Exile Vol. XXI No. 1

FICTION Lonely Wire Hangers by Larry Weber 7-11 untitled by Peggy Gifford 15-16 Anything by Joe Bolster 20-21 Easter Story by Ellen Claffy 25-27 Melanie by Dawn Patnode 31-34 PHOTOGRAPHY by Nanny Trippe 4, 22, 24, 28 by Geoffery Yeomans 6, 11, 17, 28, 30, 35, 36, 40 POETRY untitled by Martin Cloran 5 Mirror, Mirror by Tigger Montague 12 Twenty-Two Year Decay by Tigger Montague 13 Rice Puddin\u27 by Mary Mueller 14 untitled by Sharon Singleton 18 untitled by Sharon Singleton 19 untitled by Kim McMullen 23 Audience by Dawn Patnode 29 Extinction by Vic Coccimiglio 37 The Only Way I Know Her by Vic Coccimiglio 38 Touch by Vic Coccimiglio 38 Family by Vic Coccimiglio 3

Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

BACKGROUND: In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. METHODS: Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) that led quality improvement efforts in nursing homes from the six pilot states. RESULTS: QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. CONCLUSION: The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting

Resettling into a new life: Exploring aspects of acculturation that could enhance the mental health of young refugees resettled under the humanitarian programme

Globally, the exodus of individuals who have been forced to flee their home and seek refuge in countries of safety has led to a refugee crisis. The United Kingdom (UK) has engaged with the United Nations High Commissioner for Refugees (UNHCR) in playing a significant role in the long‐term resettlement of refugees, half of whom are children and young people. One initiative of such humanitarian resettlement is the Gateway Protection Programme (GPP). To date, there is a dearth of studies investigating aspects of acculturation that affect the mental health of young refugees resettled under the UNHCR humanitarian programme. This study aimed to explore aspects of acculturation that could enhance the mental health of GPP young refugees several years after resettlement. Using narrative research, a purposive sample of 31 GPP young refugees, who had a minimum of three‐year stay in the UK, were recruited from local refugee community organizations. Data were collected through a multi‐method design combining focus group discussions (FGDs) with visual arts‐based narrative research (VABNR) and analysed thematically. Three overarching themes emerged: People and places; Its nearly all new to me; and Finding self. This study contributes important knowledge regarding the mental well‐being of young people who have engaged in a resettlement programme and offers valuable information for policymakers and mental health professionals working with GPP young refugees

Resettling into a new life: Exploring aspects of acculturation that could enhance the mental health of young refugees resettled under the humanitarian programme

Globally, the exodus of individuals who have been forced to flee their home and seek refuge in countries of safety has led to a refugee crisis. The United Kingdom (UK) has engaged with the United Nations High Commissioner for Refugees (UNHCR) in playing a significant role in the long‐term resettlement of refugees, half of whom are children and young people. One initiative of such humanitarian resettlement is the Gateway Protection Programme (GPP). To date, there is a dearth of studies investigating aspects of acculturation that affect the mental health of young refugees resettled under the UNHCR humanitarian programme. This study aimed to explore aspects of acculturation that could enhance the mental health of GPP young refugees several years after resettlement. Using narrative research, a purposive sample of 31 GPP young refugees, who had a minimum of three‐year stay in the UK, were recruited from local refugee community organizations. Data were collected through a multi‐method design combining focus group discussions (FGDs) with visual arts‐based narrative research (VABNR) and analysed thematically. Three overarching themes emerged: People and places; Its nearly all new to me; and Finding self. This study contributes important knowledge regarding the mental well‐being of young people who have engaged in a resettlement programme and offers valuable information for policymakers and mental health professionals working with GPP young refugees

A Study of the Relationships and Differences Between Students\u27 Scores on Two Individually Administered Reading Tests (Ari and Drs)

In this study, the investigator identified two questions: (1) what relationships and differences exist on students\u27 scores of two comparable diagnostic reading tests and (2) what error count variables may be designated as significant between the two instruments. The subjects were thirty students with reading problems who were attending a summer reading program. Each student was given the Diagnostic Reading Scales and the Analytical Reading Inventory as posttests at the end of six weeks of clinical instruction. It was hypothesized that there would be no significant relationships or differences between students\u27 scores on the two tests for oral reading levels and each of the subtests. Pearson product-moment correlations and t-tests were used to determine if statistically significant relationships or differences existed between grade level scores and several error variables used in evaluating students\u27 oral reading competencies. Only two measurements were found to be significantly related--the oral reading level scores and the substitution and mispronunciation scores. The reading level of the Diagnostic Reading Scales was found to be .8 years higher than the Analytical Reading Inventory; therefore, it was concluded that the variability of reading levels between the two tests was strong enough that teachers should not use the tests interchangeably. Although, statistically significant, the correlations between the mispronunciation and substitution measurement errors were not strong enough for predictive purposes

When it's apple blossom time in Normandie : popular edition ; song

Gift of Dr. Mary Jane Esplen.Piano vocal [instrumentation]On a farm in Normandy [first line]When it's apple blossom time in Normandy! [first line of chorus]G [key]Moderato con espressione [tempo]Popular song [form/genre]Pink flowers ; Peggy Dougherty (photograph) [illustration]Starmer [graphic artist]The Delmar Music Co. All the Music All the Time 231 St. Catherine St. Montreal [dealer stamp]Publisher's advertisement on inside front and back cover [note

Importance of pre-impact crustal structure for the asymmetry of the Chicxulub impact crater

Impact craters are observed on the surfaces of all rocky planets and satellites in our Solar System(1); some impacts on Earth, such as the Cretaceous/Tertiary one that formed the Chicxulub impact crater(2,3), have been implicated in mass extinctions(4-12). The direction and angle of the impact - or its trajectory - is an important determinant of the severity of the consequent environmental damage, both in the downrange direction ( direction bolide travels) and in the amount of material that enters the plume of material vaporized on impact(2,13-15). The trajectory of the Chicxulub impact has previously been inferred largely from asymmetries in the gravity anomalies over the crater(2,3). Here, we use seismic data to image the Chicxulub crater in three dimensions and demonstrate that the strong asymmetry of its subsurface correlates with significant pre-existing undulations on the end-Cretaceous continental shelf that was the site of this impact. These results suggest that for rocky planets, geological and geomorphological heterogeneities at the target site may play an important role in determining impact crater structure, in addition to impact trajectories. In those cases where heterogeneous targets are inferred, deciphering impact trajectories from final crater geometries alone may be difficult and require further data such as the distribution of ejecta