Analysis and interpretation of The innocents and The turn of the screw

The purpose of this thesis is to study the script, produce the play, and evaluate the production of William Archibald's The Innocents. The play is based on The Turn of the Screw by Henry James. The first part includes the following: (1) a discussion of four theories concerning the story and the play, (2) an investigation of the production styles, (3) character description and analysis, and (4) a discussion of the setting. The second part is the director's prompt book for the production, performed on April 24, 25, and 26, 1970, in Taylor Theatre at The University of North Carolina at Greensboro. Types of notations included are: (1) movement, composition and picturization, (2) rhythm and tempo notes, (3) stage business, and (4) sound and light notes. Production photographs are included. The third part is the director's critical evaluation of the production. Discussed in this chapter are: (1) goals and achievements of interpretation, style, and mood, (2) actor-director relationships during the rehearsal period, and (3) audience reaction to the production

Meanings of athletic identity within the multidimensional self and social context

The topic of athletic identity has garnered increased attention in recent decades. While there have been shifts in understandings, the majority of studies rely on the original conceptualization of the construct based on Brewer, Van Raalte, and Linder’s (1993) work (Ronkainen, Kavoura, & Ryba, 2016a). Little to no research has assessed athletic identity within a conceptual framework that depicts the overall self-concept and related context, which would display clearer connections to identity theories (Burke & Stets, 2009; Jones & Abes, 2013; Ronkainen et al., 2016a). Thus, the current investigation was guided and organized within the Reconceptualized Model of Multiple Dimensions of Identity (RMMDI) framework, a comprehensive model depicting the multidimensional self as situated within the greater context that influences identity (Jones & Abes, 2013). The current study used a qualitative descriptive approach framed within a constructivist epistemology to explore and describe athletic identity as positioned within the holistic self and context. Participants included twelve NCAA Division I student-athletes across the following team sports: soccer, softball, and basketball. Participants completed individual semi-structured qualitative interviews which included an identity mapping activity consistent with the RMMDI framing. Three themes were generated using reflexive thematic analysis: Self and Athlete: Orientation of the Self; Lifelong Immersion in Sport Culture; and “It’s a Lifestyle”: Passion for the Game. Results indicate that athletic identity was one of the few most personally important identities within the multidimensional self. Participant accounts demonstrate that athletic identity can be positioned and described as a core identity (e.g., central; primary within self-view) or as a salient identity (e.g., important; on secondary-level within self-view). This positioning of athletic identity in relation to other identities (i.e., described in two orientation groups) seemed to be influenced by the broader sport context and connected with corresponding athletic lifestyle behaviors. Participant descriptions support that continued immersion in sport culture and engaging in athletic lifestyle decisions can reinforce the identification with the athlete role. Practical implications and related competencies for the fields of sport and exercise psychology, counseling, and student development are provided. These implications include, but are not limited to, the following: acknowledging and respecting the importance of athletic identity for individuals, working to facilitate self-reflection, striving to understand contextual factors that influence identity, and attending to these personal and contextual influences to work toward developmentally appropriate and culturally sensitive practice

Reinforcement of a Preoperative Insulin Protocol

Purpose: Patients with type 1 diabetes (T1DM) often arrive for surgery with blood glucose readings out of target goal for the healthcare facility. This often leads to surgical delays, increased healthcare expenses and increases the risk of patient complications. The purpose of this project was to evaluate an institution’s preoperative insulin management protocol and reinforce its usage by providing an education session to the preoperative clinic providers. The ultimate goal is to improve blood glucose readings and better prepare the patient for surgery. A secondary aim of this study was to improve provider confidence by expanding comprehension of the current insulin protocol. Background: Glucose management for the patient with T1DM is a highly debated topic among medical providers. Too much or too little insulin can have dramatic effects on the patient’s health and wellness. Diabetes can significantly impact patient outcomes and healthcare expenses. Barriers to consider when educating advanced practice providers is their time, willingness to learn new information, obtaining buy in, and promoting future adherence to the protocol. Method: This was a quasi-experimental design quality improvement project. Documented blood glucose readings the morning of surgery were collected for a random 50 preoperative T1DM patients. Preoperative clinic providers were surveyed on their current understanding of the preoperative insulin management protocol, followed by an educational session explaining it in detail. Two months after the educational sessions another random 50 blood glucose levels of patients were selected for comparison. The same survey was distributed to the preoperative providers to assess for change in understanding of the use of the preoperative insulin management protocol. Results: The results showed no significant change in the pre-intervention and post-intervention blood glucose readings among patients with T1DM presenting for surgery. Even though the providers all stated positive levels of confidence with managing insulin preoperatively, and all cited the protocol as their resource for decision-making regarding preoperative insulin recommendation, the answers to the sample clinical questions asked in the survey showed that the protocol was not consistently being used correctly. Conclusion and Future Recommendations: There was limited interest and participation from the providers during this project which may have impacted the results and reduced its applicability to other settings. In the future, researchers would benefit from developing protocols with the input of the providers and fully engage with upper management to promote provider buy-in and greater adherence of the new program

