<p> <b>Objective:</b> To explore patient factors that influence patients&rsquo; decisions about Neoadjuvant chemotherapy (NC) including patient unmet needs, challenges in decision making, and the role of family and caregiver involvement in treatment decision making. Our goal is to elucidate patient factors including their beliefs, values, expectations, worries about NC and MIBC, emotional challenges, and the importance of caregivers&rsquo; involvement in decision making and selection of treatment procedures. </p><p> <b>Design:</b> A qualitative study with semi-structured single interviews and focus groups. Atlas.ti software was used to analyze the qualitative data collected. </p><p> <b>Settings:</b> Icahn School of Medicine at Mount Sinai (ISMMS) and Northwell Health (NH), New York, USA. </p><p> <b>Methods and Materials:</b> 20 MIBC survivors from the ISMMS (n = 10) and NH (n = 10) were enrolled in this study from September 2015 and August 2016. 17 of them finished a semi-structured single interview and 3 of them joined a focus group interview to share their decision-making process about their treatment plans. Three ISMMS health care providers were interviewed to understand physicians&rsquo; standpoints on the challenges, barriers, and potential facilitators for MIBC patients to make a decision about their treatment plans. </p><p> <b>Results:</b> Patients decisions on whether or not to go through NC were influenced by three major parts: physician&rsquo;s opinion or suggestion, family and spouses&rsquo; opinion, and patients&rsquo; own value and preferences. Sufficient information about treatment efficacy (i.e. treatment options, survival rates, experience sharing from former patients) would benefit patients&rsquo; decision-making process. Therefore ensuring information available for patients is important Results also showed that having a second opinion, experience shared by other patients, and caregivers&rsquo; help with information search helped address some of the patients&rsquo; reported informational needs. Physicians&rsquo; recommendations and advice were reported as influential factors in patients&rsquo; treatment decision making. Physicians&rsquo; challenges confirmed by interviewed patients suggested several areas await improvement including more help with daily activities from healthcare professionals, good bedside manners and professional figures, and opportunity to communicate with former patients. </p><p> <b>Conclusions:</b> Meeting patients&rsquo; informational and emotional needs is imperative to facilitate their decision-making process. Caregivers play significant roles in treatment decision making and recovery. Preparing caregivers for treatment decision making and patient care can maximize support received from the patient&rsquo;s social network. </p><p>

<p> The low HIV prevalence in Maldives coupled with low HIV comprehensive knowledge presents a challenge to the consistency of the hypothesized HIV knowledge-prevention paradigm. Researchers had not explained why HIV prevalence in Maldives is low despite the low levels of HIV knowledge. The purpose of this qualitative case study was to investigate factors beyond HIV knowledge that contribute to the low HIV prevalence among Maldivian male youth. The research questions focused on the risk-reduction factors in the nonmarital sexual behavior of young Maldivian males that contribute to protecting them from contracting HIV and the predictors of safe and unsafe nonmarital sexual behaviors among this target group. The reasoned action approach (RAA) and the theories embedded in the RRA (i.e., the integrated behavioral model, the theory of reasoned action, and the theory of planned behavior) provided the theoretical foundation for this research. A purposeful sample of 18 male university students participated in open-ended interviews. Data were coded and analyzed to identify themes and subthemes. The results indicated that the low HIV prevalence in Maldives can be attributed to long-standing social values and norms that discourage nonmarital sexual engagement; however, these social values and norms are currently fading away, putting the low HIV prevalence status of Maldives at risk. The implications for social change include providing practitioners with specific risk factors they should address to prevent the spread of HIV that would result in the loss of lives and deterioration in the quality of life among young Maldivian men.</p><p>

