A familiar theme in Greek myth is that of the deadly gift that passes between a man and a woman. Analysis of exchanges between men and women reveals the gendered nature of exchange in ancient Greek mythic thinking. Using the anthropological categories of male and female wealth (with examples drawn from many cultures), it is possible to arrive at an understanding of the protocols of exchange as they relate to men and especially to women. These protocols, which are based in part on the distinction between metals and other durable goods as "male" and textiles as "female," are closely related to the gendered division of labor. Anxiety about women as exchangers derives in part from their status as objects exchanged in marriage (as exemplified by Helen in the Iliad), and partly from a misogynist and pessimistic strand of Greek thought (embodied by Hesiod's Pandora) that discounts any female economic contribution to the oikos. Indeed, the majority of destructive exchanges take place within the context of marital crisis. While some texts, beginning with the Odyssey, show the positive side of women's economic role, tragedy tends to follow the Hesiodic distrust of women as exchange partners. Passages from the Agamemnon and the Trachiniai are analyzed to show how in situations of perverted reciprocity brought about by marital discord, even women's traditional gifts of textiles may become deadly.
The intervention group showed improvement in continence (p = .020), with no difference between groups on discharge disposition (p = .744). Results showed an unexpected higher occurrence of falls in the treatment group (p = .000). DISCUSSION AND CLINICAL RELEVANCE: This study supports existing literature indicating that continence is not an independent predictor of nursing home admission and offers new evidence that use of an evidence-based intervention bundle can significantly improve patient continence including those patients with mild to moderate cognitive impairment.
2016-11-15T19:38:30
Context: Electronic medical records hold promise to transform clinical practice. However, technological and other barriers may preclude using them to guide care in real time. We used the Virtual Data Warehouse (VDW) to develop a tool that enables physicians to generate real-time, personalized prognostic information about survival after cancer. Case description: Patients with cancer often ask their oncologists, “Have you ever seen a patient like me?” To help oncologists answer this question, we developed a prototype Prognostic Information System (PRISM), a web-based tool that gathers data about the index patient from Kaiser Permanente’s clinical information systems, selects a historical cohort of similar patients, and displays the survival curve of the similar patients relative to key points in their treatment course. Findings and major themes: The prototype was developed by a multidisciplinary team with expertise in oncology, research, and technology. We have completed two rounds of user testing and refinement. Successful development rested on: (1) executive support and a clinical champion; (2) collaboration among experts from multiple disciplines; (3) starting with simple cases rather than ambitious ones; (4) extensive research experience with the Virtual Data Warehouse, related databases, and an existing query tool; and (5) following agile software development principles, especially iterative user testing. Conclusion: Clinical data stored in health care systems’ electronic medical records can be used to personalize clinical care in real time. Development of prognostic information systems can be accelerated by collaborations among researchers, technology specialists, and clinicians and by use of existing technology like the Virtual Data Warehouse.
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