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Negotiating the middle years: ego-resiliency and successful midlife adjustment in women.

Midlife is a time of heightened reevaluation and reorientation during which individuals are faced with potentially stressful changes and turning points. Ego-resiliency (ER) is proposed to be a powerful personality resource that enables individuals to adaptively negotiate the challenges of this period. Through examination of data from 2 longitudinal samples of women (N = 208), Study 1 examined whether observer-based and self-reported ER assessed at the beginning of midlife (at age 43) can predict life adjustments of specific relevance to this period assessed in late middle age (ages 52 and 48). In Study 2 age 43 ER was used to predict directional changes in central life adjustments and feelings about life over this same period (between ages 43 and 52). Predictions across samples, across measures of ER, or both were confirmed by replicated findings.

Adult↗

Negotiating deaf-hearing friendships: coping strategies of deaf boys and girls in mainstream schools.

BACKGROUND: Increasingly, deaf students are educated in mainstream school environments. This poses a question of how deaf children negotiate the demands of forming friendships with their hearing peers. The present study was designed to examine coping strategies of 35 deaf children attending full or partial mainstream school settings. METHOD: Using a qualitative analysis design, a range of coping strategies used by the children was described based on parents' reports. The relative success of these coping strategies in establishing relationships with hearing peers was assessed by examining strategies that increased the social success of deaf girls and boys. RESULTS: The results showed differences by gender in the effectiveness of coping strategies used by the participants. Deaf girls who were confident and frequently asked for clarifications or who were comfortable playing alone tended to achieve good relationships with hearing peers. In contrast, deaf boys' relationships with hearing peers benefited mostly from the boys' ability to perform well in sports. CONCLUSIONS: These findings are discussed in light of existing research on coping and current debates on the benefits of mainstreaming for deaf children.

Adaptation, Psychological↗

Goal negotiation with older people in three day care settings.

Drawing on a wider study of effectiveness in three models of day care, this paper explores the process and outcome of goal negotiation with older people in a day hospital, an outreach service and a day centre. Using qualitative data from interviews with day care attenders and focus groups with service providers, differing perspectives on goal setting and achievement are presented. It concludes with a brief discussion of this approach in the wider context of promoting older people's participation in decision-making in day care settings, where the espoused emphasis is on maintaining and maximising personal autonomy and independent living.

Journal Article↗

A randomized control trial of the effect of negotiated telephone support on glycaemic control in young people with Type 1 diabetes.

AIM: To evaluate changes in self-efficacy for self-management in young people with Type 1 diabetes participating in a "Negotiated Telephone Support" (NTS) intervention developed using the principles of problem solving and social learning theory. METHODS: One-year RCT with 79 young people (male 39; mean age +/- sd 16.5 +/- 3.2 years, duration 6.7 +/- 4.4 years, HbA(1c) 8.6 +/- 1.5%) randomized into: Group 1 (control group), continued routine management, n = 28; Group 2, continued routine management with NTS, n = 25; Group 3, annual clinic with NTS, n = 26. OUTCOME MEASURES: HbA(1c), self-efficacy, barriers to adherence, problem solving, and diabetes knowledge. RESULTS: There were no differences between the groups at baseline. Participants in Groups 2 and 3 received an average of 16 telephone calls/year (range 5-19), median duration 9 min (2-30), with a median interval of 3 weeks (1-24) between calls. Significant correlations were found between age and average length of call (r = 0.44, P < 0.01) and frequency of contact (r = 0.36, P < 0.05). Social and school topics were discussed frequently. After 1 year, while the participants in the two intervention groups showed significant improvements in self-efficacy (P = 0.035), there was no difference in glycaemic control in the three groups. Barriers to insulin use adherence were a significant predictor of HbA(1c) (P < 0.001) after controlling for baseline. CONCLUSIONS: NTS is an effective medium to deliver a simple theory-based psychological intervention to enhance self-efficacy for diabetes self-management. Reduced clinic attendance, combined with NTS, did not result in a deterioration of HbA(1c). Intensive personal support needs to be combined with intensive diabetes therapy to improve glycaemic control in this age group.

Adolescent↗

A comparison of foot/ground interaction during stair negotiation and level walking in young and older women.

