How I Write

For me the whole process begins with Henry James’ advice: A writer should strive to be a person on whom nothing is lost. So my first task is to pay strict attention—with all of my senses—to whatever moment I am in. What I am trying to be alert to are things that have for me a kind of shimmer of resonance around them, things that, were I with a trusted friend, I would say, “hey, look at that!” or “did you hear that?

Development and Validation of an Open Access Snp Array for Nile Tilapia (Oreochromis niloticus)

Tilapia are among the most important farmed fish species worldwide, and are fundamental for the food security of many developing countries. Several genetically improved Nile tilapia (Oreochromis niloticus) strains exist, such as the iconic Genetically Improved Farmed Tilapia (GIFT), and breeding programs typically follow classical pedigree-based selection. The use of genome-wide single-nucleotide polymorphism (SNP) data can enable an understanding of the genetic architecture of economically important traits and the acceleration of genetic gain via genomic selection. Due to the global importance and diversity of Nile tilapia, an open access SNP array would be beneficial for aquaculture research and production. In the current study, a ∼65K SNP array was designed based on SNPs discovered from whole-genome sequence data from a GIFT breeding nucleus population and the overlap with SNP datasets from wild fish populations and several other farmed Nile tilapia strains. The SNP array was applied to clearly distinguish between different tilapia populations across Asia and Africa, with at least ∼30,000 SNPs segregating in each of the diverse population samples tested. It is anticipated that this SNP array will be an enabling tool for population genetics and tilapia breeding research, facilitating consistency and comparison of results across studies

A Community-Wide Collaboration to Reduce Cardiovascular Disease Risk: The Hearts of Sonoma County Initiative.

PURPOSE AND OBJECTIVES: Collaboration across multiple sectors is needed to bring about health system transformation, but creating effective and sustainable collaboratives is challenging. We describe outcomes and lessons learned from the Hearts of Sonoma County (HSC) initiative, a successful multi-sector collaborative effort to reduce cardiovascular disease (CVD) risk in Sonoma County, California. INTERVENTION APPROACH: HSC works in both clinical systems and communities to reduce CVD risk. The initiative grew out of a longer-term county-wide collaborative effort known as Health Action. The clinical component involves activating primary care providers around management of CVD risk factors; community activities include community health workers conducting blood pressure screenings and a local heart disease prevention campaign. EVALUATION METHODS: The impact of the clinical improvement efforts was tracked using blood pressure data from the 4 health systems participating in HSC. Descriptive information on the community-engagement efforts was obtained from program records. Lessons learned in developing and maintaining the collaborative were gathered through document review and interviews with key informants. RESULTS: Favorable trends were seen in blood pressure control among patients with hypertension in the participating health systems: patients with controlled blood pressure increased from 58% in 2014 to 67% in 2016 (P \u3c .001). Between 2017 and 2019, the community engagement effort conducted 99 outreach events, reaching 1,751 individuals, and conducted 1,729 blood pressure screenings, with 441 individuals referred to clinical providers for follow-up care. HSC scored highly on 6 essential elements of an effective coalition and achieved a degree of sustainability that has eluded many other collaboratives. IMPLICATIONS FOR PUBLIC HEALTH: Factors contributing to the success of HSC include 1) starting small and focused to build trust among participants and demonstrate value, 2) working within the framework of a larger effort, and 3) providing long-term, open-ended backbone support

Exile Vol. XXIX No. 2

Photo by John Taylor 2 Poem by Ezra Pound 3 Photo by James Lundy 4 Balanced Budget by August West 5 The Lighter by John Zarchen 6-7 Photo by Theodore Granberg 8 Uptown by Christopher B. Brougham 9 Photo by Jeff Russell 9 Heartstrings by Pete Waters 10 Spell by Eric Stevenson 10 Mums by Mandy Wilson 10 A New Day by Chad Hussey 11 Photo by Chad Hussey 12 Solitare by Gordon Black 13-14 Photo by James Lundy 15 A Grave Day-Dream by John Zarchen 16 Photo by James Lundy 17 Photo by Pauela Theodotou 18 Reconciliation by R. T. Hayashi 19 Michigan Rt. 37 by Ruth Wick 20 Shenango Valley by August West 20 Photo by James Lundy 21 Drawing by Adrienne Wehr 22 Ultraviolet Blues by Kathy Shelton 23 New Orleans & The Silky Black Seams Of My Stockings by Kate Reynolds 23 Refraction by Pam Houston 23-31 Photo by James Lundy 32 A Midsummer Night\u27s... by R. T. Hayashi 33 Couch sleeping by Eric Stevenson 33 Before We Could Build by Kim Kiefer 34 Photo by Chad Hussey 35 The Legend Of The Bear Mother by Amy Pence 36 Photo by James Lundy 37 Cover Drawing by Peter Brooke -title pag

Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study.

BACKGROUND: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients. OBJECTIVE: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress. DESIGN: Semi-structured in-depth qualitative interviews. PARTICIPANTS: Twenty-two internal medicine residents and fellows across three American academic medical centers. APPROACH: This study uses systematic qualitative methods of data gathering, analysis and interpretation. KEY RESULTS: Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life. CONCLUSIONS: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.This study was funded by the Health Resources and Service Administration T32 HP10025-20 Training Grant, the Gates Cambridge Scholarship, Society of General Internal Medicine Founders Grant, and the Ho-Chiang Palliative Care Research Fellowship at the Johns Hopkins School of Medicine.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s11606-015-3505-

Quality Assurance Driving Factors as Antecedents of Knowledge Management: a Stakeholder-Focussed Perspective in Higher Education

Similar to many other types of organisations, the successful development of higher education institutions generally depends on proactive multi-stakeholder management strategy. As a social responsibility of universities, quality assurance (QA) of higher education is already an established research domain. However, the issues that serve as driving factors in higher education’s quality are acknowledged in this vast knowledge stream in a dispersed way. An objective of this paper is to provide a quick snapshot of the major QA driving factors in higher education. Another objective here is to discuss the significance of these existing QA driving factors in higher education as prospective antecedents of knowledge management among the key stakeholders in the higher education sector and beyond. An inductive constructivist approach is followed to review the relevant QA driving factors from the extant scholarly views. A number of relevant factors are précised from the literature that would be instrumental to uphold quality in higher education. The discussion demonstrates that these factors are also significant to transfer and share knowledge between the key stakeholders not only for universities, but also for businesses, governments and other organisational stakeholders. The paper proposes a framework of the QA drivers’ application for meaningful knowledge transfer between diverse stakeholders and clarifies the framework’s managerial implications. This conceptual framework specifies different scenarios and perspectives of QA drivers’ application in the global education sector. The academic novelty is based on the inductive approach applied in the paper. QA practitioners will be able to follow these factors as steering phenomena to effectively assure quality, in relation to their multi-stakeholder relationships in higher education and beyond

Reading: Pam Houston

In this video from Wednesday, March 28, 2012 during the 43rd Annual UND Writers Conference, “Humanimal,” Pam Houston reads from Contents May Have Shifted (2012), including “Delta #55,” “Juneau, Alaska,” “Ban Xang Hai, Laos,” “Atigun Pass, Alaska,” “Tucson, Arizona,” “Milwaukee, Wisconsin,” “Portland, Oregon,” “Trenton, New Jersey,” and “Bend, Oregon.” She also answers questions from the audience. Introduction by Therese Borkenhagen. A transcription of this reading is available here