A Barrier to Child Welfare Reform: The Supreme Court’s Flexible Approach to Federal Rule of Civil Procedure 60(b)(5) and Granting Relief to States in Institutional Reform Litigation

In a recent decision, Horne v. Flores, the Court demanded a broader and more flexible application of Federal Rule of Civil Procedure (Rule) 60(b)(5). In doing so, the Court opened the door for states to seek relief from court-enforced agreements like consent decrees. This decision undermines the use of institutional reform litigation as a means of fixing the child welfare system and thus deals a further blow to the nation’s most vulnerable citizens. This Note will discuss Horne’s impact on consent decrees stemming from institutional reform litigation in child welfare. Part II will explore the history of Rule 60 as it applies to final judgments, and specifically consent decrees. Additionally, Part II discusses the Supreme Court’s application of Rule 60(b)(5) in Horne. Part III will critique the Court’s decision for providing a more flexible standard that weighs federalism concerns above the merits of the case. Part IV discusses the importance of consent decrees in child welfare and proposes suggestions for their ongoing use to be effective. Finally, Part V provides a brief conclusion

Optimizing the integration of advanced practitioners in a department of surgery: An operational improvement model

Physician assistants (PAs) and nurse practitioners (NPs) have established themselves as key members of the healthcare team to supplement practicing physicians in patient care. PAs and NPs are collectively referred to as “advanced providers” (APs) and work not only in primary care but in general surgery and surgical subspecialties. Studies have addressed AP integration into the profession of medicine and have examined cost and efficacy of APs, attitudes about APs among residents, and educational impact of APs, but very little literature exists that describes a formalized approach to AP integration into a department of surgery, specifically with AP/resident integration. The purpose of this paper is to describe an initiative for developing an operational improvement model for APs working with residents on surgical inpatient services in a large academic health center. The model consists of four components and each component is described in detail from discovery state towards continuous improvement. Formal professional development opportunities for APs as well as appointing a Clinical Director for Surgical APs have positively impacted AP integration into the department of surgery

Regional Anesthesia And Breast Cancer Recurrence

Breast cancer is the most common type of cancer in women in the United States, and surgical resection is the definitive treatment. However, cancer recurrence and metastasis remains a concern for the lifetime of the patients affected. Therefore, much interest has been focused on how anesthetic technique may impact the rates of cancer recurrence and metastasis following breast cancer surgery. In this review, the potential for regional analgesia to reduce the recurrence rate of breast cancer post-operatively is discussed. Supporting evidence from multiple studies is presented, along with a discussion of potential areas of future research that is needed. At this time, there is no definitive answer regarding the optimal anesthetic technique to enhance patient outcomes after breast cancer surgery. However, ongoing research has the potential to enhance our understanding of how anesthetic technique may impact long-term breast cancer survival

The isolation and characterisation of Caulobacter from Manawatu water systems : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Microbiology at Massey University

This study reports the isolation of 22 strains of Caulobacter from a variety of local water supplies. Most of the strains (17) were from the sewage treatment plant, while others were isolated from rivers (2), tap water (1) and stored water (2). Conjugative plasmid transfer was demonstrated between a strain of E. coli and a sewage Caulobacter strain. Eckhardt gel analysis and antibiotic sensitivity tests confirmed that the transconjugant Caulobacter carried a plasmid conferring neomycin resistance when compared to the neomycin sensitive parent. Caulobacter isolated from sewage tended to carry more plasmids than freshwater Caulobacter, and showed an increase in resistance to many second generation antibiotics when compared to their freshwater counterparts. Based on the sequence of a 260 bp fragment of 16S rDNA. the identities of the Caulobacter isolates were confirmed. A phylogenetic tree constructed from the sequence data showed that the Caulobacter isolates form a diverse group. Some of the isolates appear to be closely related to marine Caulobacter and were able to grow in media containing 2.5% salt. Other isolates appear to be closely related to Pseudomonas diminuta. A number of new Caulobacter strains were identifed on the basis of their 16S rDNA sequences. The role of Caulobacter in the environment has not been well studied, partly due to the difficulties in detecting their presence. The use of the polymerase chain reaction to amplify the 16S rDNA sequence may help to overcome this problem, bearing in mind the diverse nature of the Caulobacter group

Domestic piano music in Victorian England : the case of (Edward) Sydney Smith (1839-89)

[From the preface]:The history of music-making in Victorian and Edwardian England has, in recent decades, been well documented. The dedication and hard work of legions of amateur singers and brass players is now appreciated and admired, and this admiration also extends to those working behind the scenes – the wives and daughters who washed uniforms, sewed on loose buttons, polished brass instruments, made teas and sandwiches for rehearsals etc. Theirs is an important story. However, there were countless other amateur musicians whose histories are much harder to unearth – the tens of thousands of amateur pianists, who laboured at their instruments for many hours in order to provide entertainment for themselves, their families, and for visitors. Their stories have remained hidden from the modern gaze because the nineteenth-century home was a private world of respectable domesticity. This thesis aims to uncover something of this hidden world of domestic music-making, through an examination of the piano compositions of (Edward) Sydney Smith (1839-89), probably the most prolific English composer working in this field

