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Objective The objective was to describe the experience of patients in self-managing. Method Phenomenology design was used in this study. Fifhteen of families who have family member which undergoing hemodialysis were recruited as participants. In-depth interviews were conducted at April to July 2018 to explore of the experiences of family in patients’ self-managing. Data were analyzed using Colaizzi. Result We found four themes of patients'self-management which reported by their family. There themes were (1) having positive and negative views on life changes after undergoing hemodialysis, (2) spirit for undergoing the process of hemodialysis, (3) controlling the activity and (4) limitation of food while undergoing hemodialysis and patient's expectations during hemodialysis. Conclusion Self-management of patients who receive hemodialysis includes self-management in physical form (controlling activities and food restrictions) and psychological (views on life changes and life zest).

In this study, we first discuss the current status and issues of disaster management education in the context of special support education in Japan, in view of the casualties of those with disabilities during major past earthquakes in Japan. We highlight that there are very few examples of practical implementation of, instructional material for, or previous studies on disaster management education for disabled children, or an established systematic instructional method. As a result, disaster management education tailored to the specific type of disability has been implemented on a school-to-school basis among Special Support Schools for children with disabilities. In many cases, teacher-led evacuation drills have been considered disaster management education. This is an indication that the disaster management education currently practiced in Special Support Schools is inadequate to achieve the goal of “fostering the attitude of acting on one’s initiative” as set forth by the Ministry of Education, Culture, Sports, Science and Technology (MEXT). In view of the situation in Japan, where casualties due to natural disasters continue to occur frequently since the Great East Japan Earthquake, it is urgent that we promote practical disaster management education to foster the Zest for Life among disabled children. This paper is a case study of disaster management education that targets those with intellectual disabilities, which is the largest reported disability type among children enrolled in Special Support Schools in Japan. We applied the ADDIE (Analyze, Design, Develop, Implement, Evaluate) process in instructional design to develop an earthquake disaster management program designed to heighten the capacity of disabled children to foresee and circumvent danger to themselves, so as to protect their lives from large earthquakes which occur frequently in Japan. Specifically, the objective is to apply the earthquake disaster management education program, developed by the authors in a previous study, to children with intellectual disabilities. To this end, we implemented the program at the target school and verified its educational effect while taking into consideration the degree or condition of disability and the learning characteristics of the intellectually disabled and developed a valid program for intellectually disabled children. The program allows the teachers of Special Support Schools to practice disaster management education in the context of daily classroom study with students without the need to dispatch a disaster management expert to the school each time a program is implemented. Additionally, the program can be customized by the onsite teacher for individual schools, which can lead to a systematic program in disaster management education. In addition, we propose a framework to establish a network of stakeholders, including disaster management experts or organizations and educational institutions to effectively and strategically promote disaster management education. This framework makes it possible to implement the present program the most impactful way, and to maximize the benefits to the schools in Tochigi prefecture.

COVID-19 was first identified in December 2019. As long as this type of coronavirus was new, the main way for governments to avoid the spread of the infection was enforced quarantine. Besides public health protection, quarantine can have a psychological impact on the residents, with main symptoms being angst, anxiety, depressive, and PTSD symptoms. As it has been found that character strengths can promote subjective wellbeing, the purpose of the study was to examine this relationship under the new situation of quarantine in the Greek population in adults who were in quarantine for at least two weeks. The total sample consisted of 354 participants who were aged 18–72-years-old. A total of 263 participants were women (74.3%), 91 were men (25.7%), and 94.6% of them were highly educated. The sample was a convenience sample. The tools used were PANAS, PERMA and finally VIA-114GR. The data analysis was completed using SPSS software version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY, USA: IBM Corp) and EQS 6.1 (Multivariate Software Inc.: Encino, CA, USA, 2006). The results showed that love, curiosity, persistence, hope, and zest are strongly associated with subjective wellbeing, even in conditions such as quarantine, and can support specific aspects of it.

Purpose: To describe, validate, and provide preliminary normative data for an open-source eye-movement perimeter (Eyecatcher).\ud \ud Methods: Visual field testing was performed monocularly in 64 normally sighted young adults, using (i) a Humphrey Field Analyzer (HFA) and (ii) the novel Eyecatcher procedure. Eyecatcher used a remote eye-tracker to position stimuli relative to the current point of fixation, and observers responded by looking towards the stimulus. In both tests, Goldman III stimuli were sampled from a 24-2 grid, and were presented against a 10 cd/m2 background. Participants completed each test twice to assess test–retest repeatability.\ud \ud Results: Mean Sensitivity (MS) did not differ between Eyecatcher and the HFA (P = 0.086), and both tests exhibited similar test–retest repeatability (CoREyecatcher = ±1.86 dB; CoRHFA = ±1.95 dB). Eyecatcher was also able to detect changes in sensitivity across the normal visual field (the “Hill of Vision”), and could differentiate the physiological blind spot from adjacent retinal locations. Mean sensitivities and 95% limits of agreement are described for each pointwise location.\ud \ud Conclusions: Eyecatcher can use eye movements to assess visual fields in young, normally sighted adults. In such observers, it provides results similar to the current gold standard clinical device (HFA).\ud \ud Translational Relevance: Given further development, eye movement perimeters such as Eyecatcher could be particularly useful for individuals unable to perform traditional perimetric assessments, such as young children or stroke patients. Full technical details and information on how to freely acquire the source code are included.

Understandings of nature, landscape and the senses have seen important shifts over time, from early medieval ideas of land ‘shaping’ to more detached contemplative notions of land ‘scoping’ since the seventeenth century. Despite a growing body of research demonstrating the richness of people’s diverse multisensory nature encounters, certain interpretations and embodiments of nature are persistently prioritised over others in both policy and practice. This essay explores how long-standing preoccupations with the visual in people’s understandings of nature and landscape have intersected with overly simplistic metanarratives of ‘blindness’ and disability in ways that are constraining contemporary opportunities for genuinely inclusive nature experiences, experiences that could instead be promoting health and wellbeing through inspiring curiosity, embodied connection, movement and challenge. To do so, I draw on the findings of a 2-year in-depth qualitative study, ‘Sensing Nature’, exploring how people with varying forms and severities of sight impairment experience a sense of wellbeing (or otherwise) in diverse types of nature during the life course. The essay examines how study participants had come to embody and experience different nature encounters, pursuing a ‘zest to curiosity’ in ‘mundane everyday’ as well as ‘riskier’ natures. In doing so, it seeks to counter overly simplistic sensory stereotypes of people with sight impairment as ‘sub-’ or ‘super-humans’, understanding people first and foremost as idiosyncratic individuals with diverse nature interests, embodied knowledge and skills.

