Galen's Avoiding Distress provides an opportunity for scholars to qualify Galen's philosophical eclecticism because his ἄσκησις to avoid distress intersects theory and practice. My thesis carefully analyzes the theoretical framework behind Galen's claim that he “trained his φαντασἰαι for the loss of all his possessions” as well as the specific practices that constitute this training regimen. I trace the concept of φαντασἰα back to the first philosophical discussions in Plato's Theaetetus-Sophist structure and Aristotle's De anima to answer the questions “What are the φαντασἰαι that he talks about?” and “How do they participate in cognition?” I analyze Galen's On the doctrines of Hippocrates and Plato, Affections and Errors, and Thrasybulus to identify Galen's specific practices and relate them to what Galen thinks is the purpose of all humans. My inquiry allows me to argue that while Galen uses his imagination to condition himself not to fear the atrocities of Commodus he subordinates emotional tranquility and practices that promote it to the greater goal of doing good deeds for others.

Some highway agencies in the United States are experiencing frequent distresses in asphalt pavements on bridge approaches/departures. Commonly observed distresses include alligator cracking and rutting, which reduce roadway smoothness and safety. To lessen the distresses in pavements it is needed to investigate the extent and root causes of the problem. Based on Florida highway conditions, this research study mainly focused on1. Literature review and identification of the extent of the problem; 2. Collection of relevant pavement condition data and descriptive analysis; 3. Development of statistical models to determine factors influencing the distresses in asphalt pavements on bridge approaches/departures. To the best of my knowledge, this is the first study that uses a statistical model to determine the factors that are responsible for causing asphalt pavement distresses on bridge approaches/departures. As part of the literature review, a nationwide questionnaire survey was targeted towards U.S state DOTs. The data collection and analysis specific to the Florida highways found that in 2015 on Florida Interstate highways, about 27% bridges with asphalt pavements on their approaches/departures showed signs of cracking, and about 20% bridges have noticeable rutting in their approach or departure pavements. A random parameter linear regression model was applied to examine the factors that may influence distresses in asphalt pavements in Florida. Pavement condition was evaluated based on the Florida Department of Transportation (FDOT) 2015 pavement condition data and video log images, and other relevant data were collected from various sources such as FDOT Roadway Characteristics Inventory (RCI) database, FDOT pavement management reports, and FDOT Ground Penetrating Radar (GPR) survey reports. A constraint existed in the availability of the GPR data that can give pavement layer thickness, which limited the number of bridge approach pavement sections included in the statistical modeling. Based on the limited data, the estimated results from the random parameter linear regression model showed that the variables influencing distresses in asphalt pavements on bridge approaches/departures, in terms of rutting and roughness, may include pavement age, annual average daily truck traffic, and surface friction course.

