Academic literature on the topic 'Brothers – Death – Case studies'
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Journal articles on the topic "Brothers – Death – Case studies"
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Hays, Judith C., Deborah T. Gold, and Carl F. Pieper. "Sibling Bereavement in Late Life." OMEGA - Journal of Death and Dying 35, no. 1 (August 1997): 25–42. http://dx.doi.org/10.2190/ye89-2gu8-c8u3-mrnx.
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Elders are more likely to confront the death of a sibling than any other kinship bereavement. Yet we know almost nothing about the impact of sibling deaths on older adults. We used attachment theory to generate hypotheses about the impact of this life event on physical health, mood, social support, and economic outcomes in late life. At the Duke University site of a large multi-center epidemiologic study (EPESE), 3173 elderly community-dwellers provided data on bereavements experienced in the past year as well as on demographic, health-related, and socioeconomic characteristics. Bereaved siblings were more functionally and cognitively impaired than bereaved friends and rated their overall health as worse than bereaved spouses or bereaved friends who were similarly impaired. Brothers and sisters bereaved of a brother reported excess financial hardship and mood impairment, respectively. Terminal care programs should screen for excess risk among surviving siblings and plan for assisting these survivors in adaptation to this loss.
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Peräkylä, Anssi. "Mara B. Adelman & Lawrence R. Frey, The fragile community: Living together with AIDS. (Everyday communication: Case studies of behavior in context.) Mahwah, NJ: Erlbaum, 1997. Pp. xii, 128. Hb $36.00, pb $16.50." Language in Society 29, no. 2 (April 2000): 277–79. http://dx.doi.org/10.1017/s0047404500272047.
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In his book The sacred canopy, Peter Berger wrote, that in the last analysis, “society” is people banded together in the face of death (1967:51). Adelman and Frey have written a small but fascinating study about this very topic. Theirs is an ethnographic study on a residential facility called Bonaventure House (BH), run by a Catholic order, the Alexian Brothers of America. The residents suffer from AIDS; and during the time of the study, BH was for most of them their last home before death. Using participant observation, interviews and questionnaires, Adelman & Frey set out to study how community is built and sustained in these circumstances: People afflicted by a dreaded illness share their everyday lives; death occurs regularly; and the departed are replaced by new people, who become part of the community.
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Suitor, J. Jill, Megan Gilligan, Catherine Stepniak, Yifei Hou, and Robert Frase. "How Gender Shapes the Effects of Immediate Family Members’ Deaths on Adults’ Psychological Well-Being." Innovation in Aging 5, Supplement_1 (December 1, 2021): 93. http://dx.doi.org/10.1093/geroni/igab046.352.
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Abstract The deaths of family members constitute one of the most serious negative life events experienced in adulthood. The impact of these losses on psychological well-being may differ considerably by the structural relationship between the deceased and the survivors, and by the genders of both family members; however, few studies have been able to explore these variations by generation, gender, and time since death. In this paper, we use mixed-methods data to explore how depressive symptoms are affected differentially in adulthood by the deaths of mothers, fathers, and siblings, as well as by the gender of survivors. We address these questions using data collected from approximately 600 adult children nested within 250 later-life families, in which approximately 55% experienced the death of at least one parent and 15% experienced the death of a sibling in the previous decade. Preliminary multilevel regression analyses showed that deaths of siblings predicted sisters’ but not brothers’ depressive symptoms. In the case of parents, only mothers’ deaths were found to predict daughters’ depressive symptoms, whereas neither parents’ deaths predicted sons’ well-being. Further, these patterns differed little by time since death. Qualitative data revealed that women were more likely to report that both their mothers’ and siblings’ deaths had led to higher conflict within the sibling network, which previous research has shown predicts psychological well-being. Taken together, these findings demonstrate the salient role of gender in shaping well-being in the face of events of deaths of parents and siblings in adulthood.
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Handley, Andrea, and Jerome Carson. "Andrea Handley in conversation with Jerome Carson." Mental Health and Social Inclusion 24, no. 3 (May 16, 2020): 125–30. http://dx.doi.org/10.1108/mhsi-04-2020-0020.
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Purpose The purpose of this paper is to provide a profile of Andrea Handley. Design/methodology/approach In this case study, Andrea gives a short account of her background and is then interviewed by Jerome. Findings Andrea outlines a number of issues from her childhood that led to her later mental health problems. Research limitations/implications Individual case studies are of course just the story of one person’s difficulties. For too long in psychiatry, case studies were written by professionals about their lives and problems. First person accounts allow the individual to tell their own narrative. Practical implications Andrea is not the first person to talk about the delay in access to mental health services. As she notes, 16 years on, she is still waiting for that referral! She notes that a friend of her could not wait even the three months that she had been and tragically took her own life. Social implications So much of Andrea’s story is overshadowed by loss, especially the death of her brother when she was a teenager. As a society, we are no as well “prepared” for death, as older generations. The coronavirus pandemic is bringing our mortality home to all of us. Originality/value Patricia Deegan once asked, “How much loss could a human heart hold?” In this moving account Andrea lets us see the huge losses she has sustained and yet she is still determined to try and help others who are suffering. Hers is truly a remarkable life.
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Amri, Aulil. "PROBLEMATICS OF SETTLEMENT OF INHERITANCE RIGHTS OF DAUGHTER WITH SIBLINGS IN THE MAHKAMAH SYAR’IYAH BANDA ACEH AND ACEH." Dusturiyah: Jurnal Hukum Islam, Perundang-undangan dan Pranata Sosial 13, no. 1 (June 11, 2023): 70. http://dx.doi.org/10.22373/dusturiyah.v13i1.16669.