Objective:Co-Phenylcaine Forte is a nasal spray routinely prescribed by otolaryngologists in Australia. The taste of Co-Phenylcaine Forte is typically described as unpleasant. This study sought to improve the overall patient experience associated with Co-Phenylcaine Forte by generating a Co-Phenylcaine Forte formulation, referred to as Co-Phenylcaine Zest, which contains an added vanilla flavour and masking agent.Methods:Participants were randomised to receive two actuations of Co-Phenylcaine Forte in each nostril followed by two actuations of Co-Phenylcaine Zest, or vice versa. There was a 6–36-hour washout period between each treatment. After the administration of each spray, participants completed a questionnaire to rate various sensory attributes of each formulation on seven-point ordinal scales. Patients reported their overall formulation preference after receiving both treatments.Results:A total of 86 participants completed the trial. Seventy-four per cent of patients preferred Co-Phenylcaine Zest, 21 per cent preferred Co-Phenylcaine Forte and 5 per cent had no preference (p < 0.001). The satisfaction score associated with Co-Phenylcaine Zest was 1.22 points greater than with Co-Phenylcaine Forte (p < 0.001).Conclusion:A novel formulation of Co-Phenylcaine Forte was created by adding a flavour and a masking agent; this formulation was preferred by most patients.

In aging societies, zest for work may be pivotal when deciding to stay occupationally active longer. Psychosocial work stress is a prevalent public health problem and may have an impact on zest for work. Work over-commitment (WOC) is a personal coping strategy for work stress with excessive striving and a health risk. However, the long-term effect of WOC on zest for work is poorly understood.To investigate the age-related associations of work over-commitment with zest for work.During 1996-1998 and 2000-2003, predominantly industrial workers (n = 2940) participated in the WOLF-Norrland study and responded to a questionnaire referring to socio-demographics, WOC, zest for work, effort-reward imbalance proxies, and mental health. Age-adjusted multiple logistic regressions were performed with original and imputed datasets.Cross-sectionally, work overcommitted middle-aged employees had an increased prevalence of poor zest for work compared to their contemporaries without WOC (OR: 3.74 [95%-CI 2.19; 6.40]). However, in a longitudinal analysis associations between onset of 'poor zest for work' and the WOC subscales 'need for approval' (OR: 3.29 [95%-CI 1.04; 10.37]) and 'inability to withdraw from work' (OR: 5.14 [95%-CI 1.32; 20.03]) were observed.The longitudinal findings among older employees could be relevant regarding the expected need to remain occupationally active longer.

Summary This article focuses on the evaluation of vaccine-induced immune responses as principal surrogate markers for predicting a given vaccine's effect on the clinical endpoint of interest. To address the problem of missing potential outcomes under the principal surrogate framework, we can utilize baseline predictors of the immune biomarker(s) or vaccinate uninfected placebo recipients at the end of the trial and measure their immune biomarkers. Examples of good baseline predictors are baseline immune responses when subjects enrolled in the trial have been previously exposed to the same antigen, as in our motivating application of the Zostavax Efficacy and Safety Trial (ZEST). However, laboratory assays of these baseline predictors are expensive and therefore their subsampling among participants is commonly performed. In this article, we develop a methodology for estimating principal surrogate values in the presence of baseline predictor subsampling. Under a multiphase sampling framework, we propose a semiparametric pseudo-score estimator based on conditional likelihood and also develop several alternative semiparametric pseudo-score or estimated likelihood estimators. We derive corresponding asymptotic theories and analytic variance formulas for these estimators. Through extensive numeric studies, we demonstrate good finite sample performance of these estimators and the efficiency advantage of the proposed pseudo-score estimator in various sampling schemes. We illustrate the application of our proposed estimators using data from an immune biomarker study nested within the ZEST trial.

Nurses are expected to deliver cost-effective, high-quality care. In order to provide this care, nurse researchers are needed to evaluate and research effective health care models and interventions. By including research concepts within a baccalaureate nursing program, interest in nursing research can be increased. The purpose of this article is to present a case study of strategies used in an undergraduate liberal arts nursing program to promote zest in research and increase the pursuit of graduate studies among baccalaureate nursing students. Using the Bronfenbrenner ecological framework, the promotion of research is categorized into microsystems (individual), mesosystems (multiple setting), exosystems (program), and macrosystem (institutional culture) levels. The microsystem level includes engagement in the classroom, engagement in one-on-one meetings, and faculty members as role models. The mesosystem involves engagement outside the classroom and encouragement from faculty members. The exosystem level describes specific learning activities and programs the nursing department utilizes such as community assessments, preconception reproductive knowledge promotion, and women supporting women. Finally, the macrosystem includes a supportive and encouraging environment. By working together, each system contributes to the students' zest for nursing research and interest in graduate studies in nursing to pursue the role of a nurse researcher.

William Gladstone presided as Prime Minister of Great Britain on four separate occasions between 1868 to 1894. Gladstone was preoccupied both personally and politically with religion, and his personal faith journey reflected the larger crisis of faith occurring in Britain in the nineteenth century as secularism and urbanization began to erode the place of faith in common life. Many scholars have referred to this period as the “Victorian Crisis of Faith.” This paper examines his personal diaries and extensive writings to understand his zest for religion, primarily regarding the supposed papal aggression of 1850 in Great Britain and his personal faith crises. The significance of this paper is that it highlights how both personally and politically this key leader was working to understand the role of religion in public life in nineteenth-century Great Britain.

Objectives: This cross-sectional study was conducted to explore the specialty chosen by the dental students for postgraduate studies and the future aspirations of students in a Saudi Arabia dental college. Materials and Methods: Of the total number of 120 questionnaires that were distributed, 107 subjects responded with selective responses and a response rate of 89%. A descriptive survey was conducted using one of the questionnaires among the students of dentistry at the dental college, Prince Sattam Bin Abdulaziz University, Al-Kharj among male students (men's college) for a period of 2 months. The data were analyzed using the statistical software program, predictive analytics software Statistics version 22.0 (SPSS Inc., Chicago, IL, USA). Results: A hundred and seven of the 120 students took part in the study. A passion for orthodontics (42.9%) was reported to be the most important factor that influenced the decision to pursue specialty training in orthodontics followed by intellectual stimulation/challenge (25%). The decision to pursue orthodontics was made by 32.1% of the respondents while in dental school; 35.7% took the decision after completing dental school during private practice and 14.3% during a dental residency, whereas 3.6% had already decided before initiating their dental school studies. Working in a private practice environment was preferred by 11 residents (39.3%). Only four residents indicated that they would most likely be practicing in an academic setting while 10 were undecided. Conclusions: The zest for nonclinical specialties is less among students at Prince Sattam Bin Abdulaziz University's dental college, Saudi Arabia.

