Spiritual Care within Oncology Care: Development of a Spiritual Care Program at an Indian Health Service Hospital

Spiritual care is essential in providing quality health care for patients and their families and is supported in the mission of the Indian Health Service (IHS). Their mission is to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level. This paper will describe the spiritual care programs at the Phoenix Indian Medical Center, an IHS hospital located in Phoenix, Arizona. Two hospital committees, the Volunteer Chaplains’ Association and the Traditional Cultural Advocacy Committee, provide spiritual care for the medical center and work to sustain a presence of spiritual and cultural awareness and well being. In this paper, particular attention is focused on the ways in which these committees have worked collaboratively with community agencies, tribes in Arizona, and academic institutions, through National Cancer Institute funded grants to raise awareness of how spiritual and cultural understandings of American Indians play an essential role in cancer care

Effect of differentiating exercise guidance based on a patient's level of low back pain in primary care:a mixed-methods systematic review protocol

IntroductionLow back pain (LBP) is one of the health conditions that lead to the most disability worldwide. Guidelines aimed at management of LBP recommend non-invasive and non-pharmacological management, including patient education, advice to stay active and exercise therapy; however, the guidelines offer no recommendation as to the allowable level of pain during exercise or how specific levels of pain should be reflected in the stage and progression of exercises or activities. The purpose of this review is to study the effect of differentiation of exercise guidance based on the level of LBP in patients in primary care.Methods and analysisA systematic search will be performed on PubMed, EMBASE, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Physiotherapy Evidence Database (PEDRO), Cochrane and PROSPERO from their inception until September 2017. Published peer-reviewed human experimental and observational studies with quantitative or qualitative designs will be included. Two independent reviewers will identify papers by reviewing titles and abstracts. Papers passing the initial selection will be appraised by two reviewers, based on their full texts. Furthermore, the reference lists of included studies will be snowballed for identification of other relevant studies. Data will be extracted using a standard extraction sheet by two independent reviewers. Disagreements will be resolved by discussion and consensus with a third reviewer. The methodological quality of studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation risk of bias tool, or the Critical Appraisal Skills Programme. Results will be reported narratively. Search histories will be documented on EndNote X8 (Clarivate Analytics).Ethics and disseminationEthical approval for this review was not required as primary data will not be collected. The results will be disseminated through a peer-reviewed international journal and conference presentations.PROSPERO registration numberCRD42017074880.</jats:sec

PENGARUH PARTISIPASI ANGGARAN DAN KOMITMEN ORGANISASI TERHADAP KINERJA MANAJERIAL PADA SEKOLAH DASAR NEGERI DI KOTA PALEMBANG

This study aims to examine the effect of budgetary participation and organizational commitment on managerial performance in public elementary schools in the city of Palembang. The research location chosen was public elementary school in Palembang City. The research sample used was managerial staff working at public elementary schools in Palembang, namely the principal, TU staff, and teachers. The data used are primary data obtained from respondents using survey methods through questionnaires. For testing the data used validity test, reliability test, classic assumption test, and hypothesis testing. The data obtained were then analyzed using the t test between the independent variable and the dependent variable. The results of data analysis show that, (1) Budget participation has a significant effect on managerial performance in public elementary schools in Palembang, (2) Organizational commitment has a significant effect on managerial performance in public elementary schools in Palembang. Keywords: budgetary participation, organizational commitment, managerial performance

Literature review on thin-walled and cellular structure designs for energy absorption

Bio-inspired structure is a topic of immense interest to researchers worldwide. In order to maximize energy absorption through biomimetic structures, this article presents bio-inspired structure particularly, thin walled and cellular structures thorough analysis of the interactions between experimental research and Finite Element Analysis (FEA) simulations. The study compiles the prior research on experimental investigations of thin-walled and cellular biomimetic structures in order to understand the significance of biomimetic structural energy absorption. These inventive works of nature serve as inspiration for these designs, which provide engineering solutions that excel in impact resistance and energy dissipation abilities. The study further highlights the mutual advantages of combining experimental research with FEA models, which enable a deeper understanding of the impact response and energy absorption mechanisms inherent in biomimetic structures, by exploring into recent developments in material science and design methodologies. The article emphasizes how important validations are in bringing experimental results in line with FEA predictions. Furthermore, the practical applications demonstrated in fields like aircraft engineering, automotive safety, and protections can serve as excellent examples of the paradigm-shifting potential of this method for boosting impact protection. This review proposes novel research avenues aimed at fully harnessing the potential of biomimetic architectures to enhance energy absorption, all while acknowledging and addressing the associated challenges.publishedVersio

Nutrient sensing in the nucleus of the solitary tract mediates non-aversive suppression of feeding via inhibition of AgRP neurons.