This study aimed at investigating the current practices and methods adopted by roads agencies around the world with regard to collection, analysis and utilization of the data elements pertaining to the main pavement condition indicators in pavement management systems (PMS). It also aimed at identifying the main predictors associated with each condition indicator and the factors that govern pavement structural and functional performance. Development of a new performance index that incorporates parameters or measures related to the main condition indicators (surface defects, roughness, deflection and skid resistance) and establishing the weight to be assigned to each indicator based on the relative impact on pavement condition was also one of the main objectives of this study. Thousands of pavement sections were subjected to thorough testing and inspection over the last few years to collect data pertaining to the main condition indicators. The collected data encompass visual distress survey, deflection measurements, roughness and skid resistance measurements. Collection of various condition indicators was accomplished according to well known international standards. The collected data were processed, tabulated and analyzed for the purpose of development of performance models and to prove certain theories or good practices. / Advanced tools and machines were utilized to collect these data with a high degree of accuracy. The Falling Weight Deflectometer (FWD) was used to collect deflection data for structural analysis. Two Non-contact laser roughness measuring devices mounted on vehicles were heavily used for collecting roughness, texture, and rutting data. Distress data were collected using a manual procedure adopted and standardized at the Pavement Management System Unit of Dubai Emirate. Powerful engineering and statistical softwares were used in the analysis for the purpose of processing the data, back calculating the main parameters pertaining to pavement response, establishing the correlation matrices between various dependent variables and their predictors, and finally, applying linear and non linear regression analysis to develop reliable and predictable deterioration models for the uses of pavement management system. The analysis procedure was supplemented by a vast literature review for the up to date information along within deep investigations and verifications for some of the current practices, theories and models used in pavement design and pavement evaluation with more emphasis on the inherent drawbacks associated to these models and procedures. The study confirmed that pavement condition deterioration and performance can be best predicted and evaluated based on four main condition indicators; First, surface distress to assess the physical condition of the pavements and detect the inherent problems and defects caused by various factors affecting pavement performance. Second; roughness measurements to evaluate the riding quality of the pavement. / Third; deflection to calculate pavement response (stress and strains) and to assess pavement structural capacity and calculating the remaining life, and finally, skid resistance measurement to assess the level of safety and surface texture properties. Thorough study and investigation of the physical condition indicators and the associated parameters, confirmed that pavement distress data are vital elements in each pavement management system. Distress data can be used effectively to identify the main problems associated with pavement performance, causes of deterioration, maintenance measures needed to prevent the acceleration of the distress, the rehabilitation schemes needed to improve the pavement condition and finally to prepare maintenance work programs and to estimate the annual maintenance needs under an open or limited budget. Alligator cracking was found to have the heaviest impact on pavement condition. Distress density, probable causes of deterioration and distress propagation rate are the required parameters in PMS. Roughness was found to have a basic influence on pavement condition and the type of selected treatment. The use of Roughness data in terms of International Roughness Index (IRI) can be optimized in PMS by using this indicator in the following forms: / Roughness, as an objective measure, can be used as a good performance predictor of the current riding quality of pavements in service and reflects the inherent imperfections and built-in irregularities embodied in the road pavement surface. Roughness measurement can be used as a reference to establish construction specifications and provides through the PMS system an organized feedback approach to correct the persistent design deficiencies detected after road construction. Roughness can be used effectively in the planning process for maintenance works and to select the candidate sections through calculating the functional remaining life based on the estimated terminal value using Roughness-Age, Roughness-ESAL, and Roughness-PSI models. Lane–IRI along with the Difference between the left and right wheel IRI values, termed as “ Yaw” are the most suitable forms to be used in PMS to report about roughness characteristics. Yaw term can be used effectively to report or feed back about geometric imperfections that exist on the road surface such as improper cross slope, shoving and the probable drainage problems. The roughness cumulative distribution curves can be used as a planning tool in PMS to report at the network level. These curves indicate the network health and the required funding at different level of risks, so proactive measures can be taken and the required budgets can be made available. / Deflection data were found to form a basic component of the PMS. It was found that these data can be used at both network and project levels. Direct deflection measurements were found Not to be the ideal form to report about structural capacity at the network level. It is rather can be used at project level to detect weak spots and critical pavements layers. At the network level, the back calculated parameters from deflection basin such as Pavement Modulus (Ep), Asphalt and Pavement Curvature (CUR), Cross Sectional Area and the other deflection basin characteristics are much more appropriate for reporting about pavement structural conditions and calculating the structural remaining life in PMS. The design deflection and curvature that characterize the pavement have been found to be calculated based on the mean along with the two times the standard deviation of the measured data. The Effective Structural Number (SNeff) was found to have good correlations with the Total Pavement Thickness (Ht), the value of the deflection measured at the center of the loading plate ( D0 ) and the difference between D0 and the deflection measured at 450mm from the center of the loading plate ( D0 - D450 ). The first two variables were found to account for more than 92% of the structural capacity prediction model. / Traffic variable in terms of the accumulated standard repetitions (ESAL) was found to account for more than 60% of the deflection model predictability. Other variables such as E value, asphalt and base layer thicknesses can improve the predictability of the model if included. The concept of the relative value of effective pavement modulus to the original pavement modulus (Eeff/E0) was found to gives a reliable representation about the exhausted and the remaining life of the in-service pavement structure. The study showed that the pavement is reported to be structurally failed, when the effective asphalt or pavement modulus is about 20 - 35 % of its original design value which is equal to the modulus of the unbound material. It was also found that when the area of the fatigue cracking and the patching distresses exceeds 17% of the total pavement section area, or the depth of rutting is more than 15mm, the pavement is reported to be structurally failed and major rehabilitation or reconstruction should be applied. Skid resistance can be reported in the form of International Friction Index (IFI), as a well defined universal index, along with other two numbers; F60 Friction (Microtexture) related number measured at 60 km/h velocity and Macrotexture related number and Vp, which constitute the IFI index can be used in Pavement management system applications to report about skid resistance characteristics and the network level of safety. These three figures can be used to report about pavement condition, accidents, airports operations, and maintenance management surveys. / In this study, new methods and models were developed and suggested to be used in PMS as an alternative to the current available methods which were found to be impractical in certain cases. Finally, further research efforts are recommended to explore the uses of other parameters in particular those related to deflection basin analysis, cross sectional area, curvature, and pavement moduli. Skid resistance testing and reporting method should be subjected to further research works for the purpose of standardizing reporting methods, identifying the relative impact of main predictors i.e. megatexture, macrotexture and microtexture components and to develop performance models.

