Boys outperform girls in mathematics in the USA, d = .22 and across OECD nations, d = .13. For science literacy, while the USA showed the largest gender difference across all OECD nations, d = .14, gender differences across OECD nations were non-significant, and a small female advantage was found for non-OECD nations, d = −.09. Across all three domains, these differences were more pronounced at both tails of the distribution for low- and high-achievers. Considerable cross-cultural variability was also observed, and national gender differences were correlated with gender equity measures, economic prosperity, and Hofstede’s cultural dimension of power distance. Educational and societal implications of such gender gaps are addressed, as well as the mechanisms by which gender differences in cognitive abilities are culturally mediated.Although gender differences in cognitive abilities are frequently reported, the magnitude of these differences and whether they hold practical significance in the educational outcomes of boys and girls is highly debated. Furthermore, when gender gaps in reading, mathematics and science literacy are reported they are often attributed to innate, biological differences rather than social and cultural factors. Cross-cultural evidence may contribute to this debate, and this study reports national gender differences in reading, mathematics and science literacy from 65 nations participating in the 2009 round of the Programme for International Student Assessment (PISA). Consistently across all nations, girls outperform boys in reading literacy,  Additional lines of evidence are required, and one such source is international testing of students. Secondly, research primarily focuses on mean gender differences, and fails to address gender differences in the tails of distributions which Hyde, et al. To this aim, I present findings from the 2009 OECD Programme for International Student Assessment (PISA), which to my knowledge has not yet been widely discussed in psychology journals. This information provides a snapshot of current gender differences and similarities in reading, mathematics and science across 65 nations. It also highlights the wide degree of cultural variation between nations, and examines the role that social and environmental factors play in the development of gender differences. Before reviewing the PISA findings, I will briefly discuss the advantages that national and cross-national testing have to offer the debate on the nature of gender differences in cognitive abilities.greater male variability hypothesisLarge national and international samples can provide a ‘yardstick’ estimate of gender differences within a given region, at a given point in time. By drawing from a broad population of students, national and international testing provide us with stronger evidence for gender similarities or differences than could be found from smaller, more selective samples. It is common practice for gender difference studies to use convenience samples drawn from psychology student subject pools A good example of this in practice comes in the form of the Scholastic Assessment Test (SAT) used for assessing suitability of students for college entry within the United States. Males consistently outperform females on the mathematical component general population, which is what researchers and laypersons alike would seek to test.This does not mean, necessarily, that one should discount any finding of gender differences in the SAT-M as being invalid. Data from the SAT may be extremely useful in estimating gender differences in the population of students considering further education. This is a very narrow, quite specific theoretical question. But such findings cannot be easily generalised to the Another source of information on gender differences comes from experimental research carried out in the laboratory, under tightly controlled conditions. Equal numbers of males and females can be recruited using random selection. When large samples are randomly drawn from the general population, the scores of both high and low achievers are included in measurements of gender differences. Such studies are time-consuming and expensive to conduct, however. More commonly, gender difference studies use much smaller convenience samples, such as a subject pool of college students which also introduces the problem of selection bias Additionally, many cognitive abilities show an interaction between gender and socioeconomic status Large national samples allow researchers to investigate objectively the existence and magnitude of gender differences or similarities. We can be more confident that any observed differences are reflective of what we would find in the general population of boys and girls, and are not simply due to sampling bias. As additional waves of testing are conducted using similar measurement instruments, we can also begin to track any changes over time. It allows us to evaluate efforts aimed at reducing gender differences, and to see areas where further progress must be made. Such data may also be of benefit to policy makers and educational institutions in advocating for educational change, and in support of programs aimed at addressing inequalities.For the United States, one such program is the National Assessment of Educational Progress (NAEP), a federal assessment of educational achievement. The NAEP is conducted for all states within the United States and since participation is both comprehensive and not self-selected, is ideally suited to answering the question of whether males and females differ in mathematical ability (a type of quantitative reasoning). Hyde all areas of mathematics. As Hyde and Mertz d = .29). Assessment that includes these types of mathematical problems, therefore, should presumably show larger gender differences and might not necessarily support the gender similarities hypothesis. Evidence from the NAEP may exhibit a ceiling effect, as test content hasn’t adequately provided the opportunity for differentiation between high and low ability levels in complex reasoning. This would make the distribution of scores largely homogenous, preventing us from adequately testing the gender differences/gender similarities hypothesis.While this evidence seems quite compelling, one must be cautious about generalising the conclusion of ‘no difference’ in maths performance on the NAEP to maths performance in Another source of evidence for evaluating claims of gender differences comes from international testing of students’ educational attainments as part of the OECD’s Programme for International Assessment (PISA). Beginning in 2000 and conducted every three years, participating nations assess the educational attainment of students using a standardized exam that allows their performance to be compared globally. PISA aims to assess the educational progress of students as they reach the end of compulsory education, at age 15, across three skill areas: these being reading literacy, mathematical literacy, and science literacy. Samples are stratified random probability samples, selected from a range of public and private institutions across geographical regions, and weighted so as to be nationally representative Additionally, the test content of PISA is somewhat different to that of other national testing assessments, such as the NAEP. PISA assesses both knowledge and problem-solving skills, reflecting the type of real-world content and skills required to be an informed and capable information consumer and citizen. It assesses a student’s reading, mathematical and scientific literacy, their ability to solve problems and to apply their knowledge and skills across each of these three domains. This is in contrast to tests that require primarily memory of learned material from the curriculum, allowing for greater differentiation between high and low ability levels. As such, it taps higher level cognitive skills than may be found in testing schemes like NAEP, which Hyde and colleagues have reported show small or trivial gender differences in science and mathematics all nations Cross-national variation in the magnitude of gender differences can provide useful information about the environmental conditions that foster, or inhibit, gender differences in domains such as mathematics. While gender differences in mathematics are frequently found at a national level, they are not found universally across origins of any observed gender differences. When we see consistent gender differences across many or all nations, and when they are large enough in magnitude to have a practical impact on the educational and occupational aspirations of boys and girls, then we might reasonably conclude some systematic process is responsible – be this biological or institutional. When we see changes in the magnitude and the direction of gender differences, as is the case for science performance reported below, then we might reasonably conclude that either cultural or environmental influences are strong moderators in the development of cognitive ability - gender differences are not an inevitable consequence of biology. Finally, if we were to see more similarities than differences in the performance of boys and girls, then this would also be useful information for shaping public policy and educational practices such as continuing support for coeducation Cross-cultural comparisons of the performance of males and females might help answer some theoretical questions about the gender stratification hypothesis A number of previous studies have examined the size of gender differences in cognitive abilities cross-culturally in an attempt to shed light on the underlying causes of such variation. Baker and Jones increased. One possibility for this seemingly paradoxical finding is that whatever natural advantage girls may have for reading is suppressed in more restrictive countries, but that under favorable conditions is allowed to flourish to its full potential. However, further replication of these findings with subsequent waves of testing is required to determine whether this association is stable across time.Mathematics is not the only cognitive domain where we see an influence of gender-equality and gender stereotypes on cognitive performance. The female advantage in reading and language, while universal, also differs in magnitude between nations. Guiso, et al. Cross-cultural evidence of gender differences or similarities provides a stronger foundation for understanding the role of social and biological factors in the development of sex differences, as noted above. The aim of this study was to explore sociocultural factors that promote, or inhibit, the development of gender gaps in highly sex-typed academic domains of reading, mathematics and science gender similarities hypothesis gender stratification hypothesis In addition to presenting data on national gender differences, it uses meta-analytic techniques to calculate global gender differences to examine evidence for Hyde’s One hypothesised influence is the economic prosperity of a nation A second mechanism by which gender differences may be culturally mediated is through the