Get the inside scoop on France. From trolling Parisian nightclubs to skiing the French Alps, MTV France shows you what you want to do and where you want to be, with choices for every budget. Alternative accommodations. Bed down anywhere from a hauntedcastle to buzzing beachfront youth hostels or alpine ski chalets. Cheap eats. Fuel up on the world's best cheeses, cr?pes, and cassoulets. Chow down in an old Parisian workers' canteen, or try affordable cutting- edge dishes by France's hottest young chefs. Great clubs & bars. Party everywhere from Paris's grungy rue Oberkampf to the velvet rope scene at Cannes' Le Baol, or tour Champagne's best bubbly cellars and the vineyards of Burgundy and Bordeaux. World-class museums & offbeat attractions. From the Mona Lisa at the Louvre and Van Gogh's house in Arles to Paris's catacombs and Lascaux's cave paintings, you'll discover France's finest and freakiest sites.
This book offers a new understanding of the relationship between family structures and narrative structure in the nineteenth-century novel. Comparing Russia and England, it argues that the two nations had fundamentally different conceptions of the family and that these, in turn, shaped the way they constructed plots. The English placed primary value on the vertical, diachronic family axis—looking back to ancestors and head to progeny—while the Russians emphasized the lateral, synchronic axis—family expanding outward in the present from nuclear core, to extended and chosen kin. This difference shaped the way authors plotted consanguineal relations, courtship and marriage, and alternative kinship constructions. Idealizing the domestic sphere and emphasizing family continuity, the English novel made family a conservative force, while Russian novels approached it as a backward site of patriarchal tyranny in desperate need of reform. Russian family plots offered a progressive, liberalizing push toward new, nontraditional family constructions. The book's comparative approach calls for a re-evaluation of reigning theories of the novel, theories that are based on the linear English family model and cannot accommodate the more complex, Russian alternative. It reveals where these theories fall short, explains the reasons for their shortcomings, and offers a new way of conceptualizing family's role in shaping the nineteenth-century novel. Classics from Dickens, Eliot, and Trollope, to Dostoevsky, Tolstoy, and Turgenev are contextualized in the broader literary landscape of their day, and Russia's great women writers regain their rightful place alongside their male counterparts as the book draws together family history, literary analysis, and novel theory.
In Russia during the second half of the eighteenth century, a public conversation emerged that altered perceptions of pregnancy, birth, and early childhood. Children began to be viewed as a national resource, and childbirth heralded new members of the body politic. The exclusively female world of mothers, midwives, and nannies came under the scrutiny of male physicians, state institutions, a host of zealous reformers, and even Empress Catherine the Great. Making innovative use of obstetrical manuals, belles lettres, children’s primers, and other primary documents from the era, Anna Kuxhausen draws together many discourses—medical, pedagogical, and political—to show the scope and audacity of new notions about childrearing. Reformers aimed to teach women to care for the bodies of pregnant mothers, infants, and children according to medical standards of the Enlightenment. Kuxhausen reveals both their optimism and their sometimes fatal blind spots in matters of implementation. In examining the implication of women in public, even political, roles as agents of state-building and the civilizing process, From the Womb to the Body Politic offers a nuanced, expanded view of the Enlightenment in Russia and the ways in which Russians imagined their nation while constructing notions of childhood.
“I tell you not to worry because I’ve done all the worrying for you!” Bonnie Stern, beloved teacher and bestselling cookbook author, wants nothing more than for you to feel like she’s in the kitchen cooking beside you. In her latest cookbook, Don’t Worry, Just Cook, written with her daughter Anna Rupert (who has, in fact, been in the kitchen cooking beside Bonnie her whole life!), Bonnie and Anna are here to help cooks of all experience foster comfort and connection through food. With her trademark encouraging style and attention to detail, Bonnie writes recipes that are consistently delicious, widely appealing, and, as always, timeless. Like all of her cookbooks, Don’t Worry, Just Cook doesn’t simply give instructions to create a dish, it also shares stories, lessons, and kitchen wisdom that will build your cooking technique and confidence in the kitchen. In this new book, you’ll find easy-to-follow recipes for all-day breakfasts, soups, starters, and side dishes, as well as breads and vegetarian, fish, and meat mains. And, for those wanting something sweet, Bonnie and Anna have included plenty of desserts! You’ll be amazed by how quickly such special dishes like Jeweled Roasted Salmon with Herbs and Sheet Pan Chicken with Lemon and Olives come together. The simplicity and beauty of dishes like Ja’ala Herb Salad with Lemon Honey Dressing and Roasted Cauliflower Steaks with Tahini and Z’hug will impress even the cook! And the desserts, like the Pavlova Cake with Lemon Curd and Berries, Bonnie’s Rugelach, and S’mores Chocolate Bark have never been so fun or delicious. Bonnie and Anna have also provided notes and variations to help you modify dishes for special diets, and have sprinkled in essays on topics that will resonate with all of us, from things not worth worrying about, to a love of leftovers and what to do with them. Bonnie and Anna’s warm voices and subtle humor come through on every page. With 125 enjoyable and thoughtful recipes, and stunning photography, home cooks will turn to this instant classic time and time again to nourish themselves and the people they love.
