The Marriage of Heaven and Hell? Philip Pullman, C.S. Lewis, and the Fantasy Tradition

Closely scrutinizes Pullman’s frequent denials of his quite obvious debt to C.S. Lewis, finding the hidden nuances in Pullman’s statements by separating out his responses to Lewis as a reader, author, and critic. The inescapable conclusion is that not only is Pullman writing classic fantasy, he is in close agreement with Lewis on many points as a reader and critic

Inside The Picture, Outside The Frame: Semiotics And The Reading Of Wordless Picture Books

The publishing world has witnessed a proliferation of word less children’s books during th e past 40 years. Books in this genre offer young readers invitat ionsto transact with a whole system of images as th ey navigate these texts. Using asemiotic framework, this study focuses on three children’s readings of word less picture books and explores the ways in which they assign meaning to a variety of visual signs and cues. The data indicate that the children make sens e of wordlesspicture books by using sense-making processes similar to those used in the reading of print-based texts. Specifically, they construct mean ing through the use of priorknowledge and experiences, attention to inter textual cues, multiple perspectivetaking, reliance upon story langu age and rituals, and the implementation ofactive, playful behaviors as part of the reading process. © 2000 by the Association for Childhood Education International

Classes sociales et motricité /

Bibliogr.: p. 289-30

Biological nutrient removal from a phosphorus-rich pre-fermented industrial wastewater

The objective of this work was to demonstrate the feasibility and to quantify the maximum extent of enhanced biological phosphorus (bio-P) removal from a phosphorus-rich (60 to 100 mg P/L) wastewater originating from a cheese factory (2100 mg total COD/L; 57 mg total TKN-N/L). An existing wastewater treatment plant at the industrial site consisted of an anaerobic equalization tank followed by an anaerobic upflow sludge blanket (UASB) and aerated lagoons. In a bench-scale sequencing batch reactor, bio-P removal was better achieved by treating the effluent from the equalization tank in which a high level of volatile fatty acids were produced (1230 mg as HAc/L) rather than the effluent from the UASB. The effluent orthophosphates concentration reached as low as 5 mg P/L. An intracellular polyphosphates content in the biomass greater than 5% (g P/g MLVSS) was observed which demonstrated without doubt that bio-P removal, and not just normal metabolic phosphorus accumulation, took place. Optimizing industrial bio-P removal should consider prior acidogenesis of the influent wastewater, acetate or chemical addition, and an efficient control over effluent suspended solids.</jats:p

Dossier : la formation des enseignants et des enseignantes du collégial : réflexions autour de l'avis du Conseil supérieur de l'éducation.

Bibliogr.La FNEEQ [Fédération nationale des enseignantes et des enseignants du Québec] et la formation du personnel enseignant de l'ordre collégial / Réaction de la FAC [Fédération autonome du collégial] à l'avis du Conseil supérieur de l'éducation sur la formation du personnel enseignant au collégial : vers une déformation de l'enseignement collégial / La formation professionnelle des enseignants et la FEC [Fédération des enseignants et enseignantes de cégeps] (CSQ) / La FECQ [Fédération étudiante collégiale du Québec] et la formation du personnel enseignant du collégial : un projet qui lui tient à coeur / PERFORMA et l'insertion professionnelle du nouveau personnel enseignant / L'avis du Conseil supérieur de l'éducation : réaction préliminaire de la Fédération des cégeps, L'AQPC [Association québécoise de pédagogie collégiale] et l'avis du Conseil supérieur de l'éducation, Pédagogie collégiale et les thèmes abordés dans l'avis du Conseil supérieur de l'éducation : bibliographie

Searching for management approaches to reduce HAI transmission (SMART): a study protocol

Abstract Background Healthcare-associated infections (HAIs) impact patients’ lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)—including culture and management strategies—to proactively support clinical teams. Methods Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an implementation program for toolkit use, and disseminate that Toolkit nationwide. Discussion Providing hospitals with the tools they need to successfully measure management structures that support clinical care provides a powerful approach that can be leveraged to reduce the incidence of HAIs experienced by patients. This study is critical to providing the information necessary to successfully “make health care safer” by providing guidance on how contextual factors within a healthcare setting can improve patient safety across hospitals

Assets for integrating task-sharing strategies for hypertension within HIV clinics: Stakeholder's perspectives using the PEN-3 cultural model.

