The development of facility standards for common outpatient procedures and implications for the context of abortion.

BackgroundIn recent years, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. In this study, we sought to understand the processes used to develop facility standards in the context of other, less politically charged areas of health care and consider implications for the context of abortion.MethodsWe conducted key informant interviews with 20 clinicians and accreditation professionals involved in facility standards development for common outpatient procedures (endoscopy, gynecology, oral surgery, plastic surgery). We examined the motivations for and processes used in facility standards development, use of scientific evidence in standards development, and decision-making in the absence of evidence. Interview data were thematically coded and analyzed using an iterative approach.ResultsIn contrast to U.S. state laws that target abortion facilities, standards for other outpatient procedures are commonly set by committees of clinicians organized by professional associations or accreditation organizations. These committees seek to establish standards that ensure patient safety without placing unnecessary burden on clinicians in practice. They aim to create evidence-based standards but can be hampered by lack of relevant research. In the absence of research evidence, committees rely on their clinical expertise and sense of best practices in decision-making. According to respondents, considerations of potential harm (e.g., deeper levels of sedation, invasiveness), rather than the specific procedure, should prompt additional requirements.ConclusionsIf facility standards in the context of abortion were developed through processes similar to other outpatient procedures, 1) professionals who perform the procedure would be involved in standards development and 2) in the absence of clear research evidence, the expertise of clinicians, and the guidelines and standards of other organizations, are used to describe a best practice standard of care

Culturally Responsive Teaching For Significant Relationships

This article expands discussions of culturally responsive teaching to include the framework of what it is, why it matters and how it can be accomplished in the classroom. The four principles of interaction, accommodation, ownership, and opportunity outline culturally responsive strategies teachers use to create significant relationships with all students in the classroom

Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider - but do not have - abortions.

We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy. Participants were recruited at prenatal care clinics in Louisiana and Maryland for a mixed-methods study (N = 589). On self-administered surveys and structured interviews, participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. A subset (n = 83), including participants who considered abortion for this pregnancy, completed in-depth phone interviews. Multivariable logistic regression analyses examined characteristics associated with having considered abortion and experiencing a policy-related barrier to having an abortion; analyses focused on economic insecurity and of mental health/substance use as main predictors of interest. Louisiana interviews (n = 43) were analyzed using modified grounded theory to understand concrete experiences of policy-related factors. In regression analyses, women who reported greater economic insecurity (aOR 1.21 [95% CI 1.17, 1.26]) and more mental health diagnoses/substance use (aOR 1.29 [1.16, 1.45] had higher odds of having considered abortion. Those who reported greater economic insecurity (aOR 1.50 [1.09, 2.08]) and more mental health diagnoses/substance use (aOR 1.45 [95% CI 1.03, 2.05] had higher odds of reporting policy-related barriers. Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion. Many described simultaneously navigating economic insecurity, mental health disorders, substance use, and interpersonal opposition to abortion from family and the man involved in the pregnancy. Current restrictive abortion policies appear to have more of an impact on women who report greater economic insecurity and more mental health diagnoses/substance use. These policies work in concert with each other, with people's individual complex situations-including economic insecurity, mental health, and substance use-and with anti-abortion attitudes of other people to make abortion care impossible for some pregnant women to access

Achieving Foundation Accountability and Transparency: Lessons From the Robert Wood Johnson Foundation’s \u3ci\u3eScorecard\u3c/i\u3e

· The purpose of this article is to help foundations in their accountability and transparency efforts by sharing lessons from one foundation’s journey to develop a scorecard. · A commitment to funding and sharing the results from rigorous evaluations set the tone for Robert Wood Johnson Foundation (RWJF) accountability. · The Scorecard is a powerful tool for RWJF to set goals, track organizational effectiveness, and motivate responses to shortcomings. · Foundations can tailor their scorecard to include what best serves their needs. · With its Scorecard, RWJF found that comparative and quantitative measures are the most powerful forces to motivate change. · Setting targets motivates staff to focus their efforts on certain areas and make improvements