Purpose: To investigate a novel approach for structure-function modeling in glaucoma to improve visual field testing in the macula.\ud \ud Methods: We acquired data from the macular region in 20 healthy eyes and 31 with central glaucomatous damage. Optical coherence tomography (OCT) scans were used to estimate the local macular ganglion cell density. Perimetry was performed with a fundus-tracking device using a 10-2 grid. OCT scans were matched to the retinal image from the fundus perimeter to accurately map the tested locations onto the structural damage. Binary responses from the subjects to all presented stimuli were used to calculate the structure-function model used to generate prior distributions for a ZEST (Zippy Estimation by Sequential Testing) Bayesian strategy. We used simulations based on structural and functional data acquired from an independent dataset of 20 glaucoma patients to compare the performance of this new strategy, structural macular ZEST (MacS-ZEST), with a standard ZEST.\ud \ud Results: Compared to the standard ZEST, MacS-ZEST reduced the number of presentations by 13% in reliable simulated subjects and 14% with higher rates (≥20%) of false positive or false negative errors. Reduction in mean absolute error was not present for reliable subjects but was gradually more important with unreliable responses (≥10% at 30% error rate).\ud \ud Conclusions: Binary responses can be modeled to incorporate detailed structural information from macular OCT into visual field testing, improving overall speed and accuracy in poor responders.\ud \ud Translational Relevance: Structural information can improve speed and reliability for macular testing in glaucoma practice.

Children in pre-adolescence stage and adolescents are at the juncture of transition budded with dreams of bright future. They are developing their identity and are full of zest. A diagnosis of a life threatening illness like cancer at such a phase of life can uproot and devastate the child and its family. The diagnosis and treatment demands can drain these patients physically and mentally. Providing psychological support during this phase becomes crucial to assist their coping. Arts-based Therapy (ABT) was used to offer psychological support to young individuals (11-22 years) undergoing cancer treatment in a tertiary cancer hospital in Mumbai. ABT was offered in group set-up for the duration of 4 months. Effects of ABT was studied among 6 participants who competed their participation of 4 months in ABT sessions. Feedback from the participants, parents and teachers reported reduction in distress, development of positive attitude, improved mindfulness, general feelings of relaxation and improvement in quality of life with ABT. The research findings support previously documented evidence of effectiveness of ABT.

Previous research suggests implicit cognition can predict suicidal behavior. This study examined the utility of the death/suicide implicit association test (d/s-IAT) in acute and prospective assessment of suicide risk and protective factors, relative to clinician and patient estimates of future suicide risk. Patients (N = 128; 79 female; 111 Caucasian) presenting to an emergency department were recruited if they reported current suicidal ideation or had been admitted because of an acute suicide attempt. Patients completed the d/s-IAT and self-report measures assessing three death-promoting (e.g., suicide ideation) and two life-sustaining (e.g., zest for life) factors, with self-report measures completed again at 3- and 6-month follow-ups. The clinician and patient provided risk estimates of that patient making a suicide attempt within the next 6 months. Results showed that among current attempters, the d/s-IAT differentiated between first time and multiple attempters; with multiple attempters having significantly weaker self-associations with life relative to death. The d/s-IAT was associated with concurrent suicidal ideation and zest for life, but only predicted the desire to die prospectively at 3 months. By contrast, clinician and patient estimates predicted suicide risk at 3- and 6-month follow-up, with clinician estimates predicting death-promoting factors, and only patient estimates predicting life-sustaining factors. The utility of the d/s-IAT was more pronounced in the assessment of concurrent risk. Prospectively, clinician and patient predictions complemented each other in predicting suicide risk and resilience, respectively. Our findings indicate collaborative rather than implicit approaches add greater value to the management of risk and recovery in suicidal patients. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background Mindfulness is a trainable skill that may enhance resilience to suicidality among vulnerable groups such as young people. The current study examined whether mindfulness protects against suicidal desire in the face of heightened risk and adversity by increasing zest for life in a sample of university students. Methods In a prospective design, participants (N = 233) were assessed at two time points over eight weeks. Online surveys included the Mindful Attention and Awareness Scale, Zest for Life Scale, Interpersonal Needs Questionnaire, Kessler Psychological Distress Scale, and items assessing suicidal ideation and suicidal intent. Results Baseline mindfulness was associated with lower suicidal ideation and intent at follow-up. Moderated mediation analyses confirmed the effects of mindfulness on ideation and intent were mediated by zest for life and these indirect effects were stronger at higher versus lower levels of general (psychological distress) and suicide-specific (perceived burdensomeness and thwarted belongingness) risk. Limitations Single item assessments of suicidal desire. Conclusions Findings suggest that mindfulness protects against suicidal desire in conditions of heightened risk and adversity by enhancing one's orientation towards a life worth living. Theories of suicide should consider the dynamic interplay between risk and life-sustaining resilience, while clinicians treating suicidality could use mindfulness strategies to strengthen the desire to (re)engage with life, thereby complementing direct amelioration of suicide risk factors.

This paper examines the role of gamification for enjoyment in physical exercise and a healthy diet. The lack of motivation for these health-related behaviors is associated with the rising incidence of cardiovascular diseases, diabetes, hypertension, and obesity. Gamification involves leveraging on enjoyment derived from game mechanics that could galvanize individuals to exercise and consume healthier meals. Literature has also noted that enjoyment is associated with competing activities, personal investments, valuable opportunities, social constraints, and social support. This work introduces Zest!, a gamified application designed to enhance enjoyment to exercise and diet. Zest! aims to enhance enjoyment by entwining exercising and dieting activities with game mechanics. An evaluation was conducted to understand users’ perception of enjoyment associated with exercising and dieting as a result of using Zest!. It validates the game mechanics in enhancing the enjoyment to the activities. A total of 70 participants took part in the study and used it for two days. During the study, the participants were given tasks to utilize the available features. A questionnaire was administered at the end of the study to elicit their perceptions. Regression analyses were performed on the data collected. The results indicate that gamified applications has to potential to enhance enjoyment for physical exercise and a healthy diet. The implications from this study are presented.

This study aimed to determine if response times gathered during perimetry can be exploited within a thresholding algorithm to improve the speed and accuracy of the test. Frequency of seeing (FoS) curves were measured at 24 locations across the central 30° of the visual field of 10 subjects using a Method of Constant Stimuli, with response times recorded for each presentation. Spatial locations were interleaved, and built up over multiple 5-min blocks, in order to mimic the attentional conditions of clinical perimetry. FoS curves were fitted to each participant’s data for each location, and response times derived as a function of distance-from-threshold normalised to the slope of each FoS curve. This data was then used to derive a function for the probability of observing response times given the distance-from-threshold, and to seed simulations of a new test procedure (BURTO) that exploited the probability function for stimulus placement. Test time and error were then simulated for patients with various false response rates. When compared with a ZEST algorithm, simulations revealed that BURTO was about one presentation per location faster than ZEST, on average, while sacrificing less precision and bias in threshold estimates than simply terminating the ZEST earlier. Despite response times varying considerably for a given individual and their thresholds, response times can be exploited to reduce the number of presentations required in a visual field test without loss of accuracy.

