Academic literature on the topic 'Sisters – Death – Case studies'

Multiple bereaved adult children, as siblings, have rarely been studied. We expand the paradigm of bereavement research to explore the ways that two sisters describe the experience and meaning of the death of their elderly father. The two sisters each participated in two separate qualitative ethnographic interviews, followed by standard qualitative analyses of the transcribed narratives. The findings yield contrasting perspectives of the sisters' disparate views of their family, of their father, and their views of each other, that provide insight into the complexity of the sharp differences in their reactions to their father's death. Their views of their father's death reflected their particular relationship with their father, their non-shared experiences over the life course, and their personal world views. Differences and contradictions in the views of multiple siblings can broaden our understanding of bereavement and of the processes central to parent-child ties at the end of life.

We report the case of an Italian family in which three sisters experienced transient global amnesia (TGA). Since its early description, this transitory pure memory deficit has attracted increasing interest, especially within the neurological community. In 1964 the term “TGA” was coined to identify the abrupt onset of anterograde amnesia, accompanied by repetitive queries lasting for hours and then gradually recovering, leaving an amnesic gap for the duration of the attack. Afterwards, many studies focused on TGA, and in 1990 clinical criteria were defined by Hodges and Warlow (1990). Further studies showed that meeting diagnostic criteria was a significant predictor for a better outcome than in other forms of transient amnesia, while amnesic patients who did not fulfil the TGA criteria had different outcomes. Precipitating and trigger events for TGA were identified and divided into physical and psychological factors (Inzitari et al., 1997; Quinette et al., 2006). Physical precipitants were found to be gardening, housework and sawing wood, contact with water and changes in body temperature occurring during hot baths or showers, or a cold swim at the swimming pool. Emotional trigger events included a major life or death event, emotional stress triggered by a gastric endoscopy, an exhausting work session, and anxiety resulting from conflicts at home or at work, health problems and money worries. Several hypotheses have been proposed for its pathogenesis such as psychogenic, venous dysfunction due to jugular venous valve incompetence, or ischemic aetiology, but the enigma of TGA still needs to be unravelled (Lewis, 1998; Akkawi et al., 2001).

Since Jessica Mitford’s 1963 scathing critique of the mortuary business in the United States, there has been an ongoing debate about how best to honor and dispose of the dead in ways that do not exploit people. However, the backlash to predatory mortuary practices led to an impersonal and detached process culminating in online purchasing of post-mortem services. More recently, this discussion has expanded to consider the resulting psychological and spiritual detachment around end-of-life, and a return to natural, simple, and fully engaged burial practices, known as “Green Burial”, are being reintroduced and practiced. While many Catholic cemeteries still call the use of embalming and concrete vaults “traditional burial”, these expensive and unnecessary practices are only 150 years old and have significantly affected the natural environment. A different “traditional burial” is possible when using the model of Francis of Assisi himself who offers a more intimate model of dying and death by embracing his own death and calling it, “Sister Death”. This article will use the interdisciplinary approach of Christian Spirituality to explore the Franciscan concern with creation and link it to the burgeoning practice of Green Burial. A discussion of a Franciscan congregation that initiated the practice for their own sisters, the FSPA in La Cross, Wisconsin, will offer a concrete example of rationale, best practices, and challenges for those considering this as a personal option or as a community endeavor.

The present study intends to look at the ways in which humour enacts modes of knowledge and self-expression in Katherine Mansfield’s short story “The Daughters of the Late Colonel” (1921). The story revolves around two spinsterly sisters who have spent most of their lives tending to their tyrannical father and now find themselves at a loss when they are finally free of him. The narrative is both sympathetic and merciless towards the sisters’ fumbling attempts at independence, but the women are often in on the joke; humour is both a “black dressing-gown” which envelops the sisters and renders them objects of ridicule, but it is also a way out, offering a subversive counterpoint to the voice of the Father, as the sisters imagine the patriarch in very comical and undignified positions, while perceiving themselves as outsiders, “creeping off…like black cats”. Though the short story has often been read in terms of hopelessness and despair by Rhoda B. Nathan and Gerri Kimber, this paper wishes to show how humour modulates and moderates this hopelessness, allowing for the two single women to assert their personality within the stifling society of their time. The ridiculous, in this case, does not need to be a death sentence, but rather a form of knowledge and resistance: the spinsters are aware of the absurdity of their condition and the futility of their place in the modern world and choose comedy over tragedy.