Evaluation of Xpert® MTB/RIF and ustar easyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania : a prospective descriptive study

Fine needle aspiration biopsy has become a standard approach for diagnosis of peripheral tuberculous lymphadenitis. The aim of this study was to compare the performance of Xpert MTB/RIF and Ustar EasyNAT TB IAD nucleic acid amplification assays, against acid-fast bacilli microscopy, cytology and mycobacterial culture for the diagnosis of TB lymphadenitis in children from a TB-endemic setting in Tanzania.; Children of 8 weeks to 16 years of age, suspected of having TB lymphadenitis, were recruited at a district hospital in Tanzania. Fine needle aspirates of lymph nodes were analysed using acid-fast bacilli microscopy, liquid TB culture, cytology, Xpert MTB/RIF and EasyNAT. Latent class analysis and comparison against a composite reference standard comprising "culture and/or cytology" was done, to assess the performance of Xpert MTB/RIF and EasyNAT for the diagnosis of TB lymphadenitis.; Seventy-nine children were recruited; 4 were excluded from analysis. Against a composite reference standard of culture and/or cytology, Xpert MTB/RIF and EasyNAT had a sensitivity and specificity of 58 % and 93 %; and 19 % and 100 % respectively. Relative to latent class definitions, cytology had a sensitivity of 100 % and specificity of 94.7 %.; Combining clinical assessment, cytology and Xpert MTB/RIF may allow for a rapid and accurate diagnosis of childhood TB lymphadenitis. Larger diagnostic evaluation studies are recommended to validate these findings and on Xpert MTB/RIF to assess its use as a solitary initial test for TB lymphadenitis in children

Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study

Copyright ©Juhee Kim, Holly Mathews, Lindsay M Cortright, Xiaoming Zeng, Edward Newton. Originally published in JMIR Formative Research (http://formative.jmir.org), 22.03.2018. Licensed under a Creative Commons CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).Background: Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women. Objective: This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women. Methods: A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview. Results: Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women. Conclusions: The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.ECU Open Access Publishing Support Fun

Distinct genetic architectures and environmental factors associate with host response to the γ2-herpesvirus infections

Kaposi’s sarcoma-associated herpesvirus (KSHV) and Epstein-Barr Virus (EBV) establish life-long infections and are associated with malignancies. Striking geographic variation in incidence and the fact that virus alone is insufficient to cause disease, suggests other co-factors are involved. Here we present epidemiological analysis and genome-wide association study (GWAS) in 4365 individuals from an African population cohort, to assess the influence of host genetic and non-genetic factors on virus antibody responses. EBV/KSHV co-infection (OR = 5.71(1.58–7.12)), HIV positivity (OR = 2.22(1.32–3.73)) and living in a more rural area (OR = 1.38(1.01–1.89)) are strongly associated with immunogenicity. GWAS reveals associations with KSHV antibody response in the HLA-B/C region (p = 6.64 × 10−09). For EBV, associations are identified for VCA (rs71542439, p = 1.15 × 10−12). Human leucocyte antigen (HLA) and trans-ancestry fine-mapping substantiate that distinct variants in HLA-DQA1 (p = 5.24 × 10−44) are driving associations for EBNA-1 in Africa. This study highlights complex interactions between KSHV and EBV, in addition to distinct genetic architectures resulting in important differences in pathogenesis and transmission

Causes of Morbidity in Wild Raptor Populations Admitted at a Wildlife Rehabilitation Centre in Spain from 1995-2007: A Long Term Retrospective Study