<p> Despite the direct connection between anal sex and pleasure (Hite, 1981; Morin, 2010), the majority of academic literature on anal sex frames the topic in terms of homophobia (when referring to male-bodied people) and/or disease (Aguilar, 2017; Brody &amp; Weiss, 2011; McBride &amp; Fortenberry, 2010). While only two academic articles (Branfman &amp; Stiritz, 2012; Branfman, Stiritz, &amp; Anderson, 2017) have been published on the topic of anoreceptive heterosexual males (ARHMs), there is evidence of this type of sexuality dating back to Ancient Egypt and Greece (Bullough, 1976; Foucault, 1990b). This is indicative of the socially systemic heteronormativity and associated constructs of heterosexism, homophobia, and phallocentrism that can instill shame and stigma in those with non-conforming sexual preferences, such as ARHMs, BDSM practitioners, and BDSM-oriented ARHMs (Ayres &amp; Leudeman, 2013; Bosson, Prewitt-Freilino, &amp; Taylor, 2005; Crane &amp; Crane-Seeber, 2003; Heasley, 2005; Taormino, 2008; Yost, 2010). Therefore, this research examined levels of heteronormativity, sexual shame, and sexual pride to determine whether higher levels of heteronormativity predict higher levels of sexual shame and lower levels of sexual pride in ARHMs, and whether heteronormativity, sexual shame, and sexual pride in ARHMs differ according to BDSM status. In multivariate linear regressions and independent-samples t-tests on data from 906 ARHMs, heteronormativity did not significantly contribute to the prediction of sexual shame in ARHMs; there was not a significant difference in heteronormativity between BDSM-oriented and non-BDSM-oriented ARHMs; there was a significant difference in sexual shame between BDSM-oriented and non-BDSM-oriented ARHMs, but not in the hypothesized direction (there were higher levels of sexual shame among BDSM-oriented ARHMs); and there was not a significant difference in sexual pride between BDSM-oriented and non-BDSM-oriented ARHMs. These findings highlight the nuance in sexual orientation and expression. It remains unclear whether the constructs of masculinity and heteronormativity are expanding to accommodate what were previously considered non-conforming sexual and gender expressions, or whether these constructs continue to obfuscate and repress through a manipulation of language that reinforces privilege. These findings have implications for clinicians who work with those who have both privileged and marginalized identities and/or sexual orientations.</p><p>

<p> One in every three women are victims of domestic violence. The social phenomena of intimate partner violence has been classified as an epidemic due to its impact on political, economic, social, and health development of human female populations. Research frequently questions mental health professionals&rsquo; ability to properly assess domestic violence severity. The purpose of this study was to investigate the relationship between the level of DV severity, PTSD, self-esteem, and therapists&rsquo; minimization in female victims of DV. A total of 40 female victims of DV responded to the survey either online or on paper. The survey consisted of four measures and was administered in English or Spanish. Seven hypotheses were tested using the SEM path analysis, but none of them were supported. A close examination of the responses to the minimization scale revealed that half of the participants reported that their therapists minimized the need for law enforcement and courts to get involved in domestic violence situations. The need for further training in domestic violence treatment and addressing such subtle minimization is discussed. Major limitations of the study included small sample size and sample recruitment from DV shelters. Factors potentially contributed to the small sample size were explored. Suggestions for future qualitative research to explore and understand victims of domestic violence experience of minimization by mental health providers as well as quantitative research to develop and test a DV training program were discussed. Keywords: domestic violence minimization, PTSD, domestic violence, intimate partner violence.</p>