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This research discusses the Polarization of Judges' Decisions in the Settlement of Sibling Inheritance Rights (Case Study of Decision Number: 193/Pdt.G/2020/MS.Bna AND 21/Pdt.G/2021/MS.Aceh). The formulation of the problem studied is: 1. Why is there a disparity in the judge's decision regarding the position of relatives as heirs in an inheritance dispute at the Religious Court in decision number: 193/Pdt.G/2020/MS.Bna vs. 21/Pdt.G/2021/ MS. Aceh? 2. Has the judge's decision in resolving the dispute over the determination of heirs protected the rights of heirs in accordance with faraidh? This research is normative and practical juridical research, namely library research supported by results in the field in the form of interviews with related functional officials of the Banda Aceh Syar'iyah Court and Aceh Syar'iyah Court. This study concludes that: 1. The disparity in the decisions of the Banda Aceh Syar'iyah Court and the Aceh Syar'iyah Court occurred due to an understanding of the Jumhur Ulama's opinion which stated that a daughter cannot be hindered by a daughter in receiving an inheritance. Jumhur Ulama's definition of "kalalah" is the death of someone who does not have a father or son. This is in line with jurisprudence and the opinion of Ibn 'Abbas, which stipulates that girls can wear the hijab to inherit, but girls cannot wear the hijab inherited from their brothers. 2. The judge's decision at the Banda Aceh Syar'iyah Court in resolving the dispute over the determination of heirs has protected the rights of heirs in accordance with faraidh. This is because the opinion of the jumhur of scholars and the opinion of Ibn 'Abbas are in line with the opinion of the panel of judges. Then the daughter in this case is an adult and has a steady job and income, which is different from the case in jurisprudence.
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Walker, Paul E. "The Fatimid Caliph al-Aziz and His Daughter Sitt al-Mulk: A Case of Delayed but Eventual Succession to Rule by a Woman." Journal of Persianate Studies 4, no. 1 (2011): 30–44. http://dx.doi.org/10.1163/187471611x568276.
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AbstractIn his youth the future al-Aziz, then merely the third son of the caliph al-Muizz, acquired a concubine, most likely a Greek-speaking captive, and produced with her a daughter who was to become the famous Sitt al-Mulk. Not only did her mother remain al-Aziz’s favorite long after he rose to the Fatimid throne in 975, she remained so until her death twenty years later, and the daughter continued throughout to hold a claim on his attention many considered unusually intense and extraordinary. This favor, combined with her own political acumen and sharp intelligence, enabled Sitt al-Mulk to exercise authority throughout her lifetime until she finally became the real ruler of the empire upon the disappearance of her eccentric half-brother, al-Hākim, in 1021. Drawing on chronicles written by both Fatimid and anti-Fatimid historians, this article considers the context for Sitt al-Mulk’s rise to power amid the unusual dynamics of the Fatimid royal family. It reveals the implausibility of accounts that attempt to discredit her and demonstrates that when at last she governed the empire, she did so quite competently through a difficult time of transition.
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Vollmann, Sarah Reed. "A Legacy of Loss: Stories of Replacement Dynamics and the Subsequent Child." OMEGA - Journal of Death and Dying 69, no. 3 (November 2014): 219–47. http://dx.doi.org/10.2190/om69.3.a.
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This article, a qualitative exploration of the experiences of subsequent children, endeavors to clarify common issues and experiences of this population. Subsequent children, also known as subsequent siblings, are children born after the death of a brother or sister. For this study, 25 adult subsequent siblings participated in semi-structured interviews. Few researchers have written about this population, and much of what has been documented was researched from single case studies, or from very small samples. This study aims to explore the commonalities of the unique experience of being a subsequent child. Themes which emerged include various replacement child dynamics, impaired bonding with parents or altered parenting as a result of the loss, family grief and its repercussions, meaning making and spiritual questioning, fantasies about the lost sibling, disenfranchised and unresolved grief, taking on a caregiver role, and survivor guilt. The implications for clinical practice are presented.
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Doherty, James. "Commemorating the Crusading Past in Late Medieval England: The Worksop Priory Tabula." English Historical Review 136, no. 581 (August 1, 2021): 809–35. http://dx.doi.org/10.1093/ehr/ceab275.
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Abstract Memory has featured prominently in recent scholarship on the crusades. In particular, the remembrance of crusaders by their descendants and associated ecclesiastical institutions in the high Middle Ages has attracted considerable attention; however, few studies have concentrated on the commemoration of crusaders in the later Middle Ages. This article examines a late fifteenth-century genealogical poem, which was produced for public display on a tablet at Worksop Priory (Nottinghamshire) and contains unique information about members of the Furnival family on the Barons’ Crusade (1239–41), in order to explore how and why medieval institutions preserved memories of crusaders into the late Middle Ages. It argues that, although inaccurate in its crusade narrative, the poem provides invaluable insights into the mechanisms of aristocratic family memory in medieval England; and it focuses on the important role of material prompts in the process of commemoration. Specifically, it suggests that an effigy of Sir Thomas de Furnival was erected at Worksop soon after his death away from home in 1241. In the absence of a written record, this cenotaph acted as a prompt to an oral narrative tradition which informed the Worksop poet when he came to compose his genealogical work. This study is, therefore, an analysis of crusade memory, but it is also an examination of the presentation of a crusade narrative to a public audience, an opportunity to unravel the confused history of three crusading brothers, and an attempt to understand the response of a medieval community that had suffered losses in overseas ventures.
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Gibbons, Alison. "Multimodal metaphors in contemporary experimental literature." Metaphor and the Social World 3, no. 2 (December 31, 2013): 180–98. http://dx.doi.org/10.1075/msw.3.2.04gib.
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Multimodal metaphor studies has hitherto neglected one key arena in the creative arts: literature. This article explores four case studies of multimodal metaphor within contemporary experimental literature. In poetry, the metaphor EMOTIONS ARE OBJECTS is discussed within Anne Carson’s (2009) accordion ‘poem in a box’, in which the poet struggles with the death of her brother; in literature, Steve Tomasula and Stephen Farrell’s (1996) fold-out fiction TOC and Mark Z. Danielewski’s (2006) novel Only Revolutions, both thematically interested in time and designed to be rotated in reading, are explored to reveal the metaphor TIME IS CIRCULAR MOTION; and in the graphic novel, analysis of Warren Ellis’ (2011) “SVK”, for which readers use a torch to reveal characters’ thoughts printed in UV ink, exposes the metaphor KNOWLEDGE IS LIGHT. Throughout, it is shown that multimodal metaphors are generated through both the interaction of verbal and visual modes, and through a reader-user’s performative engagement with the text. Moreover, early theorisations of multimodal metaphor in which the two domains (source and target) were required to stem from different modalities, are called into question. Rather, the creative affordances of multimodal literature show such metaphors to be more integrative in nature, both cognitively and semantically.
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Ghrissi, F., F. Fekih-Romdhane, M. Stambouli, B. Abassi, and M. Cheour. "A rare case of trauma related dissociative identity disorder." European Psychiatry 66, S1 (March 2023): S957. http://dx.doi.org/10.1192/j.eurpsy.2023.2030.
