The day surgery experience from a service users perspective

Although health policy would suggest that day surgery is the best service for patients undergoing a surgical procedure, it is important to consider the patient and whether this type of service is what they want. This information can be generated through a service evaluation with the results used to inform local decision-making, changes to care delivery and improvements in patient care. This article describes the results of a service evaluation performed in a single-site day surgery unit.

How much is '5-a-day'? A qualitative investigation into consumer understanding of fruit and vegetable intake guidelines

BACKGROUND: Despite the known health benefits of fruit and vegetables (FV), population intakes remain low. One potential contributing factor may be a lack of understanding surrounding recommended intakes. The present study aimed to explore the understanding of FV intake guidelines among a sample of low FV consumers.

METHODS: Six semi-structured focus groups were held with low FV consumers (n = 28, age range 19-55 years). Focus groups were recorded digitally, transcribed verbatim and analysed thematically using nvivo (QSR International, Melbourne, Australia) to manage the coded data. Participants also completed a short questionnaire assessing knowledge on FV intake guidelines. Descriptive statistics were used to analyse responses.

RESULTS: The discussions highlighted that, although participants were aware of FV intake guidelines, they lacked clarity with regard to the meaning of the '5-a-day' message, including what foods are included in the guideline, as well as what constitutes a portion of FV. There was also a sense of confusion surrounding the concept of achieving variety with regard to FV intake. The sample highlighted a lack of previous education on FV portion sizes and put forward suggestions for improving knowledge, including increased information on food packaging and through health campaigns. Questionnaire findings were generally congruent with the qualitative findings, showing high awareness of the '5-a-day' message but a lack of knowledge surrounding FV portion sizes.

CONCLUSIONS: Future public health campaigns should consider how best to address the gaps in knowledge identified in the present study, and incorporate evaluations that will allow the impact of future initiatives on knowledge, and ultimately behaviour, to be investigated.

UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method

Introduction
Evaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.

Aim
To develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.

Methods
Using a modified version of the RAND/UCLA appropriateness method (Fitch et al., 2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.

Results
71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.

Conclusion
The final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.

Reference

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001. http://www.rand.org/pubs/monograph_reports/MR1269

Optimal day-ahead scheduling of integrated urban energy systems

An optimal day-ahead scheduling method (ODSM) for the integrated urban energy system (IUES) is introduced, which considers the reconfigurable capability of an electric distribution network. The hourly topology of a distribution network, a natural gas network, the energy centers including the combined heat and power (CHP) units, different energy conversion devices and demand responsive loads (DRLs), are optimized to minimize the day-ahead operation cost of the IUES. The hourly reconfigurable capability of the electric distribution network utilizing remotely controlled switches (RCSs) is explored and discussed. The operational constraints from the unbalanced three-phase electric distribution network, the natural gas network, and the energy centers are considered. The interactions between the electric distribution network and the natural gas network take place through conversion of energy among different energy vectors in the energy centers. An energy conversion analysis model for the energy center was developed based on the energy hub model. A hybrid optimization method based on genetic algorithm (GA) and a nonlinear interior point method (IPM) is utilized to solve the ODSM model. Numerical studies demonstrate that the proposed ODSM is able to provide the IUES with an effective and economical day-ahead scheduling scheme and reduce the operational cost of the IUES.

Faulkner revisited : narrating property, race, gender and history in William Faulkner's Go Down, Moses, Toni Morrison's Song of Solomon and Gloria Naylor's Mama Day