Treatment of partially edentulous patients with few remaining teeth is very challenging. These cases can be successfully treated with natural teeth supported overdentures. Comprehensive treatment plan with natural teeth supported overdentures saves the proprioceptive response of the teeth, along with other benefits such as improved masticatory efficiency, better retention, stability, support as compared to conventional tissue supported complete dentures. The other most important benefit of overdentures is the psychological security of well retaining dentures which increases patient's confidence level. This article presents a case report in which a partially edentulous patient was successfully rehabilitated with comprehensive treatment of maxillary natural teeth supported overdenture with locator attachment (Zest Anchors) and mandibular partial denture.How to cite this articleMengal GP, Ram SM, Nadgere J, Shah N. Comprehensive Treatment of a Partially Edentulous Patient with Overdentures. J Contemp Dent 2014;4(3):185-189.

Paola Domizio, the pathologist and professor who has died from breast cancer, may be the only person to have incorporated card tricks into her inaugural professorial lecture. It was typical of the flair she brought to her teaching role at Barts and the London School of Medicine and Dentistry at Queen Mary University of London and to her ambassadorial and leadership positions with the Royal College of Pathologists. Having served as assistant registrar and then registrar for a total of nine years from 2001, Domizio deployed her communication skills and zest for the specialty as director of public engagement at the college from 2011. Concerned that the public’s view of pathology was shaped by TV crime solving sleuths in pristine white coats, running between antiseptic laboratory and faintly exotic murder scenes, she wrote articles and took to television and radio herself to redress the balance. It was during this period that the college adopted the strapline “Pathology: the science behind the cure.” This was in the 1990s, and Domizio was among those to take on the discredited former doctor and antivaccine activist Andrew Wakefield, writing two articles challenging his research methods and conclusions around links between the measles, mumps, and rubella vaccine and autism. Domizio may also have been the first clinician to offer children who had undergone colectomies for bowel disease the opportunity to view and learn about the bowel resection tissue that had caused their distressing symptoms. She …

Patient Empowerment (PE) can be considered as an active and self-determining role of patient than a passive recipient of health related services. It encourages the provider–patient relationship to blossom and helps in clearing patients’ doubts, confusion and fears to bring in clarity, relief and assurance. For the active involvement of the patient's in own health management they need to be awakened, motivated, educated and enlightened to enable them to exercise their rights. Active patient involvement in the decision-making achieves favourable health outcome. In an empowerment based approach, the focus is not on defining a particular type of behaviour, but on how the behaviour is defined as a goal to be achieved by a particular individual. As a result of their empowerment process, the patients can better self-manage their illness and their lives. Thus empowerment of the patients will positively help medical uprising of the community by creating an educated, health aware, informed and health conscious mass.

Positive life orientation (PLO) is considered an important dimension of successful aging.To investigate how self-reported PLO changed among home-dwelling people from age 70 to 80 and 85 years.A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland.The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (N=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. PLO was assessed with the following items: life satisfaction, feeling needed, having plans for the future, having zest for life, feeling depressed, and suffering from loneliness. We created a PLO score from the answers to these questions, where 1 represented the best PLO and 0 the poorest.At baseline, the participants showed rather high levels of positive life orientation (PLO total score 0.83). PLO declined markedly after the 70-year-old participants reached the age of 80 and 85 years (p.001). However, depressive feelings remained quite stable. The decrease was similar among men and women except for the items suffering from loneliness and feeling needed. At age 70 and 80 years women suffered more from loneliness than men, while men experienced feeling needed more than women.Positive life orientation declines during old age, especially from age 70 to 80 years. Thereafter the decline is less steep except for changes in future plans and feeling needed.

Educational attainment is inversely associated with SBP level in young adulthood. This association has not been studied in an older cohort, and confounding and mediating factors are not well known.The authors hypothesized that higher education is associated with lower levels of SBP independent of many risk factors for hypertension. This prospective observational study included a sample of 764 older community-living participants in the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly (MOBILIZE) Boston Study.Compared to participants with more than college education, regression analyses showed those with a high school education or less had a SBP value 6.33 mmHg higher [95% confidence interval (CI): 2.55-10.10], and those who had a college education had a SBP value 4.01 mmHg higher (95% CI: 0.77-7.25) independent of many hypothesized confounders and mediators.Results of a path analysis confirmed that higher level of education was associated with lower SBP even after adjustment for hypothesized mediators. Although slightly attenuated by multivariable adjustment for hypertension risk factors, the significant inverse association between educational attainment and SBP was not entirely mediated by these risk factors. These findings indicate that education is inversely associated with SBP in a diverse cohort of community-living older adults, independent of many known or suspected risk factors.This study is the first to report the association between education and SBP in an older sample, representing a population at the highest risk for hypertension-related morbidity and mortality.

The renowned surgeon, neuroanatomist, and artist Sir Charles Bell not only impacted the lives of his peers through his creative endeavors and passion for art, but also sparked noteworthy breakthroughs in the field of neuroscience. His empathetic nature and zest for life enabled him to develop an early proclivity for patient care. As a result of his innovative findings regarding sensory and motor nerves and the anatomical makeup of the brain, he accepted some of the most prestigious awards and received an honorable reputation in society. Bell is recognized for his diligence, perseverance, and his remarkable contributions to surgery. The present review will explore his contributions to the discipline now known as neurosurgery.

Background Self-rating scales developed for monitoring depression severity are potentially informative and cost effective tools. There is an increasing tendency to use the Montgomery–Asberg Depression Rating Scale (MADRS) and the self-rating version (MADRS-S) interchangeably. Methods 400 patients with major depressive disorder were included. Concordance between patient and physician ratings was measured by means of repeated MADRS and MADRS-S ratings during a six-month drug trial and one-year follow-up. Results Overall scores from patients and physicians show the same trends and both are sensitive to improvements. Our results, however, show only moderate to good agreement between patient and physician ratings. Intraclass coefficients ranged from 0.47 to 0.75 with highest agreement at week 8. Limitations Generalizability is restricted to outpatients in general practice with moderate to severe depression. MADRS-S and MADRS scale definitions are similar but not identical concerning language and are scaled differently, 0–6 vs. 0–3, respectively, which may have influenced the results. The exclusion criteria restricted the range of values for the item Suicidal thoughts/Zest for life, which may have reduced the correlations. Conclusions MADRS-S is a suitable tool for following patients' symptoms on a regular basis over time and may also be used to compensate for bias in physicians' ratings in drug trials.

Several studies link attachment insecurities with lower levels of life satisfaction. Positive psychology studies link character strengths, especially those associated with social interactions (i.e., love and gratitude) or optimism (hope and zest), with higher levels of life satisfaction. We hypothesized that the negative associations between insecure attachment and life satisfaction is mediated by low endorsement of such strengths. In this study 394 individuals completed the ECR measure of attachment orientations, the VIA-IS measure of virtues and character strengths, and the SWLS measure of life satisfaction. Results showed that most strengths were negatively associated with both avoidant and anxious attachment orientations. A bootstrapping procedure revealed that: (a) Love, zest, gratitude and hope fully mediated the association between avoidance and lower life satisfaction. (b) Hope, curiosity and perspective partially mediated the association between attachment anxiety and life satisfaction. These findings suggest that the mechanisms underlying life satisfaction are different for avoidant and for anxious individuals, although hope is prevalent for both attachment orientations. The theoretical and clinical implications of the findings are discussed.