<p> Dissatisfaction caused by work conflicts between members of different generations is possibly rooted in misinterpretations of the millennial generation, those born between 1980 and 2001, especially in relation to the type of supervisory leadership behavior they favor. The purpose of this quantitative study was to examine whether there is a statistically significant relationship between transformational leadership and job satisfaction among millennial workers in an intergenerational workforce. The Multifactor Leadership Questionnaire (MLQ) questionnaire was selected to measure the five subscales of transformational leadership and the Minnesota Satisfaction Questionnaire (MSQ) to measure job satisfaction. A sample of 133 U.S. millennial employees in information technology (IT), healthcare, and sales and marketing selected from LinkedIn groups completed the survey. Two statistical models were developed and findings indicated a significant positive relationship between transformational leadership and its five factors and the job satisfaction of millennials. The five transformational leadership factors were attributed as an explanation of 37.8% of millennials&rsquo; job satisfaction in the first model. The second model of overall transformational leadership score was applied to explain 36.4% of the relationship. The individual consideration component showed the highest score indicating a significant positive relationship with millennial job satisfaction (<i>r</i> = .584; <i>p</i> &lt; .05). As such, the component&rsquo;s contribution to the predictive model was the highest of all transformational leadership factors (<i>R²</i> = .341, <i>F</i>(1, 133) = 15.451, <i>p</i> &lt; .05; <i> B</i> = 5.52), indicating that when leadership behaviors displayed individualized attention, job satisfaction increased. Variables of gender and occupational sector did not correlate significantly with job satisfaction of millennials and therefore were excluded. There was a significant relationship between covariate annual income and job satisfaction of millennials (r = .150; <i> p</i> &lt; .05). Across occupational sectors, job satisfaction did not differ much and millennial males indicated a higher level of satisfaction at work (<i>M</i> = 71.5556; <i>SD</i> = 15.7548) compared to women (<i>M</i> = 66.6582; <i>SD</i> = 18.59479). Recommendations for future research include expanding the study with a full range MLQ questionnaire to capture additional information as well as scrutinizing the mediation of gender and occupational sectors on job satisfaction.</p>

<p> The ability to flexibly control or inhibit unwanted actions is critical for everyday behavior. Lack of this capacity is characteristic of numerous psychiatric diseases including attention deficit hyperactivity disorder (ADHD). My project is designed to study the neural underpinnings of response inhibition and to what extent these mechanisms are disrupted in animals with impaired impulse control. I therefore recorded single neurons from dorsal striatum, orbitofrontal cortex, and medial prefrontal cortex from rats performing a novel rodent variant of the classic "stop signal" task used in clinical settings. This task asks motivated rats to repeatedly produce simple actions to obtain rewards while needing to semi-occasionally inhibit an already initiated response. To take this a step further, I compared normal rats to rats prenatally exposed to nicotine in order to better understand the mechanism underlying inhibitory control. Rats exposed to nicotine before birth show abnormal attention, poor inhibitory control, and brain deficits consistent with impairments seen in humans prenatally exposed to nicotine and those with ADHD.</p><p> I found that dorsal striatum neurons tend to encode the direction of a response and the motor refinement necessary to guide behaviors within the task rather than playing a causal role in response inhibition. However the orbitofrontal cortex, a direct afferent of dorsal striatum, possesses the capacity to inform the striatum of the correct action during response inhibition within the critical time window required to flexibly alter an initiated movement. On the other hand, medial prefrontal cortex functions as a conflict &ldquo;monitor&rdquo; to broadly increase preparedness for flexible response inhibition by aggregating current and past conflict history. Lastly, rat pups exposed to nicotine during gestation exhibit faster movement speeds and reduced capacity for inhibitory behavior. Physiologically, prenatal nicotine exposure manifests in a hypoactive prefrontal cortex, diminished encoding of task parameters, and reduced capacity to maintain conflict information.</p>

<p> Leaders are frequently called to apologize on behalf of their organizations, in some cases skillfully resolving episodes of failure while meeting the unique, competing needs of diverse stakeholders. However, too often leaders handle apology poorly, exacerbating tense situations and alienating key constituents. This study is an examination of the practice of apology as a leadership behavior in an organizational context. To answer the question, <i>How might the existing literatures on apology be examined, integrated and refocused to apply specifically to leaders operating within an organizational context </i>? the study provides a meta-analysis of the diverse literatures that address the practice of apology. Examining literature from theology and philosophy, the social sciences, law, public relations and organizational management, the study builds a framework to understand and evaluate apology and its appropriate application to episodes of organizational failure. The literature integration and analysis demonstrates a diversity of perspectives on the definition of apology, its purpose and goals, the modes through which apology is delivered, the process or steps involved in apology, and the alternatives to apology. Using the adaptive leadership framework and a stakeholder management perspective on organization, the research is organized around the unique and distinct needs of organizational leaders. The Organizational Apology Model, offered in Chapter 5, provides a robust set of tools and examples designed to support organizational leaders considering the practice of apology.</p>