The Psalter has formed the basis of Judeo-Christian worship since ancient times. It has served, and continues to serve, individuals and communities of faith as a foundation for communal and personal devotion. As a devotional tool it is unique in that it provides prayers which address God directly concerning the whole gamut of life experience. While the Psalms can be examined and analysed as a literary text, they must be used and experienced by people to more fully discover and recognize their power in providing a pathway for expressing life experience. The lament psalms are of particular interest in this regard. There appears to be a reluctance, in some quarters, to employ them as an expression of prayer. As a result, the lament psalms as a way of engaging with experiences of personal distress, and voicing the reflections and responses such experiences produce, have often been ignored. This study suggests that psalms of lament provide a framework for expressing personal distress in the context of prayer. The framework, identified as a matrix of lament, consists of various modes of articulation characterized as expressing, asserting, investing and imagining constellations. The study examines what happens when individuals, who have first been made aware of the matrix of lament and its constellations, use lament psalms for prayer. Praying of lament psalms in this study is embedded in a prescribed process through which participants engage with their experiences of personal distress. As a result of such a process any significant psychodynamic changes which may take place can be observed, examined and explored, thereby, highlighting the efficacy of using lament psalms as a form of prayer. The study achieves this by examining the reflections and responses of selected individuals to see whether the process does in fact facilitate changes in the individual’s levels of distress, sense of personal control over distress and the nature of relationship between the individual and God. The reflections and responses also provide some indication of how the process might ‘birth’ a fresh perspective on personal distress for those who choose to incorporate these psalms into their journey of faith.

This cross-sectional study examined the prevalence of bullying and victimization among children identified as gifted who are in the last grade of elementary school (4th grade) and first two grades of middle school (5th and 6th grades). Additionally, I investigated if the children experienced distress associated with bullying and victimization and if the distress varied systematically across the three grades. The study took place at one elementary school and two middle schools located in Tennessee. There were a total of 35 participants [4th grade (n = 15), 5th grade (n = 13), and 6th grade (n =7)]. The results indicated that the 4th graders reported a significantly higher prevalence of bullying compared to the 5th graders. Furthermore there were significant, strong correlations between victimization and level of total distress; bullying and level of externalizing distress; and victimization and level of internalizing distress. The principal limitation of the study was the small sample size (N = 35). Additional studies investigating this topic should be conducted to help educators become more aware of the prevalence of bullying and victimization during the elementary-middle school transition period among children who are gifted. Such studies can also potentially shed light on the manner in which children who are gifted handle bullying and victimization.

Children undergoing surgical procedures often experience pain in the recovery room where parents are typically responsible for managing children’s distress. Research suggests that parents’ behavior influences children’s distress; however, no study has used time-window sequential analysis to examine the likelihood of parents’ reassurance and children’s distress interactions. The purpose of this study was to utilize time-window sequential analysis to examine the likelihood of parents’ distress preceding and following the start of children’s distress. Participants included 148 families with children 2-11 years old undergoing outpatient surgery. Reassurance was positively associated with children’s distress, but sequential analyses revealed that children’s nonverbal distress was significantly less likely to start and stop following parents’ reassurance and children’s verbal distress was significantly less likely to occur after fathers’ reassurance. These data suggest that reassurance does not prompt distress to start; however, it may maintain children’s distress.

