Selected poems,

"Introductory," by F.M. Hueffer, v. 1, p. xi-xvi.

Michigan Theater

People waiting in line for the premiere showing of "It happens every spring"

First Voters' Republican Club of Leslie, Mich.

verso: This is a picture of the "First Voters' Republican Club" of Leslie, taken in the fall of 1896, during the gold and silver campaign. Arthur J. Tuttle, captain of the outfit, is shown at the right, in front, wearing his father's silk wedding hat, gilded for the occasion. The horsemen are facing the Michigan Central Railroad traks [sic] and this picture was taken while they were waiting for the train which was to bring Civil War veterans, including General Alger Captain Tanner and several others. The building shown in the background is the old Allen House, which was an aristocratic country hotel at that time. This picture is greatly valued by Judge Tuttle and the only one he has.

Royal Subjects : Feminist Perspectives on Diary Writing and the Diary Form in Meg Cabot's The Princess Diaries Series

Meg Cabot’s young adult (YA) novel series The Princess Diaries (2000-2009) is one of many modern-day examples of attempts to redefine what Western society considers the classic princess narrative: the story of a beautiful princess passively waiting for Prince Charming. As critics such as Kay Stone and Sarah Rothschild emphasize, the fictional princess is traditionally linked to notions of ideal femininity which, in turn, makes princess stories interesting texts from a feminist perspective. Rothschild notes a surge in YA princess novels in recent years, with YA writers such as Cabot aiming to challenge the traditional image of the princess as a passive feminine stereotype in their re-workings of the princess story. Previous feminist research on The Princess Diaries series celebrates the main character Mia as a symbol of third wave feminism and as such, a positive role model for Cabot’s predominantly young, female readers. Mia’s characteristic Dr Martens boots are frequently cited as an example of how greatly Mia differs from her princess predecessors. However, these critics ignore important changes in Mia’s personality over the course of the series. By the end of the series, the Dr Martens-wearing heroine introduced in the first book has replaced her combat boots with high heels. In my thesis, I will argue that Mia’s transformation in terms of appearance and preoccupation with mainstream fashion, from quirky outsider to stereotype girly girl, complicates the idea of The Princess Diaries series as feminist texts. Moreover, previous feminist research largely ignores diary writing’s prominent role in the series, and the ways in which the diary format influences the reader-narrator relationship in the novels. In my feminist reading of The Princess Diaries series, I therefore use Mia’s diary writing and the diary format of the series as my starting points. I argue that while Mia’s diary writing is portrayed as empowering, and thereby inspiring, the diary format as a narrative structure creates a rather ambiguous tone and effect; questioning but simultaneously conforming to traditional, restricting notions of femininity.

On My Mind

Thesis (Master's)--University of Washington, 2016-06

Assessing Temperament as a Predictor of Distress at Anesthesia Induction Using the Children’s Behavior Questionnaire Short Form

Thesis (Master's)--University of Washington, 2016-06

Treatment delays in paediatric dento-alveolar trauma at a tertiary referral hospital

Background: Paediatric dento-alveolar trauma is a common event. Delays in treatment can have adverse effects on long term outcomes and the aim of this study was to quantify the treatment delays in paediatric dento-alveolar trauma in a tertiary referral hospital. Methods: All cases of paediatric dento-alveolar trauma over a two-year period from July 2000 to June 2002 were identified and the charts were reviewed retrospectively. All children presenting the emergency department with dento-alveolar trauma within 48 hours of injury during the time period were included. Results: Forty-three patients were identified. The average age was 5.51 years, though there was a bias towards one and two year olds. Males were injured 1.5 times more frequently than females. There was an average delay of 9.6 hours between injury and treatment for all patients. Transit time from outside practitioners to hospital and waiting times in hospital made up the greatest delays. Children injured an average of 2.37 teeth and only 14 per cent were uncomplicated crown fractures. Conclusions: Children who present to children's hospitals for treatment of dento-alveolar trauma have more severe injuries than those treated elsewhere. They have large but potentially reducible delays between injury and treatment.

Prospective study of men's psychological and decision-related adjustment after treatment for localized prostate cancer

Objectives. To undertake a prospective longitudinal study to assess psychological and decision-related distress after the diagnosis of localized prostate cancer. Methods. A total of I 11 men (93% response rate) with localized prostate cancer were recruited from outpatient urology clinics and urologists' private practices. More than one half (56%) elected to undergo radical prostatectomy, 19% underwent external beam radiotherapy, and 25% chose watchful waiting. Men completed self-report measures before treatment and 2 and 12 months after treatment. The measures used included the University of California, Los Angeles, Prostate Cancer Index, International Prostate Symptom Score, Impact of Events Scale, Constructed Meaning Scale, Satisfaction with Life Scale, Health Care Orientation subscale, and Decisional Conflict Scale. Results. No statistically significant differences were found by medical treatment group in the psychological and decision-related adjustment at baseline or with time. Men who were undecided about their treatment choice had greater decisional conflict and a more negative healthcare orientation, but were not more psychologically distressed, compared with men who had decided. At diagnosis, 63% of men had high decision-related distress, and this persisted for 42% of men 12 months after treatment, despite high satisfaction with their treatment choice. At diagnosis, low-to-moderate psychological distress was most common, with distress decreasing after treatment. The overall quality of life was similar to community norms. Conclusions. The results of our study indicated that men who were undecided about what treatment to receive experienced greater decision-related distress. The final treatment choice was not related to psychological distress about prostate cancer. Psychological and decision-related distress decreased with time, independent of treatment modality. Interventions should target decision-related distress for all men and in-depth psychological support for those who experience ongoing difficulties. (C) 2004 Elsevier Inc.

