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91.
This mixed-methods study of BDSM investigates the nuances of BDSM participants’ role identities, role frequencies, and role fluidities—shifts in identities and play across time, location, scene, and play partner. Data were gathered from 202 online surveys and 25 semistructured interviews about participants’ roles given their gender and sexual identities. These data reveal that men tend to self-identify as Dominant, Master, Top, or Sadist (DMTS) and always perform dominant roles, while women tend to self-identify as Submissive, Slave, Bottom, or Masochist (SSBM) and always perform submissive roles. Although this would seem to support the theory that BDSM reinforces gendered dominant/submissive binaries, further analyses indicate that women and queer/pansexual individuals disrupt this binary through their Switch identities and roles. Switching and queer identities, thus, offer the possibility for transforming dominant/submissive and other binaries.  相似文献   
92.

Background

Second-degree tears are the most common form of perineal trauma occurring after vaginal birth managed by New Zealand midwives, although little is known about midwives’ perineal practice.

Aim

The aim of this study was to identify how midwives managed the last second-degree perineal tear they treated and the level to which their practice reflects National Institute for Health and Care Excellence guidelines.

Methods

An (anonymous) online survey was conducted over a six-week period in 2013. New Zealand midwives who self-identified as currently practising perineal management and could recall management of the last second-degree tear they treated were included in the analysis.

Findings

Of those invited, 645 (57.1% self-employed, 42.9% employed) were eligible and completed surveys. Self-employed midwives reported greater confidence (88.0% vs 74.4%, p < 0.001) and more recent experience (85.1% vs 57.4%, p < 0.001) with perineal repair than employed midwives. Midwives who left the last second-degree tear unsutured (7.3%) were more likely to report low confidence (48.9% vs 15.4%, p < 0.001) and less recent experience with repair (53.2% vs 24.7%, p < 0.001), and were less likely to report a digital-rectal examination (10.6% vs 49.0%, p < 0.001), compared to midwives who sutured. Care consistent with evidence-based guidelines (performing a digital-rectal examination, 59.4% vs 49.3% p = 0.005; optimal suturing techniques, 62.2% vs 48.7%, p = 0.001) was associated with recent perineal education.

