From Microscope to the Marriage Contract of Castile\u27s Trastamara Dynasts Isabel and Fernando: Evidence of African Berber and Germanic Cultural Fusion

This paper explores aspects of African diasporas beyond the context of the trans-Atlantic slave trade. The author examines genetic evidence that calls for a syncretic history of Spain. Exploring the fusion of cultural practices with respect to gender and power as found in the fifteenth-century marriage contract between Isabel of Castile and Fernando of Aragon, this paper further analyzes the historiography of the Christian expansion on the peninsula, the Berber legal system that arrived in Iberia with the Islamic conquest, and the Visigothic legal system that dominated in Aragon. The author further examines evidence of cultural fusion of African Berber customs in a Germanic zone, by focusing on the domestic practices and elements of material culture illustrated by the conduct of Isabel I and her brother, Enrique IV, and by analyzing the customs reflected in Isabel and Fernando\u27s marriage contract

Leveraging University-Community Partnerships in Rural Georgia: A Community Health Needs Assessment Template for Hospitals

Background: Under the Affordable Care Act, nonprofit hospitals are required to conduct a Community Health Needs Assessment (CHNA) every three years. Using recommendations proposed by Georgia Watch, students and faculty members from the University of Georgia (UGA) conducted a CHNA for a hospital in a rural county in Georgia. The purpose of the CHNA was to identify community health problems and needs, as well as community assets and resources. The aim of this report is to describe the process for conducting the CHNA, the findings, and the lessons learned. Methods: The CHNA team consisted of students and faculty members from UGA’s College of Public Health and a Public Service and Outreach professional who worked in the community. In completing the CHNA, the team used the following fivestep process: define community, collect secondary data on community health, gather community input and collect primary data, prioritize community health needs, and implement strategies to address community health needs. Primary and secondary data were collected. Results: By triangulating findings across data sources, the CHNA team created a community health profile for the service area of the hospital. Based on these findings, the community identified four main areas for improvement, prioritized these health issues, and developed an implementation strategy for the hospital and community. Conclusions: The process used to conduct this CHNA can serve as a model for other rural communities undergoing similar assessments. Lessons learned from completing this CHNA can be applied to future CHNA efforts

Rural Community Health Needs Assessment Findings: Access to Care and Mental Health

This article highlights the qualitative results from focus groups conducted as part of a Community Health Needs Assessments in two rural Georgia communities. Four 1-hr focus groups were facilitated with 32 community stakeholders. Sessions were audio recorded and transcribed verbatim. Thematic analysis identified two primary themes: mental health and barriers to accessing health care. Focus group participants discussed mental health challenges as they related to substance abuse and suicide. Participants acknowledged barriers to access, including no health insurance, cost, eligibility gaps for government-sponsored programs, the low availability of specialty care, and poverty. Addressing mental health and access to care in rural communities may require alternative, tailored programs

School Perspectives on Collaborative Inquiry: Lessons Learned From New York City, 2009-2010

The New York City Department of Education has supported collaborative inquiry as a potentially powerful process for helping administrators and teachers use student data to improve instruction and raise student achievement. Beginning with a pilot project in 2006, teams of teachers have learned to work together to diagnose the needs of students who have not been successful in their classrooms and to develop strategies to improve their learning. Collaborative inquiry sits at the heart of the Department\u27s larger Children First initiative and aims to help educators close the achievement gap in their schools. Each year New York City schools have engaged higher proportions of faculty in the inquiry work. The goal is at least 90% participation in collaborative inquiry. The purpose of this research report is to share lessons learned about the conditions, structures, relationships, and leadership practice that support teacher participation in inquiry. The report also presents perceived benefits of collaborative inquiry as reported by school leaders and teachers. Data come from site visits to 13 schools actively engaged in collaborative inquiry. The research team conducted 213 interviews with principals, assistant principals, instructional support staffs, and teachers participating in inquiry and 37 observations of inquiry team meetings

Distance education methods are useful for delivering education to palliative caregivers: A single-arm trial of an education package (PalliativE Caregivers Education Package)