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.

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.

The cblC defect is the most common inborn error of cobalamin (Cbl) metabolism. Clinical severity and presentation of the cblC defect ranges from death to mild disability. Only 71 cases of late-onset cblC defect have been described in the literature. We provide the 41-year follow up of two siblings with a late-onset cblC defect, first described after initial diagnosis in 1996. While one of the siblings showed initial symptoms resembling multiple sclerosis with a good response to corticosteroids, the other sister showed only subclinical signs of the disease. The course of the first case was characterized by a severe deterioration and intensive-care therapy after respiratory failure. After diagnoses and Cbl treatment, the patient survived and showed a pronounced improvement of the symptoms. Both sisters have an active life and gave birth to healthy children. The reason for the initial improvement after corticosteroids could not be explained by the classical metabolic pathways of Cbl. Recent studies have suggested that Cbl plays an important role as a regulator of the balance between neurotrophic and neurotoxic factors in the central and peripheral nervous system (CNS and PNS). This first long-term follow up revealed that ultra-high-dose intramuscular Hydroxocobalamin (OH-Cbl) treatment can effectively protect patients from disease progression. It underlines the importance of diagnostic vigilance and laboratory work up even in cases without typical hematologic signs of Cbl deficiency. Cbl-related diseases are often a chameleon and must always be considered in the differential of demyelinating diseases of the PNS and CNS. The case supports the theory that it is not only the classical biochemical pathways that play a key role in Cbl deficiency, especially with regard to neurological symptoms.

Abstract In marked contrast to contemporary eighteenth-century cultural and political inscriptions of the body, the Moravians articulated a radical body dialectic in which the natural manifestations of manhood and womanhood were considered to be integral elements of manifested spiritual consciousness. However, the positive corporeality of eighteenth-century Moravian faith attracted fierce criticism to the group, as the hyper-realistic linguistic and artistic depictions of the significance of the crucified Christ gave rise to virulent attacks on the ethical practices of the Moravian Church. From Goethe's age until now, both the parties of reason and religion have been fundamentally threatened by the intertwining of faith and the body and the concomitant spiritual and religious enactment in the Moravian Church. Tire Principia and the Instructions that were compiled by the synods directly after Zinzendorf's death constitute unique examples of a codification of what had been a tradition and rite within the renewed church since its very inception in 1722. This article examines the implementation of the Instructions specifically within the older girls' choir, the content of the Instructions, and explores the memoirs of eighteenth-century Bethlehem sisters for evidence of their efficacy.

This paper examines the literary representation of the beginnings of the Northern Irish Troubles with regard to a gender variable (women’s roles and functions ascribed to them, mostly punitively, by men ), in the selected poems by Heaney, Durcan, Boland, Meehan and Morrissey. The reading of Heaney’s “Punishment” will attempt to focus not solely on the poem’s repeatedly criticized misogyny but on analyzing it in a broader, historical context of the North’s conflict. In Durcan’s case, his prominent nationalist descent or his declared contempt for any form of paramilitary terrorism (including the IRA) do not seem to prevent him entirely from immortalizing female victims of the Troubles. Boland’s attitude seems the most unequivocal: the clear aversion to the language of death and rendering Irish women’s experiences (and children’s) in this discourse. The article concludes with analysis of Meehan’s “Southern” guilt for the situation of Catholics in the North with the simultaneous critique of perpetrated violence and Morrissey’s complicated standpoint: atheist/neutral/Protestant/communist and her striving for the impossible impartiality in a war-ridden and politically divided country. Trying to avoid systemic victimization of Irish women, the paper intends to analyze the historical and political circumstances which made them more susceptible to various forms of attacks at the beginnings of the Troubles, as reflected in the titular labels.