Despite the growing national and international regulatory framework to support cross-border mediation, the use of such mediation appears to remain stubbornly low. This book focuses in particular on the European Union’s (EU’s) continued efforts to encourage the use of cross-border mediation and examines why such efforts have had a limited impact. It does so by drawing on rare, and at times surprising, detailed insights from in-house counsel of multinational companies regarding their use of EU cross-border commercial mediation. By viewing mediation through the lens of disputants, new and important findings regarding why disputants do, and do not, use cross-border mediation have emerged. While these findings are of primary relevance to EU policy and practice, they have implications far beyond the EU context at a time of increasing international interest in cross-border mediation. The analysis of the insights provided by the disputants reveals, for example: the prominent role played by negotiation as a cross-border dispute resolution process; that negotiation is a key comparator for disputants when considering whether to use mediation; how the EU’s continued focus on understanding and presenting mediation as an alternative to litigation has resulted in measures which are insufficient to address fully the barriers to the use of mediation; intriguing barriers to the use of mediation which arise from the association which disputants draw between mediation and negotiation; how the relationship which disputants draw between mediation and negotiation paradoxically raises both opportunities for, and obstacles to, the increased use of mediation; and what disputants need in order to increase their use of cross-border mediation. The qualitative nature (by way of interviews) of the research conducted for this book has enabled the identification of nuanced and novel findings regarding mediation’s position and potential in cross-border dispute resolution. These findings, together with a detailed examination of the EU Directive on Certain Aspects of Mediation in Civil and Commercial Matters and the EU’s continued initiatives to foster the use of mediation, form the foundation upon which this book’s recommendations are built. Changing the frame to view the use of mediation through the disputants’ perspective, as this book does, provides the opportunity for the EU to promote cross-border mediation in a way which resonates more deeply with disputants and responds more fully to their concerns and needs. This thought-provoking book will be of interest not only to European and national bodies seeking to promote the use of mediation but clearly also to dispute resolution academics, in-house counsel, and of course mediators and dispute resolution practitioners in general.
Drawing on urban and community resilience literature, Urban Preppers and the Pandemic in New York City: Class, Resilience and Sheltering in Place offers a detailed qualitative analysis of the impact of the COVID-19 pandemic on New York City and on the philosophy and practices of the city’s urban prepper subculture. With a special focus on the height of the pandemic in New York, this book considers the city’s unique position as the pandemic’s first epicenter in the United States. It also explores the lived experience of enduring the pandemic as reflections of class division, considering key themes, including the exodus of the wealthy, sheltering in place for the middle class, the inability to leave high-risk neighborhoods for the poor, and sheltering-in-place practices and community resilience efforts by New York preppers. It analyzes the importance of good government and an engaged citizenry in developing an agenda for the city’s continued recovery and its future, underscoring the need for cities to develop disaster management approaches that expand traditional “command and control” models to make space for local knowledge and resources. At its core, Urban Preppers and the Pandemic in New York City: Class, Resilience and Sheltering in Place is about understanding New York City’s pandemic experience and how self-reliance evolves into community resilience outside of institutions. It is vital reading for scholars and students of sociology, anthropology, geography and urban studies with interests in subcultures, ethnography and the sociology of disasters.
This book addresses practical issues in connoisseurship and authentication, as well as the legal implications that arise when an artwork’s authenticity is challenged. In addition, the standards and processes of authentication are critically examined and the legal complications which can inhibit the expression of expert opinions are discussed. The notion of authenticity has always commanded the attention of art market participants and the general art-minded public alike. Coinciding with this, forgery is often considered to be the world’s most glamorous crime, packed with detective stories that are usually astonishing and often bizarre. The research includes findings by economists, sociologists, art historians, lawyers, academics and practitioners, all of which yield insights into the mechanics and peculiarities of the art business and explain why it works so differently from other markets. However, this book will be of interest not only to academics, but to everyone interested in questions of authenticity, forgery and connoisseurship. At the same time, one of its main aims is to advocate best practices in the art market and to stress the importance of cooperation among all disciplines with a stake in it. The results are intended to offer guidance to art market stakeholders, legal practitioners and art historians alike, while also promoting mutual understanding and cooperation.
Europe’s banking system is weighed down by high levels of non-performing loans (NPLs), which are holding down credit growth and economic activity. This discussion note uses a new survey of European country authorities and banks to examine the structural obstacles that discourage banks from addressing their problem loans. A three pillared strategy is advocated to remedy the situation, comprising: (i) tightened supervisory policies, (ii) insolvency reforms, and (iii) the development of distressed debt markets.
The Clinical Interview offers a new perspective on the patient encounter. Interpreting decades of evidence-based psychotherapy and neuroscience, it provides 60 succinct techniques to help clinicians develop rapport, solicit better histories, and plan treatment with even the most challenging patients. This book describes brief skills and techniques for clinical providers to improve their patient interactions. Although evidence-based psychotherapies are typically designed for longer specialized treatments, elements of these psychotherapies can help clinicians obtain better patient histories, develop more effective treatment plans, and more capably handle anxiety-provoking interactions. Each chapter is brief and easily digestible, contains sample clinical dialogue, and provides references for further reading. These skills help clinicians practice more effectively, more efficiently, and with greater resilience. Whatever your clinical specialty or role, whether you are a trainee or an experienced clinician, The Clinical Interview offers practical wisdom and an entirely new way to think about the clinical encounter. The Clinical Interview will be of great use to any student in a health-related field of study or a healthcare professional interested in refining their interviewing skills. It will help anyone from emergency medical technicians, nurses, and physician assistants, to nurse practitioners and physicians to build more meaningful patient relationships.