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IntroductionDissociative identity disorder (DID) is a debilitating and controversial psychiatric disorder with a lifetime prevalence estimated around 1,5%. It remains underdiagnosed despite recognition in international classification of mental disorders. In fact, based on the DSM-5 criteria, DID is characterised by two or more distinct personality states that coincide, with fluctuating consciousness and changing access to autobiographical memory. The aetiology of DID has long been debated with recent neuroimaging evidence supporting the trauma model of this condition.ObjectivesThe aim of this presentation is to describe the case of a young female diagnosed with DID related to childhood trauma.MethodsWe also conducted a literature review in order to discuss the aetiology of the disorder. The following keywords were searched through the pubmed website: dissociative identity disorder, trauma, aetiology.ResultsWe report the case of a 20 years old female with no past medical, nor psychiatric history. However, she had a family history of an uncle and an aunt with chronic psychosis. Her father died when she was 8, thus she lived with her mother and her brother and two sisters. She was a brilliant student and started engineering studies. She has no particular personality trait. She was raised within a strict religious family with little time dedicated to leisure activities. Importantly, since the age of 10, she was exposed to her mother’s religious extremist and threatening discourses, related to death and “grave’s torture” and comprising many cultural beliefs. She seeks for psychiatric care complaining of “soliloquy” that became remarkable by her relatives. On psychiatric evaluation she presented daily fluctuating consciousness during at least one hour, in which she switches identity toward the daughter of a famous singer. This alter was having pleasant activity with her mother and was singing and hanging out most of the time. No particular triggers were identified. The trouble started by the age of 14 then worsened gradually and became an unvoluntary phenomenon with significant distress. She had no depressive nor psychotic nor anxiety or obsessive symptoms. Her sleep and appetite were not disturbed. She met DSM-5 diagnostic criteria for DID and was referred to a trained psychiatrist for adequate psychotherapy management.ConclusionsWe exposed a rare case of a young student complaining of soliloquy since the age of 14 that was diagnosed with DID subsequent to a particular childhood trauma which consisted in exposure to threatening religious and cultural beliefs about life after death told by her mother. This unique case emphasises the trauma model of DID, where the nature of the trauma influences the clinical expression of DID. Given the recent neuroimaging evidence, DID can be framed as a chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress.Disclosure of InterestNone Declared
Dissertations / Theses on the topic "Brothers – Death – Case studies"
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Cuttill, Casey. "High school siblings of children with disabilities : five case studies /." View online, 2008. http://repository.eiu.edu/theses/docs/32211131414962.pdf.
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Jackson, Indya J. "There Will Be No Pictures of Pigs Shooting Down Brothers in the Instant Replay: Surveillance and Death in the Black Arts Movement." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1588601272757038.
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Hattori, Keiko. "Good Death Among Elderly Japanese Americans in Hawaii." Diss., University of Hawaii at Manoa, 2007. http://hdl.handle.net/10125/22054.
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The purpose of this focused ethnographic study was to describe the patterns of a good death held by elderly Japanese Americans living in Hawaii. Eighteen "healthy active" elderly Japanese Americans were interviewed individually. In addition, supplementary data, such as interviews with experts and field observations were collected for triangulation of the data. Four themes were derived from 1224 keywords, 56 categories, and 13 patterns. These were: being a burden to the family, process of life and death, individual views on death, and Japanese culture in Hawaii. Being a burden to the family was the largest concern in the participants' idea of dying a good death. Having secure financial resources were key for adequate preparation. The elderly Japanese Americans believed that suffering at the end-of-life should be avoided in order to achieve a good death. Their concept of suffering included: unmanageable pain, being ill for a long time, and being bedridden. Several participants preferred a sudden type of death because they would not have to suffer and not be burdens their family. Contentment in life was also an important aspect of a good death. There was a common belief that the way a person lived was connected with the way he/she died. A number of the participants preferred to die in their own home. Hospitals and retirement homes were other alternatives for the place of death. Individual views on death contributed to establish the concept of good death among elderly Japanese American participants. They shared similar attitudes toward death which were a part of life and inevitable. These attitudes were influenced by religious beliefs and past experiences with death. Different generations of elderly Japanese Americans had different views. The Shin-Issei (first generation who immigrated after World War II) and the Nisei (second generation) held more Japanese views compared to the Sansei (third generation) who were more acculturated. Although the Japanese American parents and children might have different views on life and death, the importance of close family relations and family support was passed on to younger generations.
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De, Marco Elga <1996>. "Digitalising a controversial theme: The death of Robin Hood Two case studies: “A Gest of Robyn Hode” and “Robin Hood's Death”." Master's Degree Thesis, Università Ca' Foscari Venezia, 2021. http://hdl.handle.net/10579/19231.
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This work has as primary aim that of showing, through a comparison of two old texts, how a same theme can be developed and matured in a different way. In order to achieve this purpose, I will execute a process of digitalisation on two ballads dating back to the Middle English period. Both revolve around the character of Robin Hood and affect the same topic, namely his death, but having a rather diverse extent of this same theme which, consequently, can influence its interpretation. The two case studies will be “Robin Hood’s Death”, the version edited by John W. Hales and Frederick J. Furnivall in the I volume “Bishop Percy’s folio Manuscript- Ballads and Romances-“ (1867) and “A Gest of Robyn Hode”, the version edited by Stephen Knight and Thomas Ohlgren in the volume “Robin Hood and other outlaw tales” (2000). I will proceed with the encodings of these texts employing an XML TEI language, encodings that will represent the base to create the related digitalisations. The choice of digitalising is made to highlight features/traits, peculiarities and potential differences which can emerge in a digitalised text compared to the same text in paper belonging to a different era, therefore not todays. As a matter of fact, sometimes a digital version of a text permits to discover and reveal some aspects that could be overlooked on paper.
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Steele, Charles A. "Brothers in arms case studies of officer and NCO integration in the new states of the Federal Republic of Germany /." Morgantown, W. Va. : [West Virginia University Libraries], 2000. http://etd.wvu.edu/templates/showETD.cfm?recnum=1715.
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Thesis (Ph. D.)--West Virginia University, 2000.Title from document title page. Document formatted into pages; contains viii, 194 p. Vita. Includes abstract. Includes bibliographical references (p. 176-186).
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Jervis, Sarah Jenny. "Exploring the experiences of the sibling of a child with an intellectual disability." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/21630.