The portrayal of death is one of the most common themes in movies and is often unrealistic, promoting misconceptions to the public. However, there are also many films that portray death acceptance in an instructive way. Such films depict the development of character strengths useful in embracing life and lessening death anxiety, namely zest, curiosity, self-regulation, and humor. Moreover, the role of meaning in films is pivotal for understanding death attitudes. The authors discussed key elements in a number of popular, independent, and international films and emphasized the use of films as an important adjunct for both teachers and clinicians addressing death attitudes with students and clients. A program of death education using movies is briefly discussed.

Adaptive thresholding procedures (e.g., ZEST) benefit from testing near the current estimate of threshold. Therefore, small increments may improve precision of these techniques. We evaluated the validity of visual acuity assessment when letters are not constrained to a multiple of 5 pixels high.Snellen letters were presented over a ±5 pixel range spanning the final threshold estimate. Sizes that were a multiple of 5 pixels (e.g., 20 and 25) were presented 160 times, and other sizes were presented 40 times. This resulted in 320 letter presentations at multiples of 5 and at non-multiples of 5. Post hoc ZEST procedures were used to compute acuity threshold estimates based on testing at those two sets of sizes. Two subjects participated: subject 1 for the right and left eyes and subject 2 in two sessions with binocular viewing. Psychometric functions were fit to the data and were used to model simulated observers. Simulations were run for each data set, and the number of presentations at each size matched the number presented to the subject. Ninety percent limits for proportion correct at each letter size were determined from the simulation data, and these limits were used as criteria for identifying outliers in the subject's data.No significant difference in acuity thresholds were found when letters were rendered in multiples of 5 pixel heights vs. letters without this constraint. Empirical data fell within the bounds defined by simulations, with no idiosyncratic results found for either set of letter sizes.Letter sizes that do not conform to a multiple of 5 pixel letter height yield valid acuity scores. This facilitates adaptive psychometric procedures for acuity testing, such as ZEST and QUEST, in which letter sizes are selected to be as close to the current estimate of threshold size as possible.

Esthetic demands in today's world of dentistry are scaling new heights, and are driven by the zest to look beautiful. The soft tissue esthetics around implants is the foci of attention, which, if failed to meet, leads to unacceptable esthetic failure. The aim of this article is to give a brief overview of the various vital parameters influencing the esthetics governing the peri-implant area.

Walking speed is one of the strongest predictors of health outcomes in older adults, and has been associated with falls, morbidity, and mortality. Slow walking has also been linked to reduced executive functioning and altered functional brain integrity. Specifically, our previous work has demonstrated that reduced activation of the executive network during a working memory (n-back) task is associated with slow walking speed in a cohort of older adults from the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly of Boston Study (MOBILIZE Boston Study). However, the simultaneous influence of underlying white matter integrity on executive functioning, executive network brain activation, and walking speed is unknown. Thus, we used diffusion weighted imaging and fMRI during the n-back task to assess associations between executive network structure, function, and walking speed. Whole-brain tract-based spatial statistics (TBSS) were used to identify regions of white matter microstructural integrity that were associated with slow walking speed. The integrity of these regions, quantified by fractional anisotropy (FA), was then correlated with n-back performance and executive network activation. Lower FA in the right superior longitudinal fasciculus, right anterior thalamic radiation, and the forceps minor of the corpus callosum was significantly associated with slow walking speed. Low FA in these frontal white matter regions was further associated with poor n-back performance (response speed) and reduced executive network activation. These findings suggest that microstructural damage to the right frontal white matter may partially account for altered executive network activation and slow walking speed in older adults.

Purpose Correctly classifying progression in moderate to advanced glaucoma is difficult. Pointwise visual field test–retest variability is high for sensitivities below approximately 20 dB; hence, reliably detecting progression requires many test repeats. We developed a testing approach that does not attempt to threshold accurately in areas with high variability, but instead expends presentations increasing spatial fidelity. Methods Our visual field procedure Australian Reduced Range Extended Spatial Test (ARREST; a variant of the Bayesian procedure Zippy Estimation by Sequential Testing [ZEST]) applies the following approach: once a location has an estimated sensitivity of 17 dB to “defect”, or (3) “defect” to blind. To test this approach we used an empirical database of progressing moderate-advanced 24-2 visual fields (121 eyes) that we “reverse engineered” to create visual field series that progressed from normal to the end observed field. ARREST and ZEST were run on these fields with test accuracy, presentation time, and ability to detect progression compared. Results With specificity for detecting progression matched at 95%, ZEST and ARREST showed similar sensitivity for detecting progression. However, ARREST used approximately 25% to 40% fewer test presentations to achieve this result in advanced visual field damage. ARREST spatially defined the visual field deficit with greater precision than ZEST due to the addition of non–24-2 locations. Conclusions Spending time trying to accurately measure visual field locations that have high variability is not productive. Our simulations indicate that giving up attempting to quantify size III white-on-white sensitivities below 17 dB and using the presentations saved to test extra locations should better describe progression in moderate-to-advanced glaucoma in shorter time. Translational Relevance ARREST is a new visual field test algorithm that provides better spatial definition of visual field defects in faster test time than current procedures. This outcome is achieved by substituting inaccurate quantification of sensitivities

Aims: To describe the consequences of long-term sick leave (>28 days) on working situation, health and lifestyle among employees from the public sector in Sweden. Methods: Employees in four county councils and two municipalities on long term sick leave on 1 November 2005 (n = 1,128) answered a questionnaire in February 2006. The response rate was 71.7%. Eighty seven per cent were still on sick leave when the questionnaire was answered: 54% part time and 33% full time. Results: Reporting positive consequences was rare but reporting negative consequences, such as effects on the development of salary, the possibilities of pursuing a career or to change to another job were common. Sick leave seemed to lead to a considerable loss of zest for work, even if the respondents were back in work full time. Regardless of the negative consequences at work, 92% of those on part-time sick leave believed that the part-time sick leave was good for them even if many thought it had negative consequences for employer and colleagues. Conclusions: Long-term sick leave has negative consequences for the individual in work situations, even for those back at work full time. The development of salary and career seem to be most affected. The attitude towards part-time sick leave was positive and this result indicates that there is a potential for an increased degree of partial return to work in the group of people on long-term sick leave.

The authors briefly review the literature on occupational health, including occupational medicine, occupational health psychology, and occupational safety, framing the current convergence of these from their scientific origins in preventive medicine and its most basic science of epidemiology, in psychology, and in engineering. They give attention to the burden of suffering, which concerns issues of morbidity and mortality within a population group, and consider both the economic and humanitarian perspectives of the burden of suffering, which may occur within a working population as a result of poor occupational health. The authors see reason for optimism for the future and identify two sets of emerging trends: one set that includes four positive advances—positive health, leadership, mood and emotions, and interventions—and one that falls under the authors' rubric of new horizons—technology, virtual work, globalization, and aging. The authors conclude with attention to zest at work, along with cardiovascular health and well-being.