attitudes, values, and beliefs of a nation. While beliefs about the role of women in society vary considerably from nation to nation, there are few instruments available that have wide global coverage of gender stereotypes and attitudes towards women power distance describes the ways in which societies address the issue of human inequality, and the ways in which social groups are segregated The dimension Based on prior research and theoretical perspectives, it was hypothesised that:Gender differences in the domains of mathematics, and science would be found for the United States, and these would be larger than those reported by Hyde Gender differences in reading performance in favor of girls would be found in reading for the United States and cross-culturally, reflecting an inherent biological disposition that is only weakly influenced by cultural environment.Measures of national gender equity would be associated with smaller gender gaps in mathematics and science, in support of the gender stratification hypothesis. Furthermore, increased gender equity would be weakly associated with wider reading gaps in favor of girls.Economic prosperity would be associated with wider gender gaps in mathematics and science than in less prosperous nations, reflecting increased spending on education, increased demand for these skills, and heightened competition by males. Such competition may not be helpful to the career aspirations of women, but will not influence reading performance which is less malleable to social and cultural influences.Countries that score highly on Hofestede’s power distance dimension have greater segregation and foster inequalities, particularly for women. A compensatory strategy for women is to acquire culturally-valued skills such as science and mathematics. High power distance nations would be associated with smaller gender gaps or a slight female advantage in these domains. Boys may have increased motivation to develop reading and writing proficiency in high power distance cultures, resulting in smaller gender gaps for reading literacy.Performance data for students accessed under PISA is offered as a publicly accessible archive for researchers. Additionally, aggregate national performance profiles are published as separate male and female subgroups statistically significant, even though it may have no practical significance. For this reason, an effect size is presented in the form of Cohen’s d, the mean standardized difference. This allows the reader to draw his or her own conclusions as to the practical significance of reported gender differences.National performance profiles in reading, mathematics and science literacy were obtained from OECD d indicates higher scores for males while a negative d reflects higher scores for females. This convention is observed for readability reasons only, and the interested reader may choose to rephrase the equations so that male scores are subtracted from female scores simply by inverting the sign of any effect size given.The computation is calculated as the mean difference between male and female scores, divided by the pooled within-gender standard deviation. By convention, female scores are subtracted from male scores, so that a positive d ≤.20 could be considered a “small” effect for the purpose of estimating statistical power, and that many legitimate psychological phenomena studied are in fact small effects. The label of small is perhaps an unfortunate one as some researchers have mistakenly taken small to be of no practical significance, a practice Rosenthal and Rubin d = .04 should be regarded as trivial, a cut-off which seems sound practice. Hyde d ≤. 10 should be actually be regarded “as close to zero” (p.581), a cut-off which is overly conservative and dismisses what are legitimate, albeit very small, between-group differences. Accordingly, Cohen’s conventions for labelling are followed for reporting. Additionally, gender differences are presented using Rosenthal and Rubin’s Conventional criteria for labelling effect sizes as “small”, “medium”, or “large” have many limitations and should be used with great caution In order to test the gender similarities hypothesis, national gender gaps in reading, mathematics, and science were combined using meta-analysis. Comprehensive Meta Analysis (CMA) V2 software was used for the calculation of statistics Favreau Moderation effects of sociocultural factors were examined to test the gender stratification hypothesis for national gender gaps using correlational analysis. Although past researchers For comparability with Guiso, et al.’s findings, the Gender Gap Index (GGI) produced by the World Economic Forum was selected as one measure of gender equity As an alternative conceptualisation of gender equity, the Relative Status of Women (RSW) measures gender differences across educational attainment, life expectancy, and women’s share of income Else-Quest, et al. Economic data was obtained from the World Economic Outlook database produces by the International Monetary Fund. Archived information for the calendar year 2009 was obtained for sixty-one nations.“Culture’s consequences”http://geert-hofstede.com). This provided coverage of fifty two nations.National power distance scores are published in Hofstede’s text n = 65) for correlation analysis the sample size is relatively small. Additionally, data for gender equity measures and for Hofstede’s cultural dimension of power distance was unavailable for many non-OECD nations reducing sample size even further. With a reduced sample size, correlations may lack sufficient power to detect relationships that are relatively weak in nature one-tailed would often have allowed such a correlation to be deemed statistically significant . For this reason exact probability values are given, along with the size of the correlation coefficient, so that the reader can decide whether to make the appropriate adjustment. All tests report two-tailed correlations unless otherwise specified. Data for one nation, Colombia, represented both a univariate and multivariate outlier, and was excluded from all correlational analysis.While the sample size represented by the PISA 2009 was extremely large, when examining gender differences at the country level , the trend is reversed with over twice the number of girls than boys achieving the highest standard. Thus boys are overrepresented at the lower end of the spectrum, while girls are overrepresented at the highest end.d = −.44 , Zma = –31.04, p<.001, with a similar gender difference also being found for OECD nations only as a group. Additionally, statistically significant gender differences in reading favoring girls were found in every nation surveyed, and have since the first assessment in 2000 Overall, across all sixty-five nations the gender difference in reading literacy favored girls, r = −.33, p = .018, such that increased gender equality was associated with larger reading gaps favoring females. Additionally, the educational measure of women in research (WIR) was associated with larger reading gaps, r = −.38, p = .016. Surprisingly though, there was no association between the gender gap index (GGI) and reading ability, r = 01. Examination of the scatterplot showed no discernable pattern, and the result was not driven by outliers.To investigate the gender stratification hypothesis, I examined correlations between gender equity and the gender gap in reading. Partial support was found for the gender stratification hypothesis. National scores on the Relative Status of Women (RSW) measure were negatively correlated with reading, r = −.32, p = .021; GGI, r = −.41, p = .002, which is consistent with the findings of Guiso, et al. r = .57, p<.001. While the role of women in higher education may make a contribution to the mean performance of girls and boys in basic reading literacy, it may be the case that for high-achieving reading comprehension skills, boys and girls benefit equally from female role-models in higher learning.Stronger support for the gender stratification hypothesis was found when examining gender differences in the percentage of students attaining the highest level of reading. Improvements in national gender equity was associated with a wider gender gap in high achieving girls, RSW, r = .04, consistent with predictions. However, a strong association with economic prosperity was found for reading high achievers, r = −.43, p<.001 with a greater ratio of female to male high achievers as GDP increased. This suggests an interaction between gender and GDP, with girls benefiting more from economic prosperity than boys. Furthermore, while no association was found between power distance and mean reading literacy scores of boys and girls, a strong positive association with the gender gap in high achievers was found as hypothesized, r = .40, p = .003 with gender ratios approaching more equal representation as power distance increased. Cultural mediation through economic prosperity and power distance was not found for mean male and female performance, only for gender ratios in high achievement.No association between GDP and gender differences in reading was found, d = .22 which is a small but non-trivial effect size. Additionally, the size of the gender differences was almost twice that of the OECD average. This is in contrast to previous studies examining national mathematics performance by Hyde, et al. d = .13 95%CI , Zma = 11.22, p<.001. While this is a small effect size, it does exceed the criteria set forth by Hyde and Linn d = .07 95%CI , Zma = 3.10, p = .001 although this difference was somewhat smaller.As the distribution of gender differences differed somewhat between OECD and partner nations, they are reported separately. Overall, across all 34 OECD nations, there was a significant gender difference favoring males on mathematical literacy, Cohen’s d = −.12 to d = .43  that these gender equity measures do not assess.Since the PISA 2009 dataset includes a much broader range of partner nations than was examined by Guiso, et al. r = −.63, p<.001, with increased representation of women in research positions associated with a smaller gender difference in high achievers approaching zero  for gender-gaps in science across OECD nations. Gender similarities, rather than differences, were the norm which is consistent with the findings of Hyde and Linn outperformed boys to a statistically significant degree . One of the advantages of cross-cultural comparisons in national testing is that it highlights just how powerfully cultural and environmental influences can be in either promoting - or inhibiting - the cognitive development and learning of a child.In contrast to US performance, across OECD countries there was no difference between boys and girls, d = −.09 95%CI , Zma = −3.44, p = .001. For some nations, the gender difference was trivial or favored boys, but these were the exception; this is in contrast to the gender similarities in science noted above for OECD nations.A markedly different picture of gender differences in science can be found across the 31 non-OECD nations. In general, females scored higher in science literacy than