In hospitalized adult patients experiencing sleep disturbances at cobb hospital Cardiac telemetry unit, will a nonpharmacological multi-component sleep promotion protocol compared to current pharmacological practices, effectively result in better patient sleep quality and satisfaction scores?

Background: The purpose of this evidence-based practice project is to implement and evaluate a nonpharmacological multi-component sleep promotion protocol for adult patients experiencing sleep disturbances related to hospitalization. Sleep is extremely important and plays a major role in restoring and healing our bodies. However, recent studies have shown that roughly 30 to 60% of hospitalized patients experience sleep issues or disturbances. Brief Literature Review: Poor sleep negatively impacts all physiological systems, impairing immune function, delaying wound healing, and increasing the risk of various comorbid diagnoses such as diabetes, obesity, depression, heart attacks, and hypertension. Current sleep promoting methods used on the cardiac telemetry unity are pharmacological based. The use and availability of nonpharmacological sleep promotion methods are, however, limited. Proposed Project: The multi-component sleep promotion protocol will have a focus on a sleep questionnaire. Once admitted to the floor, patients will fill out the form. The patients will have the opportunity to answer questions about their preferred sleep environment and what their routine consists of when at home. Additionally, patients will rate their satisfaction and sleep quality levels from their hospital stay thus far. Evaluation: Patients admitted to the floor will have the choice of whether to consent to filling out the sleep questionnaire or not. Baseline and post-intervention scores will be analyzed to evaluate the effects of the multi-component sleep promotion protocol

Guest editorial/Gasskrywersrubriek: Museum in the service of the community

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Costume Design for Adam Rapp’s The Metal Children at the University of Arkansas

The following thesis explains the process utilized to create and implement the costume design for the production of The Metal Children produced at the University of Arkansas University Theatre in the Fall of 2016. Throughout this thesis I will illustrate how the costumes went from initial research ideas to sketches and colored renderings and finally to finished three-dimensional costumes. The design process detailed here includes an analysis of the play, inspiration collage, portrait gallery, research, renderings, production images and an evaluation of the overall process

XRCC1 is required for DNA single-strand break repair in human cells

The X-ray repair cross complementing 1 (XRCC1) protein is required for viability and efficient repair of DNA single-strand breaks (SSBs) in rodents. XRCC1-deficient mouse or hamster cells are hypersensitive to DNA damaging agents generating SSBs and display genetic instability after such DNA damage. The presence of certain polymorphisms in the human XRCC1 gene has been associated with altered cancer risk, but the role of XRCC1 in SSB repair (SSBR) in human cells is poorly defined. To elucidate this role, we used RNA interference to modulate XRCC1 protein levels in human cell lines. A reduction in XRCC1 protein levels resulted in decreased SSBR capacity as measured by the comet assay and intracellular NAD(P)H levels, hypersensitivity to the cell killing effects of the DNA damaging agents methyl methanesulfonate (MMS), hydrogen peroxide and ionizing radiation and enhanced formation of micronuclei following exposure to MMS. Lowered XRCC1 protein levels were also associated with a significant delay in S-phase progression after exposure to MMS. These data clearly demonstrate that XRCC1 is required for efficient SSBR and genomic stability in human cells