<p> Ainsworth and Bowlby&rsquo;s Attachment Theory suggest that young children experience lasting effects of disconnection if separated from their primary caretaker. Foster children are legally removed from their primary caretakers, yet the effects of foster care on later social relationships of foster children is unknown.</p><p> The purpose of this exploratory study was to investigate the perceptions of adult foster children, ages 18 years and over, who were placed into foster care under 5 years of age. The major challenge was to obtain qualifying participants, first, because this is an invisible population in the American culture and, secondly, these individuals are hesitant to share their stories. The initial population included 5 persons from a local shelter and, using the snowball method, the researcher secured an additional 15 adult foster children that met the criteria.</p><p> Applying the phenomenological approach, these long interviews included 6 questions that addressed the research question: What do adults who have been in foster care placements prior to age 5 and have experienced more than 5 years in foster care placements from age 0-18 perceive are the long-term effects of foster care on their adult social relationships? The interviews occurred throughout Southern California and were taped and lasted 40 minutes to 2 hours, often filled with tears and high emotion. The participants included 3 with prior jail time, 6 who were homeless, 14 who were employed, 10 with an addiction, and 2 who were married. All had obtained a high school degree. All shared repeated unsuccessful friendship or romantic relationships.</p><p> The transcribed interviews were reviewed by 4 trained coders in a doctoral program and produced 8 themes, leading to the 8 conclusions. The primary conclusions are adult foster children express that abandonment is a deep core aspect of their psychological profile (95%); share the mental health issues of low self-esteem, lack of trust, and putting up walls in their social relationships (100%); act out their generational cycles of various addictive behavior relating to abandonment (100%); spirituality helped to stabilize more than half of these adult foster children through challenging times; and those without spiritual connections described the support of mentors in their lives.</p>

<p> Poor executive leadership of organizations over the last 20 years has resulted in the destruction of stakeholder value, loss of jobs, and in some cases, risk to the entire enterprise. An executive search firm database, encompassing 16,000 leaders from 300 organizations, was analyzed to determine if the commonality and transferability of leadership competences could be used to improve executive assessment. Implicit leadership theory, where leaders are gauged by the individuals that surround them, served as the theoretical foundation. The study also relies on a leadership competency model used by the executive search firm that constructed the database and is based primarily on behavioral-event interviewing method of assessment. Inferential statistics were used to analysis the data with analysis of variance and Tukey post-hoc methods for testing mean differences, and with correlation and regression analysis to test for associations and explained variances. The executive roles were found to show a commonality of competency profiles and transferability across the disciplines studied, with the exception of the chief executive officer (CEO) role. These findings suggest that a new CEO should not be sourced directly from the other executive functions inside or outside the firm. The Outstanding leader database indicates a strong universality and interchangeability of leaders at this higher-ranking level, regardless of discipline and industry; the database is a source of new potential CEOs. Results Orientation is by far the strongest developed of the competencies for all leaders. Social change will result from better selection of top executive leaders with a positive impact for employees and all the stakeholders of the corporation or institution.</p>

<p> The current investigation examined the nature of the activation-competition process that is the hallmark of spoken word recognition (Luce &amp; Pisoni, 1998). The present experiments focused on acquisition of new nonword forms that are carefully designed to compete with existing lexical items (e.g., "cathedruke" &rarr; "cathedral"; "shum" &rarr; "shun"). The specific aim of the research was to examine the processing costs for recognition of established neighboring words following exposure to new items. Experiments 1a and b examined processing for both mono- and multisyllabic words for which listeners have learned a new competitor in an attempt to contrast claims about the nature of lexical competition made by two prominent models of spoken word recognition, Cohort Theory and the Neighborhood Activation Model. Experiments 2a and b delved further into an examination of the nature of the competitive environment by manipulating the number and exposure frequency of novel items in an attempt to directly assess the costs of multiple activation. In both Experiments 2a and b, effects of more training (additional novel neighbors or increased exposure frequency, respectively) were facilitative, not competitive. The results are discussed within the context of Vitevitch and Luce's (1999) two-stage model of spoken word recognition.</p>