Background: Morbidity studies complement the understanding of hazards to raptors by identifying natural or anthropogenic factors. Descriptive epidemiological studies of wildlife have become an important source of information about hazards to wildlife populations. On the other hand, data referenced to the overall wild population could provide a more accurate assessment of the potential impact of the morbidity/mortality causes in populations of wild birds. Methodology/Principal Findings: The present study described the morbidity causes of hospitalized wild raptors and their incidence in the wild populations, through a long term retrospective study conducted at a wildlife rehabilitation centre of Catalonia (1995-2007). Importantly, Seasonal Cumulative Incidences (SCI) were calculated considering estimations of the wild population in the region and trend analyses were applied among the different years. A total of 7021 birds were analysed: 7 species of Strigiformes (n = 3521) and 23 of Falconiformes (n = 3500). The main causes of morbidity were trauma (49.5%), mostly in the Falconiformes, and orphaned/young birds (32.2%) mainly in the Strigiformes. During wintering periods, the largest morbidity incidence was observed in Accipiter gentillis due to gunshot wounds and in Tyto alba due to vehicle trauma. Within the breeding season, Falco tinnunculus (orphaned/young category) and Bubo bubo (electrocution and metabolic disorders) represented the most affected species. Cases due to orphaned/young, infectious/parasitic diseases, electrocution and unknown trauma tended to increase among years. By contrast, cases by undetermined cause, vehicle trauma and captivity decreased throughout the study period. Interestingly, gunshot injuries remained constant during the study period. Conclusions/Significance: Frequencies of morbidity causes calculated as the proportion of each cause referred to the total number of admitted cases, allowed a qualitative assessment of hazards for the studied populations. However, cumulative incidences based on estimated wild raptor population provided a more accurate approach to the potential ecological impact of the morbidity causes in the wild populations

Information gaps for patients requiring craniotomy for benign brain lesion: a qualitative study

Doctor–patient communication in the setting of a life-threatening illness poses considerable challenges. This study aimed to determine the information needs of a subset of neurosurgical patients. Qualitative case study methodology was used. Twenty-five semi-structured interviews were conducted with ambulatory adult patients who had undergone surgery for a benign brain tumor, arteriovenous malformation, or unruptured aneurysm. Interviews were digitally audio recorded and transcribed, and the data subjected to thematic analysis. Six overarching themes emerged from the data: (1) the amount of information patients want varies; (2) the type of information needed is not limited to information about treatment options and risks; (3) patients engage in independent information seeking for a variety of reasons; (4) patients consider compassion from their surgeon as important; (5) direct communication with the surgeon post-operatively is very important; and (6) patients’ information needs are greatest post-operatively. Many patients felt that the amount and quality of information they received was not sufficient, particularly regarding post-operative recovery and long-term life issues, leading many to do their own research. The findings from this study emphasize the need for improved communication with patients so they can participate meaningfully in choices about their treatment, give a truly informed consent, and effectively participate in their own recovery

Inter-hemispheric EEG coherence analysis in Parkinson's disease : Assessing brain activity during emotion processing

Parkinson’s disease (PD) is not only characterized by its prominent motor symptoms but also associated with disturbances in cognitive and emotional functioning. The objective of the present study was to investigate the influence of emotion processing on inter-hemispheric electroencephalography (EEG) coherence in PD. Multimodal emotional stimuli (happiness, sadness, fear, anger, surprise, and disgust) were presented to 20 PD patients and 30 age-, education level-, and gender-matched healthy controls (HC) while EEG was recorded. Inter-hemispheric coherence was computed from seven homologous EEG electrode pairs (AF3–AF4, F7–F8, F3–F4, FC5–FC6, T7–T8, P7–P8, and O1–O2) for delta, theta, alpha, beta, and gamma frequency bands. In addition, subjective ratings were obtained for a representative of emotional stimuli. Interhemispherically, PD patients showed significantly lower coherence in theta, alpha, beta, and gamma frequency bands than HC during emotion processing. No significant changes were found in the delta frequency band coherence. We also found that PD patients were more impaired in recognizing negative emotions (sadness, fear, anger, and disgust) than relatively positive emotions (happiness and surprise). Behaviorally, PD patients did not show impairment in emotion recognition as measured by subjective ratings. These findings suggest that PD patients may have an impairment of inter-hemispheric functional connectivity (i.e., a decline in cortical connectivity) during emotion processing. This study may increase the awareness of EEG emotional response studies in clinical practice to uncover potential neurophysiologic abnormalities