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PubMed2000

Stair negotiation in older people: a review.

Locomotion on stairs is among the most challenging and hazardous activities of daily living for older individuals. This is evidenced by the reports that stair falls account for more than 10% of fatal fall accidents. The demands that stairs place on the musculoskeletal and cardiovascular systems are compounded by the need for input from the somatosensory, visual, and vestibular systems at various stages in the task. Many of these collaborating systems deteriorate with aging, thus increasing the difficulty and risk of failure in a task that inherently involves exposure to significant danger. The task itself varies in its degree of challenge depending on many structural and environmental factors that are outside the control of the stair user. This review explores existing literature in the area of stair negotiation by older persons in an effort to define the key factors associated with difficulty and safety on stairs and to interpret these findings in the light of possible interventions that could increase stair safety. Further research is needed to ensure that current recommendations for stair design are suitable for older stair users. A Glossary of Terms is also provided.

Accidental Falls↗

PubMed1994

Enhancing patient well-being: advocacy or negotiation?

The United Kingdom Central Council for Nursing, Midwifery and Health Visitors (UKCC) document, Exercising Accountability, states that the role of patient's advocate is an essential aspect of good professional nursing practice (1). The author examines the case for and against the nurse being the best person to act as advocate, and critically evaluates the criteria of advocacy. The problematic moral issues arising are discussed, and a case made for negotiation between the members of the multidisciplinary team and the patient/client (or a significant person to the patient) in order to promote the well-being of the patient and to minimise suffering. She concludes that the health care professional's (including the nurse's) role is to help people to assert control over the factors which affect their lives, that is empowerment, rather than advocacy.

Cultural Diversity↗

PubMed1991

Effect of the angle of slope on the ease with which pigs negotiate loading ramps.

In experiments to investigate the time taken by pigs to negotiate ramps with different slopes it was found that they ascended with greater facility than they descended. Between 0 degrees and 20 degrees, the slope appeared to have little effect on the time taken to ascend or descend. Above 20 degrees the time taken to ascend increased linearly. The relationship between the time taken to descend and the slope above 20 degrees was biphasic with times increasing substantially above 35 degrees. There were also differences between the times taken on different days but no evidence of habituation. Pigs took longer to climb steeper ramps with wider spaces between cleats but there was no significant effect on the time taken to descend.

Animals↗

PubMed2006

Britain's genetically modified crop controversies: the Agriculture and Environment Biotechnology Commission and the negotiation of 'uncertainty'.

The genetically modified crop controversies in Britain between 1997 and 2004 involved tensions surrounding the role of science in policy. The author of the paper was a member of the Agriculture and Environment Biotechnology Commission, a novel government advisory body created in 2000, which played a central role in negotiating new policy frameworks. The commission was also a key influence in the creation and execution of the three-pronged official 'GM dialogue' in 2002 and 2003. New understandings of 'uncertainty', both scientific and social, emerged as a result. The outcomes have relevance for the future political handling of other technological fields, including human genetics.

Biotechnology↗

PubMed1995

Negotiating ureteral stenoses and kinks with a hydrophilic wire.

Negotiating a tortuous or obstructed ureter with a wire can be time-consuming and sometimes tiring. The principle of using a slippery floppy wire and then replacing it with a stiff wire through a 5-french open-ended ureteral catheter yields a high success rate. The ureteral catheter can be used for a radiocontrast study and allows access for a 0.035 'coaxial wire', which can be used as a guide wire for a single or double J stent.

Humans↗

PubMedDate not supplied

Teachers with LD: Ongoing negotiations with discourses of disability.

The purpose of this study is to examine how 4 teachers with learning disabilities (LD) negotiate multiple, complex, and sometimes contradictory discourses of disabilities in constructing their own understandings of LD. We chose to study teachers with LD because of their unique access to at least 3 different sources of knowledge about LD: (a) professional discourses on disability, (b) mainstream cultural messages about LD, and (c) insights gained from their own life experience. We drew on aspects of critical discourse analysis and narrative inquiry for this investigation. Our findings indicate that participants draw on these discourses and on their teaching experience in various and complex ways to construct meaning about LD. In some instances, participants use the dominant discourses; at other times, they work to subvert these meanings. Yet, paradoxically, whether speaking with or against these meanings, their voices are inescapably engaging with authoritative discourses and cultural scripts surrounding disability.

Adult↗

PubMed1977

Police negotiations. A new role for the community psychiatrist.

This paper reviews the type of individual who might be involved in a hostage situation and police negotations. It singles out those clinical characteristics which are important in determining the management of the negotiations, and in doing so adds a plea for psychiatrists to become involved in an advisory role. By pointing out the need for psychiatrists and police to review some of the problems and determine a common approach before the situations arise, an additional characteristic is added to the role description of the community psychiatrist.

Community Psychiatry↗

PubMed2004

Constructing agency in treatment decisions: negotiating responsibility in cancer.