Buy a new version of this textbook and receive access to the Connected eBook with Study Center on Casebook Connect, including lifetime access to the online ebook with highlight, annotation, and search capabilities. Access also includes practice questions, an outline tool, and other helpful resources. Connected eBooks provide what you need most to be successful in your law school classes. An innovative Property casebook that reimagines the law school casebook format. Covering all the major topics included in a basic 1L Property course, Property Law leverages resources more typicall to an undergraduate textbook than a traditional law school casebook, making use of sidebars, illustrations, and other design devices to present material more clearly. The authors present concepts simply, then move the discussion toward complexity in contrast to the approach taken by many current property texts. Clear yet sophisticated, the casebook is the perfect choice for all skill levels. Including problems that students can and should be able to do on their own, explanatory answers, and skills-based exercises, this casebook is both professor-friendly and student-friendly. Themes that run through the course are highlighted throughout the book, resulting in a casebook that clearly presents the fundamentals of property law. This allows students to develop an understanding of basic concepts on their own while allowing professors to assist their students in developing an advanced understanding of property law. Although Property Law goes far beyond bar tested topics, the authors are experts on the property coverage on the bar exam, and wrote the book to give students exposure to every topic they are likely to see on the bar exam. New to the 3rd Edition: ● Some cases have been eliminated or shortened to make coverage more manageable, especially for four-credit courses. Edits from Second Edition will be included in the teacher's manual. ● Chapter 9 revised to include Cedar Point Nursery v. Hassid, the Supreme Court's most recent takings case. ● Additional corrections, updates, and refinements throughout. Professors and students will benefit from: ● Property Law starts from simplicity and moves to complexity: The book first provides text that explains the basic doctrine, then presents a simple case example, and finally moves to more complex issues. ● Cases are introduced with explanatory text discussing the law and issues surrounding the case. This radically different approach from most other casebooks allows students to have a better grasp of the concepts and themes before they even read the case. ● Problems and exercises that students can complete on their own, with explanatory answers included in an appendix. ● Innovative design that aids student learning, with sidebars, diagrams, charts, and illustrations that make concepts clearer to students. ● Cases that are used as examples, not introductions to legal rules. Many topics in the book feature introductory text, illustrations, and problem sets before a single case is introduced, to aid in students' legal learning. ● The inclusion of sample documents, helping students to understand core concepts. ● Perfect for a four-credit course, the book also features a modular design that can be used in courses of varying credit size. ● More comprehensive bar exam topic coverage than any competing book.
Tangolo and Massi offer a complete manual for transactional analysis (TA)-based group therapy. Group Therapy in Transactional Analysis demonstrates the evolution of TA as a relational psychodynamic therapy rich in clinical experiences both within individual and group settings. The authors outline how to select clients, which setting to provide, how to establish contracts, and which techniques to use during group sessions. The book includes a full assessment of research and theory, clearly demonstrating efficacy and taking into account neuroscientific studies on intersubjectivity and the social brain. This is combined with a practical approach which supports therapists from the very first steps to the analysis of more complex interpersonal dynamics and dream analysis in a group setting. Finally, future research directions are discussed, together with an overview of an experiment on online groups in the time of coronavirus. This foundational text will be a key reference for therapists in training and professionals new to the principles of transactional analysis. It will also be of interest to students on psychotherapy training and clinical psychology courses.
“A fantastically smart, funny, and thoughtful thriller.”—Nicola Yoon, #1 New York Times best-selling author of Everything, Everything and The Sun Is Also a Star The year is 1998: Titanic just won six Oscars, boy bands are dominating MTV’s airwaves, and like any other teenager Jess Flynn is just trying to survive high school. Between a crush on her childhood best friend, overprotective parents, and her sister’s worsening health, the only constant is her hometown of Swickley, which feels smaller by the day. Jess is resigned to her small-town life, until the day she discovers a mysterious device with an apple logo, causing her to question everything and everyone she’s ever known. As more cracks appear in Jess’s world, she faces a choice: can she live the rest of her life knowing it’s a lie, or should she risk everything for the truth? A fast-paced, mind-bending YA thriller packed with ’90s pop culture references and perfect for fans of Riverdale, This Is Not the Jess Show will keep readers guessing until the very end. Now with an excerpt from the explosive and thrilling conclusion, This Is Not the Real World!
Representing two generations of counselor education and practice, Megan Anna Neff and Mark McMinn provide practitioners with a fresh look at integration in a postmodern world. Modeling how to engage hard questions, they consider how different theological views, gendered perspectives, and cultures integrate with psychology and counseling.
This book presents a complete summary about the 12 pairs of cranial nerves (CN). They control much of the motor and sensory functions of the head and neck such as smell, sight, eye movement, and feeling in the face. The CN also control balance, hearing, and swallowing. The examination of the CN is an important part of the clinical neurological examination. Additionally, to the anatomy, extensive knowledge about further diagnostic tools are necessary such as neuroimaging, and electrophysiology. The book is divided into three parts: a general part with anatomy and imaging, a systematic part grouping the 12 pairs of cranial nerves, and a part describing cranial nerve functions in specific conditions and diseases.