A Barrier to Child Welfare Reform: The Supreme Court’s Flexible Approach to Federal Rule of Civil Procedure 60(b)(5) and Granting Relief to States in Institutional Reform Litigation

In a recent decision, Horne v. Flores, the Court demanded a broader and more flexible application of Federal Rule of Civil Procedure (Rule) 60(b)(5). In doing so, the Court opened the door for states to seek relief from court-enforced agreements like consent decrees. This decision undermines the use of institutional reform litigation as a means of fixing the child welfare system and thus deals a further blow to the nation’s most vulnerable citizens. This Note will discuss Horne’s impact on consent decrees stemming from institutional reform litigation in child welfare. Part II will explore the history of Rule 60 as it applies to final judgments, and specifically consent decrees. Additionally, Part II discusses the Supreme Court’s application of Rule 60(b)(5) in Horne. Part III will critique the Court’s decision for providing a more flexible standard that weighs federalism concerns above the merits of the case. Part IV discusses the importance of consent decrees in child welfare and proposes suggestions for their ongoing use to be effective. Finally, Part V provides a brief conclusion

Identifying an appropriate science curriculum for undergraduate nursing in New Zealand

The depth and breadth of science knowledge that is required to educate registered nurses has been the subject of much debate, both nationally and internationally. Central to the debate is the lack of clarity on what science is required for nursing. Nursing students world-wide report anxieties and difficulties with learning science within nursing programmes. It has not been established if science is required for nursing, nor has it been established how science is used by nurses engaged in clinical practice. This research was aimed at examining the use of science in nursing practice and therefore identifying an appropriate undergraduate nursing science curriculum for New Zealand nursing schools. To achieve this aim, a mixed method, interpretive, naturalistic approach has been employed involving interviews, surveys, observation studies and document analysis. The research had four phases; interviews with nine nurse educators and lecturers, written surveys undertaken by 71 registered nurses, observation and in-depth interviews with 17 registered nurses’ in practice across the central and lower North Island, and document analysis. Nurse educators and lecturers were interviewed to gain their perspectives of the role of science in nursing. A Science Attitude and Self-Efficacy (SASE) survey included sections that focused on nurses’ attitudes towards their nursing science courses, attitudes towards science in nursing, and probed their confidence in their own ability to use science in practice. Observations of nurses in their clinical practice were conducted over several hours and the nurses interviewed about their observed actions. The observed nursing actions and espoused science knowledge that were extracted from clinical practice were categorised into science and science-related topics which frame the breadth of content used in nursing practice, and the depth was ascertained by the level of complexity the nurse was able to articulate. Document analysis of curriculum information as well as Nursing Council of New Zealand standards for education, competencies and scopes of practice was also performed to ascertain the importance and relevance of science to nursing practice. Nursing Council documents state that science is important for all levels of nursing practice, from patient observation, to clinical decision-making. Science knowledge assists the nurse when conducting risk analyses and when performing nursing care and assessment. A competent nurse needs to provide advocacy and education for a patient. To be effective at this, a nurse needs to be able to read, critique, understand and translate scientific information and be able to effectively communicate with other health professionals. The majority of nurses in practice felt that science knowledge was the foundation for nursing practice, and that nurses require an in-depth knowledge of science. Nurses who had passed Level 3 secondary school science were more likely to have found studying nursing science courses easy, and had a positive attitude towards using science-in-practice. Those nurses who had a positive attitude towards science were more likely to use in-depth science knowledge in their nursing practice. Nurses who practice in areas where their decision-making is independent and autonomous were more likely to use more in-depth science to inform their practice. Nurses that had a less positive attitude towards science were more likely to have experienced difficulty studying science courses as a student, and were more likely to apply shallow science in their nursing practice. The curriculum design processes within nursing schools may contribute to devaluation of science in nursing. Nursing lecturers were more likely to have a less positive attitude of science’s relevance to nursing practice than nurses in practice. Some aspects of science’s contribution to nursing were unrecognised and may explain why aspects of science-based knowledge and skills that were observed in clinical practice were not represented formally in the reviewed curricula. Nursing science curricula are often represented as discrete packages of science information, whereas in nursing practice, science is entirely integrated. As such, nursing science education needs to become integrated, but explicit within nursing, and its contribution and relevance to nursing more emphasised. Trends in healthcare indicate that the nursing workplace of the future will require nurses to engage in more independent and autonomous practice in the community. This will require nurses who can engage with scientific material, as well be able to innovate and advance nursing practice, which has implications for nursing education. This thesis identifies an appropriate science curriculum for undergraduate nursing in New Zealand and contains recommendations for its implementation

An analysis of Rowan University fund raising and communication practices

Public colleges and universities need more income than government can provide. States now typically provide less than half the funding for public universities, like Rowan University. Alumni fund raising and other gifts bridge this gap. This study describes variables that affect donor motivation in other schools, and measures those variables among Rowan University subjects. The author applied a 16-question protocol to a purposive sample of 31. The sample was comprised of key fund raising personnel and target study subjects from students to college presidents in seven groups. Extensive individual commentary supplements the sample\u27s small size. The major findings clearly support the university\u27s promotion of its 10-year building plan, as well as its successful academic and sports programs. Fund raising and other respondents prefer directed giving and specification of gift use