My thesis explores the formation of the subject in the novels of Faulkner’s Go Down, Moses, Toni Morrison’s Song of Solomon, and Gloria Naylor’s Mama Day. I attach the concept of property in terms of how male protagonists are obsessed with materialistic ownership and with the subordination of women who, as properties, consolidate their manhood. The three novelists despite their racial, gendered, and literary differences share the view that identity and truth are mere social and cultural constructs. I incorporate the work of Judith Butler and other poststructuralist figures, who see identity as a matter of performance rather than a natural entity. My thesis explores the theme of freedom, which I attached to the ways characters use their bodies either to confine or to emancipate themselves from the restricting world of race, class, and gender. The three novelists deconstruct any system of belief that promulgates the objectivity of truth in historical documents. History in the three novels, as with the protagonists, perception of identity, remains a social construct laden with distortions to serve particular political or ideological agendas. My thesis gives voice to African American female characters who are associated with love and racial and gender resistance. They become the reservoirs of the African American legacy in terms of their association with the oral and intuitionist mode of knowing, which subverts the male characters’ obsession with property and with the mainstream empiricist world. In this dissertation, I use the concept of hybridity as a literary and theoretical devise that African-American writers employ. In effect, I embark on the postcolonial studies of Henry Louise Gates, Paul Gilroy, W. E. B Du Bois, James Clifford, and Arjun Appadurai in order to reflect upon the fluidity of Morrison’s and Naylor’s works. I show how these two novelists subvert Faulkner’s essentialist perception of truth, and of racial and gendered identity. They associate the myth of the Flying African with the notion of hybridity by making their male protagonists criss-cross Northern and Southern regions. I refer to Mae Gwendolyn Henderson’s article on “Speaking in Tongues” in my analysis of how Naylor subverts the patriarchal text of both Faulkner and Morrison in embarking on a more feminine version of the flying African, which she relates to an ex-slave, Sapphira Wade, a volatile female character who resists fixed claim over her story and identity. In dealing with the concept of hybridity, I show that Naylor rewrites both authors’ South by making Willow Springs a more fluid space, an assumption that unsettles the scores of critics who associate the island with authenticity and exclusive rootedness.

Determining day length and temperature regulation of flowering: a molecular and modelling approach

Thesis (Ph.D.)--University of Washington, 2016-08

Effects of a 12-week aerobic exercise intervention on eating behaviour, food cravings and 7-day energy intake and energy expenditure in inactive men

This study examined effects of 12 weeks of moderate-intensity aerobic exercise on eating behaviour, food cravings and weekly energy intake and expenditure in inactive men. Eleven healthy men (mean ± SD: age, 26 ± 5 years; body mass index, 24.6 ± 3.8 kg/m2; maximum oxygen uptake, 43.1 ± 7.4 mL/kg/min) completed the 12-week supervised exercise programme. Body composition, health markers (e.g. blood pressure), eating behaviour, food cravings and weekly energy intake and expenditure were assessed before and after the exercise intervention. There were no intervention effects on weekly free-living energy intake (p=0.326, d=-0.12) and expenditure (p=0.799, d=0.04), or uncontrolled eating and emotional eating scores (p>0.05). However, there was a trend with a medium effect size (p=0.058, d=0.68) for cognitive restraint to be greater after the exercise intervention. Total food cravings (p=0.009, d=-1.19) and specific cravings of high-fat foods (p=0.023, d=-0.90), fast-food fats (p=0.009, d=-0.71) and carbohydrates/starches (p=0.009, d=-0.56) decreased from baseline to 12 weeks. Moreover, there was a trend with a large effect size for cravings of sweets (p=0.052, d=-0.86) to be lower after the exercise intervention. In summary, 12 weeks of moderate-intensity aerobic exercise reduced food cravings and increased cognitive restraint, however, these were not accompanied by changes in other eating behaviours and weekly energy intake and expenditure. The results indicate the importance of exercising for health improvements even when reductions in body mass are modest.

'Day number': a promoter routine of flexibility and conceptual understanding

This paper is part of the Project “Adaptive thinking and flexible computation: Critical issues”. In this paper we discuss different perspectives of flexibility and adaptive thinking in literature. We also discuss the idea of proceptual thinking and how this idea is important in our perspective of adaptive thinking. The paper analyses a situation developed with a first grade classroom and its teacher named the day number. It is a daily activity at the beginning of the school day. It consists on to look for the date number and to think about different ways of writing it using the four arithmetic operations. The analyzed activity was developed on March 19, so the challenge was to write 19 in several ways. The data show the pupils’ enthusiasm and their efforts to find different ways of writing the number. Some used large numbers and division, which they were just starting to learn. The pupils presented symbolic expressions of 19, decomposing and recomposing it in a flexible manner.