People belonging to cancer patient support groups participated in focus groups concerning their experiences of orthodox and complementary medicine. Their accounts of treatment decisions for cancer were analysed through discourse analysis. Accounts of both complementary and orthodox medicine addressed an ideological dilemma concerning the positioning of individuals as active or passive. Active positions were congruent with the everyday value of autonomy and responsible individuality, but conflicted with the established expertise of the medical profession in cancer and entailed being accountable for one's health. Passive positions reversed this situation. Complementary medicine provided an opportunity for people with cancer to negotiate active positions in a limited domain of health care. The responsibility for health associated with taking active treatment decisions was problematic in accounts of both orthodox and complementary medicine.

Aged↗

PubMed1982

Antitrust law and collective physician negotiations with third parties: the relative value guide object lesson.

This article examines the role of collective physician participation in the third-party reimbursement system. It critiques the Havighurst-Kissam analysis of the antitrust implications of professionally-developed relative value guides and, using lessons derived from the only litigated case on relative value guides, argues that collective physician input into third-party reimbursement plans can be made in a manner which is consistent with the antitrust law as and cost-containment policy objectives. In particular, collective "negotiations" by organized physicians with third parties, unaccompanied by fee agreements among physicians or by actual or threatened physician boycotts, are found to be procompetitive and hence permissible under the rule of reason.

Anesthesiology↗

PubMed2004

Negotiating brain anoxia survival in the turtle.

The turtle brain's extraordinary ability to tolerate anoxia is based on constitutive and expressed factors. Constitutive factors that predispose for anoxia tolerance include enhanced levels of glycogen stores, increased densities of protective receptors, elevated antioxidant capacities and elevated heat shock protein. However, to survive an anoxic insult, three distinct phases must be negotiated successfully. (1) A coordinated downregulation of ATP demand processes to basal levels. This phase, which takes 1-2 h, includes a reduction in voltage-gated K(+) (Kv) channel transcription and a substantial increase in Hsp72 and Hsc73 levels. During this period, adenosine and K(ATP) channels mediate several key events including channel arrest initiation and a reduction in the release of excitatory amino acids (EAAs). (2) Long-term survival (days) at basal levels of ATP expenditure. Neuronal network integrity is preserved through the continued operation of core activities. These include periodic electrical activity, an increased release of GABA and a continued release of glutamate and dopamine. Adenosine and GABA modulate the glutamate release. There is a further increase in Hsc73, indicating a 'housekeeping' role for this protein during this period. (3) A rapid upregulation of neuronal processes when oxygen becomes available to restore full function, together with the activation of protection mechanisms against reperfusion-generated reactive oxygen species.

Adenosine Triphosphate↗

PubMedDate not supplied

Managing awareness: negotiating and coping with a terminal prognosis.

This study examined the way in which a terminal cancer prognosis was negotiated by patients and their lay carers, and the complexities involved in managing a context of awareness. Individual semi-structured interviews were undertaken with 16 patients and 14 lay carers. These were transcribed verbatim and analysed using a grounded theory approach. The process started with being given bad news, when the concept of life was no longer open-ended. The need to maintain hope influenced the amount of information sought by patients and their families and was an important strategy in helping patients cope with the knowledge of their disease. Levels of awareness appeared to be influenced less by setting, than by the way the prognosis was managed within individual families. Difficulties facing patients and carers in knowing how to communicate with each other within a context of open awareness suggest that they need help in learning how to do this. Achieving an environment to enable this requires private space and staff skilled in enabling and facilitating the complexities of communication between patients and their carers.

Adaptation, Psychological↗

PubMed2005

Remarriage in later life: older women's negotiation of power, resources and domestic labor.

Using data from in-depth interviews with 24 community-dwelling women aged 52-90, this paper analyzes the remarriage experiences of older women in contrast to their first marital relationships. The women's accounts of their experiences in their first and later life marriages are examined in terms of the negotiation of power, resources, and domestic labor. While first marriages were frequently characterized by incompatibility, alcoholism, abuse, and infidelity, second marriages were viewed as the marriages the women wished they had had in the first place or as relationships that met their later life needs. The women's lived experiences are discussed in terms of the changing cultural norms pertaining to gender roles, marriage, and divorce.

Activities of Daily Living↗

PubMed2003

Negotiating multiple identities in a queer Vietnamese support group.

My participant-observation with O-Môi, a support group for Vietnamese lesbians, bisexual women and female-to-male transgenders, and interviews with members, focusing on how different identity issues are negotiated, suggest that despite O-Môi's claim of supporting its members' multiple marginalized identities, group processes in everyday pragmatic interactions construct a hierarchy that centers and normalizes experiences of bilingual Vietnamese lesbians. This renders the marginalization of bisexual women, transgender men, and Vietnamese/English monolingual members. Using the concept of "identity work" to examine the intersection of race/ethnicity, class, and gender/sexuality as everyday (counter)hegemonic processes, I discuss how organizational structure, discourse resources, and personal politics orient and mold members' talk and interactions leading to normalization and/or marginalization of certain groups' experiences.