Stair design and environmental conditions may play a role in slip accidents on stairs in the workplace, but little is known about the slip resistance requirements on stairs compared to level walking. Older adults have an increased risk of falling compared to younger adults and may be at greater risk during stair negotiation. The purpose of this study was to determine whether the ground reaction force profiles and peak required coefficient of friction (RCOF) differed between young and elderly women or between stair ascent, stair descent and overground walking. While there was a trend towards less risky stair descent behaviour in the older women in terms of their peak RCOF values during stair descent, the increased vertical loading rate in the older women may imply reduced dynamic balance control. The largest mean RCOF peaks occurred during stair ascent in both young and older women, but there were several overground walking trials in both groups and a few stair descent trials of the young women, which resulted in RCOF peaks greater than 0.5. These results should be considered when choosing stair surface materials, particularly in occupational and outdoor settings where the tread surfaces may become wet or contaminated.

Accidental Falls↗

Postmodern negotiations with medical technology: the role of midwifery clients in the new midwifery in Canada.

In 1994, after more than a century of uncertain legal status, the Province of Ontario legalized midwifery and incorporated midwives into the formal health care system. Midwifery is now accessible and publicly funded for all women experiencing "normal" uncomplicated pregnancy and birth. Yet midwifery's move from the margins into the mainstream health care system has brought many new challenges. Midwives must now contend with an expanded scope of practice; they use more medical technology both to fulfill their professional obligations and to respond to the choices of women. This and an increased accessibility to a wider clientele seem to work against midwifery as a critical, low-tech alternative to "technocratic birth." In this article, through re-telling and analyzing women's narratives of pregnancy and birth, I explore the role of midwifery clients in re-shaping midwifery's relationship to medical technology. Steering away from essentialist explanations that hold that women are either inherently opposed to technology by virtue of their closeness to nature or wholly oppressed by technology and the systems within which it is imbedded, my analysis focuses on women's agency (on what women do rather than on what is done to them). My study suggests that women act pragmatically both with regard to biomedical technology and to midwifery. I argue that women's negotiations with medical technology have been instrumental in re-shaping midwifery as a postmodern phenomenon.

Biomedical Technology↗

Helping adolescents who have disabilities negotiate transitions to adulthood.

Adolescents who have disabilities face unique challenges as they progress through the transitions necessary to achieve optimum functioning in adulthood. These youths often need professional assistance to successfully negotiate these important transitions. Our article describes processes for collaborating with these adolescents, their families, and other professionals to facilitate successful transitions to a more healthy, productive, and satisfying adulthood.

Adaptation, Psychological↗

The experiences of young Korean immigrants: a grounded theory of negotiating social, cultural, and generational boundaries.

The experiences of young Korean immigrants in the U.S. were explored through in-depth interviews with 19 participants. The research method employed was Grounded Theory whereby data collection and analysis were conducted concurrently. Study findings indicated that the young immigrants engaged in the process of negotiating social, cultural, and generational boundaries in order to adapt in the new country. Several structural and personal factors were identified as salient conditions of the process. These findings will help health care professionals have a better understanding of how young immigrants adapt in their new environment and what structural and personal conditions play a main role in this adaptation.

Acculturation↗

Negotiated safety: what you don't know won't hurt you, or will it?

People inject drugs for a variety of reasons, and most do not want to harm themselves in the process. Drug injectors develop rituals for 'low risk' drug-taking based on experience, information received, hearsay and ignorance. The rituals developed are not always able to be used due to the illegal nature of the activity. Understanding of the beliefs of injecting drug-users (IDUs) and the events that influence behaviour is a potential pathway for ameliorating this often hazardous act. Needle-sharing is now not a common behaviour although, if there are no new needles at the time of injecting, IDUs will still share needles, usually with sexual partners and 'close friends'. Other injecting equipment, such as spoons, filters, water, etc., are usually shared. IDUs, like all other drug users, make many assumptions and it appears that IDUs rarely negotiate their drug use to make it 'safer'.

Journal Article↗

Pharmacy management company-negotiated contract for drug information services.

University-based drug information services provided on a contractual basis to the pharmacies of a pharmacy management company are described. Allied Pharmacy Management, Inc. (APM), the manager of 34 institutional pharmacies, 3 community pharmacies, and 6 long-term-care and infusion therapy pharmacies, determined a need to contract for the services of a drug information center. Centers meeting basic criteria were invited to submit proposals. After careful research and negotiations, APM chose the University of Tennessee Drug Information Center for a one-year contract beginning in November 1992. Services provided under the contract include drug information consultations, formulary drug class reviews, new drug monographs, drug-use evaluation (DUE) criteria, literature reviews, and newsletters. Seven months after the contract went into effect, APM-affiliated pharmacy directors stated that they were either satisfied or very satisfied with the quality of the answers to drug information requests, the newsletters, and the drug monographs and agreed overwhelmingly that the contract should be renewed. The contract has been renewed for second and third years. During the first year, the drug information center answered 155 questions and took 121 hours to do so. In the second year there were 244 questions, requiring 161 hours. In year 1 there were 21 formulary class reviews, 6 newsletters, 5 new drug monographs, and 1 set of DUE criteria. There have been 20-25 literature searches during each contract year. The drug information services provided by a university-based drug information center under contract with a pharmacy management company satisfied the directors of the affiliated pharmacies.