DNA demethylation during Chrysanthemum floral transition following short-day treatment

Background: Analytical techniques such as methylation-sensitive amplification polymorphism and high-performance liquid chromatography were used to detect variation in DNA methylation of mature Chrysanthemum leaves during the floral transition induced by short-day (SD) treatment. Results: For both early- and late-flowering cultivars, the time from the date of planting to the appearance of the capitulum bud and early blooming were significantly shorter than those of the control. The capitulum development of the early-flowering cultivar was significantly accelerated compared to the control, unlike the late-flowering cultivar. The DNA methylation percentage of leaves was significantly altered during flower development. For the early-flowering cultivar, DNA methylation was 42.2–51.3% before the capitulum bud appeared and 30.5–44.5% after. The respective DNA methylation percentages for the late-flowering cultivar were 43.5–56% and 37.2–44.9%. Conclusions: The DNA methylation percentage of Chrysanthemum leaves decreased significantly during floral development. The decline in DNA methylation was elevated in the early-flowering cultivar compared with the late-flowering cultivar.

Pontic Influence In The Territory Of Present-Day Poland As Illustrated By Leafshaped Points Without A Marked Tang

This publication constitutes the fruits of National Science Centre research projects (grant no 2011/01/M/HS3/02142 – 6 articles) and the National Programme for the Development of the Humanities (grant no 0108/NPH3/H12/82/2014 – 3 articles). We would like to acknowledge and at the same time express our sincere gratitude for the generosity shown by the following at the Adam Mickiewicz University in making this publication possible: the Dean of the Department of History, Institute of Pre-history and the Eastern Institute.

Faulkner revisited : narrating property, race, gender and history in William Faulkner's Go Down, Moses, Toni Morrison's Song of Solomon and Gloria Naylor's Mama Day

My thesis explores the formation of the subject in the novels of Faulkner’s Go Down, Moses, Toni Morrison’s Song of Solomon, and Gloria Naylor’s Mama Day. I attach the concept of property in terms of how male protagonists are obsessed with materialistic ownership and with the subordination of women who, as properties, consolidate their manhood. The three novelists despite their racial, gendered, and literary differences share the view that identity and truth are mere social and cultural constructs. I incorporate the work of Judith Butler and other poststructuralist figures, who see identity as a matter of performance rather than a natural entity. My thesis explores the theme of freedom, which I attached to the ways characters use their bodies either to confine or to emancipate themselves from the restricting world of race, class, and gender. The three novelists deconstruct any system of belief that promulgates the objectivity of truth in historical documents. History in the three novels, as with the protagonists, perception of identity, remains a social construct laden with distortions to serve particular political or ideological agendas. My thesis gives voice to African American female characters who are associated with love and racial and gender resistance. They become the reservoirs of the African American legacy in terms of their association with the oral and intuitionist mode of knowing, which subverts the male characters’ obsession with property and with the mainstream empiricist world. In this dissertation, I use the concept of hybridity as a literary and theoretical devise that African-American writers employ. In effect, I embark on the postcolonial studies of Henry Louise Gates, Paul Gilroy, W. E. B Du Bois, James Clifford, and Arjun Appadurai in order to reflect upon the fluidity of Morrison’s and Naylor’s works. I show how these two novelists subvert Faulkner’s essentialist perception of truth, and of racial and gendered identity. They associate the myth of the Flying African with the notion of hybridity by making their male protagonists criss-cross Northern and Southern regions. I refer to Mae Gwendolyn Henderson’s article on “Speaking in Tongues” in my analysis of how Naylor subverts the patriarchal text of both Faulkner and Morrison in embarking on a more feminine version of the flying African, which she relates to an ex-slave, Sapphira Wade, a volatile female character who resists fixed claim over her story and identity. In dealing with the concept of hybridity, I show that Naylor rewrites both authors’ South by making Willow Springs a more fluid space, an assumption that unsettles the scores of critics who associate the island with authenticity and exclusive rootedness.

A perfect day for zebrafish : neuromodulation of sleep in a diurnal vertebrate

Every day, we shift among various states of sleep and arousal to meet the many demands of our bodies and environment. A central puzzle in neurobiology is how the brain controls these behavioral states, which are essential to an animal's well-being and survival. Mammalian models have predominated sleep and arousal research, although in the past decade, invertebrate models have made significant contributions to our understanding of the genetic underpinnings of behavioral states. More recently, the zebrafish (Danio rerio), a diurnal vertebrate, has emerged as a promising model system for sleep and arousal research.