Sustaining the Digital Humanities: Host Institution Support Beyond the Start Up Phase

This project builds on the Ithaka Case Studies in Sustainability, which helped to surface the significance of the host institution as a key element in the survival of digital humanities projects. To unwrap the layers of assumptions concerning the sort of support a host institution is expected or hoped to be providing, this research will be based on a sector-wide scan to map key points in a project’s lifecycle when the host institution is likely to play a role and "deep dives" at two institutions to develop an in-depth picture of the range of digital humanities projects on these campuses. By examining the institutional support ecosystem and the value system that undergirds it, we will provide both project leaders and university decision-makers the data, examples, and guidance they need, including a toolkit to conduct their own research, to work together to encourage the long-term sustainability of the digital humanities resources that continue to enrich the scholarly landscape

SELENIUM FORM-INDUCED CHANGES IN THE EARLY LUTEAL PHASE CORPUS LUTEUM, THE BLOOD, AND THE ENDOMETRIUM DURING EARLY GESTATION IN BEEF COWS

Selenium (Se) deficient soils and thus forages are widespread throughout the United States, necessitating supplementation of this trace mineral in the diet of grass-fed cattle to negate detrimental effects of a deficiency on immune function, growth, and fertility. Conventionally, Se is supplemented to cattle in a vitamin-mineral mix as an inorganic form (ISe) although the organic forms (OSe) are available when cattle consumer forage, and OSe has been shown to increase the bioavailability of Se in cattle. Previous research has demonstrated supplementation with 1:1 mixture (MIX) of ISe and OSe compared to ISe alone increases systemic concentrations of progesterone (P4) in the early luteal phase of cows at a time in which the concentration of P4 can critically influence the endometrium and developing conceptus. Herein, a series of experiments were conducted to 1) determine the mechanism responsible for the MIX-induced increase in the early luteal phase concentration of systemic P4, 2) identify form of Se effects on systemic blood metabolites during early gestation, and 3) investigate interferon-induced changes in the caruncular (CAR) tissue of the endometrium as a response of different supplemental forms of Se (ISe vs. MIX) which may affect the ensuing process of implantation. The objectives of Experiment 1 were to confirm and expand upon the initial report of the MIX-induced increase in early luteal phase P4, determining systemic changes in P4 throughout gestation, and prolactin (PRL) throughout lactation. We observed a MIX-induced increase in systemic concentrations of P4 on day 7 of the estrous cycle, consistent with our initial report, with circulating P4 then remaining higher throughout gestation. In contrast, prolactin was lower in the MIX supplemented heifers at months 5 and 6 of lactation; supplemental form of Se can be used to manipulate early luteal phase and gestational concentrations of P4, and postpartum concentration of PRL. The objective of Experiment 2 was to investigate the mechanistic changes in the CL contributing to the increase in systemic P4 by analyzing changes in mRNA transcripts in the CL and the responses of steroidogenic luteal cells to select agonists in vitro. Initially, we observed human chorionic gonadotropin (hCG)-induced increases in P4 in culture media of luteal cells obtained from ISe-supplemented cows. Interestingly, qPCR revealed no significant differences in the steroidogenic transcripts in the CL, however the abundance of mRNA encoding 2 key transcripts regulating cholesterol uptake (Ldlr and Hsl) was increased in MIX-supplemented cows, collectively suggesting that the form of Se-induced effects on luteal production of P4 are the result of changes in cholesterol availability, rather than a direct effect on the expression of steroidogenic enzymes within the CL. Following Experiment 2, we investigated changes in systemic blood metabolites during early gestation in response to the form of Se. Therefore, the objective of Experiment 3 was to quantify relative changes in serum metabolic parameters at estrus, during the early luteal phase, and at maternal recognition of pregnancy (MRP). MIX-supplemented heifers compared to ISe had significantly lower concentration of total serum cholesterol and low/very low-density lipoproteins, as well as changes in serum glucose, aspartate aminotransferase (AST), and beta hydroxybutyrate (BHBA). The objective of Experiment 4 was to investigate transcriptomic changes in the CAR regions of the endometrium at MRP. Results revealed significant changes in interferon signaling and endometrial restructuring that would be expected just prior to implantation. Given the advanced conceptus development observed in MIX vs. ISe-supplemented heifers, coincident with the concurrent decrease in the level of expression of several known MRP-associated transcripts, it appears that the MIX supplement is shifting the timing of MRP, resulting in hastened conceptus development. Encompassing all results, manipulating the form of Se in the diet of grazing beef cattle significantly alters systemic levels of P4, blood metabolites, and transcriptomic changes in the CL and endometrium that can advance conceptus development during early gestation. MIX Se is a novel producer-friendly supplement that can ultimately improve whole animal physiology and fertility

