Walking Through the Darkness: Pastoral Care to Survivors of Traumatic Loss

The aim of this thesis is to define and expand on the experience of traumatic loss and to examine the helpful role that pastoral caregivers play in supporting survivors of traumatic loss. The thesis will discuss and analyze theological and psychological responses to traumatic loss that are both life-giving or growth-oriented and life-limiting or growth-inhibiting. Its goal is to serve as a guide for pastoral caregivers who are caring for with bereaved people walking through the darkness of traumatic loss. Part I will begin with an overview/analysis of the grief process, and parts II and III will build on the claim that traumatic loss is complex, warranting its own space for theological and psychological study. Part IV of the paper will examine theological responses to grief and traumatic loss, expanding on Pargament et al.\u27s (2006) work on spiritual orienting systems. Parts V and VI explore the role of pastoral caregivers in the grief process, delving into the ministry of presence and identifying healing practices, including an overview of the role of social support, prayer, forgiveness, meditation, and guided imagery. In conclusion, this thesis argues pastoral caregivers have a unique and impactful role in supporting survivors of traumatic loss. The goal is for this thesis to offer guidelines, both practical and theological, for pastoral caregivers and to contribute to the overall healing of those affected by traumatic loss

Dominance of grain size impacts on seasonal snow albedo at deforested sites in New Hampshire

Snow cover serves as a major control on the surface energy budget in temperate regions due to its high reflectivity compared to underlying surfaces. Winter in the northeastern United States has changed over the last several decades, resulting in shallower snowpacks, fewer days of snow cover, and increasing precipitation falling as rain in the winter. As these climatic changes occur, it is imperative that we understand current controls on the evolution of seasonal snow albedo in the region. Over three winter seasons between 2013 and 2015, snow characterization measurements were made at three open sites across New Hampshire. These near-daily measurements include spectral albedo, snow optical grain size determined through contact spectroscopy, snow depth, snow density, black carbon content, local meteorological parameters, and analysis of storm trajectories using the Hybrid Single-Particle Lagrangian Integrated Trajectory model. Using analysis of variance, we determine that land-based winter storms result in marginally higher albedo than coastal storms or storms from the Atlantic Ocean. Through multiple regression analysis, we determine that snow grain size is significantly more important in albedo reduction than black carbon content or snow density. And finally, we present a parameterization of albedo based on days since snowfall and temperature that accounts for 52% of variance in albedo over all three sites and years. Our improved understanding of current controls on snow albedo in the region will allow for better assessment of potential response of seasonal snow albedo and snow cover to changing climate

Using the literature to test pollination syndromes — some methodological cautions

“Pollination syndromes” are specific combinations of floral traits that are proposed to evolve convergently across angiosperm lineages in response to different types of animal pollinators. In spite of their long history, pollination syndromes have not been tested adequately–they rarely have been examined critically to determine how well they describe floral trait diversity or predict pollinators. In a recent meta-analysis of data from the literature, Rosas-Guerrero et al. (2014) provide a welcome test that draws on insights from past studies. At the same time, their study illustrates several difficulties of meta-analysis approaches in general, and for pollination biology in particular. Here we discuss those difficulties and propose some solutions. We first consider how to gather studies from the literature without introducing unintended bias, such as the old-fashioned method of working backward from cited literature. We next consider how to deal with difficulties that invariably arise when extracting and analyzing often-incomplete information from heterogeneous studies. Finally we discuss issues of interpreting and presenting the results in the most informative manner. We conclude that although Rosas-Guerrero et al. (2014) and other studies such as Ollerton et al. (2009) have arrived at different conclusions about the utility of pollination syndromes, their results are not necessarily incompatible

Patient-Centered Medical Homes in Community Oncology Practices: Changes in Spending and Care Quality Associated With the COME HOME Experience