males across most nations. Overall, across non-OECD nations surveyed there was a statistically significant difference in science literacy favoring girls, d = −.04  Zma = −2.84, p = .005. This effect size would fall into the trivial size by Hyde’s When both OECD and non-OECD nations were combined, there was a statistically significant difference in favor of girls, r = .29, p = .035, with greater gender equity associated with smaller gender gaps approaching zero. However, only a weak non-significant association was found for the RSW, r = .14.Examining mean gender differences in science literacy, partial support for the gender stratification hypothesis was found. There was a strong correlation between national GGI scores and science, r = −.39, p = .011, with increased representation of women being associated with a stronger female advantage over males in science. Thus increased gender equity was associated with more equal science performance, but this was offset by higher female performance as the share of women in research positions increased.Additionally, there was a strong negative correlation between the percentage of women in research and gender gaps in science, r = −.57, p<.001  was found for reading literacy, which would be inconsistent with Hyde’s gender similarities hypothesis every nation, but also showed considerable between-nation variation. Though the direction of gender differences would be consistent with a biological explanation, it appears at least partially malleable by social and cultural factors. While there was no support for cultural mediation through economic prosperity and power distance in mean gender differences, contrary to predictions associations were found for high achievers in reading literacy.Cross-culturally, a medium sized gender difference  was also small in size and subject to wide cultural variation. The likelihood of being average or higher in mathematical ability increases from 46.7% for girls to 53.2% for boys, a small but non-trivial difference. Unlike reading literacy, there were a number of countries which had non-significant gender differences, which would be inconsistent with strong biological differences between boys and girls in mathematical reasoning While cross-culturally, gender differences favored males across OECD and partner nations, the magnitude of this difference  in such nations, this also translates to increased female representation in high achievers as well. This provides for stronger support of the gender stratification hypothesis.Mean gender differences were larger for mathematics and science in economically prosperous nations as hypothesised but were largely unrelated to reading literacy. This likely reflects both increased educational spending for economically prosperous nations, as well as increased emphasis being placed on mathematics and science skills. Student achievement in less prosperous nations may be more homogenous with smaller gender differences, and there may be a reduced focus on teaching of these skills. It may also be the case that there is greater competition by males to achieve in these masculine sex-typed domains. These associations were also found for gender ratios in high achievement. Additionally, gender ratios for high achievers in reading literacy were also related to economic prosperity, which was unexpected.Hofstede The question of whether gender differences exist in cognitive abilities has important implications for parents, educators, and policy-makers Society as a whole also has a vested interest in this question, both directly and indirectly. We as citizens rely on the services and advancements that a highly skilled science and technology workforce provide, with direct benefits for our health and lifestyle, and for an economy that depends on the brightest and most innovative of minds entering these fields to sustain an internationally competitive advantage. There are also indirect benefits from having a society that is at least partially scientifically literate – making decisions through the political process and personal choices about issues such as the use of stem-cell technologies, vaccination of children against disease, or evidence of climate change. When students, particularly girls, disengage with science learning there are costs to the individual, in the form of reduced security and income, but also to the wider society. While not every child may have the ability or interest to pursue a scientific career, a basic scientific literacy is required for full participation in society.The underrepresentation of women in science is a serious social issue, and considerable resources are being expended to address this problem The broader coverage of nations included in the PISA 2009 round of assessment makes for a stronger test of research hypotheses than was previously possible. Additionally, many of the partner nations would be categorised as lower in human development, with reduced access to the educational advantages found in other nations. While researching educational outcomes for large and economically prosperous nations like the United States is important, debate about gender differences is often shaped by evidence from relatively affluent samples. In less advantaged nations, provided girls and boys are still afforded the same access to education, performance in maths and science literacy is more homogenous giving greater support to the gender similarities hypothesis. However, there is still substantial cultural variability in gender differences, and much of this is driven by cultural variation in gender equality. For a large portion of the world, the strongest predictor of gender differences in educational outcomes is equivalent access to education, occupational segregation, and representation of women in technical and research professions. If priority were to be given to improving these globally, substantial improvements in female literacy in maths and science could be realised.While support for research hypotheses were generally observed, availability of data for cross-cultural correlations meant reduced statistical power to detect relatively weak correlations. It may well be the case that the hypothesised associations with mean gender differences across reading, maths, and science could have been detected with expanded coverage of Hofstede’s cultural dimensions Evidence from national testing for the United States shows that there are meaningful gender gaps to be addressed in academic achievement across reading, mathematical and science literacy. Furthermore, these are larger than that found cross-culturally, where evidence for the gender similarities hypothesis is stronger. Globally, there is a small gender difference in mathematics literacy favoring males, and a small difference in science literacy favoring girls in non-OECD nations. However, a consistent finding for reading literacy is that girls outperform boys both in mean differences overall and gender ratios in attaining high reading achievement. Correlational analyses show that economic prosperity, gender equity, and the dimension of power distance are good predictors of global gender differences in cognitive abilities.


In this study, we have explored the prospect of assessing and following level of total denture adaptation by use of EMG signals recorded during gum chewing. Total of 14 edentulous patients, 6 women and 8 men, with an average age of 63±9 years, were recruited. Separate EMG recordings were obtained from left and right temporalis and masseter muscles of the patients for a period of 10 seconds, while they were chewing a sugar-free gum on their left and right sides. EMG recordings were repeated at three times: before, right after, and six months after the placement of the denture. We have tried to standardize environmental and individual factors during EMG recordings. The EMG data have been pre-processed and analyzed using Discrete Wavelet Transform (DWT) and obtained features were statistically evaluated using the paired sample t-test. Chewing activity on the right and left side is analyzed by making comparisons of muscle activity between before and right-after cases and before and six-months-after denture fixation cases. A comparison between right and left side mastication is also made at different time points. We have suggested and implemented a new test and comparison procedure in order to assess adaptation to denture fixation using EMG analysis. In this study, the results indicate that DWT based EMG analysis is instrumental in evaluating denture adaptation and as time progresses the adaptation to denture and hence chewing efficiency increases in patients with total denture replacement. Study of mechanical and electrical features of muscles have become focal point for researchers in dentistry as well as many medical disciplines including physiology, biomechanics, neurologic sciences, physical medicine and rehabilitation Okeson . One of EMG analyses are used in order to evaluate how fixed or removable dentures affect the performance of chewing muscles  who were admitted to the Faculty of Dentistry at Erciyes University from Cappadoccia region of Turkey between years of 2007 and 2008. Informed consent was obtained from subjects prior to the study. The average age of our edentulous patients was 63 ± 9 years. Oral examination was carried out by two dentists, according to the WHO method  of subjects while they were chewing on the left and right sides separately. Right after finishing the denture with routine techniques, and six months after the denture usage, activation of the muscles during chewing on right and left sides and were evaluated again using EMG.