Developing ways of working with parents and their infants to improve the core deficits of autism

Autistic spectrum conditions (ASCs) are a group of conditions which impair aspects of social communication and interaction. Genetic and epigenetic influences in utero and relational experiences all contribute to the development of the child who goes on to be diagnosed as having an ASC (Crittenden et al., 2014). Our clinical team works in London, UK, with families of children and adults who have received a diagnosis of an autistic spectrum condition (ASC) and those with other neurodevelopmental disorders or learning disabilities. This article describes some of our learning and clinical work over the past 15 years with this patient group

Racial Disparities in the Association Between Stress and Preterm Birth

Background: High levels of maternal stress have been linked to preterm births. However, findings from previous studies are inconsistent due to the varied use of stress measures. This study examined the effect of maternal stress on preterm birth, using both psychosocial and physiological measures. Methods: This study was conducted among 231 pregnant women enrolled during their first prenatal care visit. Presence of stress was assessed at enrollment using the Perceived Stress Scale (PSS) and Stressful Life Events Inventory (SLEI). Samples of maternal salivary cortisol were obtained during the first trimester and birth outcomes were ascertained at delivery. Multiple logistic regression was conducted to assess the association between stress and preterm birth. Results: The majority of the study participants were Black, not married, less educated and low income. There was an association between cortisol level and preterm birth. Per 1µg/dL increase in cortisol level, the odds of preterm birth increased by 26%. The increase was accentuated in Blacks where a unit increase in cortisol level was associated with higher odds of preterm birth (29%). Conclusions: Stress measures using PSS and SLEI did not reveal a statistically significant association with preterm birth. Health care and public health professionals should be aware of the association between increased cortisol level and preterm birth. Salivary cortisol may be a better predictor of preterm birth than PSS and SLEI

Organizational socialization as kin-work::A psychoanalytic model of settling into a new job

Socialization, the transition from newcomer to embedded organizational citizen, is an inevitable feature of organizational life. It is often a painful and traumatic experience, but why this is so, and how its difficulties can be ameliorated, is not well understood. This article addresses this issue by developing a new person-centred model of socialization. We introduce the concept of kin-work, i.e. the replication of one’s first experiences of becoming part of a family, to explain how ‘successful’ socialization is achieved. Drawing on the methodology of memory work and psychoanalytical theories of object relations, we illustrate how entry into new jobs involves the unconscious re-enactment in adult life of the infant’s initiation into the family. On entry as a stranger to a new organization, one’s sense of self is fractured; processes of kin-work knit the pieces back together and one develops a sense of personhood and being at home. However, there is a sting in this tale: the homely contains its uncanny, unhomely opposite, so socialization is always ambivalent – one can never be at home in this place that feels like home

Love in Pieces and Urban Myths: One-Acts

Two one-acts by Cleveland authors were performed at John Carroll University in October of 2001.https://collected.jcu.edu/plays/1125/thumbnail.jp