Agency and fatalism in older Appalachian women’s information seeking about gynecological cancer

Researchers consider older women in rural Appalachia to have low levels of agency and high levels of fatalism regarding decision making about cancer treatment. Using the life course perspective, we examined older women’s agency with information seeking about gynecological cancer. Semistructured interviews with 20 White women living in central Appalachia revealed four trajectories: Surrendering Control, Accepting Death, Self-Care, and Advocacy, each with its own forms of agency. Some women experienced personal transformation, increased self-efficacy, and a passion for community empowerment. Fatalism was not understood apart from placing trust in medical expertise. We implore researchers to further explore rural expressions of agency.     

Everything for the Children: Orphans Growing Up in Informal Adoptive Families in China

Most orphaned children in China are cared for by their extended families or become state wards under the guardianship of child welfare institutions. Some exceptions are children who are found and cared for by families in the community, without a formalized adoption or foster relationship. In some locations, institutions now accept guardianship for these children and support the informal adoptive family to continue to care for them. This article examines the outcomes for these children as they became young adults by comparing these 12 children raised within the system as they approach or have approached young adulthood (now aged 16–40 years-old). Some of the participants were either informally adopted or lived in institutional care. The results of this study found that the family environment was more conducive to the young people’s wellbeing as they approached or entered adulthood. The participants raised in informal care appeared to be treated similar to the biological children in these families. When the institution formalized the state guardianship responsibility, it also meant the families had state resources for support to protect the children’s rights to economic security, education, health care, and social participation. This practice by the institution supported the addition of informal adoption, as one step closer to permanency than foster care. Future implications include considering this option to help promote the family system assisting these children, families, and the state.     

Exploring Heideggerian hermeneutic phenomenology: A perfect fit for midwifery research

BackgroundHeideggerian hermeneutic phenomenology has been used widely to understand the meaning of lived experiences in health research. For midwifery scholars this approach enables deep understanding of women's and midwives’ lived experiences of specific phenomena. However, for beginning researchers this is not a methodology for the faint hearted. It requires a period of deep immersion to come to terms with at times impenetrable language and perplexing concepts.ObjectivesThis paper aims to assist midwives to untangle and examine some of the choices they face when they first come to terms with an understanding of this methodology and highlights the methodology's capacity to reveal midwifery authenticity and holistic practice.DiscussionThe illumination of a selection of various concepts underpinning hermeneutic phenomenology will inform midwives considering this methodology as suitable framework for exploring contemporary midwifery phenomena.     

Introduction to the Special Issues on the Supervision of Staff and Field Education of Students

Two Special Issues of the Clinical Social Work Journal have been dedicated to building on the social work discipline’s tradition and commitment to the supervision of staff and field education of students. These issues bring together contemporary theorizing, clinical supervisory and field education practice experience and wisdom, and research studies to contribute to the knowledge base for practicing supervisors and field educators. As the first of the Special Issues, this issue has been dedicated to the supervision of staff. In this Introduction, we share the salient aspects of the articles published, as they relate to contemporary social work supervision, relational considerations within the supervisory dyad, models of supervision for fields of specialization, as well as measurement and evaluation. Implications are shared, with highlights and connections for practicing supervisors made throughout.     

Rendering sexism invisible in workplace narratives. A narrative analysis of female entrepreneurs’ stories of not being talked to by men

Entrepreneurism is widely regarded as being one way in which women can sidestep the sexism of male‐dominated institutionalized work environments and enter into a world in which men and women operate on a level playing field. Yet, in a corpus of stories of female entrepreneurs’ experiences, we noted that being ignored by men was a constant theme. Taking a social constructionist and narrative approach to identity, we analyse the gendered identity work that female entrepreneurs do in these stories and we seek to explicate the process through which female entrepreneurs do not evaluate being ignored by men as sexism‐in‐action. Using positioning theory as an analytical tool, we analyse these stories at three different levels: the here‐and‐now interaction between interviewer and storyteller; the there‐and‐then identity work of the characters in the storyworld; and the wider societal Discourses that the storytellers enact, and which are enacted by such identity work. Findings indicate that despite making gendered difference, inferiority and lack of agency relevant, the stories are not evaluated as sexism‐in‐action because the female entrepreneurs enact a postfeminist and neoliberal Discourse of freedom, autonomy and choice, rather than a feminist Discourse of discrimination and sexism.     

Reports of Conferences,Institutes, and Seminars

This installment of "Serials Spoken Here" covers events that transpired between late September and late October 2008. Reported herein are two Webinars, one on ONIX for Serials, the other on SUSHI, and two conferences: the eighty-fourth annual Meeting of the Potomac Technical Processing Librarians and the New England Library Association's Annual Conference.     

Statistical modeling for Bayesian extrapolation of adult clinical trial information in pediatric drug evaluation

Children represent a large underserved population of “therapeutic orphans,” as an estimated 80% of children are treated off‐label. However, pediatric drug development often faces substantial challenges, including economic, logistical, technical, and ethical barriers, among others. Among many efforts trying to remove these barriers, increased recent attention has been paid to extrapolation; that is, the leveraging of available data from adults or older age groups to draw conclusions for the pediatric population. The Bayesian statistical paradigm is natural in this setting, as it permits the combining (or “borrowing”) of information across disparate sources, such as the adult and pediatric data. In this paper, authored by the pediatric subteam of the Drug Information Association Bayesian Scientific Working Group and Adaptive Design Working Group, we develop, illustrate, and provide suggestions on Bayesian statistical methods that could be used to design improved pediatric development programs that use all available information in the most efficient manner. A variety of relevant Bayesian approaches are described, several of which are illustrated through 2 case studies: extrapolating adult efficacy data to expand the labeling for Remicade to include pediatric ulcerative colitis and extrapolating adult exposure‐response information for antiepileptic drugs to pediatrics.     

Endless Pressure: Life on a Low Income in Austere Times

Much has been written that details the decline in living standards following the ‘credit crunch’ in the UK. It remains that we understand to a lesser degree the lived reality of poverty through the Great Recession and into the era of austerity. This article draws on testimonies of 62 participants from low income households conducted in three different areas of the UK during 2012–13 to document the pressures that this period brought to bear on these households. According to these testimonies, the experience of poverty intensified in key respects: first, participants reported feeling, more than ever before, that they were ‘existing, rather than living’ due to the meagre budgets they were forced to live on; second, the precarious nature of work and social security contributed to a sense of insecurity that was all pervasive in our participants' lives; third, due to the pejorative political rhetoric and media coverage of poverty, our participants felt that their lives were placed under increased scrutiny which deleteriously impacted their wider relationships and sense of belonging. Our analysis demonstrates the profound consequences for those living on low incomes of the continued shift to residual forms of state welfare and the increased reliance on the ‘Big Society’ as a means to deal with the pressures identified in this article.     

Medicare and Amyloid PET Imaging: The Battle Over Evidence

We examine a recent dispute regarding the Centers for Medicare and Medicaid Services’ (CMS) refusal to unconditionally pay for amyloid positron emission tomography (PET) imaging for Medicare beneficiaries being assessed for Alzheimer’s disease. CMS will only pay for amyloid PET imaging when patients are enrolled in clinical trials that meet certain criteria. The dispute reflects CMS’s willingness in certain circumstances to require effectiveness evidence that differs from the Food and Drug Administration’s standard for pre-market approval of a medical intervention and reveals how stakeholders with differing perspectives about evidentiary standards have played a role in attempting to shape the Medicare program’s coverage policies.