PURPOSE: We examined whether the Community Oncology Medical Home (COME HOME) program, a medical home program implemented in seven community oncology practices, was associated with changes in spending and care quality. PATIENTS AND METHODS: We compared outcomes from elderly fee-for-service Medicare beneficiaries diagnosed between 2011 and 2015 with breast, lung, colorectal, thyroid, or pancreatic cancer, lymphoma, or melanoma and served by COME HOME practices before and after program implementation versus similar beneficiaries served by other geographically proximate oncologists. Difference-in-differences analysis compared changes in outcomes for COME HOME patients versus concurrent controls. Propensity score matching and regression methods were adjusted for clinical and sociodemographic differences. Our primary outcome was 6-month medical spending per beneficiary. Secondary outcomes included 6-month out-of-pocket spending, inpatient and ambulatory care–sensitive hospitalizations, readmissions, length of stay, and emergency department and evaluation and management visits. RESULTS: Before COME HOME, 6-month medical spending was $2,975 higher for the study group compared with controls (95$1,635 to $4,315; P \u3c .001) and increasing at a similar rate. After intervention, this difference was reduced to$318 (95% CI, −$1,105 to$1,741; P = .661), a significant change of −$2,657 (95$4,631 to −$683; P = .008) or 8.1$32,866). COME HOME was also associated with significantly reduced (10.2 %) emergency department visits per 1,000 patients per 6-month period (P = .024). There were no statistically significant differences in other outcomes. CONCLUSION: COME HOME was associated with reduced Medicare spending and improved emergency department use. The patient-centered medical home model holds promise for oncology practices, but improvements were not uniform

Analysis of auditory functions in grades one, two, and three.

Thesis (Ed.M.)--Boston Universit

Factors influencing critical care nurses' family engagement practices: An international perspective

Background: Family engagement positively impacts patient and family members' experiences of care and health outcomes. While partnering with families denotes best practice in intensive care units (ICUs), its full adoption requires improvement. A better understanding of the factors that influence the implementation of family engagement practices is necessary. Aim: To investigate the factors that enable or hinder adult ICU nurse-family engagement and to explore potential international variations. Study design: Descriptive, cross-sectional survey. Nurses from 10 countries completed the 'Questionnaire on Factors that Influence Family Engagement' (QFIFE), including five open-ended questions. We performed descriptive statistics on quantitative data and content analysis for open-ended questions, and then integrated the findings according to influencing factors and geographical patterns. This was part of a larger qualitative study where 65 nurses participated from adult intensive care units. Results: Sixty-one nurses completed the questionnaire, making a response rate of 94%. Overall, patient acuity (Md = 5.0) and nurses' attitudes (Md = 4.6) seemed to be the most influential facilitator, followed by nurse workflow (Md = 4.0) and ICU environment (Md = 3.1) (score 1-6 most influential). The open-ended question data showed a more nuanced picture of the complexity of family engagement in care around these four determinants. Adding a fifth determinant, namely Families are complex structures that respond uniquely to the ICU and patient, revealed that difficult family dynamics, miscommunication and family having difficulty in understanding the situation or health literacy, hindered family engagement. Exploring geographical variations, Africa/Middle East consistently differed from others on three of the four QFIFE subscales, showing lower median levels. Conclusions: Some determinants are perceived to be more influential than others, becoming barriers or enablers to nurse-family engagement in adult ICU. Research that investigates contextual determinants and which compares implementation and improvement initiatives tailored to address family engagement practices barriers and enablers are needed. Relevance to clinical practice: Knowledge of this international study expands our understanding of enablers and barriers in family engagement that may inform family engagement practice improvement efforts around the world. Keywords: communication; critical care nursing; family nursing; intensive care unit; social factor

Exploring Ethical Development from Standard Instruction in the Contexts of Biomedical Engineering and Earth Science