™  brand, 1.3 g rectangular shaped portions of sugar free chewing gums.During EMG data collection, which lasted for 10 seconds, we asked the participants to chew FalımElectrical activity of right and left masseter and temporalis muscles were evaluated for the study. During recording process, the patients were seated on a chair with their heads in upright position. While placing the electrodes, the patients were asked to hold their jaws tightly closed so that we could palpate the muscles for a proper placement. Electrode sites were cleaned with isopropyl alcohol soaked pads, before placing the electrodes. In order to reduce the contact impedance between the surface electrodes and the skin, we used conductive electrode-gel. All of the electrodes were attached to the skin with medical plasters.Bipolar surface electrodes  filled with a conductive gel were placed on both the right and left masseter and anterior temporalis muscles as shown in Figure The EMG signals are band-pass filtered (10–500 Hz), amplified with a gain of 2000  and converted to digital signals at a sampling rate of 2000 samples per second, using a MP100A-CE . Surface EMG recordings are obtained from the left and right anterior temporalis muscle, the left and right masseter muscle and from the left and right digastric muscle using 4 channel PC based EMG apparatus, for simultaneous recording of the myoelectrical activity. Ag/AgCl disc electrodes with 1 cm diameter were placed 2 cm apart in the main direction of the muscle fibers.The collected raw EMG signals were pre-processed using rectification and low-pass filtering De Luca . The recIn this study, EMGs were decomposed or analyzed with ‘Db3’ Daubechies Wavelets to the third level as shown in Figure The Wavelet Transform (WT) is designed for time-frequency analysis of non-stationary signals. It involves representing signals in terms of simple, fixed building blocks termed wavelets. These building blocks are actually a group of functions, which are derived from a single generating function called the mother wavelet by translation and scaling operations in time  denotes the z-transform of the filter h. Its complementary high-pass filter can be defined as,where i) can be obtained.A sequence of filters with increasing length (indexed by H0(z) = 1. It is expressed as a two-scale relation in time domainwith the initial condition ↑m indicates the up-sampling by a factor of m and k is the equally sampled discrete time.where the subscript φi,l(k),  ψi,l(k) can be defined as,The normalized wavelet and scale basis functions i/2 is an inner product normalization, i and l are the scale and translation parameter, respectively. The discrete wavelet transform decomposition can be described aswhere the factor 2Ai)((l) and Di(l) are the approximation and detail coefficients at resolution i, respectively  and its processing steps, in Figure DWT coefficients obtained from pre-processed EMG recordings for different cases were compared statistically using the “paired sampled t-test.” We used the paired sample t-test, rather than the independent sample t-test, as the groups of DWT parameters being compared were obtained from the same set of subjects under different conditions. The p-values less than 0.05 were considered as statistically significant.In Table Similarly, in Table In Tables In Table In Tables In this study, the effect of complete dentures on the chewing muscle activity was investigated with the analysis of EMG collected during chewing on the right and left side, from masseter and temporalis muscles which are known to be more effective in assisting mastication. In an attempt to make denture adaptation comparisons using EMG signals in a simple manner, we have chosen to work with edentulous patients who naturally chew on their right side.In order to evaluate mastication activity of total denture patients, four channels of EMG signals are recorded from right and left masseter and temporalis muscles at three different times: “before”, “right-after”, and “six-months-after” denture fixation. The EMG signals have been processed by using wavelet analysis to extract several level wavelet parameters. These parameters or coefficients were then compared statistically with the “paired sampled t-test.”For “before and right-after” and “before and six-months-after” denture fixation comparison of mastication on the right side, there is a significant difference between left masseter and temporalis muscle activities was observed, whereas there is no such significant difference for the right side muscles. Since the patients used to masticate on the right side when they were edentulous, after the denture is made, same activity is observed on the right side muscles. However, the change in the left side muscles during right side mastication shows that the left side mastication is also in effect due to the obtained occlusion by the denture.For “before and right-after” and “before and six-months-after” denture fixation comparisons of mastication on the left side, there are statistically significant changes for all four observed muscle activities for both comparisons. Since the left side was not used before denture fixation by our subjects, we expected such changes in muscle activity on the left side, as a sign of adaptation to denture.For “before”, “right-after”, and “six-months-after” comparison of between right and left side mastication, there is a significant difference only for the “before” case. This may signify that before the use the left side for mastication, there was differential activation of all four observed muscles during right and left side chewing. However, as the patients start using and adapting to the dentures, a homogenous mastication distribution is obtained on the muscles.For all wavelet coefficients A1, A2, and A3 significant or non-significant decision are consistently in agreement. This observation confirms that the wavelet analysis is instrumental in extracting information from EMG signals. Making comparisons using raw EMG signals is a formidable task. Instead, we have first processed EMG signals to obtain their envelope, which represents the force produced by the underlying muscle in a more accurate manner, and obtained several wavelet parameters from this EMG-envelope.When we examine the results presented in Tables These observations confirm that wavelet based EMG analysis is instrumental in evaluating denture adaptation for patients with total denture replacement and denture adaptation and hence chewing efficiency increases with time.In conclusion, we have suggested and implemented a new test and comparison procedure in order to assess adaptation to denture fixation using EMG analysis. Using chewing gum as a test food is an important aspect of this approach.In this study, for ease of analysis, we have chosen to work with edentulous subjects who naturally chew on their side as our study group. In a future study, we are going to evaluate the efficacy of this approach in different scenarios, where the edentulous subjects to be selected could have different characteristics, in terms of their natural chewing preferences.


This essay focuses on the possibility of adopting a representational approach for technoscience, in which representation is considered as a situated process of dynamic “intra-action” Barad . Re-elab Let us : in this case, representation is described as the perception of relations among the element of the observed and self-observing system, which is characterized by its operational closure. Once we consider representations not as passive, however, accurate, reflections of an independent reality, but as active constructions and viable, embodied and contingent processes of knowing, we can continue to employ them and at the same time disengage them from a correspondence with reality .According to a radical realist position, the domain of our experiences as The acknowledgement of the agency of matter and of the hybrid connections between theory and practice, human and non-human beings, takes the form of a strong critique of representation in non-representational theory in particular. This, in most cases, associates representation with the metaphysics of visualism, although, to paraphrase Pickering , when viIn non-representational theory, knowledge is firmly located in matter or, to partially paraphrase the subtitle of Barad’s book 2008), in “the entanglements of matter and meaning;” it is also relationally generated, and by no way solely rational, nor a subjective or even a human property, all assumptions that, on the contrary, belong to the tradition of Western Modernity . Instead, “a map of tensions and resonances between the fixed ends of a charged dichotomy better represents the potent politics and epistemologies of embodied, therefore accountable, objectivity” (ibid.). As Jacobs and Nash  affirm, It is in this direction that Hayles ( 1997) haWhat we call “observables,” writes Hayles, always depends on locally situated perspectives according to which different pieces of information about the environment are processed, as demonstrated in the example of the frog’s visuality, which Hayles gives at the beginning of her essay, drawing on the well-known article of Lettvin et al. . For thecontra Maturana and Varela, the observer is caught in continuous feedback loops within the autopoietic processes of the system, rendering “the domain of the observer” a convenient fiction (ibid.: 78). Not willing to renounce a term like representation, but rather intending to formulate it differently, as “a dynamic process rather than a static mirroring” , Htwists the closed circle of tautological repetition (“we do not see what we do not see”) into an asymmetric figure (“one does not perceive when one perceives”). The energy generated by these contradictory propositions rebounds like a loaded spring toward the very term that Maturana’s closure was designed to erase, namely “reality.” What is enacted rhetorically within the structure of this sentence is formalized in Luhmann’s theory by investing the observer with the agency to draw a distinction. By making a distinction, the observer reduces the unfathomable complexity of undifferentiated reality into something she can understand (ibid.: 97).What Hayles appreciates in Luhmann’s position is that he recognizes “that closure too has an outside it cannot see” (ibid.: 98). This leads us to acknowledge, on the one hand, the fact that “the very interlocking assumptions used to achieve closure are themselves the result of historical contingencies and embedded contextualities.” (ibid.: 98). On the other, it allows for a preservation of the “correlation” or “interactivity” that connections, rather than absolute distinctions, make possible .In Hayles’s terms (Hayles  1997), aRepresentations, then, connect the sides of the cusp and allow us to ride it. The more representations are consistent, manifesting “local interactions rather than positive correspondences” with the flux, the more their “instrumental efficacy” allows us to “ride the cusp,” so to speak (ibid.). Representations are ruled by constraints, which do not tell us what reality “in its positivity” is, but can tell us when representations are consistent with reality, enacting some possibilities and enabling certain distinctions instead of others. Constraints, then, operate in the making of selections between those representations which are viable and those which are not (ibid.).To better show the role of constraints for representations in her theory of constrained constructivism, Hayles adopts and modifies the Greimas Square Fig. .Fig. 1Haconsistent with the flux, while not-true are all the unknown representations, that is, the not yet practiced representations. This puts not-true and not-false in a relation that is one of consistency and of unknowability, rather than of antithesis—a relation that “folds together the ability to negate with the ability to specify,” that is a relation of denial (the unknown) and assertion (the consistent) rather than of negation and affirmation (ibid.). If I, for instance, look at the pen that lies at my desk, I can surely say that it is an orange pen. However, my assertion is based on the observation of the colour that the plastic case of my pen appears to be. But if someone asks whether I have a black pen to lend, I can surely give them the same pen, given that it writes in black ink, thus is a black pen too. While asserting that my pen writes in black ink, I am not negating the orangeness of my pen, so to speak, but only further specifying something about the way it works.False and True occupy the top line of the square, so that they are mutually