BackgroundAccess to antiretroviral therapy has increased life expectancy and survival among people living with HIV (PLWH) in African countries like Nigeria. Unfortunately, non-communicable diseases such as cardiovascular diseases are on the rise as important drivers of morbidity and mortality rates among this group. The aim of this study was to explore the perspectives of key stakeholders in Nigeria on the integration of evidence-based task-sharing strategies for hypertension care (TASSH) within existing HIV clinics in Nigeria.MethodsStakeholders representing PLWH, patient advocates, health care professionals (i.e. community health nurses, physicians and chief medical officers), as well as policymakers, completed in-depth qualitative interviews. Stakeholders were asked to discuss facilitators and barriers likely to influence the integration of TASSH within HIV clinics in Akwa Ibom, Nigeria. The interviews were transcribed, keywords and phrases were coded using the PEN-3 cultural model as a guide. Framework thematic analysis guided by the PEN-3 cultural model was used to identify emergent themes.ResultsTwenty-four stakeholders participated in the interviews. Analysis of the transcribed data using the PEN-3 cultural model as a guide yielded three emergent themes as assets for the integration of TASSH in existing HIV clinics. The themes identified are: 1) extending continuity of care among PLWH; 2) empowering health care professionals and 3) enhancing existing workflow, staff motivation, and stakeholder advocacy to strengthen the capacity of HIV clinics to integrate TASSH.ConclusionThese findings advance the field by providing key stakeholders with knowledge of assets within HIV clinics that can be harnessed to enhance the integration of TASSH for PLWH in Nigeria. Future studies should evaluate the effect of these assets on the implementation of TASSH within HIV clinics as well as their effect on patient-level outcomes over time

Organizational readiness to implement task-strengthening strategy for hypertension management among people living with HIV in Nigeria

Abstract Background Hypertension (HTN) is highly prevalent among people living with HIV (PLHIV), but there is limited access to standardized HTN management strategies in public primary healthcare facilities in Nigeria. The shortage of trained healthcare providers in Nigeria is an important contributor to the increased unmet need for HTN management among PLHIV. Evidence-based TAsk-Strengthening Strategies for HTN control (TASSH) have shown promise to address this gap in other resource-constrained settings. However, little is known regarding primary health care facilities’ capacity to implement this strategy. The objective of this study was to determine primary healthcare facilities’ readiness to implement TASSH among PLHIV in Nigeria. Methods This study was conducted with purposively selected healthcare providers at fifty-nine primary healthcare facilities in Akwa-Ibom State, Nigeria. Healthcare facility readiness data were measured using the Organizational Readiness to Change Assessment (ORCA) tool. ORCA is based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework that identifies evidence, context, and facilitation as the key factors for effective knowledge translation. Quantitative data were analyzed using descriptive statistics (including mean ORCA subscales). We focused on the ORCA context domain, and responses were scored on a 5-point Likert scale, with 1 corresponding to disagree strongly. Findings Fifty-nine healthcare providers (mean age 45; standard deviation [SD]: 7.4, 88% female, 68% with technical training, 56% nurses, 56% with 1–5 years providing HIV care) participated in the study. Most healthcare providers provide care to 11–30 patients living with HIV per month in their health facility, with about 42% of providers reporting that they see between 1 and 10 patients with HTN each month. Overall, staff culture (mean 4.9 [0.4]), leadership support (mean 4.9 [0.4]), and measurement/evidence-assessment (mean 4.6 [0.5]) were the topped-scored ORCA subscales, while scores on facility resources (mean 3.6 [0.8]) were the lowest. Conclusion Findings show organizational support for innovation and the health providers at the participating health facilities. However, a concerted effort is needed to promote training capabilities and resources to deliver services within these primary healthcare facilities. These results are invaluable in developing future strategies to improve the integration, adoption, and sustainability of TASSH in primary healthcare facilities in Nigeria. Trial registration NCT05031819