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Thesis (MEdPsych)--Stellenbosch University, 2008.ENGLISH ABSTRACT: This study is aimed at gaining insight into the experiences of siblings of an individual with an intellectual and physical disability. Attaining greater insight into their lived reality, their feelings and concerns could make it possible to provide appropriate support. The review of selected literature provides information on many aspects of the these siblings' experience. Although many studies are quantitative in their approach, the literature review provides relevant and useful findings and inferences which were used to support and substantiate findings. During this qualitative study, which is situated within an interpretive phenomenological paradigm, four participants between the ages of eight and sixteen years were interviewed using semi-structured interviews. This format of interview allowed participants to use their own words to express their personal experiences. The results showed that siblings have both positive and negative experiences when another sibling has an intellectual disability. Other common difficulties include embarrassment, guilt, and the experience of differential treatment. Positive experiences and competencies include love and acceptance, personal growth, maturity, pride in siblings accomplishments, and appreciation for one's sibling. Several experiences were congruent with those mentioned in the literature. The insights into the experiences this study provides has implications for the development and provision of sibling support programmes and interventions. At present, state group support programmes for siblings are not provided within the Western Cape area. The interventions and assistance that do exist seem to be provided by the private sector only. Support can prove very costly, which means that it is not accessible to many who require it. Sibling workshop groups could provide a valuable support alternative to a currently "unsupported" group, the siblings.
AFRIKAANSE OPSOMMING: Hierdie studie poog om insig te verkry in die ondervindings van die broers en susters van 'n kind met intellektuele en fisiese gestremdhede. Beter insig in die realiteit van hul leefwyse, hulle gevoelens en bekommernisse kan beter ondersteuning aan hulle moontlik te maak. Die ondersoek van geselekteerde literatuur voorsien inligting rakende vele aspekte van die ondervindings van hierdie kinders. Alhoewel baie van die studies kwantitatief in hul benadering is, het die bestaande literatuur tog relevante en bruikbare bydraes en gevolgtrekkings verskaf wat gebruik kon word om bevindings te bevestig en te staaf. Hierdie kwantitatiewe studie het plaasgevind in 'n verklarende fenomenologiese paradigma en vier semi-gestruktureerde onderhoude is gevoer met deelnemers tussen die ouderomme van 8 jaar en 16 jaar. Hierdie formaat van onderhoudvoering dra by dat deelnemers hulle gevoelens in hul eie woorde uitdruk. Die bevindings het gewys dat broers/susters beide positiewe en negatiewe ondervindings van kinders met 'n intellektuele gestremdheid het. Ander algemene probleme sluit in skaamte, skuldgevoelens en die gevoel van gedifferensieerde behandeling. Positiewe ondervindings en vaardighede van broers en susters sluit liefde en aanvaarding, persoonlike groei, volwassenheid, trots op die broers/suster se bekwaamheid en die waardering van so 'n broer/suster in. Verskeie van die ondervindings het ooreengestem met bevindings wat in die literatuur gevind is. Die insigte in hierdie ondervindings wat deur hierdie studie voorsien word het implikasies vir programme en intervensies wat ondersteuning aan hierdie kinders bied. Tans is daar nie sodanige staatsgefinansierde ondersteuningsprogramme in die Wes-Kaap area nie. Die intervensies en ondersteuning wat wel beskikbaar is word slegs in die privaatsektor aangebied. Ondersteuning kan baie duur wees, wat beteken dat dit vir baie kinders wat dit nodig het, ontoeganklik is. Ondersteuningsgroepwerkswinkels kan 'n waardevolle alternatief bied vir die "nieondersteunde" groep, die kinders.
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Exley, Catherine Elizabeth. "Living with cancer : living with dying : the individual's experience." Thesis, Coventry University, 1998. http://curve.coventry.ac.uk/open/items/94145345-36cc-92ad-7d6f-f8aae99dc41d/1.
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This thesis explores the experience of living with cancer and a terminal prognosis from the dying individual's perspective. It is based on qualitative sociological research. My study group comprised nineteen hospice patients, eighteen women and one man, aged 27 to 67, all of whom had been diagnosed with cancer. Thirty focused interviews were conducted; each respondent was interviewed at least once with a sub-group being interviewed a second or third time dependent upon symptoms, willingness to participate again and the need to explore issues further. My thesis is a sociological account of respndents' views and experiences. Its focus is the management and negotiation of dying and death at an individual level. A central tenet of my thesis is how self-identity is constructed and negotiated in different social encounters, in both the public and the private sphere. With reference to the public sphere I consider respondents' experiences of communicating with health professionals, and the difficulties they encountered. Within this discussion I look at how respondents constructed understandings of their illness within the context of their own biographies. I also discuss individuals' experiences of treatment, and the choices they made about this. In addition, I examine respondents' hopes and fears for their own deaths, and I suggest the notion of a 'good enough' death may be useful in interpreting their views. Repsondents perceived they had a spoiled identity as a result of their cancer and dying status. As a result, they spent a great deal of time and effort engaging in emotional work, in order to reassert their more valued roles. Much has been written about the emotional work of paid and unpaid carers. Here I suggest attention must also be given to the work of dying individuals themselves. However, I do not conceive of this emotional work as selfless, rather I suggest such work has benefits for individuals themselves. Emotional work enabled them to reaffirm or renegotiate more valued self-identities while alive, but in addition, I suggest that it also meant that respondents were able to contribute towards their own 'disembodied' after-death identities.
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Sharag-Eldin, Adiyana. "The Role of Geography Space and Place in Social Media Communication:Two Case Studies of Policy Perspectives." Kent State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=kent1571484284023254.
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Welman, Mark. "Death and gnosis: archetypal dream imagery in terminal illness." Thesis, Rhodes University, 1996. http://hdl.handle.net/10962/d1002593.