Although there are various definitions o/wellness, few conceptual definitions have addressed the contextual dimensions of wellness relative to African American counselors. The authors present an overview of generic models of wellness, discuss factors that both inhibit and promote wellness, offer some culture-specific models of wellness, and address implications for future research. ********** In recent years, the issue of promoting wellness has gained considerable interest among counseling, human development, and medical professionals (Constantine & Sue, 2006; J. E. Myers, 1992; J. E. Myers, Madathil, & Tingle, 2005; Prilleltensky & Prilleltensky, 2003). Although wellness does not constitute a new domain for counselors, it appears to be so because historically the profession has maintained a mental health orientation that emphasizes the treatment of pathology rather than the application of interventions that optimize human potential. The promotion of wellness has been linked to several populations, such as children (Cicchetti, Rappaport, Sandier, & Weissberg, 2000), patients with AIDS (Holt, Houg, & Romano, 1999), teachers (Queen & Queen, 2003), and persons with physical and mental illness (Sperry, Lewis, Carlson, & Englar-Carlson, 2005). However, for the past 2 decades, the holistic notion of wellness in counseling has received less attention and, consequently, the focus on developmental theories and wellness strategies have been underemphasized (J. E. Myers, 1992). J. E. Myers (1991) defined wellness as the "maximizing of human potential through positive life-style choices" (p. 183). In another definition, Ardell (1985) emphasized that wellness is a conscious and intentional approach to an advanced state of physical and psychological/spiritual health. In order to illustrate the distinction between health and wellness, Greenberg (1985) offered a definition of wellness that integrates social, mental, emotional, spiritual, and physical components, where a high level of wellness is exhibited when the components are balanced. He further commented that health is typically defined as the absence of illness, whereas wellness emphasizes a zest and enthusiasm for life. Within the counseling literature, two models of wellness have emerged: the Wheel of Wellness (J. E. Myers, Sweeney, & Witmer, 2000) and the Indivisible Self (J. E. Myers & Sweeney, 2005) models. These models characterize holistic constructions of wellness and prevention over the life span and encompass both a multidisciplinary focus and theoretical grounding in Adlerian individual psychology. The Wheel model is composed of five life tasks that are essential to optimal wellness: spirituality, self-direction, work and leisure, friendship, and love. The self-direction life task includes 12 additional tasks necessary for wellness: sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self-care, stress management, gender identity, and cultural identity. The Wheel of Wellness highlights the overlaps of these various domains of wellness, which can ultimately help counselors understand clients as individuals and as part of their respective environments. The second model, the Indivisible Self, is more evidence-based and incorporates 17 wellness dimensions and five "selves": the essential sell social sell creative sell physical sell and coping self (J. E. Myers & Sweeney, 2005). The essential self is composed of four components: spirituality, self-care, gender identity, and cultural identity. The creative self consists of thinking, emotions, control, positive humor, and work. The coping self includes four components: realistic beliefs, stress management, self-worth, and leisure. The social self consists of two components: friendship and love. The physical self includes two components: exercise and nutrition. …

PURPOSE: To introduce a perimetric algorithm (Spatially Weighted Likelihoods in Zippy Estimation by Sequential Testing [ZEST] [SWeLZ]) that uses spatial information on every presentation to alter visual field (VF) estimates, to reduce test times without affecting output precision and accuracy. METHODS: SWeLZ is a maximum likelihood Bayesian procedure, which updates probability mass functions at VF locations using a spatial model. Spatial models were created from empirical data, computational models, nearest neighbor, random relationships, and interconnecting all locations. SWeLZ was compared to an implementation of the ZEST algorithm for perimetry using computer simulations on 163 glaucomatous and 233 normal VFs (Humphrey Field Analyzer 24-2). Output measures included number of presentations and visual sensitivity estimates. RESULTS: There was no significant difference in accuracy or precision of SWeLZ for the different spatial models relative to ZEST, either when collated across whole fields or when split by input sensitivity. Inspection of VF maps showed that SWeLZ was able to detect localized VF loss. SWeLZ was faster than ZEST for normal VFs: median number of presentations reduced by 20% to 38%. The number of presentations was equivalent for SWeLZ and ZEST when simulated on glaucomatous VFs. CONCLUSIONS: SWeLZ has the potential to reduce VF test times in people with normal VFs, without detriment to output precision and accuracy in glaucomatous VFs. TRANSLATIONAL RELEVANCE: SWeLZ is a novel perimetric algorithm. Simulations show that SWeLZ can reduce the number of test presentations for people with normal VFs. Since many patients have normal fields, this has the potential for significant time savings in clinical settings.

Few studies shed light on what older people themselves consider a good or dignified death. This study is part of a larger project where interviews were used to follow 12 nursing home residents over time. The aim of the present study was to reach a deeper understanding of seven older people’s thoughts, feelings and attitudes towards death. The participants were interviewed on four occasions across 18–24 months, and the interviews were analysed using a hermeneutic method. The findings revealed three main themes: 1. Zest for life, 2. Indifferent attitude, 3. Longing for death. The themes mirror the complexity of what ageing and nearing the end of life can mean. A strong desire among the participants was to be more involved in their own personal care and in everyday life at the nursing home. Person-oriented care based on the philosophy of palliative care, and including conversation as a natural component, might promote the older person’s possibilities to obtain a good death.

Health means vital force : a phenomenological study about self-image, ability and zest for life

In this work, originally undertaken 10 years ago, the author asks whether there might be any one particular psychopathology likely to be linked specifically with the physical illness known as chronic fatigue syndrome (CFS) or myalgic encephalitis (ME), and whether CFS/ME aids and abets, and ‘fits’, an original mental state. She thinks the question cannot yet be answered, but hypothesizes that in some personality structures the onset of CFS/ME following a physical illness exacerbates negativity, and is an aspect of ordinary depression where there is a lowering of energy levels and a loss of zest for life, or it may reveal the pathological aspect of unresolved rage. Depending on the degree of pathological disturbance, working with and through the rage may or may not result in a resolution of the symptoms of ME. Some of the problems in the transference and countertransference relationship are considered, which make it extremely difficult to separate out reality from fantasy. There is then the further problem of the denial of the psyche by the patient as part of the violence inherent in the illness. The findings in this paper are corroborated by research undertaken over the last four years and these are incorporated into the paper. One case is presented, an example of ME in a borderline male patient in whom resolution could not be achieved. Copyright © 2005 The British Association of Psychotherapists

This paper primarily compares retention among three types of stud attachments of dentures and analyzes the stress associated with polarized photoelasticity to elucidate the stress distribution of various implants near the ambient surface of an implant under different conditions of loading on the prosthetics of a tooth. The experimental results yield many significant data. Using the two‐force principle to measure the retention of attachments yields two important areas of results. Under dry conditions, the O‐ring attachment has the largest retention force. While under wet conditions, the Zest attachment has the largest retention force. The photoelastic method is applied to analyze the stress distribution on the arch mandible. When the implants are loaded, the magnetic attachment will generate the largest stresses on the implant. The stresses associated with the Zest attachment are the smallest and can be neglected. Concerning the materials of the experimental arch model, PL‐2 photoelastic birefring...

