The Spiritual Transformative Process in Roethke’s “Cuttings (later)” and “Root Cellar”

This paper discusses the groundbreaking greenhouse poems of Theodore Roethke as a manifestation of the poet\u27s internal psyche and personal childhood memories. It analyzes Cuttings (later) and Root Cellar as poems within a sequence, all exploring the speaker\u27s desire for spiritual transformation and transcendence through the necessary process of decay, death, and rebirth. The paper reveals the poems as emulating the Roethke\u27s own cycles of spiritual awakening and darkness amidst the cycles of manic depression he experienced throughout his life

The WWI Middle East: Western Intervention and Modern-Day Political Conflict

This paper analyzes three conflicting agreements made by the Allied powers between 1915 and 1917: the Husayn-McMahon correspondence, the Sykes-Picot arrangements, and the Balfour Declaration. It reveals the agreements as demonstrative of deeper patterns of political power and strategy in the Middle East that persist today. This paper moreover compares the Middle East with the European colonization of Rwanda in the 1880s, and how the nation\u27s internal division was caused by external global powers seeking political and economic gain. This analysis seeks to connect global events as part of a wider political agenda propagated by Western powers

Extracorporeal Membrane Oxygenation in the Context of the 2009 H1N1 Influenza A Pandemic

Background: Extracorporeal membrane oxygenation (ECMO) incorporates surgical techniques as adjuncts in the management of refractory respiratory dysfunction. For many years, its primary application was for support of neonatal infants in cardiorespiratory failure. As the 2009 H1N1 influenza A pandemic developed, more reports came in of severe respiratory dysfunction and even death that seemed to be occurring preferentially in younger adults. Centers with the capability began to use ECMO to salvage these patients. Results: The H1N1 virus is a subtype of influenza A. The hemagglutinin receptor binding is similar to that of the seasonal influenza virus, but 2009 H1N1 also binds to •2,3-linked receptors, which are found in the conjunctivae, distal airways, and alveolar pneumocytes. Influenza viruses elude host immune responses through drift and shift in the hemagglutinin (HA) and neuraminidase (NA) proteins. The incubation period ranges from 1-7 days. The majority of patients present with fever and cough, but a broad spectrum of clinical syndromes has been reported, and laboratory testing remains the mainstay of diagnosis. Most patients recover within a week without treatment. The H1N1 virus remains largely sensitive to the NA inhibitors but is resistant to the matrix protein-2 inhibitors. Extracorporeal membrane oxygenation provides continuous pulmonary (and sometimes cardiac) support and minimizes ventilator-induced lung injury. The potential for life-threatening complications is high. In 2009, in the Conventional Ventilation or ECMO for Severe Adult Respiratory Failure (CESAR) randomized trial of ECMO, the overall survival rate was 63% in the ECMO group compared with 47% in the control group (p = 0.03). Similar studies have been reported from Australia and New Zealand, Canada, and France. Conclusions: Supportive management is continued along with ECMO. Antiviral drugs and antimicrobial agents should be given as appropriate, as should nutritional support. Volume management should be used. Ventilator settings should be reduced as ECMO support allows, with a goal of reducing airway pressures, ventilator rate, and FiO2. Complications of ECMO are common. Bleeding, the most common, can result in death, especially if it occurs intracranially.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90458/1/sur-2E2010-2E082.pd

Corporate Social Responsibility in the U.S. Travel Industry

As the travel industry consists of various sectors, which often depend on environmental and cultural resources, socially responsible business policies, programs and practices are essential to achieve sustainable tourism at the local as well as the global level. nonetheless, it has yet to be known how the industry perceives and practices corporate social responsibility (CSR) activities. Thus, this study aims to better understand the opinions about and engagementin (CSR) by the the U.S. travel industry. Results of a survey conducted to the members of Travel Industry Association of America can provide travel companies with an important reference point about the concept of and practices of CSR by the industry members. Moreover, results of this study will reveal areas for further research

Estimation of leaf area index and its sunlit portion from DSCOVR EPIC data: theoretical basis

This paper presents the theoretical basis of the algorithm designed for the generation of leaf area index and diurnal course of its sunlit portion from NASA's Earth Polychromatic Imaging Camera (EPIC) onboard NOAA's Deep Space Climate Observatory (DSCOVR). The Look-up-Table (LUT) approach implemented in the MODIS operational LAI/FPAR algorithm is adopted. The LUT, which is the heart of the approach, has been significantly modified. First, its parameterization incorporates the canopy hot spot phenomenon and recent advances in the theory of canopy spectral invariants. This allows more accurate decoupling of the structural and radiometric components of the measured Bidirectional Reflectance Factor (BRF), improves scaling properties of the LUT and consequently simplifies adjustments of the algorithm for data spatial resolution and spectral band compositions. Second, the stochastic radiative transfer equations are used to generate the LUT for all biome types. The equations naturally account for radiative effects of the three-dimensional canopy structure on the BRF and allow for an accurate discrimination between sunlit and shaded leaf areas. Third, the LUT entries are measurable, i.e., they can be independently derived from both below canopy measurements of the transmitted and above canopy measurements of reflected radiation fields. This feature makes possible direct validation of the LUT, facilitates identification of its deficiencies and development of refinements. Analyses of field data on canopy structure and leaf optics collected at 18 sites in the Hyytiälä forest in southern boreal zone in Finland and hyperspectral images acquired by the EO-1 Hyperion sensor support the theoretical basis.Shared Services Center NAS