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The central aim of this study was to explore the meaning of death as both a literal and an imaginative reality, and to elucidate the fundamental tensions between these meanings of death in modern existence. Recognition was given to the need for a poetic rather than a scientific approach to thanatology, and an epistemological foundation for a poetics of death was sought in the tradition of gnosis. Theoretically, the study was grounded in the analytical psychology of C.G. Jung. It was argued that despite Jung's erratic allegiance to a Cartesian ontology and epistemology, his approach to death was nevertheless fundamentally poetic. The poetic parameters of death and dying were explored in the context of Jung's understanding of the dialectical tension between the ego and the self, and it was concluded that while death represents an opening to the imaginative possibilities of existence, these potentialities can come to the fore only when there is a corresponding willingness to die. In these terms, it was concluded that the tension between life and death forms a pivotal dynamic of human existence. These considerations led to the Question of whether the poetic parameters of death and dying are applicable to the encounter with death as a concrete actuality. It was hypothesised that the approach of death would be met at two levels of reality, that of the ego and that of the self. The expectation was that while death would be seen as a literal ending from the perspective of the former, it may represent the fulfilment of Being from the viewpoint of the self. It was also assumed that the tension between these images of death would be mediated by way of archetypal symbols, which represent the bearers of gnosis in modern culture. To address these issues at an empirical level, a hermeneutically grounded thematic analysis of 108 dreams reported by dying persons was undertaken. Twenty initial themes emerged from the data. Each of these themes was in turn elucidated by way of Jung's method of amplification. This exercise yielded five concise themes, these being (a) death, (b) transformation, (c) the self (d) the Feminine, and (e) the Masculine. It was concluded that dreams manifesting during the dying process reveal a fundamental tension between literal and metaphoric possibilities of death. Dream symbols were also found to mediate between this tension, and to orchestrate the individuation process. It was concluded that in the context of dying, dreams may reflect and facilitate the emergence of a meaningful gnosis of death. The clinical implications of these findings were onsidered, and indications for further research were provided.
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Boshoff, Annemi. "Kinders se ervaring van 'n sibbe met kanker: 'n kwalitatiewe studie." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/1721.
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Thesis (MEdPsych (Educational Psychology)--University of Stellenbosch, 2009.This study focused on South African siblings' experiences of a brother or sister with cancer. Social constructionism was used as an epistemological framework. Three in-depth interviews with siblings (ages 12 – 16 years) of pediatric cancer patients, were done. The case study approach was chosen as the most suitable method to gain the information. The thematic content analysis was the method of analysis. Participants' experiences with regard to their siblings' cancer were reconstructed according to themes. Recurring themes were elucidated and linked with the literature. The study allowed participants to express their conscious and unconscious experiences by means of verbal and non-verbal (art activities) communication. Results support the concern by previous studies about siblings' vulnerability since the diagnosis of a brother's/sister's cancer. The uniqueness of each sib's experience and the implementation of individualy-centered intervention strategies is emphasized. Educational Psychologists as well as members of the multidisciplinary team (teachers, medical and nursing staff, parents, family and peers) interested in supporting siblings of pediatric cancer patients can benefit from this study.
Books on the topic "Brothers – Death – Case studies"
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Loomis, Romond Janis, ed. Children facing grief: Letters from bereaved brothers and sisters. St. Meinrad, Ind: Abbey Press, 1989.
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McCumber, David. X-rated: The Mitchell brothers : a true story of sex, money, and death. New York: Simon & Schuster, 1992.
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Berg, David. Run, brother, run: A memoir of a murder in my family. New York: Scribner, 2013.
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Gibson, Ray. Blind justice: A murder, a scandal, and a brother's search to avenge his sister's death. New York: St. Martin's Press, 1991.
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Edie, Gibson, and Turner Randall, eds. Blind justice: A murder, a scandal, and a brother's search to avenge his sister's death. New York, N.Y: St. Martin's Paperbacks, 1992.
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Edie, Gibson, and Turner Randall, eds. Blind justice: A murder, a scandal, and a brother's search to avenge his sister's death. New York: St. Martin's Press, 1991.
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Yitshar, Ṿardi, ed. ha-Naʻar she-nafal min ha-shamayim: Sipur amiti. Or Yehudah: Zemorah-Bitan, 2007.
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Ascher, Barbara Lazear. Landscape without gravity: A memoir of grief. New York, N.Y: Penguin Books, 1994.
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Copyright Paperback Collection (Library of Congress), ed. A professor's rage: The chilling true story of Harvard Ph.D. Amy Bishop, her brother's mysterious death, and the shooting spree that shocked the nation. New York: St. Martin's Paperbacks, 2011.
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Colt, George Howe. Brothers: On his brothers and brothers in history. Waterville, Maine: Thorndike Press, 2012.
Find full textBook chapters on the topic "Brothers – Death – Case studies"
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Chan, Garrett K. "Death Notification After Unexpected Death." In Case Studies in Palliative and End-of-Life Care, 73–82. West Sussex, UK: John Wiley & Sons, Inc.,, 2013. http://dx.doi.org/10.1002/9781118704707.ch10.
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Hunyady, Orsoly. "Faced with death." In Psychoanalytic Case Studies from an Interpersonal-Relational Perspective, 170–84. Abingdon, Oxon ; New York, NY : Routledge, 2018.: Routledge, 2017. http://dx.doi.org/10.4324/9780203709832-8.
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Jacob, Yannick. "Death of a parent." In Ethical Case Studies for Coach Development and Practice, 44–48. London: Routledge, 2023. http://dx.doi.org/10.4324/b23351-8.
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Westphal, Christine, and Rebecca Williams. "Discussing Brain Death, Organ Donation, and Donation After Cardiac Death." In Case Studies in Palliative and End-of-Life Care, 41–51. West Sussex, UK: John Wiley & Sons, Inc.,, 2013. http://dx.doi.org/10.1002/9781118704707.ch6.
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Chan, Garrett K. "Bereavement After Unexpected Death." In Case Studies in Palliative and End-of-Life Care, 289–99. West Sussex, UK: John Wiley & Sons, Inc.,, 2013. http://dx.doi.org/10.1002/9781118704707.ch35.
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Fowler, Catherine S. "Historical Perspectives On Timbisha Shoshone Land Management Practices Death Valley California." In Case Studies in Environmental Archaeology, 43–57. New York, NY: Springer New York, 2008. http://dx.doi.org/10.1007/978-0-387-71303-8_3.
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Nelson, Peg. "Notification of an Expected Death." In Case Studies in Palliative and End-of-Life Care, 68–72. West Sussex, UK: John Wiley & Sons, Inc.,, 2013. http://dx.doi.org/10.1002/9781118704707.ch9.
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Betta, Michela. "Three Case Studies: Australian HIH, American Enron, and Global Lehman Brothers." In Ethicmentality - Ethics in Capitalist Economy, Business, and Society, 79–97. Dordrecht: Springer Netherlands, 2016. http://dx.doi.org/10.1007/978-94-017-7590-8_5.