exclusive, since they stand in an exclusionary relation of opposition. Instead, the bottom line is occupied by the couple Not-true and Not-false, whose relation is not an oppositional one: actually, not-false are those representations which are not exclude the corresponding terms along the vertical axis, but stand with them in a relation of implication, which, nonetheless, is in no way symmetrical: “denial implies negation while subtly differing from it, just as assertion implies affirmation without exactly being affirmation.” This, then, should rather be intended as a relation of articulation, where “articulations emerge from particular people speaking at specific times and places, with all of the species-specific processing and culturally-conditioned expectations that implies” (ibid.).The difference here is that denial and assertion are what Hayles calls “marked,” or modal, terms, which cannot be assimilated to the “transparencies of non-modal statements” proper to realism, like true and false ones. This means that both not-true and not-false positions do not only But the terms of the semiotic square are implicated along the diagonal axis too, revealing what Hayles calls “a common concern with the limits of representation” (ibid.). The “elusive negativity” expressed by the not-true position at the bottom left of the semiotic square is worth considering in detail. This, in fact, is the position that mostly escapes the either/or alternative of both realism and anti-realism, being a kind of negativity that is neither negative nor positive, and is thus inassimilable: let us think of the inappropriate/d other in Min-ha’s terms as Haraway  explainsat the cusp:The diagonal connecting true and not-true reveals their common concern with the limits of representation. At the positive (“true”) end of the diagonal, the limits imply that we cannot speak the truth. At the negative (“not-true”) end, they paradoxically perform the positive function of gesturing toward that which cannot be spoken. Elusive negativity, precisely because of its doubly negative position, opens onto the flux that cannot be represented in itself (Hayles  1997).Elusive negativity is, for Hayles, precisely what designates the position The signification of the cusp is obviously always ambiguous, depending on the result of the encounter between physical and semiotic constraints that allude both to the reality of the world and the reality of language—the Harawaian material-semiotic field—without fully representing them. Such a position recognizes that what we can get to know are, at least, the boundaries of the cusp; it thus bypasses not only realism but also relativism. As Hayles explains at the end of her text (ibid.), commenting on the notion of partial perspective elaborated by Haraway, it is not that we only partially see the truth in things while remaining ignorant of its totality. It is, rather, that partiality is the whole that we see as the result of contextual and specific interactions with the “flux.” That is why she insists on what happens “at the dividing line,” in between the two sides .figurations to name such “performative images that can be inhabited” , o, o1987),It is once again Braidotti who, drawing on Haraway, shows how Harawaian figurations can be employed to develop a “politically charged practice of alternative representation:”This alternative practice, as Haraway repeats, can be delinked from the theologics of representation that revolves around reflection and reflexivity and their root in the mastery of light, which the tradition of feminist critique rightly dismisses, and be rather coupled with an optics that registers the passages of light rays through screens and slits, looking at the resonance and interference that light undergoes while passing through them.First and foremost […] a diffractive methodology is a critical practice for making a difference in the world. It is a commitment to understanding which differences matter, how they matter, and for whom. It is a critical practice of engagement, not a distance-learning practice of reflecting from afar. (ibid.: 90)As a joke, albeit a serious one, Haraway affirms that semiotics is a science of four branches, “syntactics, semantics, pragmatics and diffraction” Haraway : 104. Inmetaphysics of representations, while at the same time she articulates representations by means of diffractive practices, so as to render them still employable for feminist technoscience.Undoubtedly, reflection and reflexivity have their roots in representationalism (ibid.: 87), but the opposite is not necessarily true. I thus disagree with the reading that Campbell : 174 ff.representational practices that produce “what we take to be the evidence” (ibid.); our belief in them depends on historical and cultural variables, so that critically engaging with representations is always possible and, according to Haraway, also desirable . According to classical physics, only waves can produce diffraction patterns, since only waves, not particles, can simultaneously occupy the same place. Barad, however, shows that quantum physics studies how particles can also behave like waves under certain circumstances. She then discusses the “modified” two-slit experiment at length, drawing on Niels Bohr’s diagrams; without entering into too much detail here, it suffices to say for the purpose of our argument that depending on the apparatus used in the two-slit experiment, that is, whether a “which path detector” is employed or not, matter, and light as well, are observed to manifest either particle or wave behaviour. This apparent paradox forces us to radically rethink the dualism that lies at the core of representationalism and the idea that “practices of representing have no effect on the object of investigation” (ibid.: 87), given that diffraction not only shows the entanglements of meaning and matter, but is itself an entangled phenomenon.practices of knowing are material engagements that participate in (re)configuring the world” (ibid.: 91). Producing differences is what establishes connections rather than reinforcing distinctions: As Haraway writes, “diffraction patterns are about a heterogeneous history, not originals”  intra-acting neither belongs to a completely free subjectivity nor to a fully determined reality, but rather happens in a material-semiotic field where “particular possibilities for acting exist at every moment, and these changing possibilities entail a responsibility to intervene in the world’s becoming, to contest and rework what matters and what is excluded from mattering”  because it replaces the analogical methodology, which consists in relating two separate entities by way of an external observer, with a methodology that shows how “ Haraway : 101. A g” Barad : 826–827This very much complicates the notion of vision as well as that of location (and the situatedness of the observer), since it dismantles the exteriority on which both have traditionally relied, and replaces it with specific forms of connectivity as well as accountability. Even if the observer comes back, he/she does not stand in a separate domain, but is connected in continuous feedback loops with his/her cognitive processes, since the closure of the observer’s domain is never pregiven, but always achieved Hayles : 78. Evekind of theory of mediations”  trread through at the same time.This zone of intra-action is what Haraway’s practice of alternative representation goes through in order “to diffract the rays of technoscience” Haraway : 16. HarWe configure our world and establish connections with it through our ways of seeing. Diffraction, so intended, does not simply regard our visual field, but is a practice that invests our knowledge, our imaginary and our practices at the same time: it is, as Haraway writes, “a […] technology for making consequential meanings” Haraway : 273. Pr


The diagnosis of cancer creates a wide range of social and emotional problems to patients and carers. However, delivering effective psychological, emotional, and social support remains a challenge. This pilot study evaluated quality of life (QoL) and lung function before and after three months of choral singing in cancer survivors and their carers.At baseline, 30 cancer survivors and their carers, mean (standard deviation) age 60 (10), completed questions about QoL (SF-36), anxiety and depression, and the multidimensional fatigue score. Lung function was measured by spirometry, and respiratory musclestrength  was also measured. Assessments were repeated after three months of singing in the choir, and 10 participants completed semi-structured interviews to explore their experience of the choir.After three months of choral singing, 20 subjects repeated the assessments. Several domains of the SF-36 improved, including vitality, social functioning, mental health, and bodily pain. There was also a trend of reduced anxiety and depression, despite no change in fatigue. Spirometric measures of lung function were unchanged; however, there was a trend of increased MEP. Themes from the interviews revealed that the choir provided a focus, so the future participants felt uplifted and had greater confidence and self-esteem.This pilot project provides preliminary data which suggest choral singing may improve QoL and depression, despite no physiological change in cancer survivors and their carers. Choral groups offer a support mechanism applicable to cancer patients, carers, and supporters, and may be relevant to other chronic conditions. Further research examining the efficacy of this intervention in a larger controlled study is warranted. The diagnosis of cancer creates a wide range of social and emotional problems, not only for the individual with cancer but also for family members and friends . This caSocial support from family members and friends can help to counteract the negative effects of symptoms on quality of life (QoL) . PsychosPatients with cancer frequently suffer loss of muscle mass which may also affect the respiratory muscles, with implications for breathlessness, daily activity, and QoL as seen in other patients who suffer loss of muscle mass from chronic disease . In addiIt is apparent that there is a great potential for the use of voice and singing within a choir for persons with cancer and their families but the research and literature are lacking. Therefore, the aim of this pilot study was to examine changes in QoL and fatigue following the participation in a choir using a mixed methodological approach in subjects who have received treatment for cancer and their families. A secondary aim is to establish whether singing has any further benefits in improving lung function in subjects with cancer and their friends and families (carers).Sing for Life is a community choir set-up by Tenovus in January 2010, with the aim to provide support and a focus to anyone who has experienced cancer, including family, carers and friends, as well as cancer patients. It is open to all individuals regardless of musical experience or ability, with weekly rehearsals for a minimum of 2 h. A number of concerts are arranged through the year by Tenovus, and the