Providing Health Care to Patients With Intellectual and Developmental Disability During COVID-19

AbstractThis project sought to enhance the care offered in a local clinic to individuals with an intellectual and developmental disability (IDD) during the COVID-19 pandemic. Individuals with IDD are faced with the challenges of coping with some social conditions. Mainly waiting for extended periods in a doctor’s office can be challenging. To reduce this population’s waiting time, a staff education program was developed to address this concern. Currently, this local clinic did not have a prescreening exercise that would meet the needs of this population. This DNP project aimed to develop a staff education program for staff in a primary care setting that would include a prescreening questionnaire to be used when the appointment is made to highlight the main concerns for the patient visit and unique patient needs. The practice-focused question addressed what evidence supports knowledge gained using an evaluation of learning objectives in a pre and postsurvey as well as the overall effectiveness of the 1-hour in-person staff education program. The posttest rating showed a change in the rating of learning objectives from pre (M = 3.0) to posteducation (M = 3.6) suggesting an increase in knowledge. Improvement was noted with a 100% (N =5) rating of “strongly agree” that the impact of the training would lead to improvements in the overall functioning of the clinic, time management, and the application of knowledge gained. This DNP staff education program is anticipated to be used by the project partner site to facilitate an improvement in services to benefit patients with IDD. The staff training was based on new interventions and revised procedures that could be implemented to meet the demands of the health sector in serving patients new to the clinic, effecting a positive social change

Dental students' knowledge of and attitudes towards prescribing medication in Western Australia

ACKNOWLEDGEMENTThe authors would like to acknowledge UWA dental students for their time and valuable input. Open access publishing facilitated by The University of Western Australia, as part of the Wiley - The University of Western Australia agreement via the Council of Australian University Librarians. [Correction added on 14 May 2022, after first online publication: CAUL funding statement has been added.]Peer reviewedPublisher PD

Pharmacokinetics of Oseltamivir and Oseltamivir Carboxylate in Critically I ll Patients Receiving Continuous Venovenous Hemodialysis and/or Extracorporeal Membrane Oxygenation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94511/1/phar1151.pd

Lung Injury Prevention with Aspirin (LIPS-A): a Protocol for a Multicentre Randomised Clinical Trial in Medical Patients at High Risk of Acute Lung Injury

Introduction: Acute lung injury (ALI) is a devastating condition that places a heavy burden on public health resources. Although the need for effective ALI prevention strategies is increasingly recognised, no effective preventative strategies exist. The Lung Injury Prevention Study with Aspirin (LIPS-A) aims to test whether aspirin (ASA) could prevent and/or mitigate the development of ALI. Methods and analysis LIPS-A is a multicentre, double-blind, randomised clinical trial testing the hypothesis that the early administration of ASA will result in a reduced incidence of ALI in adult patients at high risk. This investigation will enrol 400 study participants from 14 hospitals across the USA. Conditional logistic regression will be used to test the primary hypothesis that early ASA administration will decrease the incidence of ALI. Ethics and dissemination Safety oversight will be under the direction of an independent Data and Safety Monitoring Board (DSMB). Approval of the protocol was obtained from the DSMB prior to enrolling the first study participant. Approval of both the protocol and informed consent documents were also obtained from the institutional review board of each participating institution prior to enrolling study participants at the respective site. In addition to providing important clinical and mechanistic information, this investigation will inform the scientific merit and feasibility of a phase III trial on ASA as an ALI prevention agent. The findings of this investigation, as well as associated ancillary studies, will be disseminated in the form of oral and abstract presentations at major national and international medical specialty meetings. The primary objective and other significant findings will also be presented in manuscript form. All final, published manuscripts resulting from this protocol will be submitted to Pub Med Central in accordance with the National Institute of Health Public Access Policy

Utilization of Intensive Care Unit Nutrition Consultation Is Associated With Reduced Mortality

BackgroundThe aim of this project was to investigate the prevalence of nutrition consultation (NC) in U.S. intensive care units (ICUs) and to examine its association with patient outcomes.MethodsData from the Healthcare Cost and Utilization Project’s state inpatient databases was utilized from 2010 â 2014. A multilevel logistic regression model was used to evaluate the relationship between NC and clinical outcomes.ResultsInstitutional ICU NC rates varied significantly (mean: 14%, range: 0.1%â 73%). Significant variation among underlying disease processes was identified, with burn patients having the highest consult rate (P < 0.001, mean: 6%, range: 2%â 25%). ICU patients who received NC had significantly lower inâ hospital mortality (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.48â 0.74, P < 0.001), as did the subset with malnutrition (OR 0.72, 95% CI 0.53â 0.99, P = 0.047) and the subset with concomitant physical therapy consultation (OR 0.53, 95% CI 0.38â 0.74, P < 0.001). NC was associated with significantly lower rates of intubation, pulmonary failure, pneumonia, and gastrointestinal bleeding (P < 0.05). Furthermore, patients who received NC were more likely to receive enteral or parenteral nutrition (ENPN) (OR 1.8, 95% CI 1.4â 2.3, P < 0.001). Patients who received followâ up NC were even more likely to receive ENPN (OR 3.0, 95% CI 2.1â 4.2, P < 0.001).ConclusionsRates of NC were low in critically ill patients. This study suggests that increased utilization of NC in critically ill patients may be associated with improved clinical outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154413/1/jpen1534_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154413/2/jpen1534.pd