Contract Services↗

Negotiating end-of-life decision making: a comparison of Japanese and U.S. residents' approaches.

PURPOSE: To compare Japanese and U.S. resident physicians' attitudes, clinical experiences, and emotional responses regarding making disclosures to patients facing incurable illnesses. METHOD: From September 2003 to June 2004, the authors used a ten-item self-administered anonymous questionnaire in a cross-sectional survey of 103 internal medicine residents at two U.S. sites in Los Angeles, California, and 244 general medical practice residents at five Japanese sites in Central Honshu, Kyushu, Okinawa, Japan. RESULTS: The Japanese residents were more likely to favor including the family in disclosing diagnosis (95% versus 45%, p<.001) and prognosis (95% versus 51%, p<.001) of metastatic gastric cancer. Of residents who favored diagnostic or prognostic disclosure to both the patient and family, Japanese residents were more likely to prefer discussion with the family first. Trainees in Japan expressed greater uncertainty about ethical practices related to disclosure of diagnosis or prognosis. Many Japanese and U.S. residents indicated that they had deceived a patient at the request of a family (76% versus 18 %, p<.001), or provided nonbeneficial care (56% versus 72%, p<.05), and many expressed guilt about these behaviors. CONCLUSIONS: The residents' approaches to end-of-life decision making reflect known cultural preferences related to the role of patients and their families. Although Japanese trainees were more likely to endorse the role of the family, they expressed greater uncertainty about their approach. Difficulty and uncertainty in end-of-life decision making were common among both the Japanese and U.S. residents. Both groups would benefit from ethical training to negotiate diverse, changing norms regarding end-of-life decision making.

Adult↗

Barn owl (Tyto alba) siblings vocally negotiate resources.

Current theory proposes that nestlings beg to signal hunger level to parents honestly, or that siblings compete by escalating begging to attract the attention of parents. Although begging is assumed to be directed at parents, barn owl (Tyto alba) nestlings vocalize in the presence but also in the absence of the parents. Applying the theory of asymmetrical contests we experimentally tested three predictions of the novel hypothesis that in the absence of the parents siblings vocally settle contests over prey items to be delivered next by a parent. This 'sibling negotiation hypothesis' proposes that offspring use each others' begging vocalization as a source of information about their relative willingness to contest the next prey item delivered. In line with the hypothesis we found that (i) a nestling barn owl refrains from vocalization when a rival is more hungry, but (ii) escalates once the rival has been fed by a parent, and (iii) nestlings refrain from and escalate vocalization in experimentally enlarged and reduced broods, respectively. Thus, when parents are not at the nest a nestling vocally refrains when the value of the next delivered prey item will be higher for its nest-mates. These findings are the exact opposite of what current models predict for begging calls produced in the presence of the parents.

Animals↗

Combining rate-adaptive cardiac pacing algorithms via multiagent negotiation.

Simulating and controlling physiological phenomena are notoriously complex tasks to tackle and require accurate models of the phenomena of interest. Currently, most physiological processes are described by a set of partial models capturing specific aspects of the phenomena, and usually their composition does not produce effective comprehensive models. A current open issue is thus the development of techniques able to effectively describe a phenomenon starting from partial models. This is particularly relevant for heart rate regulation modeling where a large number of heterogeneous partial models exists. In this paper we make the original proposal of adopting a multiagent paradigm, called anthropic agency, to provide a powerful and flexible tool for combining partial models of heart rate regulation for adaptive cardiac pacing applications. The partial models are embedded in autonomous computational entities, called agents, that cooperatively negotiate in order to smooth their conflicts on the values of the variables forming the global model the multiagent system provides. We experimentally evaluate our approach and we analyze its properties.

Adaptation, Physiological↗

Negotiating false memories: interviewer and rememberer characteristics relate to memory distortion.

