Illuminating the Sacred as Tangible: Catherine’s Private and Multi-Sensory Access to the Divine in the Hours of Catherine of Cleves

Illuminated manuscripts are some of the most significant cultural artifacts from the late Middle Ages and Renaissance. Between the mid-thirteenth and mid-sixteenth centuries, more books of hours were produced than any other type of book, including the Bible.1 Derived from official service books of the Church, books of hours from this time were personal prayer books under no control by the clergy; therefore, aspects of the content, decoration, and elaboration depended much on the patron.2 Although variations occurred, the general concepts and content of these books remained the same. By the late fourteenth century, the typical book of hours consisted of a Calendar, Gospel Lessons, Hours of the Virgin, Hours of the Cross, Hours of the Holy Spirit, the two prayers to the Virgin called the “Obsecro te” and the “O intermerata,” the Penitential Psalms and Litany, the Office of the Dead, and a group of about a dozen Suffrages.3 The Pierpont Morgan Library owns more than 370 hand-produced and printed books of hours, including the highly revered Dutch illuminated manuscripts, the Hours of Catherine of Cleves (Morgan Library, NY)

Measured Expiratory Resistance of the Blue and Green Acapella Devices as Setting is Increased From 1–5; Amplitude 20, 30, 40

Background: After reviewing the literature on both high flow and low flow Acapella devices, it was determined that most researchers evaluated only three frequency dial settings. Due to this gap, we chose to determine the expiratory resistance at each frequency dial setting for both high flow and low flow Acapella devices, as patient effort (amplitude) is increased on an electronic lung simulator. Hypothesis: 1) As the frequency dial setting is increased on the Acapella, the expiratory resistance will increase, and 2) as the patient effort (amplitude) is increased, the expiratory resistance will increase. Methods: Each Acapella device was attached, separately, via a female-to-female adapter to the Hans Rudolph 1101 Electronic Lung Simulator. HR 1101 settings: Resistance 5 cm H2O/L/sec, Compliance 50 mL/cm H2O, Respiratory Rate 20/minute, Amplitude 10, 20, 30 and 40 cm H2O (to simulate patient effort), Percent Inhale 30 %, Targeted Volume 3000 mL, Load Effort Normal. Initially, amplitude was set at 10 cm H2O and the Acapella was set at the lowest setting. After allowing for stabilization, Peak Pressure and Peak Expiratory Flowrates were recorded for 20 consecutive breaths. The Acapella dial was then increased to the next setting; pressure and flowrates were recorded again as previously described. This process was continued until reaching the highest Acapella setting. Next, data was gathered at amplitudes of 20, 30 and 40 cm H2O, following the same procedure as stated for amplitude of 10 cm H2O. Resistance was calculated as (P1-P2)/Flow. P1 = averaged peak pressure for 20 breaths; P2 = 0 (ambient pressure); Flow = averaged Peak Expiratory Flowrate for 20 breaths. Results: The expiratory resistance increased as the frequency dial setting was increased and the expiratory resistance increased as amplitude increased. At an amplitude of 20 cm H2O, the expiratory resistance increased from 25.83 to 47.02 cm H2O/L/sec on the blue Acapella and from 12.56 to 38.24 cm H2O/L/sec on the green Acapella device as the frequency dial setting was increased from 1-5 (Figure 1). Conclusion: The expiratory resistance increased as the frequency dial setting increased from 1 to 5 on both Acapella devices. The expiratory resistance increased as the amplitude increased at 10, 20, 30 and 40 cm H2O, on both devices, confirming our hypothesis

Why Do You Come to LU?

The purpose of this study was to examine the reasons that people attend and continue to attend Lindenwood University. We examined 129 surveys completed by current Lindenwood University students. The survey asked a variety of questions, including demographic data, resident/commuter status, and what the student likes/dislikes about Lindenwood. There were two hypotheses for this study. Our first hypothesis was that commuter students would attend class more often than resident students. Our second hypothesis was that scholarships/funding was the top reason that students chose to come to Lindenwood. While our second hypothesis did yield statistical significance, our first one did not. Implications of these findings are discussed

The misuse of convenient care and importance of establishing a primary care provider

Over the last decade, there has been substantial increase in the use of urgent care (UC) and convenient care (CC) clinics nationwide. While these clinics are valued and serve a purpose in our communities, more patients are utilizing their services exclusively in place of primary care (PC), resulting in millions of Americans not receiving essential preventative care and chronic disease management. An extensive literature review evaluated current and effective interventions used to decrease inappropriate use of CC clinics, while simultaneously exploring strategies in increasing patient compliance with routine comprehensive health management. Based on literature review findings, an education-based project was implemented at a rural CC clinic that serves a large volume of patients without a primary care provider (PCP). Over an eight-week implementation phase, an educational template was electronically incorporated into patient discharge instructions and reviewed verbally by the convenient care provider (CCP). The template explained current definition and scope of practice of emergency departments, UC, CC, and PC clinics. Additionally, the template outlined which respective establishment to visit for numerous common ailments and important health care needs. A total of forty-six patients were identified without a PCP. The patients were counseled and given the printed education. Through initial interview, thirty percent of these patients were found to misunderstand the purpose of the CC clinic. Following counsel and education delivery, forty-eight percent of patients without a PCP reported new motivation to establish care with one. The CCP, who dually served as project stakeholder, reported positive feedback regarding the educational tool and found it valuable, despite COVID-19 barriers and limitations. The CCP continues to use the tool in daily practice and has shared it amongst fellow providers for use. It is recommended that our exploration into the misuse of this CC clinic be furthered with future project implementations that may focus on the role of the current patient advocate coordinator

Cultivating an Environment for Continued Growth in Nurse Educators

Along with the significant shortage of registered nurses, the United States is also experiencing a serious shortage of nursing faculty. Despite the high demand for nurses, many nursing programs are unable to accept all qualified students due to this shortage. This essay identifies reasons why nurse educators are leaving the academic setting and why there are fewer qualified and willing candidates to fill the vacant positions. In addition to discussion of the problem, practical strategies for recruitment and retention are proposed. Through appropriate planning and leadership, there are many practical solutions that can be implemented in the workplace setting to cultivate a work environment for the continued growth and retention of nurse educators

Measles on the Rise: Academic Institutions be Prepared

Measles is a highly contagious, acute viral illness that can lead to serious complications and death. From January 1 through May 20, 2011, a total of 118 measles cases were reported from 23 states and New York City, the highest reported number for the same period since 1996. Patients ranged in age from 3 months to 68 years. Of the 118 cases, 105 unvaccinated persons were associated with importation from other countries. Transmission occurred in households, child care centers, shelters, schools, emergency departments, and at a large community event. It is important for those in academic institutions to understand measles and be prepared to deal with these kinds of diseases. Recommendations for preventing further measles transmissions include reminding health care providers to consider a diagnosis of measles in ill persons who have traveled overseas, to use infection control practices to prevent transmission in health-care and other group settings, and to promote high coverage with measles, mumps, and rubella (MMR) vaccine for children as well as adult vaccination

Managing Childhood Asthma in the School Environment

It is often taken for granted that schools are instrumental in the spread of illness from child to child as well as from child to teacher. In addition to the nagging colds, stomach viruses and other temporary maladies, the school environment may actually contribute to some lifelong medical conditions. Many children face an unhealthy school environment on a daily basis, year after year, which may contribute to a condition called asthma. Asthma causes the airways of the lungs to swell and constrict and can often flare up without warning. Asthma is one of the top childhood disorders and is also a leading occupational disease of teachers and custodians. Many hours are spent in the classroom setting and over time this assumed ‘safe’ setting can turn into a “sick classroom” affecting those who are most vulnerable. The focus of this article is to examine the effects of asthma on school age children and provide information to empower teachers to facilitate change in the classroom environment. Working together with parents and administrators, teachers can make changes that will reduce asthma triggers and thereby reduce and possibly prevent severe asthmatic episodes

Patient Reported Experience of Kidney Care in the UK 2019

We are pleased to present the 2019 Kidney Patient Reported Experience Measure report (Kidney PREM). Following the initial pilot in 2016, involving over 8,000 people living with kidney disease, participation has continued to grow and the measure is now collected right across the UK and the number of responses has doubled with over 16,000 patients giving their views on their care experience.This unique source of data has been recognised and used throughout the renal community as the international drive for person-centred outcome data across the healthcare system gains momentum. The UK Kidney community is proud to be a part of this international work towards better understanding and improving patient experience.More importantly, our vision of the Kidney PREM is that it is used as a driver for change at a local level. We know the top-level scores are not the full story and that improvement, particularly around the three lower scoring themes - shared decision making, transport and needling - is complicated. There are no easy answers, however, there are some centres who are getting it right and we would like to better understand why this is and what they are doing that could be shared. The working group behind delivering the Kidney PREM continues to work hard to gain a better understanding of the many questions that the Kidney PREM throws up - What is it about a centre that causes it to have the biggest impact on patient experience compared to the other variables collected? Does the Kidney PREM result in an improvement in patient experience? If so, can this improvement be translated to different settings? We do not want the Kidney PREM to stand still. Through research projects, consultation and our own quality improvement, we hope the data and community response to the Kidney PREM will continue to evolve so that it remains meaningful, embedded across the system, and improves the experience and outcomes of people living with Kidney disease, as well as those who care for them in the UK. Thank you for being a part of it.Final Published versio