How the medieval church drove state formation in Europe Sacred Foundations argues that the medieval church was a fundamental force in European state formation. Existing accounts focus on early modern warfare or contracts between the rulers and the ruled. In contrast, this major study shows that the Catholic Church both competed with medieval monarchs and provided critical templates for governing institutions, the rule of law, and parliaments. The Catholic Church was the most powerful, wealthiest, and best-organized political actor in the Middle Ages. Starting in the eleventh century, the papacy fought for the autonomy of the church, challenging European rulers and then claiming authority over people, territory, and monarchs alike. Anna Grzymała-Busse demonstrates how the church shaped distinct aspects of the European state. Conflicts with the papacy fragmented territorial authority in Europe for centuries to come, propagating urban autonomy and ideas of sovereignty. Thanks to its organizational advantages and human capital, the church also developed the institutional precedents adopted by rulers across Europe—from chanceries and taxation to courts and councils. Church innovations made possible both the rule of law and parliamentary representation. Bringing to light a wealth of historical evidence about papal conflict, excommunications, and ecclesiastical institutions, Sacred Foundations reveals how the challenge and example of powerful religious authorities gave rise to secular state institutions and galvanized state capacity.
The nature of the self is an important point at which philosophy and literature intersect. Text, Body and Indeterminacy acknowledges this connection by forging a link between the philosophical concept of the self and the category of the literary character. The philosophical horizon of Text, Body and Indeterminacy is delineated by the neo-pragmatist debate on selfhood. The book entwines the ideas of Richard Rorty and Richard Shusterman by stressing similarity in their aestheticizing of ethics and by showing the difference in their understanding of the self as textual or bodily. The characters created by Pater and Wilde are freshly assessed within this dual philosophical perspective. Their doppelgängers are seen as the forerunners of postmodernist concepts: the cerebral flâneur is reflected in Rorty’s model “ironist,” and the sensuous aesthete returns through Shusterman’s notion of the somatic self. Text, Body and Indeterminacy establishes how Pater renders his protagonists through discursive patterns—tropes of Decadence, philosophical theorems, and myths—only to subvert these vocabularies and to emphasize the reality of the body, the extra-textual dimension of the self. It also shows how Wilde’s sensuous personae, both bodily and indeterminate, transcend the vocabularies available to the Wildean flâneurs. Through its interpretations, Text Body and Indeterminacy uniquely combines literary portraits by Pater and Wilde, highlights interlocking themes and, in every reading, points to the ethical gains of tilting the idea of selfhood into the somatic realm.
The health humanities are widely understood as a way to cultivate perspective, compassion, empathy, professional identity, and self-reflection among health professional students. This innovative book links humanities themes, social science domains, and clinical practice to invite self-discovery and recognition of universal human experiences. Integrating Health Humanities, Social Science, and Clinical Care introduces critical topics that rarely receive sufficient attention in health professions education, such as cultivating resilience, witnessing suffering, overcoming unconscious bias, working with uncertainty, understanding professional and personal roles, and recognizing interdependence. The chapters encourage active engagement with a range of literary and artistic artefacts and guide the reader to question and explore the clinical skills that might be necessary to navigate clinical scenarios. Accompanied by a range of pedagogical features including writing activities, discussion prompts, and tips for leading a health humanities seminar, this unique and accessible text is suitable for those studying the health professions, on both clinical and pre-clinical pathways.
Parmana: Prehistoric Maize and Manioc Subsistence along the Amazon and Orinoco argues for a reinterpretation of prehistoric subsistence in the Greater Amazonian region of South America. Based on the preliminary results of an archaeological fieldwork in Parmana of the Orinoco basin, Venezuela, the book re-evaluates some of the assumptions made by anthropologists about human adaptation and the development of aboriginal culture in Amazonia. Comprised of six chapters, this volume begins with a review of the theories of five scholars of aboriginal Amazonia in terms of logic and documentation: Julian Steward, Betty Meggers, Robert Carneiro, Donald Lathrap, and Daniel Gross. The next chapter presents an alternative theory, the hypothesis of technological change, and explains its theoretical framework. The demographic theory of cultural evolution is discussed, and its basis in general evolutionary theory is explained. Subsequent chapters focus on the empirical evidence for the hypothesis in studies of tropical resources, with emphasis on the productivity of tropical lowland soils and Amazonian faunal resources as well as the roles of maize and manioc in prehistoric Amazonian subsistence; the physical and biological characteristics of the Parmana region as an environment for prehistoric human adaptation; and the history of subsistence and population growth in prehistoric Parmana. The final chapter suggests possible directions for future research on the development of aboriginal culture in Amazonia. The book is illustrated with numerous maps, tables, and photographs, most of them never published before. This monograph should be of interest to archaeologists and anthropologists.
An integrated, collaborative model for more comprehensivepatient care Creating Effective Mental and Primary Health Care Teamsprovides the practical information, skills, and clinical approachesneeded to implement an integrated collaborative care program andsupport the members of the care team as they learn this new,evidence-based, legislatively mandated care delivery system. Uniquein presenting information specifically designed to be used in anintegrated, collaborative care workflow, this book providesspecific guidance for each member of the team. Care managers,consulting psychiatrists, primary care providers, andadministrators alike can finally get on the same page in regard topatient care by referring to the same resource and employing acommon framework. Written by recognized experts with broadresearch, clinical, implementation, and training experience, thisbook provides a complete solution to the problem of fragmentedcare. Escalating costs and federal legislation expanding access tohealthcare are forcing the industry to transition to a new model ofhealth care delivery. This book provides guidance on navigating thechanges as a team to provide the best possible patient care. Integrate physical and behavioral care Use evidence-based treatments for both Exploit leading-edge technology for patient management Support each member of the collaborative care team Strong evidence has demonstrated the efficacy of a collaborativecare approach for delivering mental health care to patients in aprimary care setting. The field is rapidly growing, but fewresources are available and working models are limited. This bookprovides a roadmap for transitioning from traditional methods ofhealth care to the new integrated model. Providers ready to move tothe next level of care will find Creating Effective Mental andPrimary Health Care Teams an invaluable resource.
