anschließend präsentierten Pseudo-Sternbild bestanden. Als kritischer Faktor wurde die Textmodalität (auditiv vs. visuell) zwischen Versuchspersonen variiert. Die Probanden beantworteten zu jedem Text vier Fragen und reproduzierten dann das Sternbild. Der einzig signifikante Einfluss der Textmodalität fand sich in Form einer Interaktion mit der Position der Textinformation: Nur die zuletzt präsentierte Information wurde in der auditiven Bedingung besser erinnert als in der visuellen. Dieser Befund steht in Einklang mit der Annahme eines behaltenswirksamen akustisch-sensorischen Codes, der nur bei auditiver Präsentation verfügbar ist, und auch dort nur für Information, die noch nicht überschrieben wurde – allerdings unabhängig von der visuell-räumlichen Arbeitsgedächtnisbelastung.
Die Rolle der motorischen Interaktion beim Erwerb begrifflichen Wissens
Authors: v. Soden-Fraunhofen Regula , Sim Eun-Jin , Liebich Sarah , Frank Kathrin , Kiefer Markus
Published: April 2008

Die Frage, ob und unter welchen Bedingungen die Einbeziehung verschiedener Sinnesmodalitäten den Erwerb neuer Begriffe unterstützt, wird kontrovers diskutiert. Ausgehend vom Ansatz modalitätsspezifischer semantischer Gedächtnissysteme untersuchten wir dies exemplarisch anhand der Rolle motorischer Interaktion für den Begriffserwerb. Probanden erwarben über 16 Trainingssitzungen hinweg begriffliches Wissen und Bezeichnungen für künstliche, neuartige Objekte, wobei die spezifische sensumotorische Interaktionserfahrung mit den Lernobjekten variiert wurde: Eine Trainingsgruppe führte eine spezifische Handlungspantomime aus, die das Handlungsangebot der Objekte sinnvoll aufgriff; in der anderen Trainingsgruppe führten die Probanden eine Zeigebewegung auf das Objekt durch. Die Pantomime-Gruppe zeigte vor allem in der initialen Lernphase und bei verbalen Stimuli eine bessere Lernleistung als die Zeige-Gruppe. Unsere Ergebnisse belegen, dass eine sinnvolle motorische Interaktion mit dem Lernobjekt die Aneignung begrifflichen Wissens beschleunigt und die flexible Handhabung von begrifflichen Inhalten fördert. Diskutiert werden die Bedeutung von sensorischen und motorischen Erfahrungen für den Begriffserwerb sowie Implikationen für eine pädagogische Anwendung.
Computergestützte quantitative Textanalyse
Authors: Wolf Markus , Horn Andrea B. , Mehl Matthias R. , Haug Severin , Pennebaker James W. , Kordy Hans
Published: April 2008

Zusammenfassung. Im Beitrag wird die deutsche Adaptation des Linguistic Inquiry and Word Count (LIWC) vorgestellt. Das LIWC ist ein computergestütztes Textanalyseprogramm mit integriertem Wörterbuch, das von Pennebaker und Kollegen (2001) entwickelt wurde, um Essays aus Experimenten zum expressiven Schreiben zu untersuchen. Es werden zwei Studien zur Güte und Praktikabilität des deutschen LIWC berichtet: (1) An einer Stichprobe zweisprachig vorliegender Texte (N = 122) wird die Äquivalenz der deutschen Übersetzung mit dem Original überprüft. (2) An einer Stichprobe von N = 104 E-Mails wird die Robustheit des Verfahrens gegenüber Schreibfehlern untersucht. Für die meisten LIWC-Kategorien zeigt sich eine gute Äquivalenz. Des Weiteren erweist sich das LIWC als robust gegenüber Schreibfehlern. Diese Befunde sprechen für die Brauchbarkeit des LIWC für die Analyse deutscher Texte. Die beobachtete Robustheit ist von erheblicher praktischer Bedeutung für die Analyse natürlicher geschriebener Sprache aus der computervermittelten Kommunikation.
Der Gießener Beschwerdebogen für Kinder und Jugendliche (GBB-KJ): Faktorielle Validität, Reliabilität und gesamtdeutsche Normierung für 4- bis 18-Jährige im Eltern- und Selbsturteil
Authors: Barkmann Claus , Mack Bernd , Brähler Elmar , Schulte-Markwort Michael
Published: April 2008

Zusammenfassung. Der Gießener Beschwerdebogen für Kinder und Jugendliche (GBB-KJ) ist bislang das einzige speziell für das Kindes- und Jugendalter entwickelte Verfahren zur mehrdimensionalen Erfassung von körperlichen Beschwerden im Selbst- und Fremdbild. In der vorliegenden Untersuchung wurden anhand einer bundesweit repräsentativen Stichprobe von N = 1950 Kindern und Jugendlichen u.a. mittels einer linearen Strukturgleichungsanalyse die faktorielle Validität, querschnittliche Reliabilitätskennwerte, die Beurteilerübereinstimmung und eine gesamtdeutsche Normierung für 4- bis 10-Jährige im Eltern- sowie für 11- bis 18-Jährige im Eltern- und Selbsturteil bestimmt. Der GBB-KJ kann in der fünffaktoriellen Fassung bei unausgelesenen Bevölkerungsstichproben als zufriedenstellend bis gut faktoriell valide und reliabel gelten. Hauptproblem des Fragebogens sind die hohen Itemschwierigkeiten bzw. starken Bodeneffekte, insbesondere in der Skala „Kreislaufsymptomatik”. Das Elternurteil kann nur bedingt als Ersatz für das Selbsturteil dienen und sollte wann immer möglich durch die Befragung von Kindern bzw. Jugendlichen ergänzt werden. Es werden weiterführende Prüfungen u.a. der Kriteriums- und Konstruktvalidität, Retestreliabilität und Veränderungssensitivität auch an klinischen Stichproben empfohlen.
Adiponectin But Not Resistin Is Associated with Insulin Resistance‐Related Phenotypes in Baboons
Authors: Tejero M. Elizabeth , Freeland‐Graves Jeanne H. , Proffitt J. Michael , Peebles Kyle W. , Cai Guowen , Cole Shelley A. , Comuzzie Anthony G.
Published: April 2008

Objectives: The hormones adiponectin and resistin have been associated with insulin resistance. This paper analyzed the potential relationship between adiponectin and resistin and insulin resistance‐related phenotypes in baboons.

Research Methods and Procedures: One hundred eight adult baboons (84 female and 24 male) were studied. Weight was measured, and a blood sample was collected under fasting conditions for plasma and monocyte isolation. Fasting glucose, insulin, C‐peptide, and adiponectin levels in plasma were measured by standard methods. Insulin resistance was calculated by the homeostasis model assessment index. Resistin mRNA abundance in monocytes was determined by real‐time quantitative reverse transcription‐polymerase chain reaction. Data were clustered by weight tertiles for statistical analysis.

Results: As observed in humans, the insulin resistance‐related phenotypes were related to weight, plasma levels of adiponectin, and C‐peptide. No significant relationship between resistin circulating levels or expression in monocytes and insulin resistance‐related phenotypes was found in baboons.

Discussion: These findings suggest that resistin is not associated with insulin resistance. However, previous observations of relationships among weight, adiponectin, and insulin resistance are confirmed.