Ethics continues to be required in the accreditation of engineers. However, ethics is seldom the core focus of departmental instruction. Yet, standard instruction may have myriad impacts on students' ethical development. This study explores students’ ethical formation when ethics is a peripheral or non-intentional aspect of instruction in departmental courses in Biomedical Engineering and Earth Science. The research question that we seek to address is, “In what different ways and to what extent does participation in departmental engineering and science courses cultivate STEM students’ ethical formation?” To address our research question, we disseminated a survey to students before (pre) and after (post) their participation in one of 12 courses offered in Earth Science or Biomedical Engineering during the Fall 2017 or Spring 2018. The survey included four instruments: (1) the Civic-Minded Graduate scale; (2) the Interpersonal Reactivity Index; (3) two relational constructs developed by the authors; and (4) the Defining Issues Test-2. Results suggest that current Earth Science curriculum, overall, positively contributes to students' ethical growth. However, the Biomedical Engineering courses showed no evidence of change. As the Earth Science courses do not explicitly focus on ethics, one potential explanation for this trend is the community-engaged nature of the Earth Science curriculum. These findings will be beneficial locally to help direct improvements in departmental STEM instruction. In addition, these findings pave the way for future comparative analyses exploring how variations in ethical instruction contribute to students' ethical and professional formation. © 2019 American Society for Engineering Educatio

Nurses\u27 Alumnae Association Bulletin - Volume 6 Number 9

Remember the Relief Fund Welcome! Miss Childs Financial Report Calendar of Coming Events Lest You Forget! Attention Review of the Alumnae Association Meetings Institutional Staff Nurses\u27 Section Report of Staff Activities - 1947-1948 Private Duty Section The White Haven Division Barton Memorial Division Remember the Relief Fund Student Nurses\u27 Activities Jefferson Scores Again The Clara Melville Scholarship Fund Interesting Activities of the Nurses\u27 Home Committee of the Women\u27s Board Exclusive for Nurses Changes in the Maternity Division Gray Lady Musical Therapy Service Memorial Service Honoring Mrs. Bessie Dobson Altemus The Blood Donor Center The Hospital Pharmacy Medical College News Remember the Relief Fund Administrative Staff and Faculty of the School of Nursing Streptomycin Changes in the Staff at Jefferson Hospital Care of the Thoracic Surgical Patient Miscellaneous Items Marriages New Arrivals Deaths The Bulletin Committee Attention, Alumnae New Addresse

Pregnancy incidence and correlates in a clinical trial preparedness study, North West Province South Africa.

INTRODUCTION: Women in HIV prevention trials often must typically agree to avoid pregnancy. Regardless, some become pregnant. Screening tools predicting pregnancy risk could maximize trial safety and efficiency. OBJECTIVES: We assessed incidence and correlates of pregnancy among women at high HIV risk. METHODS: We enrolled sexually-active, HIV-negative women into an observational cohort (2008-2011). At enrollment demographic, contraceptive, reproductive, pregnancy intention and behavioural data were collected. Women reported if one or both partners wanted or intended for the couple to become pregnant. We measured gender role beliefs using a locally validated eight-point index. We tested HIV and pregnancy, and inquired about sexually transmitted infection symptoms (STIs) at enrollment and monthly. HIV testing included behavioural counselling and condom provision, but did not specifically counsel women to avoid pregnancy. Cox proportional hazard modelling evaluated the associations with pregnancy. The multivariate model included the following variables "Recent pregnancy attempts", "Gender Roles Beliefs", "Self-reported STIs" and "Age". RESULTS: We screened 1068 women and excluded (24.6%, 263/1068) who did not report risk behaviour. Non-pregnant, non-sterilized women aged 18-35 (median = 21 years) enrolled (n = 438). Most women reported one partner (74.7%) and a prior live birth (84.6%). Median follow-up time was 6 months (range 0.7-15.5). Pregnancy incidence was 25.1 per 100 women-years (n = 57 pregnancies). Conservative beliefs on gender roles (Adjusted Hazard Ratio (aHR) 1.8; 95% confidence interval [CI] 1.1-2.9), recent pregnancy attempts (aHR 1.9; 95% CI 1.1-3.4) and baseline self-reported STI (aHR 2.5; 95% CI 1.4-4.4) were associated with increased incident pregnancy. Report of no pregnancy intention was associated with lowered pregnancy risk (aHR 0.3; 95% CI 0.1-0.7). CONCLUSIONS: We identified new and confirmed existing factors that can facilitate screening for pregnancy risk