Background: Face-to-face/group education for palliative caregivers is successful, but relies on caregivers travelling, being absent from the patient, and rigid timings. This presents inequities for those in rural locations. Aim: To design and test an innovative distance-learning educational package (PrECEPt: PalliativE Caregivers Education Package). Design: Single-arm mixed-method feasibility proof-of-concept trial (ACTRN12616000601437). The primary outcome was carer self-efficacy, with secondary outcomes focused on caregiver preparedness and carer tasks/needs. Analysis focused on three outcome measures (taken at baseline and 6 weeks) and feasibility/acceptability qualitative data. Setting and participants: A single specialist palliative care service. Eligible informal caregivers were those of patients registered with the outpatient or community service, where the patient had a prognosis of ⩾12 weeks, supporting someone with nutrition/ hydration and/or pain management needs, proficient in English and no major mental health diagnosis. Results: Two modules were developed and tested (nutrition/hydration and pain management) with 18 caregivers. The materials did not have a statistically significant impact on carer self-efficacy. However, statistically significant improvements were observed on the two subsidiary measures of (1) caregiving tasks, consequences and needs (p = 0.03, confidence interval: 0.72, 9.4) and (2) caregiver preparedness (p = 0.001, confidence interval: −1.22, −0.46). The study determined that distance learning is acceptable and feasible for both caregivers and healthcare professionals. Conclusion: Distance education improves caregiver preparedness and is a feasible and acceptable approach. A two-arm trial would determine whether the materials benefitted caregivers and patients compared to a control group not receiving the materials. Additional modules could be fruitfully developed and offeredsch_nur1. Bee PE, Barnes P and Luker K. A systematic review of informal caregivers' needs in providing home-based endof- life care to people with cancer. J Clin Nurs 2009; 18(10): 1379-1393. 2. Harding R, Higginson IJ, Leam C, et al. Evaluation of a short-term group intervention for informal carers of patients attending a home palliative care service. J Pain Symptom Manage 2004; 27(5): 396-408. 3. Hudson P, Aranda S and Hayman-White K. A psychoeducational intervention for family caregivers of patients receiving palliative care: a randomized controlled trial. J Pain Symptom Manage 2005; 30(4): 329-340. 4. Hudson P, Quinn K, Kristjanson L, et al. Evaluation of a psycho-educational group programme for family caregivers in home-based palliative care. Palliat Med 2008; 22(3): 270-280. 5. Hudson P. Improving support for family carers: key implications for research, policy and practice. Palliat Med 2013; 27(7): 581-582. 6. Du S, Liu Z, Liu S, et al. Web-based distance learning for nurse education: a systematic review. Int Nurs Rev 2013; 60(2): 167-177. 7. Smith PJ, Wigmore SJ, Paisley A, et al. Distance learning improves attainment of professional milestones in the early years of surgical training. Ann Surg 2013; 258(5): 838-842; discussion 842-843. 8. Doyle NW and Jacobs K. Accommodating student learning styles and preferences in an online occupational therapy course. Work 2013; 44(3): 247-253. 9. Hattink B, Meiland F, van der Roest H, et al. Web-based STAR E-learning course increases empathy and understanding in dementia caregivers: results from a randomized controlled trial in the Netherlands and the United Kingdom. J Med Internet Res 2015; 17(10): e241. 10. Gant JR, Steffen AM and Lauderdale SA. Comparative outcomes of two distance-based interventions for male caregivers of family members with dementia. Am J Alzheimers Dis Other Demen 2007; 22(2): 120-128. 11. Leow MQ and Chan SW. Evaluation of a video, telephone follow-ups, and an online forum as components of a psychoeducational intervention for caregivers of persons with advanced cancer. Palliat Support Care 2016; 14(5): 474-478. 12. Thomas K and Moore G. The development and evaluation of a multimedia resource for family carers of patients receiving palliative care: a consumer-led project. Palliat Support Care 2015; 13(3): 417-423. 13. Griffiths PC, Whitney KM, Kovaleva M, et al. Development and implementation of Tele-Savvy for dementia caregivers: a department of veterans affairs clinical demonstration project. Gerontologist 2015; 56(1): 145-154. 14. Lewis M, Hobday JV and Hepburn K. Internet-based program for dementia caregivers. Am J Alzheimers Dis Other Demen 2010; 25(8): 674-679. 15. Forbat L, Haraldsdottir E, Lewis M, et al. Supporting the provision of palliative care in the home environment: a proofof- concept single-arm trial of a PalliativE Carers Education Package (PrECEPt). BMJ Open 2016; 6(10): e012681. 16. McClement SE and Harlos M. When advanced cancer patients won't eat: family responses. Int J Palliat Nurs 2008; 14(4): 182-188. 17. Cohen MZ, Torres-Vigil I, Burbach BE, et al. The meaning of parenteral hydration to family caregivers and patients with advanced cancer receiving hospice care. J Pain Symptom Manage 2012; 43(5): 855-865. 18. Chai HZ, Krishna LK and Wong VH. Feeding: what it means to patients and caregivers and how these views influence Singaporean Chinese caregivers' decisions to continue feeding at the end of life. Am J Hosp Palliat Care 2014; 31(2): 166-171. 19. Armes PJ and Addington-Hall J. Perspectives on symptom control in patients receiving community palliative care. Palliat Med 2003; 17(7): 608-615. 20. Docherty A, Owens A, Asadi-Lari M, et al. Knowledge and information needs of informal caregivers in palliative care: a qualitative systematic review. Palliat Med 2008; 22(2): 153-171. 21. Letizia M, Creech S, Norton E, et al. Barriers to caregiver administration of pain medication in hospice care. J Pain Symptom Manage 2004; 27(2): 114-124. 22. Lin CC. Barriers to the analgesic management of cancer pain: a comparison of attitudes of Taiwanese patients and their family caregivers. Pain 2000; 88(1): 7-14. 23. Mehta A, Chan LS and Cohen SR. Flying blind: sources of distress for family caregivers of palliative cancer patients managing pain at home. J Psychosoc Oncol 2014; 32(1): 94-111. 24. Ugalde A, Krishnasamy M and Schofield P. Development of an instrument to measure self-efficacy in caregivers of people with advanced cancer. Psychooncology 2013; 22(6): 1428-1434. 25. Lund L, Ross L and Groenvold M. The initial development of the 'Cancer Caregiving Tasks, Consequences and Needs Questionnaire' (CaTCoN). Acta Oncol 2012; 51(8): 1009- 1019. 26. Archbold P, Stewart B, Greenlick M, et al. Mutuality and preparedness as predictors of role strain. Res Nurs Health 1990; 13: 375-384. 27. Hudson PL and Hayman-White K. Measuring the psychosocial characteristics of family caregivers of palliative care patients: psychometric properties of nine self-report instruments. J Pain Symptom Manage 2006; 31(3): 215- 228. 28. Carter JH, Stewart BJ, Archbold PG, et al. Living with a person who has Parkinson's disease: the spouse's perspective by stage of disease. Mov Disord 1998; 13(1): 20-28. 29. Wittenberg E, Goldsmith J, Ferrell B, et al. Promoting improved family caregiver health literacy: evaluation of caregiver communication resources. Psychooncology. Epub ahead of print 16 March 2016. DOI: 10.1002/pon.4117. 30. Arain M, Campbell MJ, Cooper CL, et al. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol 2010; 10: 67. 31. Braun V and Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101. 32. Lobb EA, Hudson PL, Thomas K, et al. Psycho-educational group intervention for family caregivers of hospitalized palliative care patients: pilot study. J Palliat Med 2012; 15(3): 277-281. 33. Keefe FJ, Ahles TA, Porter LS, et al. The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life. Pain 2003; 103(1-2): 157-162. 34. Chi NC, Demiris G, Lewis FM, et al. Behavioral and educational interventions to support family caregivers in end-oflife care: a systematic review. Am J Hosp Palliat Care 2016; 33(9): 894-908. 35. Norinder M, Goliath I and Alvariza A. Patients' experiences of care and support at home after a family member's participation in an intervention during palliative care. Palliat Support Care. Epub ahead of print 17 October 2016. DOI: 10.1017/S1478951516000729.32pub4880pub

