Sleep hygiene Protocol to Improve Sleep and Delirium In a Surgical Intensive Care Unit

Background: In a special report published in 2015 by the American Geriatrics Society (AGS), a postoperative delirium expert panel was chosen and gave recommendations for best practice for the reduction of delirium. The Institute of Medicine supported the following ten behavioral and nonpharmacological strategies for prevention of delirium: 1. Sensory enhancement (ensuring glasses, hearing aids, or listening amplifiers) 2. Mobility enhancement (ambulating at least twice per day if possible) 3. Cognitive orientation and therapeutic activities (tailored to the individual) 4. Pain control with scheduled acetaminophen if appropriate 5. Cognitive stimulation (if possible, tailored to the individual’s interests and mental status) 6. Simple communication standards and approaches to prevent the escalation of behavior 7. Nutritional and fluid repletion enhancement 8. Sleep enhancement (daytime sleep hygiene, relaxation, non –pharmacologic sleep protocol, and nighttime routine) 9. Medication review and appropriate medication management 10. Daily rounding by an interdisciplinary team to reinforce the interventions The best practice statement was review by both surgical and nonsurgical experts in the field of geriatric medicine and surgery and was accepted. The best practice statement is a call for change in the care of post-operative patients 65 years and older. The AGS Geriatric for Specialist Initiative (AGS-GSI) recognized delirium as the most common surgical complication in older adults, occurring in 5% to 50% of older patients after an operation. In the United States more than one-third of inpatient surgeries are performed on patients 65 years or older (Hall & DeFrances, 2010) making it imperative that clinicians caring for surgical patients understand optimal delirium care. Delirium is a serious complication for older adults because an episode of delirium can begin a cascade of deleterious clinical events, including other postoperative complications, prolonged hospitalization, loss of functional independence, and reduced cognitive function and death (Robinson & Raebirm, 2009). Cost to patients includes impact on long-term cognitive ability and loss of preoperative quality of life. Furthermore, cost to the health care system is estimated at $150 billion annually (Leslie & Marcantonio, 2008). This proposal will examine the implementation of the eighth recommendation which is the behavioral and nonpharmacological strategies for prevention of delirium; sleep enhancement with the introduction of a best practice sleep hygiene protocol (appendix I).No embarg

Parenting experiences in elite youth football: A phenomenological study

Objectives: The purpose of this study was to explore the experiences of parents of elite specializing stage youth footballers. Method: A descriptive phenomenological approach guided the study design. Data from interviews with five mothers and five fathers of youth players registered to English football academies were analysed using descriptive phenomenological analysis (Giorgi, 2009). Findings: Three essences characterized the phenomenon of being a parent of an elite youth footballer: parent socialization into elite youth football culture; enhanced parental identity; and increased parental responsibility. Parents’ socialization into the football academy culture was facilitated by their interaction with coaches and parent peers, highlighting the social nature of parenting. Being the parent of a child identified as talented meant that parents experienced enhanced status and a heightened responsibility to facilitate his development. Although parents were compelled to support their son in football, their instinct to protect their child meant they experienced uncertainty regarding the commitment required to play at an academy, given the potential for negative consequences. Together, these findings illustrate that parents experienced a transition as their son progressed into the specialization stage of football. We postulate that formal recognition of a child as talented contributed to this transition, and that knowledge of sport and perception of the parent-child relationship shaped how parents adapted. Conclusions: This study provides a new way of understanding the psychological phenomena of parenting in elite youth football. Implications for practitioners working with parents in sport are provided

Caveolin 1 is overexpressed and amplified in a subset of basal-like and metaplastic breast carcinomas: a morphologic, ultrastructural, immunohistochemical, and in situ hybridization analysis

The distribution and significance of caveolin 1 (CAV1) expression in different breast cell types and role in breast carcinogenesis remain poorly understood. Both tumor-suppressive and oncogenic roles have been proposed for this protein. The aims of this study were to characterize the distribution of CAV1 in normal breast, benign breast lesions, breast cancer precursors, and metaplastic breast carcinomas; to assess the prognostic significance of CAV1 expression in invasive breast carcinomas; and to define whether CAV1 gene amplification is the underlying genetic mechanism driving CAV1 overexpression in breast carcinomas. Purpose: The distribution and significance of caveolin 1 (CAV1) expression in different breast cell types and role in breast carcinogenesis remain poorly understood. Both tumor-suppressive and oncogenic roles have been proposed for this protein. The aims of this study were to characterize the distribution of CAV1 in normal breast, benign breast lesions, breast cancer precursors, and metaplastic breast carcinomas; to assess the prognostic significance of CAV1 expression in invasive breast carcinomas; and to define whether CAV1 gene amplification is the underlying genetic mechanism driving CAV1 overexpression in breast carcinomas. Experimental Design: CAV1 distribution in frozen and paraffin-embedded whole tissue sections of normal breast was evaluated using immunohistochemistry, immunofluorescence, and immunoelectron microscopy. CAV1 expression was immunohistochemically analyzed in benign lesions, breast cancer precursors, and metaplastic breast carcinomas and in a cohort of 245 invasive breast carcinomas from patients treated with surgery followed by anthracycline-based chemotherapy. In 25 cases, CAV1 gene amplification was assessed by chromogenic in situ hybridization. Results: In normal breast, CAV1 was expressed in myoepithelial cells, endothelial cells, and a subset of fibroblasts. Luminal epithelial cells showed negligible staining. CAV1 was expressed in 90% of 39 metaplastic breast carcinomas and in 9.4% of 245 invasive breast cancers. In the later cohort, CAV1 expression was significantly associated with ‘basal-like’ immunophenotype and with shorter disease-free and overall survival on univariate analysis. CAV1 gene amplification was found in 13% of cases with strong CAV1 expression. Conclusions: The concurrent CAV1 amplification and overexpression call into question its tumor-suppressive effects in basal-like breast carcinomas