Physical enhancement of transdermal drug application: is delivery technology keeping up with pharmaceutical development?

Advances in molecular biology have given us a wide range of protein and peptide-based drugs that are unsuitable for oral delivery because of their high degree of first-pass metabolism. Though parenteral delivery is the obvious answer, for the successful development of commercial chronic and self-administration usage formulations it is not the ideal choice. Transdermal delivery is emerging as the biggest application target for these agents, however, the skin is extremely efficient at keeping out such large molecular weight compounds and therapeutic levels are never going to be realistically achieved by passive absorption. Physical enhancement mechanisms including: iontophoresis, electroporation, ultrasound, photomechanical waves, microneedles and jet-propelled particles are emerging as solutions to this topical delivery dilemma. Adding proteins and peptides to the list of other large molecular weight drugs with insufficient passive transdermal fluxes to be therapeutically useful, we have a collection of pharmacological agents waiting for efficient delivery methods to be introduced. This article reviews the current state of physical transdermal delivery technology, assesses the pros and cons of each technique and summarises the evidence-base of their drug delivery capabilities.

The late effects of poliomyelitis in Queensland

This paper reports an investigation of new health problems reported by Queensland residents with a prior history of poliomyelitis. 126 people with a past history of paralytic poliomyelitis were recruited from the waiting list for the trial Post Polio Clinic at Queen Elizabeth II Hospital, Brisbane. A self-administered postal questionnaire was used to examine a number of variables including acute poliomyelitis histories; presence, duration and severity of new symptoms consistent with the late effects of poliomyelitis; changes in functional status between the maximal recovery period and the time of the survey and the impact of post-polio symptoms on lifestyle and employment. The most frequent new symptoms reported were muscle weakness (87 per cent), unusual tiredness (79 per cent), joint pain (79 per cent), muscle pain (61 per cent) and muscle cramps (71 per cent). Subjects reported an increased reliance on assistive devices and a decreased level of independence with activities of daily living, particularly with mobility-related tasks. Eight three per cent of subjects had made lifestyle changes as a result of post-polio symptoms and 67 per cent of those subjects in the workforce reported making changes to their employment, such as reduced hours of work. (author abstract)

The use of cusum analysis in the early detection and management of hospital bed occupancy crises

Objective: To assess the value of cusum analysis in hospital bed management. Design: Comparative analysis of medical patient flows, bed occupancy, and emergency department admission rates and access block over 2 years. Setting: Internal Medicine Services and Emergency Department in a teaching hospital. Interventions: Improvements in bed use and changes in the level of available beds. Main outcome measures: Average length of stay; percentage occupancy of available beds; number of patients waiting more than 8 hours for admission (access block); number of medical patients occupying beds in non-medical wards; and number of elective surgical admissions. Results: Cusum analysis provided a simple means of revealing important trends in patient flows that were not obvious in conventional time-series data. This prompted improvements in bed use that resulted in a decrease of 9500 occupied bed-days over a year. Unfortunately and unexpectedly, after some initial improvement, the levels of access block, medical ward congestion and elective surgical admissions all then deteriorated significantly. This was probably caused by excessive bed closures in response to the initial improvement in bed use. Conclusion: Cusum analysis is a useful technique for the early detection of significant changes in patient flows and bed use, and in determining the appropriate number of beds required for a given rate of patient flow.

Realtime telemedicine for paediatric otolaryngology pre-admission screening

We conducted a feasibility study to examine whether a paediatric patient at a regional hospital could be assessed by an ear, nose and throat (ENT) specialist via videoconference, therefore saving at least one journey to the tertiary hospital for a pre-admission appointment. A video-otoscope was used with standard videoconference equipment, and realtime images were transmitted at a bandwidth of 384 kbit/s. In all, 13 telepaediatric ENT clinics were conducted between November 2003 and April 2005, and 98 consultations were facilitated for 64 patients. The main reasons for referral were recurrent tonsillitis (25%) and obstructive sleep apnoea (23%). Of the 64 patients examined by telemedicine, 42 (66%) were recommended for surgery and placed on the surgical waiting list. About 12 patients (19%) required travel to the tertiary centre for further investigations and tests not available locally, while four patients (6%) were reviewed via videoconference during a scheduled clinic. Six patients (9%) required no further follow-up after their initial telepaedliatric consultation. Videoconferencing is an effective method of assessing ENT conditions of paediatric patients and for pre-screening potential surgical admissions to a tertiary hospital. Careful consideration of a number of economic and logistical factors needs to be made before large investments are made to expand the service.

Teleneurology

Teleneurology enables neurology to be practised when the doctor and patient are not present in the same place, and possibly not at the same time. The two main techniques are: (1) videoconferencing, which enables communication between a doctor and a patient who are in different places at the same time (often called real-time or synchronous), and (2) email, where the consultation is carried out without the patient being present, at a time convenient to the doctors involved (asynchronous or store-and-forward teleneurology). Some problems that can be solved by teleneurology include: (1) patients admitted to hospital with acute neurological symptoms rarely see a neurologist; (2) delayed treatment for acute stroke; (3) non-optimum management of epilepsy; (4) unproductive travel time for neurologists; (5) extremely poor access to a neurologist for doctors in the developing world; (6) long waiting times to see a neurologist. Neurology is a specialty that, because of the emphasis on accurate interpretation of a history, does lend itself to telemedicine. It has been a late starter in realizing the benefits of telemedicine and most of the publications on teleneurology have been in the last five years. Its uptake within the neurological community is low but increasing. Telemedicine requires a significant change in how neurologists practise. The evidence to date is that teleneurology can narrow the gap between patients with neurological disease and the doctors who are trained to look after them.