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Dahlin, Constance. "Diagnosis/Prognosis Uncomplicated Death at Home." In Case Studies in Palliative and End-of-Life Care, 12–17. West Sussex, UK: John Wiley & Sons, Inc.,, 2013. http://dx.doi.org/10.1002/9781118704707.ch2.
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Hughes, Jessica M. F. "Death and traumatic affect on Twitter." In Dialogue Studies, 88–114. Amsterdam: John Benjamins Publishing Company, 2023. http://dx.doi.org/10.1075/ds.33.05hug.
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References to death appear frequently in activist discourse. Activists make death matter on- and offline when they speak the names of people killed, hold die-ins and vigils, mention the number of lives lost, and tell the stories or share pictures of those who have died. This chapter examines how death materializes in digital activism on Twitter. Using a relational ontological approach (Cooren, 2018) to analyze agents and relationships evident in tweets about death in her own Twitter profile, the author works to understand how references to death are used in digital disability activism and what kinds of affective impact references to death might have on Twitter users. Taking as a focal point disability activists’ responses to comments about COVID-19 deaths made by the Director of the US Centers for Disease Control and Prevention, the analysis demonstrates how references to death are used to mobilize activists, hold authorities to account, and reframe states of affairs to center the needs of vulnerable community members. Putting this case study in dialogue with other references to death on Twitter reveals the power of traumatic affect (Richardson, 2018), a force that materializes in the body and positions audience members in moral relation with those who have died.
Conference papers on the topic "Brothers – Death – Case studies"
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Yuan, Guan. "Studies on privacy protection of web accounts in the case of a user’s death in China." In 2020 3rd International Conference on Humanities Education and Social Sciences (ICHESS 2020). Paris, France: Atlantis Press, 2020. http://dx.doi.org/10.2991/assehr.k.201214.555.
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Zhabinsky, K. A. "“Case of S. Rachmaninoff – R. Pugno”: The Facts and Conjectures." In IV Международный научный форум "Наследие". SB RAS, 2023. http://dx.doi.org/10.25205/978-5-6049863-7-0-81-104.
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Until very recently, the idea that the relationship between S. Rachmaninoff and R. Pugno was not very close dominated musical and cultural studies. The situation changed in the late 2010s – early 2020s when some researchers put forward a hypothesis about Rachmaninoff’s “involvement” in the tragic death of Pugno, which occurred in Moscow during a tour in 1913. They stated that Rachmaninoff allegedly refused to help a seriously ill French colleague who asked to replace him in the announced concert program. This situation caused financial difficulties for Pugno and maybe even his sudden death (from a heart attack). The article analyzes the limited and incomplete source base underlying such statements and highlights the obviously biased interpretation of the few archival materials supporting this hypothesis. It makes an alternative assumption regarding the possible source of the allegations against Rachmaninoff, which requires further verification based on archival research.
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Baloyi, Lesiba, and Molebogeng Makobe-Rabothata. "The African Conception of Death: A Cultural Implication." In International Association of Cross Cultural Psychology Congress. International Association for Cross-Cultural Psychology, 2014. http://dx.doi.org/10.4087/frdw2511.
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From an African perspective death is a natural transition from the visible to the invisible spiritual ontology where the spirit, the essence of the person, is not destroyed but moves to live in the spirit ancestors’ realm dead. It signifies an inextricable spiritual connection between the visible and invisible worlds. This chapter focuses on how traditional Africans conceive and deal with the bereavement process. We adopt the African worldview and philosophy as our framework. We dispute the often held view in mainstream psychology that behavior, in this case the concept of death and the bereavement processes have universal applicability, articulation, representation and meaning. For Africans, death is accompanied by a series of the performance of rituals which connect the living dead and the living. Two case studies are presented and discussed to illustrate the African conception of death, its meaning, significance and accompanying mourning rituals and process. We approach the participants’ stories from a qualitative narrative inquiry viewpoint as our methodology. The experiences in the participants’ stories in the workplace reveal that African indigenous ways of dealing with death are still not recognized, respected and understood in organizations which have a dominant Western culture.
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Kshirsagar, J. T., and S. G. Joshi. "Investigation of Air Entrainment: A Numerical Approach." In ASME/JSME 2003 4th Joint Fluids Summer Engineering Conference. ASMEDC, 2003. http://dx.doi.org/10.1115/fedsm2003-45415.
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The air entrainment in sumps (Pump Intake) is a commonly observed phenomenon at low water level and high Froude number corresponding to flow rates higher than the rated flow. The air entrainment initiates with the formation of small vortex like structure on the surface with its position varying in the vicinity of Pump intake portion. Normally it calls for two-phase flow analysis (and possibly transient also) to correctly predict the air entrainment phenomenon using computational fluid dynamics approach. We at CRED, Kirloskar Brothers Limited could predict the root cause for air entrainment by studying the vortex formation well within the flow. A single-phase steady state flow was analyzed. Two test cases were studied. IOWA University had published a sump case with results from computational fluid dynamics studies. The other case was the actual sump model study carried out using experimental setup wherein the air entrainment was observed. The paper presents the comparison of the predictions with results from these two test cases.
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Vakhrusheva, T. I. "POST-MORTAL ESTABLISHMENT OF THE CAUSES OF INTERNAL DEATH OF DOUBLE FRUITS IN A MALE." In DIGEST OF ARTICLES ALL-RUSSIAN (NATIONAL) SCIENTIFIC AND PRACTICAL CONFERENCE "CURRENT ISSUES OF VETERINARY MEDICINE: EDUCATION, SCIENCE, PRACTICE", DEDICATED TO THE 190TH ANNIVERSARY FROM THE BIRTH OF A.P. Stepanova. Publishing house of RGAU - MSHA, 2021. http://dx.doi.org/10.26897/978-5-9675-1853-9-2021-31.
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The article describes a case of intrauterine death of twin fetuses in a multiple pregnancy in a mare, presents the results of postmortal diagnostics with the establishment of the causes of miscarriage, studies the picture of changes in organs and tissues, reveals cause-and-effect relationships between pathological processes and the mechanism of death.