Female↗

PubMed2005

Negotiating a pathological identity in the clinical dialogue: discourse analysis of a family therapy.

Within the framework of social constructionism, psychotherapy has been re-conceptualized as a semiotic process, which consists of the creative generation of new meanings in the context of collaborative discourse. In recent years, research approaches that draw from social constructionism, such as discourse analysis, have been fruitfully employed in the study of psychotherapy processes, whilst being in line with the contemporary emphasis on language, narrative, and meaning making. This paper aims to further the exploration of the usefulness of discourse analysis in the study of psychotherapy processes, and in particular, in situations where the medical discourse is powerfully implicated in the construction of a person's identity. It is based on the analysis of a family therapy with a family whose child has a diagnosis of autism. The analysis focuses on two features of the family's talk, namely shifts in the flexibility of employment of a diverse range of discourses and subject positions, and shifts in the ways agency is constructed and discursively negotiated in the clinical conversations. It is suggested that these shifts can be used as indications of change in the family's network of meanings. The analysis suggests that an important aspect in clinical work with families with a member with a psychiatric diagnosis lies in decentring, or deconstructing, the dominant, pathology-maintaining accounts, and allowing for a wider range of less problematic narratives and subject positions to emerge.

Communication↗

PubMed1998

Negotiating international bioethics: a response to Tom Beauchamp and Ruth Macklin.

Can the bioethical theories that have served American bioethics so well, serve international bioethics as well? In two papers in the previous issue of the Kennedy Institute of Ethics Journal, I contend that the form of principlist fundamentalism endorsed by American bioethicists like Tom Beauchamp and Ruth Macklin will not play on an international stage. Deploying techniques of postmodern scholarship, I argue that principlist fundamentalism justifies neither the condemnation of the Nazi doctors at Nuremberg, nor, as the Report of the Advisory Committee on the Human Radiation Experiments (ACHRE) demonstrates, condemnation of Cold War radiation researchers. Principlist fundamentalism thus appears to be philosophy bankrupt. In this issue of the Journal, Beauchamp and Macklin reject this claim, arguing that I have misread the ACHRE report and misunderstood Nazism. They also argue that the form of post-postmodern negotiated human rights theory that I proffer is adequate only insofar as it is itself really fundamentalist; insofar as I take postmodernism seriously, however, I mire international bioethics in relativism. In this response, I reaffirm my anti-fundamentalism, provide further evidence in support of my reading of the ACHRE report, and defend my post-postmodern version of rights theory. I also develop criteria for a minimally adequate theoretical framework for international bioethics.

Advisory Committees↗

PubMed2001

Negotiating the new health care system in Cape Town, South Africa: five case studies of the acutely chronically ill.

This article examines the experiences of chronically ill disadvantaged patients in a newly reformed health care system against a backdrop of inequalities still prevalent in the wider postapartheid sociopolitical economy of the Western Cape, South Africa. Patients negotiated a hierarchy of spaces at the national level of transformation and policy and at community-, secondary-, and tertiary-level facilities. The institutionalization of patients meant that expensive medical treatment was mobilized in accordance with different stages of illness and that certain services were available only to "qualifying" categories of diagnoses.

Acute Disease↗

PubMed1988

Contingency contracting with delinquents: effects of a brief training manual on staff contract negotiation and writing skills.

A brief training manual was developed for the purpose of teaching child-care workers to contingency contract with delinquent youths living in residential care facilities. The manual was designed to require minimal supplementary training by a professional. In Experiment 1 a multiple baseline design was used to assess the effect of the manual on 4 child-care workers' contract negotiation and writing behaviors. Experiment 2 consisted of four A-B systematic replications. Behaviors were assessed within the context of analogue training simulations and generalization tests with delinquent youths. Results from the analogue simulations indicated that the manual was successful in increasing both types of behaviors to a level of proficiency that equaled or surpassed that of behaviorally trained graduate students, and results from the generalization tests indicated that the child-care workers were able to apply their newly acquired contracting skills with delinquent youths. Procedural reliability varied across child-care workers, but was usually high.

Adolescent↗

PubMed2005

Moving forward: negotiating self and external circumstances in recovery.

This article presents a framework for understanding the concept of recovery from serious mental illnesses and other life struggles. The framework is based on findings from a longitudinal, qualitative study that involved in-depth interviews with 28 people who experienced serious mental health challenges. The purpose of this article is to clarify the concept of recovery by presenting a grounded theory analysis of the components of recovery. The framework recognizes the experiences of struggle constructed through the words of study participants and captures four main components of recovery: a) a drive to move forward, b) a spiral of positive and negative changes, c) the context of recovery, and d) a dialectical process of ongoing negotiation between self and external circumstances.

Humans↗