Understanding Quality of Care in a Hospice Setting

Assuring quality of care for patients who face the end of life has been a major concern for those in hospice settings. Limited research is available that has a focus on understanding what quality of care in a hospice setting looks like. This research is important to provide insight into hospice health care providers\u27 perceptions of the quality of care in the hospice setting and on the indicators that influence care quality. A qualitative phenomenological approach was used to answer the research questions on the perspectives of the health care providers in the hospice care setting regarding the quality of care and the factors that health care providers perceive as important to the quality of care in the hospice setting. Kolcaba\u27s comfort theory served as the theoretical framework that guided the preparation of the questions used for the interviews and for interpreting the findings. Data collection was conducted through structured interviews with a sample of 15 hospice health care providers. Interviews were held in a private office of the hospice setting. After Walden Institutional Review Board approval, participants consented and interviews commenced. Data were transcribed and Nvivo software was used to assist with identifying major themes. Recommendations from the study reflect Kolcaba\u27s comfort theory providing patient-centered care and enhanced quality of care for patients in a hospice setting. The research findings and recommendations will help promote a positive social change by raising awareness for effective provider communication, staffing, education and adequacy of resources in the hospice setting

Alien Registration- La Fese, Salvatore (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/25898/thumbnail.jp

Alien Registration- La Fese, Salvatore (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/25898/thumbnail.jp

\u3ci\u3eDrosophila\u3c/i\u3e Muller F Elements Maintain a Distinct Set of Genomic Properties Over 40 Million Years of Evolution

The Muller F element (4.2 Mb, ~80 protein-coding genes) is an unusual autosome of Drosophila melanogaster; it is mostly heterochromatic with a low recombination rate. To investigate how these properties impact the evolution of repeats and genes, we manually improved the sequence and annotated the genes on the D. erecta, D. mojavensis, and D. grimshawi F elements and euchromatic domains from the Muller D element. We find that F elements have greater transposon density (25–50%) than euchromatic reference regions (3–11%). Among the F elements, D. grimshawi has the lowest transposon density (particularly DINE-1: 2% vs. 11–27%). F element genes have larger coding spans, more coding exons, larger introns, and lower codon bias. Comparison of the Effective Number of Codons with the Codon Adaptation Index shows that, in contrast to the other species, codon bias in D. grimshawi F element genes can be attributed primarily to selection instead of mutational biases, suggesting that density and types of transposons affect the degree of local heterochromatin formation. F element genes have lower estimated DNA melting temperatures than D element genes, potentially facilitating transcription through heterochromatin. Most F element genes (~90%) have remained on that element, but the F element has smaller syntenic blocks than genome averages (3.4–3.6 vs. 8.4–8.8 genes per block), indicating greater rates of inversion despite lower rates of recombination. Overall, the F element has maintained characteristics that are distinct from other autosomes in the Drosophila lineage, illuminating the constraints imposed by a heterochromatic milieu