choir is run in partnership with the motivational and team building company Sing and Inspire who arrange music and conduct the choir rehearsals and performances.Thirty individuals were recruited to the study. Participants had a previous diagnosis of cancer, of which the type and time since treatment was variable. In addition, individuals who had been affected by cancer through a partner (carer) or friend (supporters) were included. Patients currently undergoing treatment for their malignancy or individuals diagnosed with respiratory disease were excluded. Ethical approval was gained from the School of Healthcare Studies Research and Development Ethics Committee at Cardiff University.As this was a pilot investigation, a sample size calculation was deemed unnecessary. For the qualitative phase of the study, a purposive sample of five cancer survivors and five carers was deemed appropriate for this methodology, which does not aim for full data saturation. These were individuals who had completed questionnaires before and after singing for three months. The purpose of the qualitative study was to capture the rich, individual experiences of participants, noting common themes where apparent. The questions included in the interviews are available in the The following questionnaires were self-completed by participants on commencement of the choir and 3 months after the first assessment.The RAND SF-36 questionnaire is a self-administered questionnaire which assesses multiple dimensions of QoL. It is a generic questionnaire which has been validated in a number of populations including cancer and can be used to compare healthy and pathological conditions .The hospital anxiety and depression (HAD) scale is a self-rated, widely used assessment tool for anxiety and depressionin patients with both somatic and mental health problems. It has good sensitivity and specificity as other commonly used screening instruments .Fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), a 20-item self-report instrument. It covers the following dimensions: general fatigue, physical fatigue, mental fatigue, reduced motivation, and reduced activity. Participants indicate on a five-point scale the extent to which each particular statement applies to him or her. An equal number of items are worded in a positive and in a negative sense to counteract response tendencies. High-MFI scores indicate a high degree of fatigue .1), forced vital capacity (FVC), and their ratio (FEV1:FVC). Maximal inspiratory static mouth pressure (MIP) and maximal expiratory static mouth pressure (MEP) were recorded . The best of the three attempts was recorded for all tests. All assessments were undertaken with the subject in a seated position and wearing a nose clip.Assessment of respiratory function included spirometry (Micro Lab (ML3500) , to determine forced expiratory volume in 1 s  and the Mann–Whitney U (non-parametric data). Differences before and after the choir were analysed by the paired t test (parametric data) and the Wilcoxon test (non-parametric data). The Kruskal–Wallis test was used to compare more than three groups of data . Categorical data were compared using the x2 test (HAD score categories). The significance level was set at P < 0.05.The quantitative data were analysed using SPSS . Data which were normally distributed were analysed using the independent and paired Ten individuals , who participated in the choir and the quantitative analysis, were interviewed in order to gain additional information regarding the perceived effects of singing in the choir. The semi-structured interviews lasted between 10 and 51 min and were held in the participants’ homes. Questions asked included reasons for joining the choir, previous experience of singing, expectations of the choir, benefits and downsides of being in the choir, as well as physical effects. Questions for the interview were derived from themes identified in the previous research .Interview transcripts were read a number of times, to ensure that a general sense of the account was obtained and notes were made of potential themes.Returning to the beginning, the text was reread and any emergent themes identified and organised tentatively.Attention was then focused on the themes themselves to define them in more detail and establish their interrelationships.The shared themes were organised to make consistent and meaningful statements which contributed to an account of the meaning and essence of the participants’ experience grounded in their own words.All the interviews were transcribed verbatim, and the transcripts were verified by the participants prior to analysis. Based on Interpretative Phenomenological Analysis (IPA) , transcrP > 0.05, Kruskal–Wallis test) at baseline.Thirty individuals were recruited to the study. There was no difference in any of the domains of QoL, anxiety depression or fatigue between the patients, carers, and supporters  between individuals who were new to singing and those already participating in a choir. Similarly, there were no differences in the domains of QoL, anxiety, depression, or fatigue between novice and experienced choristers (P > 0.05).Nineteen of the participants had no experience of singing in a choir within the last five years, eleven were current members of another choir. There was no difference in measures of pulmonary function . Nine were on the borderline of high anxiety and five had borderline of high depression (HAD score 8–10). The remaining had normal levels of anxiety and depression (HAD score 0–7).P > 0.05)  .n = 23)  . Althougn = 23) .P = 0.083), reduced anxiety (P = 0.069), and depression (P = 0.054), and fewer individuals had high levels of anxiety compared to baseline (P > 0.05)  .The responses of the individuals who took part in the qualitative interviews were examined to gain insight into their experience of singing in the choir. The following themes which emerged from the data will be discussed below: friendship and support, a common goal and focus for the future, improved mood, increased confidence and self-esteem, an extraordinary choir, physical effects, challenges, and future directions.Motivations for joining the choir were varied and included the need for social interaction with and support from people who had been through similar experiences. Whilst some participants stated that they had joined the choir specifically for support, others wished to provide support to other choir members and felt that their participation was a way of saying “thank you” to Tenovus (who funded the choir). Having a common cancer experience also provided participants with a connection. The choir gave them a sense of belonging and, for those who wished, an opportunity to share their experiences. This was deemed important because participants felt that people with no experience of cancer could not fully understand what they had been through.“We’re there for the social side of it, to help people to support people, for people to know there are other people going through treatment and know how they feel, but there’s a connection there.”Female, 61“I think because you’ve had cancer, or you’ve looked after someone with cancer, they will say you know how I feel. You know what it’s like. So they feel they haven’t got to express how they feel, which is not always easy anyway. They take comfort from the fact that someone else knows, or has been through that experience, without word you’ve got that empathy.”Female, 67“They’ve all had some problems. Not always what I’ve had, but similar things, they’ve gone through similar things and you can talk to them.”Female, 64“They can ask me about my cancer and stuff like that, because they all know. They’ve either lost someone to cancer, they’re going through it themselves, or they know someone. It’s a place where you can talk about it or not talk about it. That’s the brilliant part of it.”Female, 50Participants reflected that working towards a communal goal  created a sense of camaraderie which bonded the group. The choir rehearsals gave participants something to look forward to each week, and singing was viewed as a welcome distraction from the cancer. Public performances by the choir also provided a focus for the future and maintained the interest of the group.“Doing something like singing and making mistakes together and getting it right, brought people together, and you start to make friends.”Female, 46“There’s lovely camaraderie there, from singing. It’s nice to have something all the family can do. It’s been good.”Male, 60“So it’s something to look forward to, I suppose, every week. Something different.”Female, 61“The gigs are vital really, without any gigs, turning up for choir practice, people would lose interest. And it brings people together and it’s something to look forward to.”Male, 51“There’s a lot of people that need enjoyment after cancer. It gives somebody help, to think of something else, other than their illness really.”Female 64Five participants stated that singing improved their mood, lifted their spirits, and increased their levels of confidence and self-esteem. This may be related to the sense of achievement and fulfilment gained through practising and making an improvement in performance.“It takes you out. It lifts you … it makes you feel happy singing.”Female, 69“You feel elated. It makes you feel uplifted. It makes you feel a lot better. And you forget that you’re there because you had cancer, really. It’s brilliant.”Female, 64“We’ve got a focus now, we can do something together and we sing and we enjoy it, and it really does make you feel well.”Female, 46“I think confidence really and self-esteem …, [I] generally feel a lot better … after joining the choir.”Male, 51Participants suggested that the Sing for Life Choir was different from traditional choirs because its purpose is as much about providing support as about singing. The choir is also open to all ages and abilities; this differs from some traditional choirs which include only specific groups of people . Also there is not a need to be able to read music as choir members are given materials with which to practise between rehearsals. One participant who been singing for some years commented that although Sing for Life was a different kind of choir, it complemented her participation in a traditional choir. The choice of modern music by the Sing for Life Choir was also welcomed by participants who perceived it as more uplifting than classical music.“This choir is not an ordinary choir. I call it an extraordinary choir.”Female, 61“I know my singing isn’t strong enough. I accept that, I’m happy with that. This choir is geared to allow everyoneto come in.”Male, 51“It’s brought a new dimension to the musical part of my life. So it’s very much complimenting [my participation in another choir], I don’t think it’s duplicating anyway, it’s a totally different choir.”Female, 57“It is more free and easy, it is not so rigid, you know. It’s more fun and more modern singing, and it’s lovely.”Female, 69Participants offered some comments to suggest that singing may improve breathing and posture and encourage physical activity. The choir gave participants a reason to get out of the house and the rehearsals involved movement which increased their activity.