Background: Critical Care Nurses have previously noted obstacles in caring for dying patients. Obstacles noted by nurses working in more urban settings have been reported. What is not known is the obstacles to providing end-of-life (EOL) care as perceived by nurses working in Critical Access Hospitals (CAHs). Objective: To determine the stories/experiences related to obstacles in providing EOL care as reported by nurses working in CAHs. Methods: This was an exploratory, cross-sectional study. Previous quantitative data has been reported. Documentation of the qualitative stories/experiences of nurses working in CAHs related to obstacles to providing EOL care for dying patients and their families. Results: Sixty-four CAH nurses provided 96 categorizable responses. Two major categories emerged related to either Family, Physician, & Ancillary staff issues or Nursing, Environment, Protocols, and Miscellaneous issues. Issues related to family behaviors included families insisting on futile care, disagreeing about DNR/DNI orders, issues with out-of-town family members, or even family members who suggested to the nurse to hasten the death of their family member. Physician behaviors related to providing false hope, dishonest communication, continuing futile treatments, or not ordering pain medications. Nursing issues included not having enough time to provide EOL care, already knowing the patient/family, or actions of compassion for the dying patient and family. Conclusion: Family issues continue to be obstacles to providing EOL care for nurses regardless of urban or rural setting. Physician behaviors are also consistent regardless of setting. Education of family members regarding issues with EOL care in ICUs is challenging because it is likely the families first experience with ICU terminology and technology. Further research into EOL care in CAHs is needed.

This study focuses on the topic Reports of concern in preschool and aims to explore the collaboration and interaction between different professionals involved in the process of handling such reports. The study utilizes a mixed-methods approach, starting with a quantitative survey distributed to individuals working in three different preeschool institutions and through the researcher´s personal Facebook page. The survey provided insights and generated specific questions for the subsequent phase of the study, which involved interviews with the professionals from three distinct roles connected to the process of handling reports of concern in preeschool. The collected empirical data was analyzed using Tomas Brante´s professional theory and associated concepts, as well as drawing on foundational ideas and concepts from Talcott Parsons´structural-functionalistic perspective. The analysis sheds light on the collaborative dynamics betwen professionals, the nature of the reporting process, and the dilemmas that can arise for each profession involved in reporting concerns in preschool. Additionally, the study demonstrates that these dilemmas can vary based on factors such as professional experience, education, and personal opinions. Overall , this research provides valuable insigts into the intricacies of handling reports of concern in preschool and highlights the importance of interdisciplinary collaboration and understanding within this context. The findings contribute to a deeper understanding of the challanges faced by professionals during the reporting process and help inform future efforts to enhance the effectiveness and efficiency of handling concerns in preschool settings.

While much has been done in California to provide adequate facilities and programs to educate and train the child who is mentally retarded, very little has been done to assure adequate reporting of the child's progress: in the program. This assumption has been reinforced through discussion of this problem with many persons who are active in programs for the mentally retarded in California. It must be further assumed that an adequate method of evaluating and reporting pupil progress should be an inherent part of any purposeful educational program. The problem was to determine what methods should be used to report pupil progress of children in classes for the mentally retarded in the San Pablo School District.

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Denna uppsats kommer att fokusera på propaganda utifrån tidningsmedian New York Times under Operation Market Garden. Detta skedde under de sista faserna av andra världskriget. Studien argumenterar om opinionsbildning inom Market Garden. Eftersom de allierade inte hade lyckats med sitt strategiska mål att invadera Nazityskland från Nederländerna, samt avsluta kriget före jul, så hade propagandanätverket hittat olika tillvägagångssätt och följa utvecklingen under och efter operationen för att blidka hemmafronten. Genom att analysera på New York Times kommer uppsatsen att ge ett nytt perspektiv på hur militära misslyckanden rapporterades, samt hur diskurser förändras på kort tid under krigstid. Med stöd från tidigare forskning kommer uppsatsen också ge ett förståelse hur New York Times och andra media rapportage kunde censureras från krigsministeriet med mål att skydda läsarna från demoraliserade nyheter som kunde skada hemmafrontens disciplin från att stödja krigsinsatsen.

