Analysis and interpretation of The innocents and The turn of the screw

The purpose of this thesis is to study the script, produce the play, and evaluate the production of William Archibald's The Innocents. The play is based on The Turn of the Screw by Henry James. The first part includes the following: (1) a discussion of four theories concerning the story and the play, (2) an investigation of the production styles, (3) character description and analysis, and (4) a discussion of the setting. The second part is the director's prompt book for the production, performed on April 24, 25, and 26, 1970, in Taylor Theatre at The University of North Carolina at Greensboro. Types of notations included are: (1) movement, composition and picturization, (2) rhythm and tempo notes, (3) stage business, and (4) sound and light notes. Production photographs are included. The third part is the director's critical evaluation of the production. Discussed in this chapter are: (1) goals and achievements of interpretation, style, and mood, (2) actor-director relationships during the rehearsal period, and (3) audience reaction to the production

Meanings of athletic identity within the multidimensional self and social context

The topic of athletic identity has garnered increased attention in recent decades. While there have been shifts in understandings, the majority of studies rely on the original conceptualization of the construct based on Brewer, Van Raalte, and Linder’s (1993) work (Ronkainen, Kavoura, & Ryba, 2016a). Little to no research has assessed athletic identity within a conceptual framework that depicts the overall self-concept and related context, which would display clearer connections to identity theories (Burke & Stets, 2009; Jones & Abes, 2013; Ronkainen et al., 2016a). Thus, the current investigation was guided and organized within the Reconceptualized Model of Multiple Dimensions of Identity (RMMDI) framework, a comprehensive model depicting the multidimensional self as situated within the greater context that influences identity (Jones & Abes, 2013). The current study used a qualitative descriptive approach framed within a constructivist epistemology to explore and describe athletic identity as positioned within the holistic self and context. Participants included twelve NCAA Division I student-athletes across the following team sports: soccer, softball, and basketball. Participants completed individual semi-structured qualitative interviews which included an identity mapping activity consistent with the RMMDI framing. Three themes were generated using reflexive thematic analysis: Self and Athlete: Orientation of the Self; Lifelong Immersion in Sport Culture; and “It’s a Lifestyle”: Passion for the Game. Results indicate that athletic identity was one of the few most personally important identities within the multidimensional self. Participant accounts demonstrate that athletic identity can be positioned and described as a core identity (e.g., central; primary within self-view) or as a salient identity (e.g., important; on secondary-level within self-view). This positioning of athletic identity in relation to other identities (i.e., described in two orientation groups) seemed to be influenced by the broader sport context and connected with corresponding athletic lifestyle behaviors. Participant descriptions support that continued immersion in sport culture and engaging in athletic lifestyle decisions can reinforce the identification with the athlete role. Practical implications and related competencies for the fields of sport and exercise psychology, counseling, and student development are provided. These implications include, but are not limited to, the following: acknowledging and respecting the importance of athletic identity for individuals, working to facilitate self-reflection, striving to understand contextual factors that influence identity, and attending to these personal and contextual influences to work toward developmentally appropriate and culturally sensitive practice

Prevalence of Antibodies against Hantaviruses in Serum and Saliva of Adults Living or Working on Farms in Yorkshire, United Kingdom

We acknowledge Clement and colleagues for their comments [1] on our paper [2]. We agree that many controversies are being discussed by the hantavirus community, particularly surrounding the interpretation of serological results and the designation of new species and strains. Within this setting, we are grateful for the opportunity to respond to the key factual and methodological points raised by Clements et al. [...