Conclusions

Midwives’ management of the last second-degree perineal tear is variable and influenced by factors including: employment status, experience, confidence, and perineal education. There is potential for improvement in midwives’ management through increased uptake of evidence-based guidelines and through ongoing education.  相似文献   
93.
We consider supplier‐facilitated transshipments for achieving supply chain coordination in a single supplier, multi‐retailer distribution system with non‐cooperative retailers. The previous transshipment literature has focused on coordination through retailer‐negotiated transshipments and thus does not consider the supplier's decision‐making. In contrast, in this study, we assume the supplier is an active participant in the system and we seek to understand how the supplier can facilitate the implementation of coordinating transshipments. We study a two‐period model with wholesale orders at the start of the first period and preventive transshipments performed at the start of the second period. Inspired by a supplier‐facilitated transshipment scheme observed in practice, we assume the supplier implements transshipments through a bi‐directional adjustment contract. Under this contract, each retailer can either buy additional inventory from, or sell back excess inventory to, the supplier. We show that coordination can be achieved through carefully designed contracts with state‐dependent adjustment prices and a wholesale price menu. We demonstrate that the supplier's role in facilitating coordinating transshipments is critical. In addition, we use our understanding of the coordinating contract form to derive some simpler and easier‐to‐implement heuristic contracts. We use a numerical study to demonstrate the value, to the supplier, of using the coordinating adjustment and wholesale prices, and to evaluate the heuristics’ performance.  相似文献   
94.
Committed to developing an institution-wide intercultural competence curriculum for master’s-level students preparing for international careers, a team of nine professors from across disciplines deliberated for a year on their fundamental understandings of intercultural competence and what it would mean to facilitate the development of that competence in students. This article recounts the team’s philosophical debates related to intercultural competence: definitions, effective methods of teaching, intersectionality of identities, Western bias in the literature, power and inequity, and the role of language learning. The deliberations became the foundation for an institution-wide curriculum, focused on helping graduates to be not only effective workers and managers in multicultural settings, but also to be leaders in social change. This article shares the conversations and considerations of the planning process and the breadth and emphasis of the curriculum that emerged. Reflections on students’ learning and recommendations for curriculum developers are offered.  相似文献   
95.
Attachment researchers have proposed that the attachment, caregiving, and sexual behavioral systems are interrelated in adult love relationships (Mikulincer &; Shaver, 2007 Mikulincer , M. , &; Shaver , P. R. ( 2007 ). Attachment in adulthood: Structure, dynamics, and change . New York , NY : Guilford . [Google Scholar]). This study examined whether aspects of partners’ caregiving (proximity, sensitivity, control, compulsive caregiving) mediated the association between their attachment insecurities (anxiety and avoidance) and each other's sexual satisfaction in two samples of committed couples (Study 1: 126 cohabiting or married couples from the general community; Study 2: 55 clinically distressed couples). Partners completed the Experiences in Close Relationships measure (Brennan, Clark, &; Shaver, 1998 Brennan , K. A. , Clark , C. L. , &; Shaver , P. R. ( 1998 ). Self-report measurement of adult attachment: An integrative overview . In J. A. Simpson &; W. W. Rholes (Eds.), Attachment theory and close relationships (pp. 4676 ). New York : Guilford .[Crossref] [Google Scholar]), the Caregiving Questionnaire (Kunce &; Shaver, 1994 Kunce , L. J. , &; Shaver , P. R. ( 1994 ). An attachment-theoretical approach to caregiving in romantic relationships . In K. Bartholomew &; D. Perlman (Eds.), Advances in personal relationships (pp. 205237 ). London : Kingsley . [Google Scholar]), and the Global Measure of Sexual Satisfaction (Lawrance &; Byers, 1998 Lawrance , K. , &; Byers , E. S. ( 1998 ). Interpersonal Exchange Model of Sexual Satisfaction Questionnaire . In C. M. Davis , W. L. Yarber , R. Bauserman , G. Schreer &; S. L. Davis (Eds.), Sexuality-related measures: A compendium (pp. 514519 ). Thousand Oaks , CA : Sage . [Google Scholar]). Path analyses based on the actor-partner interdependence model (APIM) revealed that caregiving proximity mediated the association between low attachment avoidance and partners’ sexual satisfaction in distressed and nondistressed couples. Sensitivity mediated this association in nondistressed couples only. Control mediated the association between men's insecurities (attachment-related avoidance and anxiety) and their partners’ low sexual satisfaction in nondistressed couples. Attachment anxiety predicted compulsive caregiving, but this caregiving dimension was not a significant mediator. These results are discussed in light of attachment theory and their implications for treating distressed couples.  相似文献   
96.
The digital age has brought with it new and powerful computer-based methods of analyzing heretofore elusive patterns of nonverbal behavior. C-BAS (Meservy 2010) is a computer-assisted behavioral observation tool for identifying and tracking nonverbal behaviors from video. THEME (Magnusson, The hidden structure of interaction: from neurons to culture patterns, IOS Press, Amsterdam, pp 4–22, 2005) is a software program that discovers patterns among discrete events in time-ordered data. Together, these tools enable more precise measurement and analysis of nonverbal behavioral dynamics. Applications to three corpora derived from interpersonal deception experiments reveal unique nonverbal patterns that distinguish deceptive from nondeceptive interactions. The first and second experiments produced serial, hierarchically related patterns of behaviors that differed in length and complexity between truthful and deceptive participants during interviews about a theft and cheating, respectively. The third experiment produced differential patterns by and among group members completing a task. Deceivers were inclined toward strategic initiations and interactional control, whereas suspicious group members adopted a more passive, possibly watchful stance. Discovery of these patterns challenges the prevailing view that nonverbal behaviors are too faint and inconsistent to identify deceptive communication. Results have numerous implications regarding the following: the development of new measurement tools locating significant effects of nonverbal behaviors, support for theory that coherent and repetitive relationships exist within and among interactants’ communication, demonstration of the role of nonverbal behaviors in deceptive communication and the dynamic and strategic nature of deception.  相似文献   
97.
Despite a number of studies investigating the effect of pharmacotherapy on treatment costs for schizophrenia patients, there has been little attention given to the effect of family intervention. In this study, data from the Kansas Medicaid system were used to analyze healthcare costs for 164 schizophrenia patients who had participated in family intervention. Structural equation modeling was used to test two competing views of the role of family intervention in treatment. The results showed that a model including direct and indirect effects of family intervention provided a better fit to the data. Family intervention had a significant indirect effect on general medical costs (through other psychological treatment) that showed a savings of $586 for each unit increase in the provision of these services. In addition, the total indirect effects for family intervention showed a $580 savings for general medical costs and $796 for hospitalization costs (for each unit increase).  相似文献   
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Most cities, counties, and neighborhoods are not designed for an aging population. By providing a range of services to all residents, Lifelong Communities allow individuals to age in place. Although the Lifelong Communities Initiative is based on established guiding principles, little information exists regarding the realities of moving from policy to implementation. The Atlanta Regional Commission conducted a case study in Mableton, Georgia, and found successful implementation requires a combination of support from local citizen groups and government. The Atlanta Regional Commission is replicating these best practices in other communities and providing support to those aspiring to launch or expand Lifelong Communities.  相似文献   
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