The purpose of this study was to illuminate the experienced impact of childhood sexual abuse (CSA) within the context of intimate relationships. Few studies have examined the lived experience of CSA within the context of a relationship from the perspective both partners. Further, previous research in the area of CSA has primarily focused on the trauma experienced by the survivor, thus excluding the impact of CSA on the couple relationship. Examining the impact of CSA on intimate relationships is important as those individuals in close relationship with the survivor will often also experience the impact of the long-term sequelae associated with CSA. Interpretative phenomenological analysis (IPA) was used to explore the lived experiences of individuals who have experienced CSA and their partners. Data generated during two joint interviews with three participant couples were transcribed and analysed using an interpretative phenomenological analysis approach. An over-arching theme of hope and healing: past yet present, healed yet healing emerged from the data; this theme was impacted by the additional themes identified throughout the analysis process. The additional three themes were: living with the unknown, (barely) surviving, and commitment. Given the limited research on the impact of CSA on intimate partnerships and the focus of existing studies on the more negative aspects of the impact CSA has on relationships, the theme of hope and healing: past yet present, healed yet healing provides a valuable contribution to the literature. These themes are discussed along with implications for counselling practices and future research.

Purpose: The objective of this study was to investigate both depression and psychological distress as determinants of breast and cervical cancer screening. Methods: Ontario female respondents to the Canadian Community Health Survey version 1.2 (2002) were assessed for both Major Depressive Disorder (World Mental Health-Composite International Diagnostic Interview for depression) and psychological distress (Kessler 6-item Distress Scale (K6)>/= 8). Respondents eligible for screening (N=4042 for cervical cancer; N=1403 for breast cancer) were linked to Ontario administrative health service data to prospectively ascertain screening outcomes. Results: Women with K6 >/= 8 had reduced breast cancer screening compliance in adjusted analyses (AOR 0.63, 95% CI 0.40-0.97). The association between K6 >/= 8 and cervical cancer screening approached significance in women over age 40 (AOR=0.65, 95%CI 0.41-1.04). Conclusion: Decreased likelihood of screening in women with clinically significant psychological distress suggests that attention to adequacy of preventive services is a potential target for intervention.

Purpose: The objective of this study was to investigate both depression and psychological distress as determinants of breast and cervical cancer screening. Methods: Ontario female respondents to the Canadian Community Health Survey version 1.2 (2002) were assessed for both Major Depressive Disorder (World Mental Health-Composite International Diagnostic Interview for depression) and psychological distress (Kessler 6-item Distress Scale (K6)>/= 8). Respondents eligible for screening (N=4042 for cervical cancer; N=1403 for breast cancer) were linked to Ontario administrative health service data to prospectively ascertain screening outcomes. Results: Women with K6 >/= 8 had reduced breast cancer screening compliance in adjusted analyses (AOR 0.63, 95% CI 0.40-0.97). The association between K6 >/= 8 and cervical cancer screening approached significance in women over age 40 (AOR=0.65, 95%CI 0.41-1.04). Conclusion: Decreased likelihood of screening in women with clinically significant psychological distress suggests that attention to adequacy of preventive services is a potential target for intervention.

This study explored external and internal factors and their effect on childrens memory of a naturalistic, potentially stressful event, namely, a dental procedure. Specifically, question format (yes/no questions versus multiple choice questions) and temporal delay (short delay versus long delay) were the external factors examined, while anxiety, temperament, distress level, working memory and previous experience were the internal factors examined. Children (N=68) aged 4-12 years and their parents participated. Prior to the procedure, children provided ratings of their current anxiety on an anxiety rating scale. Following the procedure, children provided pain ratings and were given 24 forced choice questions regarding the dental event. Parents responded to questions regarding their childs previous dental experiences and temperament via a questionnaire. The findings suggest that: (a) multiple-choice questions are more problematic than yes/no questions, (b) that younger children are more suggestible than older children, especially when asked no and absent feature questions; (c) children who report more pain and anxiety, and whose parents describe them as less sociable, evidence higher rates of suggestibility; and (d) after a two month delay, on average, children accurately recalled their pain for the dental event, however, higher trait anxiety scores were associated with higher recollection of experienced pain. The findings are discussed with respect to implications for interviewing children and for management of pain in clinical settings.