Reinforcement of a Preoperative Insulin Protocol

Purpose: Patients with type 1 diabetes (T1DM) often arrive for surgery with blood glucose readings out of target goal for the healthcare facility. This often leads to surgical delays, increased healthcare expenses and increases the risk of patient complications. The purpose of this project was to evaluate an institution’s preoperative insulin management protocol and reinforce its usage by providing an education session to the preoperative clinic providers. The ultimate goal is to improve blood glucose readings and better prepare the patient for surgery. A secondary aim of this study was to improve provider confidence by expanding comprehension of the current insulin protocol. Background: Glucose management for the patient with T1DM is a highly debated topic among medical providers. Too much or too little insulin can have dramatic effects on the patient’s health and wellness. Diabetes can significantly impact patient outcomes and healthcare expenses. Barriers to consider when educating advanced practice providers is their time, willingness to learn new information, obtaining buy in, and promoting future adherence to the protocol. Method: This was a quasi-experimental design quality improvement project. Documented blood glucose readings the morning of surgery were collected for a random 50 preoperative T1DM patients. Preoperative clinic providers were surveyed on their current understanding of the preoperative insulin management protocol, followed by an educational session explaining it in detail. Two months after the educational sessions another random 50 blood glucose levels of patients were selected for comparison. The same survey was distributed to the preoperative providers to assess for change in understanding of the use of the preoperative insulin management protocol. Results: The results showed no significant change in the pre-intervention and post-intervention blood glucose readings among patients with T1DM presenting for surgery. Even though the providers all stated positive levels of confidence with managing insulin preoperatively, and all cited the protocol as their resource for decision-making regarding preoperative insulin recommendation, the answers to the sample clinical questions asked in the survey showed that the protocol was not consistently being used correctly. Conclusion and Future Recommendations: There was limited interest and participation from the providers during this project which may have impacted the results and reduced its applicability to other settings. In the future, researchers would benefit from developing protocols with the input of the providers and fully engage with upper management to promote provider buy-in and greater adherence of the new program

T-cell subpopulations αβ and γδ in cord blood of very preterm infants : The influence of intrauterine infection

Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are creditedPreterm infants are very susceptible to infections. Immune response mechanisms in this group of patients and factors that influence cord blood mononuclear cell populations remain poorly understood and are considered insufficient. However, competent immune functions of the cord blood mononuclear cells are also described. The aim of this work was to evaluate the T-cell population (CD3+) with its subpopulations bearing T-cell receptor (TCR) αβ or TCR γδ in the cord blood of preterm infants born before 32 weeks of gestation by mothers with or without an intrauterine infection. Being a pilot study, it also aimed at feasibility check and assessment of an expected effect size. The cord blood samples of 46 infants age were subjected to direct immunofluorescent staining with monoclonal antibodies and then analyzed by flow cytometry. The percentage of CD3+ cells in neonates born by mothers with diagnosis of intrauterine infection was significantly lower than in neonates born by mothers without infection (p = 0.005; Mann-Whitney U test). The number of cells did not differ between groups. Infection present in the mother did not have an influence on the TCR αβ or TCR γδ subpopulations. Our study contributes to a better understanding of preterm infants' immune mechanisms, and sets the stage for further investigations.Peer reviewedFinal Published versio

Use of the NHS Choices website for primary care consultations: results from online and general practice surveys

OBJECTIVES: To determine the effect of using the NHS Choices website on primary care consultations in England and Wales. We examined the hypothesis that using NHS Choices may reduce the frequency of primary care consultations among young, healthy users. DESIGN: Two cross-sectional surveys of NHS Choices users. SETTING: Survey of NHS Choices users using an online pop-up questionnaire on the NHS Choices website and a snapshot survey of patients in six general practices in London. PARTICIPANTS: NHS Choices website users and general practice patients. MAIN OUTCOME MEASURES: For both surveys, we measured the proportion of people using NHS Choices when considering whether to consult their GP practice and on subsequent frequency of primary care consultations. RESULTS: Around 59% (n = 1559) of online and 8% (n = 125) of general practice survey respondents reported using NHS Choices in relation to their use of primary care services. Among these, 33% (n = 515) of online and 18% (n = 23) of general practice respondents reported reduced primary care consultations as a result of using NHS Choices. We estimated the equivalent capacity savings in primary care from reduced consultations as a result of using NHS Choices to be approximately £94 million per year. CONCLUSIONS: NHS Choices has been shown to alter healthcare-seeking behaviour, attitudes and knowledge among its users. Using NHS Choices results in reduced demand for primary care consultations among young, healthy users for whom reduced health service use is likely to be appropriate. Reducing potentially avoidable consultations can result in considerable capacity savings in UK primary care

Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study

Copyright ©Juhee Kim, Holly Mathews, Lindsay M Cortright, Xiaoming Zeng, Edward Newton. Originally published in JMIR Formative Research (http://formative.jmir.org), 22.03.2018. Licensed under a Creative Commons CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).Background: Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women. Objective: This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women. Methods: A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview. Results: Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women. Conclusions: The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.ECU Open Access Publishing Support Fun

Mendelian randomization study of B-type natriuretic peptide and type 2 diabetes: evidence of causal association from population studies

<p>Background: Genetic and epidemiological evidence suggests an inverse association between B-type natriuretic peptide (BNP) levels in blood and risk of type 2 diabetes (T2D), but the prospective association of BNP with T2D is uncertain, and it is unclear whether the association is confounded.</p> <p>Methods and Findings: We analysed the association between levels of the N-terminal fragment of pro-BNP (NT-pro-BNP) in blood and risk of incident T2D in a prospective case-cohort study and genotyped the variant rs198389 within the BNP locus in three T2D case-control studies. We combined our results with existing data in a meta-analysis of 11 case-control studies. Using a Mendelian randomization approach, we compared the observed association between rs198389 and T2D to that expected from the NT-pro-BNP level to T2D association and the NT-pro-BNP difference per C allele of rs198389. In participants of our case-cohort study who were free of T2D and cardiovascular disease at baseline, we observed a 21% (95% CI 3%-36%) decreased risk of incident T2D per one standard deviation (SD) higher log-transformed NT-pro-BNP levels in analysis adjusted for age, sex, body mass index, systolic blood pressure, smoking, family history of T2D, history of hypertension, and levels of triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. The association between rs198389 and T2D observed in case-control studies (odds ratio = 0.94 per C allele, 95% CI 0.91-0.97) was similar to that expected (0.96, 0.93-0.98) based on the pooled estimate for the log-NT-pro-BNP level to T2D association derived from a meta-analysis of our study and published data (hazard ratio = 0.82 per SD, 0.74-0.90) and the difference in NT-pro-BNP levels (0.22 SD, 0.15-0.29) per C allele of rs198389. No significant associations were observed between the rs198389 genotype and potential confounders.</p> <p>Conclusions: Our results provide evidence for a potential causal role of the BNP system in the aetiology of T2D. Further studies are needed to investigate the mechanisms underlying this association and possibilities for preventive interventions.</p&gt

The CLIMATE schools combined study: a cluster randomised controlled trial of a universal Internet-based prevention program for youth substance misuse, depression and anxiety

Background: Anxiety, depressive and substance use disorders account for three quarters of the disability attributed to mental disorders and frequently co-occur. While programs for the prevention and reduction of symptoms associated with (i) substance use and (ii) mental health disorders exist, research is yet to determine if a combined approach is more effective. This paper describes the study protocol of a cluster randomised controlled trial to evaluate the effectiveness of the CLIMATE Schools Combined intervention, a universal approach to preventing substance use and mental health problems among adolescents. Methods/design: Participants will consist of approximately 8400 students aged 13 to 14-years-old from 84 secondary schools in New South Wales, Western Australia and Queensland, Australia. The schools will be cluster randomised to one of four groups; (i) CLIMATE Schools Combined intervention; (ii) CLIMATE Schools - Substance Use; (iii) CLIMATE Schools - Mental Health, or (iv) Control (Health and Physical Education as usual). The primary outcomes of the trial will be the uptake and harmful use of alcohol and other drugs, mental health symptomatology and anxiety, depression and substance use knowledge. Secondary outcomes include substance use related harms, self-efficacy to resist peer pressure, general disability, and truancy. The link between personality and substance use will also be examined.Discussion: Compared to students who receive the universal CLIMATE Schools - Substance Use, or CLIMATE Schools - Mental Health or the Control condition (who received usual Health and Physical Education), we expect students who receive the CLIMATE Schools Combined intervention to show greater delays to the initiation of substance use, reductions in substance use and mental health symptoms, and increased substance use and mental health knowledge