This book contains nine essays on Lucius Annaeus Seneca, distinguished Stoic Philosopher, creative writer, and Statesman of the Neronian Age. As author of epistles, treatises, dialogues, dramas, and epigrams, he produced a variety of works that enriched Rome's literary achievement. Like the previous volumes - Essays on Seneca (Peter Lang, 1993) and Further Essays on Seneca (Peter Lang, 2001) - this book presents an in-depth analysis of the Cordoban Philosopher's thoughts and portrays his erudition, humanitas, artistry, and deep psychological understanding of the frailties and strengths of human nature.
Examines cultural representations of women's experience of the railway in a period of heightened mobility Women's experiences of locomotion during a period of increased physical mobility and urbanisation are explored in this monograph. The 5 chapters analyse Victorian and early Modernist texts which concentrate on women in transit by train, including Wilkie Collins's No Name, George Meredith's Diana of the Crossways, Elizabeth Gaskell's North and South, Henry James's The Spoils of Poynton and The Wings of the Dove, and stories by Rhoda Broughton, Margaret Oliphant, Charles Dickens and Katherine Mansfield. They highlight the tension between women's boundless physical, emotional, and sexual aspiration - often depicted as closely related to the freedom and speed of train travel - and Victorian gender ideology which constructed the spaces of the railway as geographies of fear or manipulation. Key features: The first full-length examination of texts by and about women which explore the railway as a gendered space within a British and European context Explores a variety of cultural discourses which deal with women and the railway: fiction, poetry, news stories and commentaries, essays, paintings, and philosophical writings Proposes a reconceptualization of the public/private binary
Economic Role of Transport Infrastructure: Theory and Models helps evaluate the economic effects of transport infrastructure investments within a cost-benefit framework for maximum economic impact. The book analyzes the primary empirical approaches used to gauge the economic effects of transport infrastructures, providing in-depth discussions on data issues, input-output techniques, and econometric methodologies. Users will find empirical evidence organized from a transport mode point-of-view, inspiring researchers to conduct comparative analysis for various infrastructure projects. Topics cover infrastructure's impact on economic growth using theoretical frameworks, including exogenous growth models, endogenous growth models, and new economic geography models. In addition, readers will also learn tips for conducting infrastructure impact studies and how to improve the effectiveness of infrastructural investments design. - Explains and evaluates the economic effects of transport infrastructure investments, including direct and indirect, short and long run impact, and local and spillover outcomes - Provides up-to-date coverage of quantitative techniques and empirical results for transportation and economic impact issues - Explains the steps for conducting impact studies for proposed infrastructure projects - Analyzes infrastructure's role on economic growth through theoretical, methodological and empirical perspectives - Features case studies describing real-world methods
Background: Cancer treatment continues to improve, contributing to an ever-growing population of cancer survivors. Pelvic cancer survivors (PCS) constitute the second largest group of female cancer survivors after breast cancer. Many female PCS have been treated with radiotherapy as a part of their cancer treatment. Unfortunately, like all effective cancer treatments, pelvic radiotherapy is associated with a risk of subsequent, unwanted side effects. Some side effects remain or persist long after the end of treatment and some are even lifelong. A common and burdensome side effect after pelvic radiotherapy is urinary and/or fecal incontinence. Incontinence is known to negatively affect quality of life (QoL) and physical activity levels. Physical activity contributes to several positive health effects. In cancer survivors, it may reduce the risk of recurrence and even the mortality risk. Cancer survivors in general, and female PCS in particular, tend to be less physically active after cancer treatment than before treatment. When suffering from urinary and even fecal incontinence, pelvic floor muscle training (PFMT) is recommended as a first-line treatment for the general population. In addition to decreased incontinence levels, PFMT may contribute to increased physical activity and better QoL. However, little attention is given to PFMT as a potential treatment for incontinence in the Swedish national care program for pelvic cancer rehabilitation. Furthermore, there is as yet no evidence that PFMT is as effective in female PCS as in female non-cancer survivors. The effectiveness of PFMT cannot be taken for granted because female PCS survivors often have treatmentinduced damage to structures in the pelvic floor that might affect its applicability. However, the problem of incontinence among female PCS remains, along with the fact that they tend to be less physically active than other cancer survivors. Indeed, this is an important research area and a necessary problem for health-care providers to resolve, not least for physiotherapists. Aim: The overall aim of this