Kate 2006 Fall

Each year, kate seeks to: explore ideas about normative gender, sex, and sexuality work against oppression and hierarchies of power in any and all forms serve as a voice for race and gender equity as well as queer positivity encourage the silent to speak and feel less afraid build a zine and community that we care about and trusthttps://digitalcommons.otterbein.edu/kate/1004/thumbnail.jp

Obstetric Sphincter Injury Interacts With Diarrhea and Urgency to Increase the Risk of Fecal Incontinence in Women With Irritable Bowel Syndrome

To confirm that fecal urgency and diarrhea are independent risk factors for fecal incontinence (FI), to identify obstetrical risk factors associated with FI in women with IBS (irritable bowel syndrome), and to determine whether obstetric anal sphincter injuries interact with diarrhea or urgency to explain the occurrence of FI

A longitudinal study of patients with cirrhosis treated with L-ornithine L-aspartate, examined with magnetization transfer, diffusion-weighted imaging and magnetic resonance spectroscopy

The presence of overt hepatic encephalopathy (HE) is associated with structural, metabolic and functional changes in the brain discernible by use of a variety of magnetic resonance (MR) techniques. The changes in patients with minimal HE are less well documented. Twenty-two patients with well-compensated cirrhosis, seven of whom had minimal HE, were examined with cerebral 3 Tesla MR techniques, including T1- and T2-weighted, magnetization transfer and diffusion-weighted imaging and proton magnetic resonance spectroscopy sequences. Studies were repeated after a 4-week course of oral L-ornithine L-aspartate (LOLA). Results were compared with data obtained from 22 aged-matched healthy controls. There was no difference in mean total brain volume between patients and controls at baseline. Mean cerebral magnetization transfer ratios were significantly reduced in the globus pallidus and thalamus in the patients with cirrhosis irrespective of neuropsychiatric status; the mean ratio was significantly reduced in the frontal white matter in patients with minimal HE compared with healthy controls but not when compared with their unimpaired counterparts. There were no significant differences in either the median apparent diffusion coefficients or the mean fractional anisotropy, calculated from the diffusion-weighted imaging, or in the mean basal ganglia metabolite ratios between patients and controls. Psychometric performance improved in 50% of patients with minimal HE following LOLA, but no significant changes were observed in brain volumes, cerebral magnetization transfer ratios, the diffusion weighted imaging variables or the cerebral metabolite ratios. MR variables, as applied in this study, do not identify patients with minimal HE, nor do they reflect changes in psychometric performance following LOLA

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes