Strategies for Holistic Care in Neonatal Male Clients Undergoing Circumcision

Male circumcision is a controversial medical procedure routinely practiced in the United States. Once performed only as a religious act, this minor surgery became fashionable in the late nineteenth century. In modern society, circumcision remains popular, but the medical community continues to debate its necessity. Perhaps a larger debate concerns the use of anesthetics and analgesics in circumcision. Infants do feel pain, and pain relief measures are imperative during this procedure. Several effective methods have been established, and practice must accommodate the updated evidence. If pharmacologic and non-pharmacologic measures are employed appropriately, neonatal circumcision can be performed with minimal trauma to the infant. This knowledge is vital for nurses, who will be responsible for providing many of these essential interventions

Moving Picture Books

During my diagnostic practice on a PGCE primary course I worked with a Year 4 class at Stanville Primary School in the North East of Birmingham. The school follows the QCA scheme of work for design and technology and the topic the class was to follow was Unit 4B, Storybooks, with the focus on control mechanisms. The subject was to be taught in blocks of two weeks with three one and a quarter-hour sessions per week. This meant that the suggested timings in the QCA scheme of work had to be altered to accommodate this way of working

Doctor of Philosophy

dissertationU.S. healthcare costs have shown a marked increase as a percentage of GDP over the past decades. Additionally, the growth of U.S. healthcare spending is outpacing that of other industrialized economies. With this rapid pace of growth and spending, explorations of quality and efficiency within the U.S. healthcare system find a prominent place within the academy. This dissertation adds to extant research via three essays, each exploring unique dimensions of healthcare quality and efficiency. The first essay, Drivers of Quality and Efficiency: A Healthcare Perspective, utilizes regression and stochastic frontier analysis to explore drivers of hospital outcome quality and efficiency. Secondary source data from over 1,800 U.S. hospitals are used to evaluate the degree to which process standardization, service effectiveness and operational focus drive outcome quality and efficiency. In support of hypotheses and extant operations management theory, process standardization is found to relate positively to both outcome quality and efficiency while service effectiveness relates positively to outcome quality but is negatively related to efficiency. Contrary to hypotheses and theory, lower levels of operational focus (i.e., wider breadth of services) are found to positively contribute to outcome quality and efficiency. The second essay, Healthcare Focus and Performance: A Multidimensional Exploration, further explores the unexpected focus / performance relationship of the first essay. Using extant research and the data set from the first essay, multidimensional measures of essay. Using extant research and the data set from the first essay, multidimensional measures of both hospital focus and performance are proposed and evaluated utilizing canonical correlation analysis. This essay provides a contribution by evaluating rigorous multidimensional measures of both focus and performance and confirming that hospitals exhibiting a broader range of services also provide higher levels of overall performance. Additional insights are provided by evaluating individual indicators of focus and exploring their relative contributions to performance. The third essay, Competitive Capabilities: A Healthcare Perspective, examines the acquisition of quality and efficiency capabilities in light of Competitive Progression and Trade-off theoretical frameworks. Panel data from over 140 California hospitals from two time frames (2005-2008, and 2006-2009) and statistical differencing techniques are utilized to find support for the Competitive Progression framework for hospitals residing well off an economic performance frontier

Caught between presence and absence: Shakespeare's tragic women on film

In offering readings of Shakespeare’s tragic women on film, this thesis explores bodies that are caught between signifiers of absence and presence: the woman’s body that is present with absent body parts; the woman’s body that is spoken about or alluded to when absent from view; the woman’s living body that appears as a corpse; the woman’s body that must be exposed and concealed from sight. These are bodies that appear on the borderline of meaning, that open up a marginal or liminal space of investigation. In concentrating on a state of ‘betweenness’, I am seeking to offer new interpretive possibilities for bodies that have become the site of much critical anxiety, and bodies that, due to their own peculiar liminality, have so far been critically ignored. In reading Shakespeare’s tragic women on film, I am interested specifically in screen representations of Gertrude’s sexualised body that is both absent and present in Shakespeare’s Hamlet; Desdemona’s (un)chaste body that is both exposed and concealed in film adaptations of Othello; Juliet’s ‘living corpse’ that represents life and death in Shakespeare’s Romeo and Juliet; the woman’s naked body in Roman Polanski’s Macbeth (1971) that is absent from Shakespeare’s play-text; and Lavinia’s violated, dismembered body in Julie Taymor’s (Titus, 1999) and Titus Andronicus, which, in signifying both life and death, wholeness and fragmentation, absence and presence, something and nothing, embodies many of the paradoxes explored within this thesis. Through readings that demonstrate a combined interest in Shakespeare’s plays, Shakespeare films, and Shakespeare criticism, this thesis brings these liminal bodies into focus, revealing how an understanding of their ‘absent presence’ can affect our responses as spectators of Shakespeare’s tragedies on film

An Algorithm for Cellular Reprogramming

The day we understand the time evolution of subcellular elements at a level of detail comparable to physical systems governed by Newton's laws of motion seems far away. Even so, quantitative approaches to cellular dynamics add to our understanding of cell biology, providing data-guided frameworks that allow us to develop better predictions about and methods for control over specific biological processes and system-wide cell behavior. In this paper we describe an approach to optimizing the use of transcription factors in the context of cellular reprogramming. We construct an approximate model for the natural evolution of a synchronized population of fibroblasts, based on data obtained by sampling the expression of some 22,083 genes at several times along the cell cycle. (These data are based on a colony of cells that have been cell cycle synchronized) In order to arrive at a model of moderate complexity, we cluster gene expression based on the division of the genome into topologically associating domains (TADs) and then model the dynamics of the expression levels of the TADs. Based on this dynamical model and known bioinformatics, we develop a methodology for identifying the transcription factors that are the most likely to be effective toward a specific cellular reprogramming task. The approach used is based on a device commonly used in optimal control. From this data-guided methodology, we identify a number of validated transcription factors used in reprogramming and/or natural differentiation. Our findings highlight the immense potential of dynamical models models, mathematics, and data guided methodologies for improving methods for control over biological processes

Digital Three-Dimensional Atlas of Quail Development Using High-Resolution MRI

We present an archetypal set of three-dimensional digital atlases of the quail embryo based on microscopic magnetic resonance imaging (µMRI). The atlases are composed of three modules: (1) images of fixed ex ovo quail, ranging in age from embryonic day 5 to 10 (e05 to e10); (2) a coarsely delineated anatomical atlas of the µMRI data; and (3) an organ system–based hierarchical graph linked to the anatomical delineations. The atlas is designed to be accessed using SHIVA, a free Java application. The atlas is extensible and can contain other types of information including anatomical, physiological, and functional descriptors. It can also be linked to online resources and references. This digital atlas provides a framework to place various data types, such as gene expression and cell migration data, within the normal three-dimensional anatomy of the developing quail embryo. This provides a method for the analysis and examination of the spatial relationships among the different types of information within the context of the entire embryo

Working mothers see penalties when they adjust work schedules after having children

President Obama’s State of the Union address last month recognized that working women—and men—should not face hardship for taking care of their family responsibilities. Recent research by sociologists, Julie A. Kmec, Lindsey Trimble O’Connor and Scott Schieman suggests that workplaces have a long way to go before realizing the President’s message. In new research, they find that working mothers perceive penalties—like feeling ignored and that they are given the worst tasks—when they adjust their work schedules after having children. They suggest that policies and practices that challenge societal assumptions about ideal work are a good starting place in attempts to realize President Obama’s call to give working parents a “break.

Organic Hop Variety Trial Final Report

Hops production has increased steadily throughout the Northeast over the past 6 years. While hops were historically grown in the Northeast, they have not been commercially produced in this region for over a hundred years. With this large gap in regional production knowledge, we have a great need for region-specific, science-based research on this reemerging crop. The vast majority of hop production in the United States occurs in the arid Pacific Northwest on a very large scale. In the Northeast, the average hop yard is well under 10 acres and the humid climate provides challenges not addressed by existing hops research. Knowledge is needed on how best to produce hops on a small-scale in our region. With this in mind, in August of 2010, the UVM Extension Northwest Crops and Soils Program initiated an organic hops variety evaluation program at Borderview Research Farm in Alburgh, Vermont. Since then, UVM Extension has been evaluating 22 publicly available hop varieties and 2 experimental varieties. The goal of these efforts is to find hop varieties that demonstrate disease and pest resistance, high yields, and desirable characteristics to brewers in our region. The UVM hop variety trial was initiated in 2010 and completed with a final harvest in 2016. This seven year trial helped us learn whether we could grow hops in the Northeast. The results and observations from each of the years the variety trial was conducted can be found online on the UVM Extension Northwest Crops and Soils Hops web page: www.uvm.edu/ extension/cropsoil/hops. This document provides a summary of the knowledge gained in growing hops over the duration of this study