“I suppose you do stand properly, you think about your posture, because you’re supposed to be opening your lungs and everything.”Female 61“I’m getting out and about a bit more, so I’m walking with the walker…. I wouldn’t be doing that walking if it wasn’t for the choir.”Female, 50Two participants felt that there were some challenges to the future of the choir. These were related to the arrival of new members changing group dynamics and maintaining the connection between choristers. There was also concern that some people may join the choir simply because the concert trips are subsidised. However, the participants recognised the need to avoid the development of a closed group, which would not welcome new members. One participant who sings in another choir suggested having representatives in different sections of the choir to introduce new members and having new member sessions every quarter.“I think for me the only downside is not knowing some of the people who just turn up.”Male, 51“You have to be careful that this doesn’t become an ordinary choir, when people are there just to go on their jollies.”Female, 57This pilot study showed improvements in several aspects of QoL after 3 months of choral singing, in patients who had a previous diagnosis of cancer and their friends or partners. As measured by the SF-36, mental health improved, with gains in vitality and social function. The SF-36 is generic questionnaire which has been used in a variety of populations and allows comparison been a variety of populations. Compared to normative published data, the present cohort appeared to have lower scores at baseline . There wThe improved QoL is in agreement with a number of studies in patients with chronic lung disease , 13 and The mechanism behind these improvements is likely to be complex. The engagement in a regular pleasurable activity with individuals with the same disease or life experiences has the potential to enhance social interaction and support . Since tIn general, group therapy has been found to be an efficient means of providing long-term support for cancer patients and may provide a way of engaging and returning to daily activities . WhetherIn this study, levels of fatigue were unchanged over three months of singing in the choir. This might have been expected given the mixed group of patients and supporters, whose levels of baseline fatigue were comparable to previously published levels of fatigue in healthy individuals . AlthougOther reported physiological benefits which have been reported after singing include increased immunoglobulin (a measure of immune function), decreased cortisol, and associated emotional stress , 22. A tThe themes which emerged from the qualitative interviews compliment the findings from a survey which was developed and utilised to investigate the perceived benefits of participation in a large community choir. Of the six areas included in the survey, four similar themes were apparent in the present data, namely self-confidence, emotional wellbeing, social life, and general understanding of singing and physical health . AdditioThere are several limitations to the present study. Participants had a variable cancer experience, including patients and their family and friends, with a considerable range of time since their experience; however, QoL scores did not differ between these groups. Potentially, patients who have survived cancer may be making the most of life and may have relatively good QoL. The pulmonary function tests may have been confounded as a habituation session, which was not possible and a number of individuals had previous or current experience of singing in a choir. Previous experience of singing may also affect the effects on wellbeing. Research has shown that in response to a singing lesson, amateurs reported increasing joy and elatedness (VAS), whereas professionals did not . As a piThis pilot project provides preliminary data which suggest that choral singing can improve QoL and depression, despite no physiological change. Qualitative findings indicated that the choir provided social support, increased confidence, and gave a focus for the future. This provides a foundation for a larger scale study investigating the benefits of choral singing.


Recent antibiotic use is a risk factor for infection or colonization with resistant bacterial pathogens. Demand for antibiotics can be affected by consumers’ knowledge, attitudes, and practices. In 1998–1999, the Foodborne Diseases Active Surveillance Network (FoodNet) conducted a population-based, random-digit dialing telephone survey, including questions regarding respondents’ knowledge, attitudes, and practices of antibiotic use. Twelve percent had recently taken antibiotics; 27% believed that taking antibiotics when they had a cold made them better more quickly, 32% believed that taking antibiotics when they had a cold prevented more serious illness, and 48% expected a prescription for antibiotics when they were ill enough from a cold to seek medical attention. These misguided beliefs and expectations were associated with a lack of awareness of the dangers of antibiotic use; 58% of patients were not aware of the possible health dangers. National educational efforts are needed to address these issues if patient demand for antibiotics is to be reduced. Antimicrobial resistance is a rapidly increasing problem in the United States and worldwide. A well-documented risk factor for infection or colonization with resistant bacterial pathogens is recent antibiotic use, particularly within 4 weeks or 1 month before exposure  conducted a telephone-based population survey in Connecticut, Minnesota, and Oregon, and selected counties in California, Georgia, Maryland, and New York . Each month, approximately 150 residents in each state were interviewed. After screening to remove business and nonworking telephone numbers, an outside contractor contacted respondents by telephone using a random-digit-dialing, single-stage sampling method  addressing participants’ knowledge, attitudes, and practices regarding antibiotic use were included in the survey. Recent antibiotic use referred to antibiotic use in the past 4 weeks. Respondents who took an antibiotic were asked whether the antibiotic was prescribed by their physician for a current illness or for a previous illness or if the antibiotic was prescribed for someone else. For the question, “Are you aware of any health dangers to yourself or other people associated with taking antibiotics?” respondents’ knowledge of health dangers associated with taking antibiotics was classified into the following categories: emerging drug resistance, allergies/reactions, antibiotics may kill “friendly”/“good” microbes, it is unhealthy to take drugs/chemicals in general, misuse/overuse of antibiotics, multiple reasons, other, don't know, or refused. Answers to survey items 1 and 5 were yes/no. For statements 2, 3, and 4, participants were asked to respond according to the following 5-point Likert scale: 1=strongly agree, 2=agree somewhat, 3=unsure, 4=disagree somewhat, and 5=strongly disagree. We classified those who answered “strongly agree” or “agree somewhat” to the antibiotic knowledge questions as having agreed and those who answered “strongly disagree” or “disagree somewhat” as having disagreed. Those who refused to answer a question were not included in the analysis.>50,000 residents. Presence of children in the household (yes/no), month of interview, and medical insurance status were also recorded. Respondents were classified as being “with insurance” if they reported any of the following as their type of insurance: health maintenance organization, preferred provider organization, traditional indemnity insurance, Medicaid, Medicare, or other. If respondents reported their type of insurance as “don’t know” or if they refused to answer the question, they were not included in the analysis.In addition to eliciting participants’ responses to these questions, the survey also recorded demographic characteristics of the participants, including their sex, age, income level, education, race, state, and place of residence. Respondents’ place of residence was categorized as urban if they reported living in a city or town of To simplify our analysis, we coded persons indicating Hispanic ethnicity as Hispanic, even if they also identified themselves by race . For our multivariable analysis, we grouped persons identified as Asian, Pacific Islander, American Indian, or Alaskan Native into the category called “other.” We also added those who responded “don’t know” or “unsure” to the attitude questions to the “agree” group to divide respondents into two groups: those who responded correctly (disagree) and those who did not (agree or don’t know). For our multivariable logistic regression, we grouped respondents who answered “don’t know” to the question, “Are you aware of dangers associated with antibiotics?” with those who answered “no.” Persons responding “don’t know” to the question, “In the past 4 weeks, have you taken antibiotics?” were not included in the analysis. We evaluated respondents’ education and income levels as continuous variables.To compensate for respondents’ unequal probability of selection and allow population estimates to be made, we weighted the data following procedures from the Behavioral Risk Factor Surveillance System , a specialized statistical procedure for analyzing complex sample survey data, and ran the analysis using SAS   This software adjusts for the complexity of the sampling design  and uses Taylor series linearization methods to estimate variances. Because the ratio of sample size to population size was small, we approximated the sample design by a “with-replacement” design for purposes of variance estimation in SUDAAN. Any bias resulting from such replacement sampling will be in the conservative direction.We examined respondents’ attitudes toward, and awareness of, antibiotic use by their age, sex, race, income level, education, state, place of residence, medical insurance status, presence of children in household, and month of the interview. We then tested the relationships between respondents’ demographic characteristics and their responses to the questions and statements about antibiotics using chi-square tests for independence. We used the results of the bivariate analyses to develop two multivariable logistic regression models: 1) a model assessing the effects of respondents’ awareness of antibiotic dangers on their attitudes toward and expectations of antibiotics; and 2) a model assessing the influence of respondents’ attitudes on their recent antibiotic use.Because of the complexity of the analyses, we used only second-degree product terms to assess interaction effects. Results of the logistic regression models are reported as odds ratios (ORs) with 95% confidence intervals (CIs). The level of significance is p=0.05.The sample consisted of 12,755 respondents: 7,254 females and 5,501 males. Of these 12,755, a total of 1,975 were <18 years old or of an unknown age