Of the many honorifics bestowed on the articles in this historical series, it is doubtful that any have had applied the best—funny. The rhetorical zest and smiling outrage that Joseph Berkson brings to his puncturing of the quasi-religious precepts of traditional statistics in his classic article 1 recalls for me a public debate I witnessed in the 1980s between a highly respected statistician and a surgeon clinical-trialist. It was a debate on issues related to the adjustment of P-values in clinical trials, and what I remember best was the entrance of the physician in full surgical regalia; green operating scrubs, face mask, shoe covers, the whole bit. Playing effectively the role of the ‘aw-shucks, I’m just a country doc who don’t know nuthin’ ‘bout statistics’ he parodied traditional statistical precepts so effectively, contrasting them unfavourably with common-sense judgements, that the statistician, however meritorious his rebuttal may have been, was left sputtering, helplessly pounding the lectern. So it seems with this commentary, which asks in an innocent yet seemingly unanswerable way, ‘If the population [of people] is not human, what is it?’ This is the leading edge of an attack on Fisher’s P-value which should still be required reading for all students of epidemiology and biostatistics today. The commentary shows us several things. First, it demonstrates just how old are some current criticisms, often presented as enlightened insights from a modern era. His first sentence has almost a nostalgic quality that looks surprising over 60 years later, ‘There was a time when we did not talk about tests of significance; we simply did them.’ These words described the future as much as the pre-1942 past. Second, although it may not be immediately obvious, the argument presented here is closely related to ones that underlie modern recommendations to use CI and even Bayesian methods in lieu of P-values in biomedical research. Third, Berkson makes important distinctions between hypothesis testing and significance tests that continue to be ignored today. Fourth, and perhaps most subtly, he brings in a notion of ‘evidence’, a positive, relative concept that is critical to have on the table as separate and distinct from the P-value. And finally, he provides modern statisticians with a model for how to communicate technical concepts to applied users in an accessible and lively way. All that said, it must be admitted that Berkson’s critique is frustratingly incomplete. While he offers a scathing critique of the P-value, and shows us how standard interpretations contravene scientific intuition (grounded mainly in appeals to common sense) he does not offer a real alternative. He does call for more research, particularly into the meaning of what he calls ‘middle P’s’. It is in this gap that I will spend most of my time in this commentary; linking his insights with the ‘further research’ that indeed occurred over the succeeding 60 years.

In the present study, we report on an additive evaluation of mental well-being in an established program of preventive medicine including general and gynecologic examination, and screening mammography. An easy-to-use questionnaire including 19 questions was completed by 5247 women. Answers were grouped into mental well-being, zest for living, sexuality, and self-assessment of psychic disorders. A risk score for the presence of major depression was calculated. Women with high and intermediate risk for major depression were found in 5.0-7.2% and 15.4-19.8% depending on age, respectively. Seven to 9.2% and 19.2-26.5% of women suspected themselves to be at a high and intermediate risk for psychic disorders, respectively. Deterioration of well-being as well as the risk of developing depression is mostly overlooked in a general preventive medicine setting. We conclude that problems involving mental well-being seem to affect a significant number of women. The incorporation of easy-to-use questionnaires able to screen for mental problems to general preventive medicine programs must be strongly recommended.

We hypothesized that gelotophobia (the fear of being laughed at), gelotophilia (the joy of being laughed at), and katagelasticism (the joy of laughing at others) relate differently to character strengths. In Study 1 (N = 5,134), self-assessed gelotophobia was primarily negatively related to strengths (especially to lower hope, zest, and love), whereas only modesty yielded positive relations. Gelotophilia demonstrated mainly positive relations with humor, zest, and social intelligence. Katagelasticism existed widely unrelated from character strengths with humor demonstrating the comparatively highest coefficients. Study 2 consisted of N = 249 participants who provided self- and peer-ratings of strengths and self-reports on the three dispositions. The results converged well with those from Study 1. When comparing self- and peer-reports, those higher in gelotophobia under-estimated and those higher in gelotophilia over-estimated their virtuousness, whereas those higher in katagelasticism seemed to have a realistic appraisal of their strengths. Peer-rated (low) hope and modesty contributed to the prediction of gelotophobia beyond self-reports. The same was true for low modesty, creativity, low bravery, and authenticity for gelotophilia and for low love of learning regarding katagelasticism. Results suggest that there is a stable relation between the way people deal with ridicule and laughing and their virtuousness.

Adjustment to aging (AtA) is a multifactor adjustment process with implications on aging well among older adults. The aim of this study was to develop and validate a scale to assess the factors that older adults recognized as indicators of their AtA, with a cross-national comparative perspective towards aging well. Convenience sampling was used to gather questionnaire data, including demographics and the proposed scale. Complete data was available for 1,291 older community-dwelling adults, aged between 75 and 102 years (M = 83.9; SD = 6.68), who represented four different nationalities. Exploratory and confirmatory factor analyses were performed for dimension reduction and exploration of the factorial structure. Data gathered with the 22-items AtA five-factor scale showed overall good psychometric properties (in terms of distributional properties, statistical significant factor weights, factorial, convergent, discriminant criterion and externalrelated validities, as well as reliability). Five factors were selected for the Adjustment to Aging Scale: (a) sense of purpose and ambitions (b) zest and spirituality; (c) body and health; (d) aging in place and stability; and (e) social support. We present a 22-item scale with five factors for AtA estimation in a cross-national elderly population which produced valid and reliable data for elder persons from four different nationalities. Results showed that this scale is an adequate cross-cultural instrument for research, clinical practice and program development in the health care context. These may benefit from clearly understanding AtA as an important component for reducing health disparities and for aging well, across nationalities. Foundation for Science and Technology

"Zest for Life Instead of Strain of Illness" - Implementation and Evaluation of a Programme Activating Chronic Back Pain Patients in a Rehabilitation Clinic.A group training was developed for chronic back pain patients in a rehabilitation clinic to enhance coping, to activate internal and external resources, and to make transfer to everyday life easier. The training consists of 12 either physiotherapeutic or psychologically oriented sessions. The training was evaluated in a longitudinal, quasi-experimental control-group design. Patients of the intervention group (n = 144) and control group (n = 157) rated the usefulness of the rehabilitation for private and working life at the end of the in-patient phase (t1) and three month later (t2). They also evaluated selected elements of the rehabilitation (t2). Results show that the anticipated usefulness of the rehabilitation was rated higher at the end of the stay than three months later. This indicates frustration after returning to everyday life. Patients of the intervention group rated the transfer possibilities to working life higher than the control group. They also are more satisfied with the psychological parts of the rehabilitation. After minor revisions, such as strengthening the topic of employment, the training now is implemented in the clinic for all patients with chronic back pain.