thesis is to improve the understanding of female PCS’ experiences of incontinence in relation to physical activity, QoL, and rehabilitative efforts, including PFMT. This includes gaining increased knowledge about the relation between incontinence and physical activity in the form of exercise and QoL, and whether PCS experience that physiotherapy contributes in a valuable way to reducing their incontinence. This could enable the development of meaningful physiotherapeutic interventions, that PCS can and are willing to engage in, to achieve a potential reduction in incontinence, as well as increased QoL and activity levels. Methods: The thesis includes four different studies, using three different methods, all conducted with female PCS. Studies I (n=13) and IV (n=11) are qualitative individual interview studies, using semi-structured interview guides. Study II is a cohort-based cross-sectional observational study (n=578) and Study III is a prospective cohort-based observational study (n=260). Results: Female PCS reported an absence of information regarding incontinence as a potential side effect of radiotherapy treatment. They experienced that incontinence prevented them from being as physically active as before treatment, and that incontinence of urine and feces impaired several aspects of QoL, including sexual health. They lacked potential rehabilitative options beyond conventional pelvic cancer rehabilitation. After practicing PFMT for three months, they found it a valuable rehabilitative measure for incontinence. They also experienced the physiotherapeutic support and guidance as valuable in teaching them how to contract the pelvic floor muscles correctly and providing individual guidance regarding dose, frequency, and progression of the training. In Study II, 67% of female PCS exercised at least once a week, while 33% exercised less than once a week. Women who reported leakage of large or all volume of feces (multivariable analysis) were statistically significantly more likely to exercise less than once a week. A similar co-variation was seen among women who reported leakage of moderate to large volumes of urine (univariate analysis). This, however, was not statistically significant in a multivariable analysis. When exercising on a weekly basis, they reported less frequently depressed mood and better QoL, compared to those who exercised less than once a week. Three months after an individually designed intervention program, in line with the conventional pelvic cancer rehabilitation offered within Swedish healthcare today, female PCS reported statistically significantly lower levels of urinary and fecal incontinence. However, no statistically significant changes in frequency of exercise were seen. Conclusion: Incontinence was a barrier to physical activity and exercise, and it reduced QoL and impaired sexual health in female PCS. When experiencing incontinence, and in particular fecal incontinence, female PCS were less likely to exercise on a weekly basis. Female PCS who exercise at least once a week experienced better QoL and less frequently depressed mood than PCS who were not exercising every week. Female PCS did not exercise more often after conventional pelvic cancer rehabilitation, not even after incontinence levels were reduced. Female PCS had a positive attitude towards PFMT. After at least three months’ experience of practicing PFMT, they found it a valuable rehabilitative effort for incontinence. They also found physiotherapeutic support and guidance to be of great importance. Female PCS expressed a need for better information routines regarding side effects, such as incontinence, after cancer treatment. They also expressed a need for better information routines, including accessibility of additional rehabilitative efforts, beyond the conventional pelvic cancer rehabilitation offered today, when suffering from incontinence of urine and/or feces. Bakgrund: Behandlingen av cancersjukdomar förbättras ständigt vilket bidrar till en växande population av cancerövrelevare. Bäckencanceröverlevare utgör den näst vanligaste gruppen kvinnliga canceröverlevare efter bröstcanceröverlevare. Många av kvinnorna behandlas med strålterapi som är associerad med en risk för oönskade sidoeffekter. Vissa sidoeffekter kvarstår eller uppstår långt efter behandlingen och andra medför ett livslångt rehabiliteringsbehov. En vanlig, belastande sen sidoeffekt av strålterapi mot bäckenet är urin- och eller avföringsinkontinens. Inkontinens påverkar ofta såväl livskvalitet som fysisk aktivitetsnivå negativt. Fysisk aktivitet kan bidra till ett flertal positiva hälsoeffekter som att minska risken för återfall i sjukdomen. Det kan sannolikt också bidra till ökad överlevnad. Canceröverlevare i allmänhet, och kvinnliga bäckencanceröverlevare i synnerhet, har ofta en lägre fysisk aktivitetsnivå efter cancerbehandlingen jämfört med innan. Vid urin- och även vid avföringsinkontinens rekommenderas bäckenbottenmuskelträning (BMT) som ett förstahandsval av behandling till kvinnor i allmänhet. Bäckenbottenmuskelträning kan, förutom att bidra till att minska inkontinens, även bidra till ökad fysisk aktivitetsnivå och förbättrad livskvalitet. Bäckenbottenmuskelträning har emellertid fått obetydligt utrymme som potentiell behandlingsmetod för inkontinens i det svenska nationella vårdprogrammet för bäckencancerrehabilitering. Än så länge saknas evidens för att BMT är lika effektivt hos kvinnliga bäckencanceröverlevare som hos