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Nakano, Bruno Eiji, Gabriel Flamarin Cavasana, Paula Carolina Grande Nakazato, Sarah de Souza Chinelato, Rodrigo Batista Irikura, Bruna Santos Silva, Anouar Sacca Colognesi, et al. "Cryptococcal meningoencephalitis: case report." In XIV Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2023. http://dx.doi.org/10.5327/1516-3180.141s1.784.
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Case presentation: A 44-year-old male, retired, schizophrenic, living in an urban area, with a recent history of hospitalization due to hypokalemia, was admitted to the emergency due to paresis in lower limbs for three days associated to dysarthria and somnolence. He was confused, presenting nuchal rigidity, divergent strabismus to the left and hypoesthesia in the right lower limb. Magnetic resonance imaging of the brain showed acute periventricular ischemic events, semi-oval centers, mesencephalon and pons; human immunodeficiency virus negative (2 samples); cerebrospinal fluid (CFS): pleocytosis 123 (L49%/N48%/M8%), glucose < 5, protein 103, fungal survey suggestive of Cryptococcus sp (China ink positive), cryptococcal antigen titer: >1/1024, cultures negative. Initiated Amphotericin B and Fluconazole evolved with deteriorating clinical condition to death. Discussion: Cryptococcal meningoencephalitis is the main presentation in immunocompetent patients, usually caused by Cryptococcus gattii. The clinical presentation is assorted and may include fever, central nervous system signs or symptoms such as headache, behavioral changes, memory loss, and lethargy. Diagnosis is based on CSF analysis with China ink evaluation, its’ routine studies, fungal culture and cryptococcal antigen testing. The treatment consists of Amphotericin B in association to Fluconazole by, at least, 14 days. The outcome depends on the degree of immunocompetence, associated diseases, CSF/serum cryptococcal antigen titer. Final considerations: The relevance of the case considers the patient’s age and its rapid evolution, despite the protocoled therapeutic measures, emphasizing the importance of early identification and treatment of the neuroinfection.
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Kapadia, Ramesh, and Ayse Aysin Bilgin. "Learning From COVID-19." In Bridging the Gap: Empowering and Educating Today’s Learners in Statistics. International Association for Statistical Education, 2022. http://dx.doi.org/10.52041/iase.icots11.t6c3.
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People’s lives have been severely disrupted by COVID-19, with high numbers in hospitals and many deaths after the initial outbreak in China. If the efforts of many statistics educators were fulfilled to increase the number of statistically literate citizens who can make evidence-based decisions based on accurate data, we may have had lower infection and death rates. Unfortunately, the data is rather unreliable, especially with the use of self-testing and reporting. In this paper, we assert that statistics requires context to quantify risk. We present data and a summary of developments in Australia and England with the hope that case studies can be developed for students to understand risk better.
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Buchanan, J. R., P. W. Longest, S. Hyun, and C. Kleinstreuer. "Computational Analysis of Indicator Functions for Intimal Thickening in Branching Blood Vessels." In ASME 1999 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 1999. http://dx.doi.org/10.1115/imece1999-0367.
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Abstract Intimal thickening and thrombi formation in medium to large blood vessels due to atherosclerotic lesions and/or intimal hyperplasia are the leading causes of death in the western world. Balloon angioplasty with stenting, bypass surgery and patch reconstruction are some of the mechanical techniques currently applied to reopen or bypass occluded blood vessels. Thus, it is of interest to develop suitable indicator functions which encapsulate aggravating flow patterns, in order to determine susceptible sites of intimal thickening and/or thrombi formation. These indicator functions are then applied in four case studies to interprete experimental/clinical data of intimal thickening and design blood vessel geometries which potentially improve long-term patency rates.
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Ivanov, Zhanna A., Robert C. Scott, Jenna Rosano, Barbara Krynska, and Mohammad F. Kiani. "Engineering Cardiac Tissue Using Stem Cell Therapy to Mend the Broken Heart." In ASME 2009 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2009. http://dx.doi.org/10.1115/sbc2009-203624.
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Myocardial infarction (MI) is one of the most severe forms of coronary artery disease and is the leading cause of death in the United States [1]. Current treatments for an MI are either highly invasive, such as coronary artery bypass grafting and stent angioplasty, or might have undesirable long-term effects as is the case with pharmacological interventions. However, newly emerging methodologies, such as a less invasive stem cell therapy, aim to cure the disease rather than just alleviate its symptoms. This new tissue engineering technology has shown promise in restoring the homeostasis of the heart muscle after MI in preclinical and clinical studies [2]. However, controversies regarding inconsistent methodologies and a lack of mechanistic understanding of its actions have hampered progress in this field [3].
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Kucuk, Ezgi, and Ayşe Sema Kubat. "Rethinking Urban Design Problems through Morphological Regions: Case of Beyazıt Square." In 24th ISUF 2017 - City and Territory in the Globalization Age. Valencia: Universitat Politècnica València, 2017. http://dx.doi.org/10.4995/isuf2017.2017.6179.