In a recent study, more than half of the participants were led to create a partial or complete false memory for an emotional childhood event (e.g., serious animal attack). Using a subsample from that study, we examined the hypothesis that memory distortion is related to characteristics of interviewers and rememberers. The relations between susceptibility to memory distortion and (a) dissociation (Dissociative Experiences Scale) and (b) personality traits (NEO-Five Factor Inventory) were investigated. Results indicated that participants who exhibited memory distortion scored significantly higher on the dissociative scale than their counterparts who did not exhibit memory distortion. Further, susceptibility to memory distortion was associated with higher extraversion scores in interviewers and lower extraversion scores in participants. This pattern of findings suggests that false memories may derive from a social negotiation between particular interviewers and rememberers.

Adult↗

Negotiation of self and setting to advantage: an interactionist consideration of nursing home data.

This paper examines the dynamics of the process of negotiation in a nursing home by focusing on the process of gaining advantage. The concepts of primary and secondary advantage are introduced in order to allow comparison and organization of the data. In the course of examining what rewards are possible and how they are achieved, we are able to see that the impetus to treat and the control of treatment action often lies with the staff of the home rather than the physician, that officially imposed definitions may be unfavourable to the persons they are imposed upon and that the process of deciding on everyday activities is often complex.

Nursing Homes↗

Partition of distinct chromosomal regions: negotiable border and fixed border.

Chromosomes are partitioned into distinct functional regions. For example, heterochromatin regions consist of condensed chromatin and contain few transcriptionally active genes, whereas euchromatin regions are less condensed and majority of active genes reside in the euchromatin regions. Because distinct regions reside in each chromosome, borders are accordingly established between these regions. A prevailing view of the borders is that they are 'walls' that actively inhibit communication between distinct regions on chromosomes. Although little is known about the molecular bases of these walls, specific DNA elements are considered to recruit these walls to define the positions of the borders. We call the borders established with this mechanism as 'fixed borders'. Past studies have identified various insulators (boundary DNA elements) that have been suggested to recruit fixed borders to them. Another mechanism, which we introduce and focus on in this review, does not require walls recruited by specific DNA elements at the chromosomal borders. Instead, the borders are defined by a balance of opposing enzymatic activities located at the opposite sides of the resultant borders. We name these borders 'negotiable borders'. Here we review some of the recent progress in the field that offer valuable insight into mechanisms of establishing structural and functional borders on chromosomes.

Animals↗

Negotiating commitment and involvement in the nurse-patient relationship.

The relationship that is established between the nurse and the patient is the result of interplay or covert negotiations until a mutually satisfying relationship is reached. Depending on the duration of the contact between the nurse and the patient, the needs of the patient, the commitment of the nurse and the patient's willingness to trust the nurse, one of four types of mutual relationship will emerge: a clinical relationship, a therapeutic relationship, a connected relationship or an over-involved relationship. If the nurse is unwilling or unable to be committed to the patient, a unilateral relationship will develop, with the patient continuing to use manipulative or coercive behaviours, attempting to increase the nursing involvement in the relationship. If the patient is unwilling to trust the nurse and accept his or her illness situation, she or he will manifest 'difficult' behaviours, be withdrawn or elope. The changing nature of the relationship, and the conditions and consequences of each type of relationship are discussed.

Attitude of Health Personnel↗

Defining, navigating, and negotiating success: the experiences of mid-career Robert Wood Johnson Clinical Scholar women.

BACKGROUND: We studied female graduates of the Robert Wood Johnson Clinical Scholars Program (CSP, Class of 1984 to 1989) to explore and describe the complexity of creating balance in the life of mid-career academic woman physicians. METHODS: We conducted and qualitatively analyzed (kappa 0.35 to 1.0 for theme identification among rater pairs) data from a semi-structured survey of 21 women and obtained their curricula vitae to quantify publications and grant support, measures of academic productivity. RESULTS: Sixteen of 21 (76%) women completed the survey. Mean age was 48 (range: 45 to 56). Three were full professors, 10 were associate professors, and 3 had left academic medicine. Eleven women had had children (mean 2.4; range: 1 to 3) and 3 worked part-time. From these data, the conceptual model expands on 3 key themes: (1) defining, navigating, and negotiating success, (2) making life work, and (3) making work work. The women who described themselves as satisfied with their careers (10/16) had clarity of values and goals and a sense of control over their time. Those less satisfied with their careers (6/16) emphasized the personal and professional costs of the struggle to balance their lives and described explicit institutional barriers to fulfillment of their potential. CONCLUSION: For this group of fellowship-prepared academic women physicians satisfaction is achieving professional and personal balance.

Achievement↗