kvinnor som inte genomgått cancerbehandling. Att BMT skulle vara lika effektivt hos dessa kvinnor är inte självklart då de ofta har behandlingsinducerade skador i strukturer i bäckenbotten som kan påverka träningens resultat. Problemet att kvinnliga bäckencanceröverlevare ofta besväras av inkontinens och ofta är mindre fysiskt aktiva än andra canceröverlevare kvarstår. Det är således ett viktigt område för vidare forskning och ett problem som behöver lösas av hälso- och sjukvårdspersonal, inte minst av fysioterapeuter. Syfte: Det övergripande syftet med avhandlingen är att förbättra förståelsen för kvinnliga bäckencanceröverlevares upplevelser av inkontinens i relation till fysisk aktivitet, livskvalitet och rehabiliteringsinsatser, inklusive BMT. Detta inkluderar förbättrad kunskap om relationen mellan motion och livskvalitet och huruvida bäckencanceröverlevare upplever att fysioterapi kan bidra på ett värdefullt sätt till att reducera inkontinensbesvär. Detta för att möjliggöra utformande av meningsfulla fysioterapeutiska interventioner, som bäckencanceröverlevare kan och är villiga att delta i, för att uppnå en potentiell minskning av inkontinens såväl som ökad livskvalitet och ökad fysisk aktivitetsnivå. Metod: Avhandlingen innehåller fyra studier, med tre olika metoder, där alla studiedeltagare utgörs av kvinnliga bäckencanceröverlevare. Studie I (n=13) och IV (n=11) är kvalitativa studier där individuella intervjuer genomfördes med semistrukturerade intervjuguider. Studie II är en kohortbaserad tvärsnittsstudie (n=578) och Studie III är en prospektiv, kohortbaserad observationsstudie (n=260). Resultat: Kvinnorna uttryckte avsaknad av information om inkontinens som en potentiell bieffekt av strålterapi. De upplevde att inkontinens hindrade dem från att vara fysiskt aktiva i samma utsträckning som innan behandlingen och att urin och avföringsinkontinens försämrade flera aspekter av deras livskvalitet, inklusive sexuell hälsa. Det uttryckte avsaknad av rehabiliteringsalternativ utöver det som erbjuds inom konventionell bäckencancerrehabilitering i svensk hälso- och sjukvård. Efter att ha tränat BMT under tre månader upplevde de BMT som en meningsfull rehabiliteringsåtgärd för urin- och avföringsinkontinens. De upplevde även att stöd och guidning från en fysioterapeut var värdefullt för att lära sig att kontrahera bäckenbottenmuskulaturen korrekt och för att få individuell guidning avseende dos, frekvens och progression av träningen. I Studie II, rapporterade 67% av 568 kvinnor att de motionerade minst en gång i veckan medan 33% rapporterade att de motionerade mindre än en gång i veckan. Kvinnor som rapporterade stor mängd avföringsläckage, (p=0.01, multivariabel analys) var statistiskt signifikant mer benägna att motionera mindre än en gång i veckan. En liknande samvariation sågs hos kvinnor som rapporterade stor mängd av urinläckage (p=0.04, univariat analys). Samvariationen var inte statistiskt signifikant i en multivariabel analys (p=0.105). Kvinnliga bäckencanceröverlevare som motionerade minst en gång i veckan rapporterade mer sällan nedstämdhet (p=0.044) och bättre livskvalitet (p <0.001) jämfört med de som motionerade mindre än en gång i veckan. Tre månader efter individuell sedvanlig bäckencancerrehabilitering rapporterade kvinnorna statistiskt signifikant lägre nivåer av urin och avföringsinkontinens (p=0.046 and p <0.001). Däremot, rapporterade inte kvinnorna någon statistiskt signifikant förändring i hur ofta de motionerade (p=0.763). Konklusion: Inkontinens utgjorde ett hinder för att utöva fysisk aktivitet och för att motionera bland kvinnliga bäckencanceröverlevare. Inkontinens försämrade dessutom livskvalitet och sexuell hälsa. De som upplevde inkontinens, i synnerhet avföringsinkontinens, var mindre benägna att motionera veckovis. Kvinnliga bäckencanceröverlevare som motionerade varje vecka upplevde bättre livskvalitet och mer sällan nedstämdhet än de kvinnor som inte motionerade veckovis. Kvinnliga bäckencanceröverlevare motionerade inte oftare efter konventionell bäckencancerrehabilitering även om inkontinensbesvären minskade. Kvinnliga bäckencanceröverlevare hade en positiv attityd till BMT. Efter tre månaders erfarenhet av BMT, upplevde de att det var en meningsfull rehabiliteringsåtgärd för inkontinens. De ansåg även att stöd och guidning från en fysioterapeut var av stor vikt. Kvinnliga bäckencanceröverlevare efterfrågade bättre informationsrutiner avseende potentiella sidoeffekter efter cancerbehandling, så som urin- och avföringsinkontinens. De efterfrågade även bättre informationsrutiner och tillgänglighet vad gäller rehabilitering av inkontinens utöver det som erbjuds inom sedvanlig bäckencancerrehabilitering idag.
Since the UK Gambling Act of 2005 was introduced, gambling has stopped being seen, politically and legally as an inherent vice and is now viewed as a legitimate form of entertainment. Gambling Regulation and Vulnerability explores the laws around gambling that aim to protect society and individuals, examining the differences between regulatory rhetoric and the impact of legislative and regulatory measures. Malgorzata Carran finds that although the Gambling Act introduced many positive changes to gambling regulation, it has created an environment in which protection of vulnerable individuals becomes difficult. Carran challenges the existing legislative premise that regulation alone is able to balance the effect of liberalisation for those who are vulnerable.