The challenge of applying behavior analysis on a large scale is addressed. Behavioral safety is reviewed as an exemplar, because numerous industries worldwide are now using this technology to prevent occupational injuries. The basic principles and procedures of behavioral safety are presented with language and teaching aids that increase the acceptability of this approach. However, the broad-based marketing and application of behavioral safety has led to substantial controversy and misunderstanding about behavioral technology, as well as various misinterpretations. These issues are explicated, along with a call for action to help set the record straight and give behavior analysis the credit it deserves, thereby increasing its potential to make large-scale differences in quality of life. ********** As Malott (in press) recently pointed out, "behavior analysis is blessed with many professionals devoting their lives to chasing the noble dream--the dream of saving the world with behavior analysis." These "dream chasers" appreciate the value of an objective behavioral approach to problem solving, and realize the cost-effectiveness of using the basic three-term contingency (or Antecedent-Behavior-Consequence Model) to improve behavior on a large scale. Indeed, the research literature is replete with impressive demonstrations that this approach works, from improving learning and interpersonal care in educational and residential settings to increasing productivity and work quality in industrial environments (e.g., Goldstein & Krasner, 1987; Greene et al., 1987; Kazdin, 1994). And there have been numerous community-based applications of behavior analysis. For example, the author has seen firsthand the success of behavior analysis in addressing the human dynamics of such wide-ranging issues as environmental preservation (e.g., Cone & Hayes, 1980; Dwyer, Leeming, Cohen, Porter, & Jackson, 1993; Geller, Winett, & Everett, 1982), transportation safety (Geller, 1998; Ludwig & Geller, 2000), alcohol abuse and alcohol-impaired driving (Geller & Lehman, 1988), and childhood immunization against disease in third-world countries (Lehman & Geller, 1987). However, the potential for applied behavior analysis to solve societal problems has not been realized. The dream chasers' visions have not been reached. Beyond short-term demonstration projects, there have been very few large-scale implementations of behavior-change strategies for education, transportation safety, environmental protection, alcohol abuse, or public health. WHY HAVE OUR DREAMS FALLEN SHORT? There are a variety of possible reasons for the failure of applied behavior analysis to have far-reaching impact on critical society problems. The most obvious problem is the audience of these demonstration projects. The research is published in professional journals and books read almost exclusively by other psychologists, mostly behavior analysts. Here, the authors give convincing demonstrations of the efficacy of their behavior-change techniques to people who have little interest or influence in large-scale dissemination and application. In other words, the critical social marketing aspects of behavior-change technology have not been addressed (Geller, 1989). Bailey (1991) comments on this dissemination problem as follows, "We have a great science (the experimental analysis of behavior) and a pretty good technology (applied behavior analysis) but no product development or marketing" (p. 39). He explains further that "we do not value marketing" and have "neglected to develop socially acceptable terminology for presenting our concepts to consumers ... we have, in our zest for science and technology, taken the human concerns out of behavior analysis" (p. 39). In addition, long-term maintenance and institutionalization of behavior-change strategies have rarely been studied. Most applications of behavior analysis to address organizational, community, and societal problems have been short-term demonstration projects, conducted to show that a particular intervention procedure has a desired effect. …

There are a multitude of parent support groups for most life situations and medical conditions. The aim of this study was to discover defining characteristics and to evaluate the structure and effectiveness of parent support groups in paediatric anorectal anomalies. Over 200 non-profit organisations and parent support groups were sent questionnaires to determine their effectiveness. Many of these were excluded as they were deemed not relevant to the final study. A final 20 groups were included for review, questions were based around origins, activities, education and evaluation, organisational structure and their affiliations with the health care team. Most groups had similar origins, usually an educated parent who had a child born with the condition and a zest for further knowledge and understanding and a desire to share this with others in a similar situation. Only 20 % received government funding; few had paid staff and half had good relations with the local medical and paramedical fraternity. The majority had a team of long-term enthusiastic volunteers who remained with the group to support others long after their own child was no longer a concern. Some support groups offer a valuable service to families alongside the medical and paramedical fraternity. These groups provide families with the day-to-day lived experiences through social media, networking and meetings. Some provide more formal educational conferences designed to bring families, the medical and paramedical fraternity together to learn valuable lessons from each other.

PURPOSE To explore the performance of patient-specific prior information, for example, from structural imaging, in improving perimetric procedures. METHODS Computer simulation was used to determine the error distribution and presentation count for Structure-Zippy Estimation by Sequential Testing (ZEST), a Bayesian procedure with prior distribution centered on a threshold prediction from structure. Structure-ZEST (SZEST) was trialled for single locations with combinations of true and predicted thresholds between 1 to 35 dB, and compared with a standard procedure with variability similar to Swedish Interactive Thresholding Algorithm (SITA) (Full-Threshold, FT). Clinical tests of glaucomatous visual fields (n = 163, median mean deviation -1.8 dB, 90% range +2.1 to -22.6 dB) were also compared between techniques. RESULTS For single locations, SZEST typically outperformed FT when structural predictions were within ± 9 dB of true sensitivity, depending on response errors. In damaged locations, mean absolute error was 0.5 to 1.8 dB lower, SD of threshold estimates was 1.2 to 1.5 dB lower, and 2 to 4 (29%-41%) fewer presentations were made for SZEST. Gains were smaller across whole visual fields (SZEST, mean absolute error: 0.5 to 1.2 dB lower, threshold estimate SD: 0.3 to 0.8 dB lower, 1 [17%] fewer presentation). The 90% retest limits of SZEST were median 1 to 3 dB narrower and more consistent (interquartile range 2-8 dB narrower) across the dynamic range than those for FT. CONCLUSION Seeding Bayesian perimetric procedures with structural measurements can reduce test variability of perimetry in glaucoma, despite imprecise structural predictions of threshold. TRANSLATIONAL RELEVANCE Structural data can reduce the variability of current perimetric techniques. A strong structure-function relationship is not necessary, however, structure must predict function within ±9 dB for gains to be realized.

The objective of this study was to find an alternative to the Zest abutment (Zest Anchors Inc., Escondido, California) for attachment of a hair-replacement prosthesis. Standard implantology and surgical techniques were used to place the craniofacial implants and subsequent abutments. The new ERA (APM-Sterngold, Attleboro, Massachusetts) abutments provided superb retention of the prosthesis. Indications are that the many forms of retention made possible by the various abutments available can provide multiple attachment alternatives.

Yoga chikitsa (yoga as a holistic therapy) is becoming extremely popular, and numerous studies worldwide are providing scientific evidence of its therapeutic potential. 1-5 In our zest to make yoga popular, we may be missing the experiential link in the chain. The interconnectivity between research findings, their therapeutic applications, and the yoga therapist's practice must be strengthened to maintain the integrity of the practice of yoga. The strength of any chain is defined by its weakest link. Similarly, the healing potential of yoga chikitsa depends on the personal sadhana (practice) and conscious living of the therapist. We are the conduits, and we are responsible for transmitting the spirit of yoga to our patients or clients.