The sustentaculum tali (ST) is located at the medial aspect of the tarsus and is considered a rare anatomic location for diseases. This retrospective case series describes the management of five horses with septic and non-septic ST injuries. All horses were treated surgically with tenovaginoscopy, ST fragment and exostosis removal. In two cases, lameness was caused by an exostosis involving the ST and the plantar aspect of the medial trochlear ridge (MTR). There are no reports of exostosis involving ST and MTR causing lameness. In four horses, the long-termoutcome was considered good and the horses were able to return to the previous level; one horse developed a recurrence of ST and MTR exostosis leading to recurrence of lameness. Curettage of the ST and MTR exostosis, removal of fragments and tarsal sheath adhesions play a pivotal role in increasing prognosis and long-termoutcome. Poor prognosis is correlated with exostosis recurrence.

The purpose of this study was to develop a field-tested prior notice/due process form that would be comprehensible by parents. An ancillary purpose was to determine the comprehensibility of a prior notice form that is currently used in southwest Virginia school divisions. A research and development model was employed to develop the field-tested form. A form and an application test were written in the predesign and design stage. In the initial review stage, a panel of experts reviewed the test and revised the form, and parents read the form and took the application test. Based on expert comments and an analysis of parent responses, revisions were made to the test and form. Another form and test revision was made following a main field test of parents. The final cycle of the. study was an operational field test of 65 parents in 11 school divisions in southwest Virginia. In a secondary mail survey, 80 special education administrators indicated their preference for the two forms on various dimensions. Data from the operational field test were used to test the hypotheses. Item analyses, using both standard and educational discrimination indices, were conducted to suggest areas for improvement on the revised form. It was concluded from the findings of the study that: (1) the hypothesis that a significant difference would exist in comprehension between parents reading the revised form and those reading the standard form was not supported; (2) on the application test, parents can obtain an acceptable mean score of 80% by reading either form; (3) specific problem areas on the form still exist, and should be corrected; (4) special education administrators prefer the revised form for use with parents; and (5) the use of jargon and complex terms seem to particularly discriminate parents of lower educational levels. Recommendations were made for form development and form use. / Ed. D.