The Bible is one of the books that has aroused the most interest throughout history to the present day. However, there is one topic that has mostly been neglected and which today constitutes one of the most emblematic elements of the visual culture in which we live immersed: the language of colour. Colour is present in the biblical text from its beginning to its end, but it has hardly been studied, and we appear to have forgotten that the detailed study of the colour terms in the Bible is essential to understanding the use and symbolism that the language of colour has acquired in the literature that has forged European culture and art. The objective of the present study is to provide the modern reader with the meaning of colour terms of the lexical families related to the green tonality in order to determine whether they denote only color and, if so, what is the coloration expressed, or whether, together with the chromatic denotation, another reality inseparable from colour underlies/along with the chromatic denotation, there is another underlying reality that is inseparable from colour. We will study the symbolism that/which underpins some of these colour terms, and which European culture has inherited. This lexicographical study requires a methodology that allows us to approach colour not in accordance with our modern and abstract concept of colour, but with the concept of the ancient civilations. This is why the concept of colour that emerges from each of the versions of the Bible is studied and compared with that found in theoretical reflection in both Greek and Latin. Colour thus emerges as a concrete reality, visible on the surface of objects, reflecting in many cases, not an intrinsic quality, but their state. This concept has a reflection in the biblical languages, since the terms of colour always describe an entity (in this sense one can say that they are embodied) and include within them a wide chromatic spectrum, that is, they are mostly polysemic. Structuralism through the componential analysis, although providing interesting contributions, had at the same time serious shortcomings when it came to the study of colour. These were addressed through the theoretical framework provided by cognitive linguistics and some of its tools such as: cognitive domains, metonymy and metaphor. Our study, then, is one of the first to apply some of the contributions of cognitive linguistics to lexicography in general, and particularly with reference to the Hebrew, Greek and Latin versions of the Bible. A further novel contribution of this research is that the meaning is expressed through a definition and not through a list of possible colour terms as happens in dictionaries or in studies referring to colour in antiquity. The definition allows us to delve deeper and discover new nuances that enrich the understanding of colour in the three great civilizations involved in our study: Israel, Greece and Rome.
Anna Krugovoy Silver examines the ways nineteenth-century British writers used physical states of the female body - hunger, appetite, fat and slenderness - in the creation of female characters. Silver argues that anorexia nervosa, first diagnosed in 1873, serves as a paradigm for the cultural ideal of middle-class womanhood in Victorian Britain. In addition, Silver relates these literary expressions to the representation of women's bodies in the conduct books, beauty manuals and other non-fiction prose of the period, contending that women 'performed' their gender and class alliances through the slender body. Silver discusses a wide range of writers including Charlotte Brontë, Christina Rossetti, Charles Dickens, Alfred Lord Tennyson, Bram Stoker and Lewis Carroll to show that mainstream models of middle-class Victorian womanhood share important qualities with the beliefs or behaviours of the anorexic girl or woman.
The main emphasis of this new fifth edition ofAdvanced Therapy of Gastroenterology and Liver Diseaseis on patient management. Chapters are dedicated to general topics in gastroenterology and hepatology practice and the use of diagnostic tests in clinical decision-making. Principles in endoscopy including sedation and infection control are also examined. Each chapter consists of recommendations from an expert in the field concerning a very focused problem. The authors discuss recommendations for instituting, modifying and monitoring therapy, including combinations of drugs and / or therapeutic and diagnostic procedures.
This two book/DVD package presents a parent training approach that is accessible, evidence based, and highly practical. Grounded in developmental and behavioral research, the Practitioner's Guide provides step-by-step guidelines for conducting parent training individually or in groups. It takes proven techniques for promoting the social-communication skills of young children with autism (up to age 6) and breaks them into simple yet effective steps for parents to follow. The DVD, for use in the training sessions, features video clips of parents implementing the techniques with their children, as well as PowerPoint slides. The Practitioners Guide also features 30 reproducible handouts and forms. The companion Manual for Parents helps parents master the techniques and use them at home with their child during daily routines and activities. - Publisher.
This wide-ranging comparative study argues for a fundamental reassessment of the literary history of the nineteenth-century United States within the transamerican and multilingual contexts that shaped it. Drawing on an array of texts in English, French and Spanish by both canonical and neglected writers and activists, Anna Brickhouse investigates interactions between US, Latin American and Caribbean literatures. Her many examples and case studies include the Mexican genealogies of Nathaniel Hawthorne, the rewriting of Uncle Tom's Cabin by a Haitian dramatist, and a French Caribbean translation of the poetry of Phillis Wheatley. Brickhouse uncovers lines of literary influence and descent linking Philadelphia and Havana, Port-au-Prince and Boston, Paris and New Orleans. She argues for a new understanding of this most formative period of literary production in the United States as a 'transamerican renaissance', a rich era of literary border-crossing and transcontinental cultural exchange.
The University of Genoa - Ohio State University Joint Conference on New Trends in Systems Theory was held at the Badia di S. Andrea in Genoa on July 9-11, 1990. This Proceedings volume contains articles based on two of the three Plenary talks and most of the shorter presentations. The papers are arranged by author, and no attempt has been made to organize them by topic. We would like to thank the members of the Scientific Committee and of the Program Committee, the speakers and authors, and everyone who attended the conference. Approximately 120 researchers and students from all over the world visited Genoa for the meeting, representing a wide spectrum of areas in pure and applied control and systems theory. The success of the conference depended on their high level of scientific and engineering expertise, not to mention their enthusiasm. The Conference on New Trends in Systems Theory would not have been possible without the help of a great many institutions and people. We would like to thank the University of Genoa, particularly Professor Enrico Beltrametti, and the Ohio State University's Columbian Quincentenary Committee led by Professor Christian Zacher, for encouragement and financial assistance. The University of Genoa Mathematics Department and Communication, Computer and System Sciences Department supplied assistance and technical help. The staff of the Consorzio Genova Ricerche, particularly Ms. Piera Ponta and Ms. Camilla Marconi, worked diligently over many months and especially during the conference itself to insure a smooth and enjoyable meeting.
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