Das ist ein Brausen und Heulen (1903-11)

Charles Tomlinson Griffes Das ist ein Brausen und Heulen (1903-11) text by Heinrich Heine, Poem 57 of Lyrisches Intermezzo (Buch der Lieder

Athletic Trainer’s Self-Confidence and Experience Level in Managing Exertional Heat Related Illnesses

Objective: Explore the athletic trainer’s level of self-confidence and experience in managing and treating exertional heat illness. Design: Non-experimental, exploratory and descriptive research design. Participants: 110 respondents, 46% male, 54% female, representing all 10 National Athletic Trainers’ Association districts, highest representation from district four (N=50). Sixty-eight percent (68%) from high school outreach setting, 22% College or University settings, and 10% from clinic/hospital setting. Twenty-one percent of respondents reported earning ≥55K annual salary. Sixty-seven percent hold Masters degrees while 43% have practiced ≥11 years. Intervention: The Athletic Trainer’s Self-Confidence Scale (ATSCS), (scale range, 1=strongly agree to 7=strongly disagree) was distributed to certified athletic trainers via Qualtrics survey. Main Out-come Measures: One-way ANOVA followed by Tukey post-hoc analysis and independent-sam-ple t-tests were used to measure differences between respondents and ATSCS items. Validity and reliability of the ATSCS were evaluated using Pearson r correlations and Cronbach coefficient alphas. Results: ATSCS yielded satisfactory internal consistency and convergent validity (Pearson r correlations between scale items ranged from r=.19(p=.05) to r=.79 (p=.01); Cronbach coefficient alphas α=.82. Athletic trainers were confident (overall mean between all scale items was M=2.05±.95) in treating exertional heat illnesses. Athletic trainers were most confident (strongly agree to somewhat agree, M=1.50±.57) in their ability to “think of an emergency plan of action” if an athlete is experiencing an exertional heat illness. Athletic trainers were least confident (some-what confident to somewhat not confident, M=3.39±1.94) in their ability to know the correct read-ing of the rectal thermometer to distinguish a heat illness emergency and the proper temperature for cold water immersion. Males were somewhat confident about knowing the correct reading of a rectal thermometer and proper temperature for cold water immersion compared to females who were undecided, M=2.86±1.85 to M=3.83±1.91, t(109) p=.009. Males were also somewhat confi-dent in knowing the proper way to administer a rectal thermometer and cold water immersion com-pared to females who were undecided, M=2.76±1.67 to M=3.75±2.00, t(109) p=.007. ANOVA analysis (Tukey Post Hoc) indicated that athletic trainers earning more salary (≥55K) were more confident than athletic trainers at lower salaries (\u3e25K) in solving difficult problems with heat illness athletes, M=1.52±0.73 to M=2.43±0.94, F(4,108)=2.87, p=.004. Conclusion: Athletic train-ers are somewhat confident in their ability to handle exertional heat illness emergencies. The lowest levels of self-confidence are in their abilities to insert a rectal thermometer and execute cold water immersion and to know the correct readings of the rectal thermometer to distinguish different heat illnesses and the proper temperature for cold water immersion. Athletic training should engage in continuing education opportunities where they are instructed the proper way administer a rectal thermometer and cold water immersion, and know the correct readings. Entry-level educational programs should consider formal instruction and evaluation for care of exertional heat illnesses, and related clinical competencies

Couple relationship education content: What we have and what we are missing

Through an inductive content analysis of 15 different couple relationship education (CRE) programs, this study explored various content categories and themes that are common across programs. Analysis found four common themes across programs: relationship skills and abilities, the self in the relationship, partner bonding, and relationship motivations. These findings suggest a primacy of teaching relationship skills and abilities within CRE, though other themes are also taught in various programs. To increase efficacy of CRE, expansion into individual and relational contextual factors, relationship interaction patterns, and relationship virtues and flourishing are warranted based on recent and historical research

Regional economic impacts of changes in electricity rates resulting from Western Area Power Administration`s power marketing alternatives

This technical memorandum describes an analysis of regional economic impacts resulting from changes in retail electricity rates due to six power marketing programs proposed by Western Area Power Administration (Western). Regional economic impacts of changes in rates are estimated in terms of five key regional economic variables: population, gross regional product, disposable income, employment, and household income. The REMI (Regional Impact Models, Inc.) and IMPLAN (Impact Analysis for Planning) models simulate economic impacts in nine subregions in the area in which Western power is sold for the years 1993, 2000, and 2008. Estimates show that impacts on aggregate economic activity in any of the subregions or years would be minimal for three reasons. First, the utilities that buy power from Western sell only a relatively small proportion of the total electricity sold in any of the subregions. Second, reliance of Western customers on Western power is fairly low in each subregion. Finally, electricity is not a significant input cost for any industry or for households in any subregion

Spectral and stratigraphic mapping of hydrated sulfate and phyllosilicate-bearing deposits in northern Sinus Meridiani, Mars