Human senses for taste, odor, and visual assessment allow consumers to be selective when it comes to choosing their drinking water. In addition to wanting aesthetically pleasing water to drink, consumers want to know if their water is safe and may have misconceptions on what possible health risk contaminants could be lurking in their water supply. This thesis aimed to measure reaction of zerovalent nanoiron (nZVI) in water and human saliva, evaluate consumer's perceptions of taste, odor, and risk in their drinking water, and investigate the effectiveness of community water systems in communicating water quality information to their consumers. Since nZVI, including commercially available Nanofer 25S, is widely being used in water treatment processes and has future potential for use in fortifying foods, the exposure to these engineered nanoparticles will increase for humans and aquatic organisms. Thus, the first part of the thesis was to develop a quantitative analytical technique to measure the iron levels at environmentally relevant concentrations. Researchers developed a colorimetric assay using 1, 10-phenanthroline as an assay to determine the amount of ferrous ions produced from different iron materials, including ferrous(II)sulfate, nZVI, and goethite. Resulting ferrous ion measurements indicate that the maximum production of ferrous ions varied among the iron materials. Nanofer25S did not undergo 100% conversion to ferrous ions, as expected, goethite had no production of ferrous ions, and ferrous(II)sulfate was 100% ferrous ions. The total iron, as measured by atomic absorption for all iron materials were equal. The reactivity of these iron materials were also assessed in different water qualities ranging in salt concentrations. The capacity to produce ferrous ion did not change when added to nanopure water, tap water, and inorganic solution that is equivalent to the high ionic strength of saliva. Toxicology data for nZVI exposure to humans and aquatic organisms are limited. For that reason, authors of this manuscript measured salivary lipid oxidation (SLO) potential for the different iron materials in human saliva. They also developed an artificial saliva recipe to ensure repeatability and comparable results among laboratories due to human saliva's variability day by day. This simulated human saliva contained salts, proteins, and lipids. Using thiobarbituric acid reactive substances (TBARs), both Nanofer25S and ferrous(II)sulfate induced in-vitro SLO with human saliva. Goethite was unreactive. SLO results from this study have implications for flavor effects of nZVI in drinking water. The second chapter of this thesis is assessing the clarity of message communication of Consumer Confidence Reports (CCRs). In 1998, the United States Environmental Protection Agency (USEPA) mandated that community water systems (CWSs) provide annual water quality reports to their consumers. These CCRs summarize information regarding water sources, any detected contaminants, compliance with federal regulations, and educational information. Thirty CCRs across all ten USEPA regions were analyzed for clarity using the Centers for Disease Control and Prevention's (CDC) Clear Communication Index (CCI) tool. The analysis of these CCRs was a national representation of CWSs and revealed that currently distributed CCRs performed poorly on the CDC's CCI—all failing to meet the 90% passing mark. The overall average score for all CCRs was 50.3 ± 13.5%. The clarity scores were based on seven key areas: 1) Main message and call to action; 2) Language; 3) Information design; 4) State of the science; 5) Behavioral recommendations; 6) Numbers; and 7) Risk. Improvements in all seven areas—with the lowest average scores at 3.3 ± 18.1%, 21.7 ± 26.6%, and 37.7 ± 27.1%, respectively, for state of science, language, and main message and call to action—of the CCI will greatly improve the quality and educational capabilities of CCRs. The failing scores highlight the challenges facing CWSs in communicating water quality information. This assessment can serve as a tool for water utilities to effectively prepare and distribute information to their consumers in the future. CWSs must promote a two-way dialogue with their consumers. They should address consumer's concerns and wants in the CCRs, and they should also effectively communicate risks to the consumers so that they are not under the misconception that their water is unsafe to drink. CWSs should use the CCRs as a way to educate the public and promote drinking tap water. The last chapter of this thesis addresses the concerns that consumers may have about their drinking water and methods that could be implemented to quickly and efficiently respond to consumer complaints and contaminants with sensory properties. Just like CWSs, consumers are concerned about their water; they are the sentinels to water quality monitoring because they are uniquely positioned at the tap. Consumers are able to detect the slightest taste, odor, and appearance in their drinking water because it is well—instinctive! Thus, consumer feedback and complaint data provided to a utility should be taken seriously and stored for future comparisons. Any consumer complaint represents a fruitful data stream that should be harnessed routinely to gain knowledge about aesthetic water quality in the distribution system. Four utilities provided consumer complaints on water quality data that were categorized and visualized using radar and run-time plots. As a result, major taste, odor, and appearance patterns emerged that clarified the issue and could provide guidance to the utilities on the nature and extent of the problem. Consumer complaint data is valuable for water quality issue identification, but CWSs should understand that even though humans readily identify visual issues with water, such as color, cloudiness, or rust, describing specific tastes and particularly odors in drinking water is acknowledged to be a much more difficult task for humans to achieve without training. This was demonstrated with two utility groups, laboratory personnel and plant operators, and a group of consumers identifying the odor of orange, 2-MIB, and DMTS. All of the groups were able to identify the familiar orange odor. However, the two utility groups were much more able to identify the musty odor of 2-MIB; this may be due to the fact that the utility groups are more familiar with raw and finished water. DMTS, a garlic-onion odor associated with sulfur compounds in drinking water, was the least familiar to all three groups. The lab personnel group was the better describers of the odor, but the results within this group still varied significantly. These results suggest that utility personnel should be mindful of consumers who complain that their water is different, but cannot describe the problem. To reduce the inability to describe an odor or taste issue, a TandO program at a utility can be beneficial. The safety and aesthetic characteristics of drinking water is most important to consumers. They both complement each other; if consumers think their water tastes funny, they would probably assume that is unsafe to drink. Since nZVI is increasingly being introduced into the drinking water supply, researchers must be able to understand how it reacts in humans and the environment. Additionally, CCRs would be an effective method for CWSs to communicate water quality information and address any concerns consumers may have about their water. CWSs can use implement the radar and run-time plots to identify issues in the drinking water systems. Also, TandO programs will allow CWSs and their consumers to better describe and identify the issues in their drinking water as it arises so that it can be easily addressed and alleviated. Thus, promoting communication between water utilities and their consumers will improve the relationship and instill confidence in consumers about their drinking water. / Master of Science