and thus were excluded from the analysis . Of the Of the 10,780 respondents, 27% believed taking antibiotics when they had a cold prevented more serious illness  and each of the three different attitude statements as the outcome. Each of these relationships was significant in the univariate and multivariable analyses .Participants not aware of adverse effects of antibiotic use were 2.5 times more likely to agree with the statement, “When I have a cold, I should take antibiotics to prevent getting a more serious illness” (95% CI 2.14 to 2.92). In addition, the demographic variables of age, sex, race, income level, education level, and state were all significant predictors of agreement. We also found significant interactions between the awareness variable and race and education, as well as interactions between age and gender.We also found a significant association between participants agreeing with the statement, “When I have a cold, antibiotics help me to get better more quickly,” and their being aware of health dangers associated with indiscriminate use of antibiotics . Those agreeing with this statement were more likely to be older .Participants not aware of dangers were 1.96 times more likely to agree with the statement, “By the time I am sick enough to talk to or visit a doctor because of a cold, I usually expect a prescription for antibiotics” (95% CI 1.72 to 2.23). The other demographic variables in the model significantly associated with participants’ responses to this statement were age, sex, income level, education level, insurance, state, and place of residence.Using another multivariable model, we examined the association between respondents’ taking antibiotics in the prior 4 weeks and their attitudes toward and knowledge of the adverse effects of antibiotic use . The oveParadoxically, participants aware of dangers related to antibiotic use were 1.37 times more likely to have taken antibiotics in the previous 4 weeks (95% CI 1.11 to 1.69) even though awareness of these dangers was not a univariate predictor of antibiotic use . Of note, only one attitude statement was significant in predicting antibiotic use, suggesting that all of the statements are measuring similar things .The results of this FoodNet survey showed that 12% of adult respondents had used antibiotics during the prior month, most (91%) of which were prescribed for a current infection. Extrapolating from the survey data, we estimate that every adult in the United States in 1998 used antibiotics an average of 1.4 times and that approximately 1 in 10 adults who used antibiotics did so without seeing a physician.The results also suggest that peoples’ knowledge and attitudes regarding antibiotic use can be substantially improved and that improved knowledge may be important for efforts to reduce the misconceptions and misguided expectations contributing to inappropriate antibiotic use. Overall, 53% of respondents to this population-based survey reported at least one misconception that may put them at unnecessary risk for infection with resistant bacterial pathogens, and 58% were not aware of the health dangers associated with antibiotic use. Nearly half (48%) of the respondents indicated that they expected an antibiotic when they visit a doctor.This survey identified persons in demographic groups who had both higher levels of misconceptions and lower levels of knowledge about the potential adverse impact of antibiotics. These groups included persons of lower socioeconomic status, lower educational status, males, those in younger age groups, and the elderly. Efforts to reach these groups must be a part of any educational efforts to change patient expectations and to reduce the corresponding pressure on providers to prescribe antibiotics inappropriately.The results of this study did not show a consistent direct link between misguided expectations and higher levels of recent antibiotic use. In part, this lack may have been due to the design of the survey, which focused on collecting frequency data and did not aim to define the reasons for antibiotic use. In addition, in our analysis, we found that the three attitude statements were similar measures of a person’s opinions on antibiotic use. The statements have the same demographic predictors and association with the knowledge variable and, in reality, they appear to measure the same thing .We did not find an association between recent antibiotic use and lower knowledge levels. Before the analysis, we assumed that persons lacking knowledge about the dangers associated with antibiotic use would be more likely to take antibiotics. However, we found that study participants aware of these health dangers were actually more likely to have taken antibiotics in the prior 4 weeks. Persons of higher socioeconomic status (higher education and income) have better access to health care and are more likely to use antibiotics in general; we did find that people who took an antibiotic recently were more likely to have medical insurance. Another possible explanation is that those who recently took antibiotics may have learned about the adverse effects of antibiotic use from their physician or pharmacist or from their personal experience with antibiotic side effects. Future epidemiologic studies of antibiotic use in diverse populations should be designed to collect information on why participants use antibiotics to distinguish between appropriate and inappropriate antibiotic use.This type of study has several other important limitations. A telephone survey creates the possibility of selection bias because it may not reflect the population being surveyed (Another limitation is the cross-sectional nature of this study. Each participant was assessed only once, and the study was not designed to detect recent changes in opinion. Furthermore, the indicators used measured self-reported behavior not actual behavior. We did not attempt to validate responses on the basis of actual observation, and the survey did not determine whether the antibiotic use was appropriate.Additionally, respondents may have misunderstood the statements about colds and antibiotics. For example, if they had previous experience with what they thought was a cold, and a physician diagnosed a bacterial ear infection, they may have responded that antibiotics help them get better more quickly when they have a cold (This study focused only on antibiotic use among adults. Antibiotic use is, however, highest among children, as is the potential for its misuse. In fact, we found that respondents with children in the household were more likely to agree with the attitude statements, demonstrating that it is often parents who influence their children’s perceptions of antibiotic use.The results of this analysis demonstrate that population-based surveys can contribute to efforts to monitor and reduce inappropriate antibiotic use. The magnitude of recent antibiotic use among adults, as well as widespread lack of awareness about and inappropriate attitudes toward such use indicate that continued population-based surveys could be useful in efforts to monitor trends in antibiotic use. Furthermore, such surveys have the potential to effectively monitor antibiotic knowledge, attitudes, and practices among demographic subgroups of concern. Knowing the magnitude of the problem and the groups who misuse antibiotics most frequently will help public health officials develop and fund intervention efforts, including public information campaigns.However, our findings also point out some important issues that need to be addressed if this surveillance tool is to be used to full effect. First, additional population-based studies are needed not only to measure antibiotic use but also to determine the reasons that people use them. Such studies should explore the motivations, expectations, and incentives that lead persons to use or not use antibiotics. Second, future studies should include more clearly defined measures of patients’ knowledge. Better measures of knowledge may involve asking respondents to differentiate between antibiotics and other types of prescription medicine and to identify types of infections requiring antibiotics. A more thorough evaluation of respondents’ attitudes may also be useful. To this end, focus groups may help develop questions that better monitor the general population’s attitudes toward antibiotics. Finally, longitudinal tracking of these types of studies will provide important information for the assessment of public health programs.


Robert Remak was a neurologist, a physiologist, and an embryologist. He was born on July 23, 1815 in Poznań; this town and a large western part of Poland was occupied by Prussia during his lifetime. In his papers, written in Polish, he refers to Poles as his compatriots [Remak started his education at home, subsequently completed a Polish gymnasium in Poznań and in 1833 enrolled at the University of Berlin. While still an undergraduate, he started research work in the microscopic laboratory under Johannes Müller (1801–1858), professor of anatomy and physiology. The fruit of his many years’ work was a doctoral dissertation entitled “Observationes Anatomicae et Microscopicae de Systematis Nervosi Struktura” , which hAfter the doctorate, he continued neurological investigations in Müller’s lab. In 1839, he described ganglion cells in the right atrium and related them to the sympathetic system . To dateIn 1843, he became assistant in the clinic of Johann Schönlein (1793–1864) at the Charité Hospital. He rejected the offer of a chair in Vilnius and Cracow, by referring to the scope of his scientific work in Berlin. However, according to legal provisions at that time, as a Jew he was banned from occupying the post of professor in areas under Prussian rule. It was only in 1847 that he obtained an (unpaid) position of extramural lecturer (Privatdozent) at Berlin University, after many efforts and letters of support of Schönlein and Alexander von Humboldt (1769–1859). He still continued clinical work at the Charité. In 1859, he was promoted to the post of assistant professor, which was a disproportionately humble position in view of his scientific achievements.Apart from his neurological discoveries, embryology was an important field of interest. His research in this area continued over 20 years in a small laboratory at Charité Hospital. He was the first to assert that there are three germ layers in the early embryo, and that new cells are generated by division of the existing ones . AdditioFrom 1856 onwards, Remak had a private practice, largely based on electrotherapy, another field of interest. His patients were treated with galvanotherapy. The method was applied in about 700 patients, especially those affected with diseases of the brain and spinal cord. Remak determined the point where the nerves penetrated the muscles, which was essential for effective electrical stimulation. In contrast to other physicians, he therefore did not stimulate muscle tissue, but nerve terminals in muscle . His metIn 1847, Remak married Feodowa Mayer. They had a son, Ernest Juliusz Remak (1849–1912), who also became a neurologist [