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Rethinking Urban Design Problems through Morphological Regions Ezgi Küçük¹, Ayşe Sema Kubat² ¹Urban Planning Coordinator, Marmara Municipalities Union ²Prof., Dr., Istanbul Technical Univercity, Faculty of Architecture, Department of City and Regional Planning E-mail: ezgikucuk89@gmail.com, kubat@itu.edu.tr Keywords: the Historical Peninsula, morphological regions, urban blocks, urban design, Beyazıt Square Conference topics and scale: Urban form and social use of space The concept of urban square is a debated issue in the context of urban design practices in Islamic cities. Recognizing the relation between urban morphology and urban design studies in city planning and urban design practices is highly vital. Beyazıt Square, which is the center of the city of Istanbul, could not be integrated to the other parts of the city either configurationally or socially although many design projects have been previously planned and discussed. In this study, the Historical Peninsula of Istanbul is observed as an essential unit of the traditional path reflecting each civilization, namely Roman, Byzantium, Ottoman and Republic of Turkey that have been settled in the region. Transformations in urban blocks in Beyazıt region are elaborated through a series of morphological analyses based on the Conzenian approach of urban morphology. Morphological regions of the Historical Peninsula are identified and Beyazıt region is addressed in detail in terms of the transformations in urban block components, that are; street, plot and buildings. The effects of surrounding units which are the mosque, university buildings, booksellers and Grandbazaar on Beyazıt Square are discussed according to the morphological analyses that are applied to the region. Previous design practices and the existing plan of the area are observed through the analyses including town plan, building block, and land use and ownership patterns. It is revealed that existing design problems in Beyazıt Square come from the absence of urban morphological analyses in all planning and design practices. Through morphological regions as well as the conservation plans, urban design projects can be reconsidered. References Baş, Y. (2010) ‘Production of Urbanism as the Reproduction of Property Relations: Morphologenesis of Yenişehir-Ankara’, PhD thesis, Middle East Technical University. Barret, H.J. (1996) ‘Townscape changes and local planning management in city conservation areas: the example of Birmingham and Bristol’, PhD thesis, University of Birmingham. Bienstman, H. (2007) ‘Morphological Concepts and Landscape Management: The Cases of Alkmaar and Bromsgrove’, PhD thesis, University of Birmingham. Conzen, M.R.G. (1960) Alnwick Northumberland: a study in town-plan analysis, Institute of British Geographers, London. Conzen, M.R.G. (2004) Thinking About Urban Form: papers on urban morphology 1932-1998, Peter Lang, Bern. Çelik, Z. (1993) The Remaking of Istanbul: Portrait of an Ottoman City in the Nineteenth Century, University of California Press, Berkeley. Günay, B. (1999) Property Relations and Urban Space, METU Faculty of Architecture Press, Ankara. Kubat, A.S. (1999) ‘The morphological history of Istanbul’, Urban Morphology 3.1, 28-41. Noziet, H. (2008) ‘Fabrique urbaine: a new concept in urban history and morphology’, Urban Morphology, 13.1, 55-56. Panerai, P., Castex, J., Depaule, J. C. and Samuels, I. (2004) Urban Forms: The Death and Life of the Urban Block, Architectural Press, Oxford. Tekeli, İ. (2010) Türkiye’nin Kent Planlama ve Kent Araştırmaları Tarihi Yazıları, (Articles of Turkey’s History of Urban Planning and Urban Studies), Tarih Vakfı Yurt Yayınları, Istanbul. Whitehand, J.W.R. (2001) ‘British urban morphology: the Conzenian tradition’, Urban Morphology 5.2, 3-10. Whitehand, J.W.R. (2009) ‘The structure of urban landscapes: strengthening research and practice’, Urban Morphology 13.1, 5-22.
Reports on the topic "Brothers – Death – Case studies"
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Candrilli, Sean D., and Samantha Kurosky. The Response to and Cost of Meningococcal Disease Outbreaks in University Campus Settings: A Case Study in Oregon, United States. RTI Press, October 2019. http://dx.doi.org/10.3768/rtipress.2019.rr.0034.1910.
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Invasive meningococcal disease (IMD) is a contagious bacterial infection that can occur sporadically in healthy individuals. Symptoms are typically similar to other common diseases, which can result in delayed diagnosis and treatment until patients are critically ill. In the United States, IMD outbreaks are rare and unpredictable. During an outbreak, rapidly marshalling the personnel and monetary resources to respond is paramount to controlling disease spread. If a community lacks necessary resources for a quick and efficient outbreak response, the resulting economic cost can be overwhelming. We developed a conceptual framework of activities implemented by universities, health departments, and community partners when responding to university-based IMD outbreaks. Next, cost data collected from public sources and interviews were applied to the conceptual framework to estimate the economic cost, both direct and indirect, of a university-based IMD outbreak. We used data from two recent university outbreaks in Oregon as case studies. Findings indicate a university-based IMD outbreak response relies on coordination between health care providers/insurers, university staff, media, government, and volunteers, along with many other community members. The estimated economic cost was $12.3 million, inclusive of the cost of vaccines ($7.35 million). Much of the total cost was attributable to wrongful death and indirect costs (e.g., productivity loss resulting from death). Understanding the breadth of activities and the economic cost of such a response may inform budgeting for future outbreak preparedness and development of alternative strategies to prevent and/or control IMD.
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Gao, Jiang-Ping, Wei Guo, and Hong-Peng Zhang. Prevalence and Prognostic Associations of Early Postoperative Stroke and Death among Patients Undergoing Inner Branched Thoracic Endovascular Repair of Aortic Arch Pathologies: A systematic Review and Meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, August 2022. http://dx.doi.org/10.37766/inplasy2022.8.0010.
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Review question / Objective: To assess the prevalence and associations of early postoperative stroke and death among patients undergoing inner branched thoracic endovascular aortic repair (TEVAR) of arch pathologies. Eligibility criteria: Our including criteria are as follows: 1) Patients with aortic arch pathologies, who were judged unfit for open surgery in a multidisciplinary path; 2) using inner branched TEVAR for the endovascular repair. 3) report the prevalence of 30-day postoperative stroke or death as result. Excluding criteria: 1) combined with fenestration or chimney in TEVAR; 2) full-text unavailable; 2) case reports with fewer than three cases; 3) studies with an only reconstruction of the left subclavian artery (LSA) rather than innominate artery or left common carotid artery (LCCA).
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Newman-Toker, David E., Susan M. Peterson, Shervin Badihian, Ahmed Hassoon, Najlla Nassery, Donna Parizadeh, Lisa M. Wilson, et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), December 2022. http://dx.doi.org/10.23970/ahrqepccer258.
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Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.
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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
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Focusing on Multiple Micronutrient Supplements in Pregnancy: Second Edition. Sight and Life, May 2011. http://dx.doi.org/10.52439/uznq4230.
Full textAbstract:
Despite marked progress in improving nutrition and health globally, micronutrient deficiencies remain prevalent in low and middle income countries (LMIC), especially among pregnant women with far-reaching consequences for mother and baby including preterm birth, stillbirth or neonatal death, impaired fetal growth. Multiple micronutrient supplements (MMS) taken during pregnancy provide 15 vitamins and minerals to fill the dietary gaps often present in LMIC and the increased nutrient needs of pregnancy. Crucially, MMS provide benefits far beyond those of traditional iron and folic acid supplements (IFA) – prompting the World Health Organization to add the UNIMMAP (United Nations International Multiple Micronutrient Antenatal Preparation) MMS formulation to its Essential Medicines List (EML) in 2021. The Sight and Life Special Report, Focusing on Multiple Micronutrient Supplements in Pregnancy: Second Edition puts forth a compelling case that maintaining the status quo of IFA supplementation is no longer possible when so many stand to benefit from MMS, and demonstrates the benefits and process of switching to MMS. The report compiles the latest evidence, country case studies, and resources in a single place to support implementers and country governments in introducing and scaling-up MMS.