UNLABELLED: The nucleus of the solitary tract (NTS) is emerging as a major site of action for the appetite-suppressive effects of leading pharmacotherapies currently investigated to treat obesity. However, our understanding of how NTS neurons regulate appetite remains incomplete. OBJECTIVES: In this study, we used NTS nutrient sensing as an entry point to characterize stimulus-defined neuronal ensembles engaged by the NTS to produce physiological satiety. METHODS: We combined histological analysis, neuroanatomical assessment using inducible viral tracing tools, and functional tests to characterize hindbrain-forebrain circuits engaged by NTS leucine sensing to suppress hunger. RESULTS: We found that NTS detection of leucine engages NTS prolactin-releasing peptide (PrRP) neurons to inhibit AgRP neurons via a population of leptin receptor-expressing neurons in the dorsomedial hypothalamus. This circuit is necessary for the anorectic response to NTS leucine, the appetite-suppressive effect of high-protein diets, and the long-term control of energy balance. CONCLUSIONS: These results extend the integrative capability of AgRP neurons to include brainstem nutrient sensing inputs

Benefits of Surgical Intervention in Women with Endometriosis-Related Infertility

Endometriosis is one of the most common gynecological diseases in the world with a great variety of symptoms and clinical features. The true prevalence rates in the general population are not known, but according to different authors, endometriosis is to be found in 10% in women of reproductive age. According to different publications, around half of the patients with infertility were diagnosed with endometriosis which change the significance of this disease from the only female to a socio-economical problem. In this chapter, we will focus on the current view on endometriosis-associated infertility, from superficial to adenomyosis, with a closer view of surgical treatment, as it is still the standard of care for diagnosis and in severe cases—treatment of the disease

Colorectal cancer patients with liver metastases and severe hyperbilirubinemia: A consecutive series that explores the benefits and risks of chemotherapy

Tamana Walia, J Fernando Quevedo, Timothy J Hobday, Gary Croghan, Aminah JatoiDivision of Medical Oncology, Rochester, MN, USABackground: Do colorectal cancer patients with hyperbilirubinemia and liver metastases benefit from chemotherapy?Methods/Results: This study entailed a review of 3,019 consecutive patients with colorectal cancer. Within this cohort, 20 met the study&amp;rsquo;s a priori selection criteria, which included a new diagnosis of colorectal cancer, no prior therapy, and a total bilirubin of &amp;ge;3.0 mg/dL. All 20 patients had liver metastases, and as a whole the group had a median serum bilirubin of 6.4 mg/dL (range 3.1, 28 mg/dL). Six patients received chemotherapy with an oxaliplatin-containing regimen, and four subsequently sustained a drop in their bilirubin. In one instance, a drop from 27.2 to 2.5 mg/dL occurred. These six patients lived a median of 71 days (range 23+, 283 days), but one treatment-related death occurred. In contrast, patients who received only supportive care lived a median of 28 days.Conclusion: Chemotherapy appears to provide modest benefit to newly diagnosed colorectal cancer patients with severe hyperbilirubinemia.Keywords: colorectal cancer, liver metastases, hyperbilirubinemia, chemotherapy, oxaliplati

Involving practice nurse and other assistant clinical staff members in the management of low back pain:A qualitative interview study from Danish general practice

OBJECTIVES: Involving practice nurse and other assistant clinical staff members in providing information and education to patients with low back pain at follow-up appointments may release more time and improve care in general practice. However, this requires a shift in the division of tasks, and general practitioners’ barriers and facilitators for this are currently unknown. The objectives were to explore general practitioners’ experiences and perceptions of including assistant clinical staff members in the management of low back pain. METHODS: This is a semi-structured interview study in Danish general practice. General practitioners with a variation in demographics and experience with task-delegation to clinical staff were recruited for in-depth interviews. We used a phenomenological approach to guide the data collection and the analysis in order to gain insight into the subjective experiences of the general practitioners and to understand the phenomenon of ‘delegating tasks to practice staff’ from the perspective of the general practitioners’ lifeworld. Analysis was conducted using an inductive descriptive method. The sample size was guided by information power. RESULTS: We conducted five interviews with general practitioners. All general practitioners had experience with task delegation, but there was a variation in which tasks the general practitioners delegated and to which types of clinical staff members. The following themes were derived from the analysis: general practice organisation, delegating to clinical staff members, doctor–patient relationship, exercise instruction, clinical pathway for patients and external support. CONCLUSION: General practitioners consider patients with low back pain to be a heterogeneous group with a variety of treatment needs and a patient group without any predetermined content or frequency of consultations; this can be a barrier for delegating these patients to clinical staff members

Laporan Kerja Praktek Proyek Pelapisan Ulang Ruas Jalan Sei Batang Hari

50 HlmBerdasarkan hasil pengamatan dilapangan dapat ditarik sebagai berikut : 1. Sebelum pekerjaan penghamparan, kondisi lapangan harus bersih dari benda apapun. 2. Penyemprotan Tack coat harus merata dan permukaan Nozel harus selalu di Kontrol agar dapat hasil penyemprotan yang baik, dihindari gumpalan Tack Coat dilapangan. 3. Penghamparan Hot Mix minimal dilakukan pada temperatur 120 C dan pada waktu pemadatan awal, Tanden Roller harus menggunakan roda penggerak sebagai pemadat awal. 4. Pada akhir pelaksanaan harus dipasang kayu dengan ketebalan 4 cm selebar penghamparan, agar pada kelanjutan pekerjaan keesokan harinya, sambungan melintang tersebut dapat tersambung dengan baik. 5. Peralatan yang digunakan untuk pekerjaan ini sudah cukup baik