Cultural experience tourist motives dimensionality : a cross-cultural study

This empirical research of tourists&rsquo; cultural experiences aims to advance theory by developing a measurement model of tourists&rsquo; motives towards attending cultural experiences for samples of Western and Asian tourists visiting Melbourne, Australia. Drawing upon Iso-Ahola&rsquo;s (1989) seeking/avoiding dichotomy theory for tourist motivation dimensions, the hypothesized dimensions primarily included escape and seeking-related dimensions, and some hedonic dimensions because of their relevance to aesthetic products (Hirschman &amp; Holbrook, 1982; Holbrook &amp; Hirschman, 1982), which are the context for this study. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to crossvalidate the underlying dimensionality structure of cultural experience motives. A four-factor model was extracted from the EFA consistent with some theoretical formulations and was retained in the CFA. Specific cultural language group differences for the motive dimensions were also hypothesized between Western and Asian tourist samples, and within the Chinese- and Japanese-speaking Asian tourist samples, but not within the different cultural groups of English-speaking Western tourists. These cross-cultural hypotheses were tested for the motive dimension measurement model using invariance testing in CFA. The findings for the motive dimensions differing by cultural group were not as expected. Significant cultural differences between Western and Asian tourists were not found, but a new finding of this study was significant differences between English-speaking tourists in their motives for attending cultural experiences. Marketing implications of these findings are also presented.<br /

Quality of hospital care for sick newborns and severely malnourished children in Kenya: A two-year descriptive study in 8 hospitals

BACKGROUND: Given the high mortality associated with neonatal illnesses and severe malnutrition and the development of packages of interventions that provide similar challenges for service delivery mechanisms we set out to explore how well such services are provided in Kenya. METHODS: As a sub-component of a larger study we evaluated care during surveys conducted in 8 rural district hospitals using convenience samples of case records. After baseline hospitals received either a full multifaceted intervention (intervention hospitals) or a partial intervention (control hospitals) aimed largely at improving inpatient paediatric care for malaria, pneumonia and diarrhea/dehydration. Additional data were collected to: i) examine the availability of routine information at baseline and their value for morbidity, mortality and quality of care reporting, and ii) compare the care received against national guidelines disseminated to all hospitals. RESULTS: Clinical documentation for neonatal and malnutrition admissions was often very poor at baseline with case records often entirely missing. Introducing a standard newborn admission record (NAR) form was associated with an increase in median assessment (IQR) score to 25/28 (22-27) from 2/28 (1-4) at baseline. Inadequate and incorrect prescribing of penicillin and gentamicin were common at baseline. For newborns considerable improvements in prescribing in the post baseline period were seen for penicillin but potentially serious errors persisted when prescribing gentamicin, particularly to low-birth weight newborns in the first week of life. Prescribing essential feeds appeared almost universally inadequate at baseline and showed limited improvement after guideline dissemination. CONCLUSION: Routine records are inadequate to assess newborn care and thus for monitoring newborn survival interventions. Quality of documented inpatient care for neonates and severely malnourished children is poor with limited improvement after the dissemination of clinical practice guidelines. Further research evaluating approaches to improving care for these vulnerable groups is urgently needed. We also suggest pre-service training curricula should be better aligned to help improve newborn survival particularly

Integrated Functional, Gene Expression and Genomic Analysis for the Identification of Cancer Targets

The majority of new drug approvals for cancer are based on existing therapeutic targets. One approach to the identification of novel targets is to perform high-throughput RNA interference (RNAi) cellular viability screens. We describe a novel approach combining RNAi screening in multiple cell lines with gene expression and genomic profiling to identify novel cancer targets. We performed parallel RNAi screens in multiple cancer cell lines to identify genes that are essential for viability in some cell lines but not others, suggesting that these genes constitute key drivers of cellular survival in specific cancer cells. This approach was verified by the identification of PIK3CA, silencing of which was selectively lethal to the MCF7 cell line, which harbours an activating oncogenic PIK3CA mutation. We combined our functional RNAi approach with gene expression and genomic analysis, allowing the identification of several novel kinases, including WEE1, that are essential for viability only in cell lines that have an elevated level of expression of this kinase. Furthermore, we identified a subset of breast tumours that highly express WEE1 suggesting that WEE1 could be a novel therapeutic target in breast cancer. In conclusion, this strategy represents a novel and effective strategy for the identification of functionally important therapeutic targets in cancer

A Politico-Communal Reading of the Rose

Lettura del Fiore in rapporto alle fonti retoriche e politiche di ambiente comunal

Progress and prospects for event tourism research

This paper examines event tourism as a field of study and area of professional practice updating the previous review article published in 2008. In this substantially extended review, a deeper analysis of the field’s evolution and development is presented, charting the growth of the literature, focusing both chronologically and thematically. A framework for understanding and creating knowledge about events and tourism is presented, forming the basis which signposts established research themes and concepts and outlines future directions for research. In addition, the review article focuses on constraining and propelling forces, ontological advances, contributions from key journals, and emerging themes and issues. It also presents a roadmap for research activity in event tourism