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Meaning and Purpose (MaP) therapy aims to enhance meaning-based coping through a life review that focuses on the value and worth of the person, key relationships, sources of fulfillment, roles, and future priorities in living life out fully. We sought to test the feasibility and acceptability of a six-session model of MaP therapy against a wait-list control cohort in a pilot study seeking effect sizes on measures of adaptation.
We randomized patients with advanced cancer to MaP therapy or wait-list control, with measures administered at baseline and after 6–8 weeks. Wait-list patients could then crossover to receive therapy, with further measures collected postintervention. Adherence to the manualized model was sustained through weekly supervision and fidelity coding of recorded sessions. We used generalized estimating equations to control for baseline and any correlation of data.
From 134 eligible participants, 57 (43%) consented, and 40 of 45 (89%) offered therapy completed 6 sessions. Key barriers to consenting patients were poor health (15 refusers and 4 withdrawals) and death intervened in 6 participants. MaP therapy generated adequate effect sizes in posttraumatic growth (new possibilities, appreciation of life, and personal strength) and life attitudes (choices and goal seeking) to permit calculation of power for a formal randomized, controlled trial.
Significance of results
Delivery of this model of existentially oriented therapy is feasible and acceptable to patients. A properly powered randomized controlled trial is justified to examine the efficacy of this intervention.
Models of products and design processes are key to interacting with engineering designs and managing the processes by which they are developed. In practice, companies maintain networks of many interrelated models which need to be synthesised in the minds of their users when considering issues that cut across them. This article considers how information from product and design process models can be integrated with a view to help manage these complex interrelationships. A framework highlighting key issues surrounding model integration is introduced and terminology for describing these issues is developed. To illustrate the framework and terminology, selected modelling approaches that integrate product and process information are discussed and organised according to their levels and forms of integration. Opportunities for further work to advance integrated modelling in engineering design research and practice are discussed.
This paper examines fertility transition in Kinshasa, capital of the Democratic Republic of the Congo (DRC) and second-largest city in sub-Saharan Africa. Shapiro (1996) documented the onset of fertility transition in the city, using data from 1990. Women's education was strongly inversely related to fertility, beginning with secondary schooling, and increases in women's education were important in initiating fertility transition in the city. The paper uses data from the 2007 Demographic and Health Survey in the DRC to examine fertility in Kinshasa and assess fertility transition since 1990, a period characterized by severe adverse economic conditions in the DRC. Fertility transition has continued at a strong pace. In part this reflects increased educational attainment of women, but it appears also to be largely a consequence of enduring economic hardship. The ongoing fertility decline has been accompanied by substantial delays in entry to marriage and childbearing, reflecting adverse economic conditions, which in turn have contributed to continuing declines in fertility.
Terrorist groups repeatedly include operatives of varying commitment and often rely on a common set of security-reducing bureaucratic tools to manage these individuals. This is puzzling in that covert organizations are commonly thought to screen their operatives very carefully and pay a particularly heavy price for record keeping. The authors use terrorist memoirs and the internal correspondence of one particularly prominent group to highlight the organizational challenges terrorist groups face and use a game-theoretic model of moral hazard in a finitely sized organization to explain why record keeping and bureaucracy emerge in these groups. The model provides two novel results. First, in small heterogeneous organizations longer institutional memory can enhance organizational efficiency. Second, such organizations will use worse agents in equilibrium under certain conditions. The core logic is that in small organizations the punishment strategies that allow leaders to extract greater effort are credible only when operatives can identify and react to deviations from the leaders' equilibrium strategy. This dynamic creates incentives for record keeping and means that small organizations will periodically use problematic agents in equilibrium as part of a strategy that optimally motivates their best operatives.
Objective: Hematopoietic syndrome (HS) is a clinical diagnosis assigned to people who present with ≥1 new-onset cytopenias in the setting of acute radiation exposure. The World Health Organization convened a panel of experts to evaluate the evidence and develop recommendations for medical countermeasures for the management of HS in a hypothetical scenario involving the hospitalization of 100 to 200 individuals exposed to radiation. The objective of this consultancy was to develop recommendations for treatment of the HS based upon the quality of evidence.
Methods: English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to panel members before the meeting and updated during the meeting. Published case series and case reports of individuals with HS, published randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. In cases in which data were limited or incomplete, a narrative review of the observations was made. No randomized controlled trials of medical countermeasures have been completed for individuals with radiation-associated HS. The use of GRADE analysis of countermeasures for injury to hematopoietic tissue was restricted by the lack of comparator groups in humans. Reliance on data generated in nonirradiated humans and experimental animals was necessary.
Results: Based upon GRADE analysis and narrative review, a strong recommendation was made for the administration of granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor and a weak recommendation was made for the use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation.
Conclusions: Assessment of therapeutic interventions for HS in humans exposed to nontherapeutic radiation is difficult because of the limits of the evidence.
(Disaster Med Public Health Preparedness. 2011;5:202-212)