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

This study provides an account and analysis of the role of women in the African Methodist Episcopal Church and discusses their attempts to achieve equal status with men in service to and leadership in the church. The study also examines and analyzes the personal style, skills and abilities of each of the women bishops and assesses the factors that led to her election. A case study approach was used to explain the causal links that have led to the historic election of three women bishops; to describe the context in which this event has occurred; to explore the issues and outcomes of women's efforts to gain leadership in the church; and to evaluate the likelihood that these elections signify far-reaching changes in the policy of the African Methodist Episcopal Church. The researcher found that the progress of women within the African Methodist Episcopal Church has been slow but consistent throughout the history of the church, and that changes in society as well as within the church itself have culminated in the election of women as bishops. Although future elections of women can be expected based on events to date, the researcher did not achieve a definitive assertion from the women bishops that they intend to actively engage in the promotion of the advancement of women in the African Methodist Episcopal Church.

Abstract Presently there are few studies that describe the current experiences of women warriors relative to issues such as sexual hostility, sexual harassment, and other uncommon experiences during their military careers. Very little is known about how being a woman in a male-dominated military may affect women warriors' choices between making the military a career or returning to civilian life. With better understanding of women warriors' military experiences, mental health professionals, educators, and other human services professionals may have a better understanding of the issues that may affect women in the military. To date there are limited studies that have examined the effects of military experiences on the psychological and emotional well-being of women warriors. Whether its effects are positive, negative, contextual, or permanent is not yet known. This study supports the earlier research regarding the needs and unknown needs of women programs and the training of counselors and helping professionals. With the United States Military being one of the largest special populations, and women warriors making up 15% of that population, it is imperative that appropriate training becomes available for counselors, educators, and other helping professionals.

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.

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.

Thesis (MEdPsych)--Stellenbosch University, 2008.<br>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.<br>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.

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.

Thesis (MEdPsych (Educational Psychology)--University of Stellenbosch, 2009.<br>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.

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.

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.

The dissemination of fake news is a problem that has already been addressed but by no means is solved. After the manipulation made by Cambridge Analytica which was based on classifying users by their political views and targeting specific political propaganda on the Brexit campaign, the Trump election and the Bolsonaro election, there is no doubt this issue can have a real impact on society in ‘normal times’. During a pandemic, any type of fake news can be the difference between life and death when the data shared can directly hurt the people who are believing in it. Moreover, there is also a new trend of using artificial robots to disseminate such news with a special target on Twitter which can be linked with political campaigns. Thus, it is essential that we identify and understand what kind of news is selected to be 'dressed' as fake and how it is disseminated. This paper aims to investigate the dissemination of fake news related with Covid-19 in the UK and Brazil in order to understand the impact of fake news on public sector actions, social isolation and quarantine imposition. Those two case studies are well versed on the fake news dissemination. Our initial dataset of Twitter posts have focused on posts from four different cities (Natal, São Paulo, Sheffield and London) and have shown interesting pointers that will be discussed.

The dissemination of fake news is a problem that has already been addressed but by no means is solved. After the manipulation made by Cambridge Analytica which was based on classifying users by their political views and targeting specific political propaganda on the Brexit campaign, the Trump election and the Bolsonaro election, there is no doubt this issue can have a real impact on society in ‘normal times’. During a pandemic, any type of fake news can be the difference between life and death when the data shared can directly hurt the people who are believing in it. Moreover, there is also a new trend of using artificial robots to disseminate such news with a special target on Twitter which can be linked with political campaigns. Thus, it is essential that we identify and understand what kind of news is selected to be 'dressed' as fake and how it is disseminated. This paper aims to investigate the dissemination of fake news related with Covid-19 in the UK and Brazil in order to understand the impact of fake news on public sector actions, social isolation and quarantine imposition. Those two case studies are well versed on the fake news dissemination. Our initial dataset of Twitter posts have focused on posts from four different cities (Natal, São Paulo, Sheffield and London) and have shown interesting pointers that will be discussed.

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.

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.

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.

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 &lt; 5, protein 103, fungal survey suggestive of Cryptococcus sp (China ink positive), cryptococcal antigen titer: &gt;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.

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.

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.

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].

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.

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).

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.

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.

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.