Health Care Safety-Net Programs After The Affordable Care Act

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents

Nursing and being nursed from patients\u27 perspectives : an ethnographic study

The research was commenced to understand why patients submissively accept compliance in the nursing relationship. To understand this phenomenon, an anthropological perspective about nursing was sought through ethnographic processes, utilising The Ethnographic Research Cycle and The Developmental Research Sequence as detailed by James Spradley (1980). Ethnographic methods of fieldwork and participant observation were undertaken over a three month period in a district nursing service in a rural area of Victoria, Australia. There are three over arching aims. The first is to record information at risk of being lost, hence the ethnography is an archival record describing insiders\u27 perspectives of nursing practice. Description brings into view broad contextual issues that shape nursing practice, the daily routines and cultural norms of nursing, whilst also giving voice to patients\u27 experiences about being nursed. The early part of the thesis is descriptive of the mundanity of nursing practice and of being a patient as these interactions are of fundamental significance in giving meaning to people\u27s lives. Secondly the inquiry seeks to capture the meaning patients attach to nursing. Further description continued to uncover perspectives of nursing that were layered to present an integrated whole that still acknowledges the integrity of individuals and structures that make up that whole. As the cultural picture gained detail, the expected norms of being a nurse and a patient became evident, revealing how culture gives shape to nursing and being nursed. Notions of time and space were found to be constructs of being a patient which shape the illness experience. They are not necessarily within a patient\u27s control, nonetheless, there is a norm and deviation from this norm has consequences for patients. Thirdly, the ethnography conveys the expected behaviour for a person who becomes a patient, to make known the implicit meanings, norms of behaviour and unwritten rules that a patient needs to understand as they pass through various stages of the health care system. In conclusion, the ethnography consistently reveals the underlying conflict between what nurses believe they do and the meaning attached to the experience of being nursed. For example, some nurses practice with patients\u27 values as central to practice; others believe they care, yet observation and patient conversations suggest that they do not. The ethnography revealed that society expects nurses to elicit and reinforce compliance. Similarly, the power of culture shapes the experience of patients as the desire to be accepted, as a personal need, and as a means of having their nursing needs met, means that patients will invariably be passively compliant. The consequence is that nurses have a dominant power differential over patients, therefore, if nursing is to continue to describe practice as humanistic and caring, they ought to actively seek to be aware of patients\u27 values and be motivated to accept these as central to practice

Disrespect and abuse during facility‐based childbirth in central Ethiopia

Background: Respectful maternity care is a fundamental human right, and an important component of quality maternity care. Objective: The aim of this study was to quantify the frequency and categories of D&A and identify factors associated with reporting D&A among women in north Showa zone of Ethiopia. Method: A cross-sectional study was conducted with 435 randomly selected women who had given birth at public health facility within the previous 12 months in North Showa zone of Ethiopia. A digital (tablet-based) structured and researcher administered tool was used for data collection. Frequencies of D&A items organised around the Bowser and Hill categories of D&A and presented in the White Ribbon Alliance’s Universal Rights of Childbearing Women Framework were calculated. Multivariable logistic regression was used to identify the association between experience of disrespect and abuse and interpersonal and structural factors at p-value <0.05 and odds ratio values with 95% confidence interval. Results: All participants reported at least one form of disrespect and abuse during childbirth. Types of disrespect and abuse experienced by participants were physical abuse 435 (100%), non-consented care 423 (97.2%), non-confidential care 288 (66.2%), abandonment/neglect (34.7%), non-dignified care 126 (29%), discriminatory care 99 (22.8%) and detention 24 (5.5%). Hospital birth [AOR: 3.04, 95% CI: 1.75, 5.27], rural residence [AOR: 1.44, 95% CI: 0.76, 2.71], monthly household income less than 1,644 Birr (USD 57) [AOR: 2.26, 95% CI: 1.20, 4.26], being attended by female providers [AOR: 1.74, 95% CI: 1.06, 2.86] and midwifery nurses [AOR: 2.23, 95% CI: 1.13, 4.39] showed positive association with experience of disrespect and abuse. Conclusion: Hospital birth showed consistent association with all forms of disrespect and abuse. Expanding the size and skill mix of professionals in the hospitals, sensitizing providers consequences of disrespect and abuse could promote dignified and respectful care. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Tribal Gaming Leader Strategies toward a Sustainable Future

One aspect of leadership strategy is the need to account for the core values of the organization.The purpose of this case study was to explore the tribal gaming leader strategies used toward sustainability, an action that leads to tribal economic development and stability. The conceptual framework of situational leadership theory was used to guide the scope and analysis of this study. Six tribal gaming leaders from Oklahoma participated in a focus group session; 7 additional tribal gaming leaders from the same gaming organization participated in individual interview sessions. Member checking was used to strengthen the credibility and trustworthiness of the interpretation of the participants’ responses. Additionally, company documents were reviewed to triangulate the data. Four emergent themes were identified after data analysis: business value, which was attributed to tribal leaders’ alignment to their mission; strategic vision, which included their marketing and overall business environment; collaboration, which was evident wherein the tribal gaming leaders utilized internal and external partnerships to improve local communities and maintain competitive advantage; and communication, which was emphasized for its importance as a daily skill for information sharing