We present detailed stratigraphic and spectral analyses that focus on a region in northern Sinus Meridiani located between 1°N to 5°N latitude and 3°W to 1°E longitude. Several stratigraphically distinct units are defined and mapped using morphologic expression, spectral properties, and superposition relationships. Previously unreported exposures of hydrated sulfates and Fe/Mg smectites are identified using MRO CRISM and MEX OMEGA near‐infrared (1.0 to 2.5 µm) spectral reflectance observations. Layered deposits with monohydrated and polyhydrated sulfate spectral signatures that occur in association with a northeast‐southwest trending valley are reexamined using highresolution CRISM, HiRISE, and CTX images. Layers that are spectrally dominated by monohydrated and polyhydrated sulfates are intercalated. The observed compositional layering implies that multiple wetting events, brine recharge, or fluctuations in evaporation rate occurred. We infer that these hydrated sulfate‐bearing layers were unconformably deposited following the extensive erosion of preexisting layered sedimentary rocks and may postdate the formation of the sulfate‐ and hematite‐bearing unit analyzed by the MER Opportunity rover. Therefore, at least two episodes of deposition separated by an unconformity occurred. Fe/Mg phyllosilicates are detected in units that predate the sulfateand hematite‐bearing unit. The presence of Fe/Mg smectite in older units indicates that the relatively low pH formation conditions inferred for the younger sulfate‐ and hematitebearing unit are not representative of the aqueous geochemical environment that prevailed during the formation and alteration of earlier materials. Sedimentary deposits indicative of a complex aqueous history that evolved over time are preserved in Sinus Meridiani, Mars

Measuring case severity: a novel tool for benchmarking and clinical documentation improvement

BACKGROUND: Severity of illness (SOI) is an All Patients Refined Diagnosis Related Groups (APR DRG) modifier based on comorbidity capture. Tracking SOI helps hospitals improve performance and resource distribution. Furthermore, benchmarking SOI plays a key role in Quality Improvement (QI) efforts such as Clinical Documentation Improvement (CDI) programs. The current SOI system highly relies on the 3 M APR DRG grouper that is updated annually, making it difficult to track severity longitudinally and benchmark against hospitals with different patient populations. Here, we describe an alternative SOI scoring system that is grouper-independent and that can be tracked longitudinally. METHODS: Admission data for 2019-2020 U.S. News and World Report Honor Roll facilities were downloaded from the Vizient Clinical Database and split into training and testing datasets. Elixhauser comorbidities, body systems developed from the Healthcare Cost and Utilization Project (HCUP), and ICD-10-CM complication and comorbidity (CC/MCC) indicators were selected as the predictors for orthogonal polynomial regression models to predict patients\u27 admission and discharge SOI. Receiver operating characteristic (ROC) and Precision-Recall (PR) analysis, and prediction accuracy were used to evaluate model performance. RESULTS: In the training dataset, the full model including both Elixhauser comorbidities and body system CC/MCC indicators had the highest ROC AUC, PR AUC and predication accuracy for both admission (ROC AUC: 92.9%; PR AUC: 91.0%; prediction accuracy: 85.4%) and discharge SOI (ROC AUC: 93.6%; PR AUC: 92.8%; prediction accuracy: 86.2%). The model including only body system CC/MCC indicators had similar performance for admission (ROC AUC: 92.4%; PR AUC: 90.4%; prediction accuracy: 84.8%) and discharge SOI (ROC AUC: 93.1%; PR AUC: 92.2%; prediction accuracy: 85.6%) as the full model. The model including only Elixhauser comorbidities exhibited the lowest performance. Similarly, in the validation dataset, the prediction accuracy was 86.2% for the full model, 85.6% for the body system model, and 79.3% for the comorbidity model. With fewer variables and less model complexity, the body system model was more efficient and was determined to be the optimal model. The probabilities generated from this model, named J_Score and J_Score_POA, successfully measured SOI and had practical applications in assessment of CDI performance. CONCLUSIONS: The J_Scores generated from the body system model have significant value in evaluating admission and discharge severity of illness. We believe that this new scoring system will provide a useful tool for healthcare institutions to benchmark patients\u27 illness severity and augment Quality Improvement (QI) efforts

Mineralogy of a Mudstone at Yellowknife Bay, Gale Crater, Mars

Sedimentary rocks at Yellowknife Bay (Gale Crater) on Mars include mudstone sampled by the Curiosity rover. The samples, John Klein and Cumberland, contain detrital basaltic minerals, Ca-sulfates, Fe oxide/hydroxides, Fe-sulfides, amorphous material, and trioctahedral smectites. The John Klein smectite has basal spacing of ~10 Å indicating little interlayer hydration. The Cumberland smectite has basal spacing at ~13.2 Å as well as ~10 Å. The ~13.2 Å spacing suggests a partially chloritized interlayer or interlayer Mg or Ca facilitating H_2O retention. Basaltic minerals in the mudstone are similar to those in nearby eolian deposits. However, the mudstone has far less Fe-forsterite, possibly lost with formation of smectite plus magnetite. Late Noachian/Early Hesperian or younger age indicates that clay mineral formation on Mars extended beyond Noachian time

X-ray Diffraction Results from Mars Science Laboratory: Mineralogy of Rocknest at Gale Crater

The Mars Science Laboratory rover Curiosity scooped samples of soil from the Rocknest aeolian bedform in Gale crater. Analysis of the soil with the Chemistry and Mineralogy (CheMin) x-ray diffraction (XRD) instrument revealed plagioclase (~An57), forsteritic olivine (~Fo62), augite, and pigeonite, with minor K-feldspar, magnetite, quartz, anhydrite, hematite, and ilmenite. The minor phases are present at, or near, detection limits. The soil also contains 27 ± 14 weight percent x-ray amorphous material, likely containing multiple Fe^(3+)- and volatile-bearing phases, including possibly a substance resembling hisingerite. The crystalline component is similar to the normative mineralogy of certain basaltic rocks from Gusev crater on Mars and of martian basaltic meteorites. The amorphous component is similar to that found on Earth in places such as soils on the Mauna Kea volcano, Hawaii