In this thesis, I describe two studies on sleep/arousal pathways that I conducted using zebrafish, and I discuss how the findings can be combined in future projects to advance our understanding of vertebrate sleep/arousal pathways. In the first study, I discovered a neuropeptide that regulates zebrafish sleep and arousal as a result of a large-scale effort to identify molecules that regulate behavioral states. Taking advantage of facile zebrafish genetics, I constructed mutants for the three known receptors of this peptide and identified the one receptor that exclusively mediates the observed behavioral effects. I further show that the peptide exerts its behavioral effects independently of signaling at a key module of a neuroendocrine signaling pathway. This finding contradicts the hypothesis put forth in mammalian systems that the peptide acts through the classical neuroendocrine pathway; our data further generate new testable hypotheses for determining the central nervous system or alternative neuroendocrine pathways involved.

Second, I will present the development of a chemigenetic method to non-invasively manipulate neurons in the behaving zebrafish. I validated this technique by expressing and inducing the chemigenetic tool in a restricted population of sleep-regulating neurons in the zebrafish. As predicted by established models of this vertebrate sleep regulator, chemigenetic activation of these neurons induced hyperactivity, whereas chemigenetic ablation of these neurons induced increased sleep behavior. Given that light is a potent modulator of behavior in zebrafish, our proof-of-principle data provide a springboard for future studies of sleep/arousal and other light-dependent behaviors to interrogate genetically-defined populations of neurons independently of optogenetic tools.

The Predation of Artemia Nauplii by the Larvae of the Amazon River Prawn, Macrobrachium amazonicum (Heller, 1862), is Affected by Prey Density, Time of Day, and Ontogenetic Development

The present study analyzed the effects of prey density, the time of day, and ontogenetic development on the predation of Artemia nauplii by the larvae of the Amazon river prawn, Macrobrachium amazonicum, as well as possible synergy among these factors. Larvae were raised in 120-L tanks with biological filter systems, and fed on recently hatched Artemia nauplii, using two feeding management protocols: (a) fed once per day at 2000 h (high density HD) and (b) half of the ration provided at 2000 h, complemented at 0800 h the following day by a replacement of the nauplii consumed up to a maximum of the full ration (low density with replacement LDWR). Each treatment consisted of six replicates. The consumption of nauplii was estimated prior to the feeding times. Consumption varied according to time of day, ontogenetic development, and feeding protocol. The larvae ingested more nauplii during the daytime at most developmental stages. Ingestion rates were similar during the day under both treatments, but at night the higher density of prey in the HD treatment caused a higher encounter rate and increased ingestion of nauplii by the larvae. Among the performance indicators only survival was greater in HD in comparison with LDWR; productivity and dry weight were similar. The results indicate a circadian trophic rhythm in M. amazonicum, with the encounter rate being an important mechanism for the capture of prey during the night. A second mechanism probably the visual system aids the perception of prey during the daytime. Based on these results, we suggest that feeding captive Amazon river prawn larvae only once a day would be appropriate and economically beneficial. Further work is necessary to determine the most effective time that this single feed should be applied.

Perceptions of Character Education in a Seventh-Day Adventist School

Character education has been viewed by many educators as having significant historical, academic, and social value. Many stakeholders in education argue for character development as a curricular experience. While understanding the degree to which character education is of worth to stakeholders of institutions is important, understanding students, teachers, and administrators perspectives from their lived experiences is likewise significant. The purpose of this phenomenological study was to gain a deeper understanding of character education within a Biblical framework environment by examining the lived experiences of students, administrators, and teachers of a Seventh-day Adventist School. Phenomenology describes individuals’ daily experiences of phenomena, the manner in which these experiences are structured, and focuses analysis on the perspectives of the persons having the experience (Moustakas, 1994). ). This inquiry was undertaken to answer the question: What are the perceptions of students, teachers, and an administrator toward character education in a Seventh-day Adventist school setting? Ten participants (seven students and three adults) formed the homogeneous purposive sample, and the major data collection tool was semi-structured interviews (Patton, 1990; Seidman, 2006). Three 90-minute open-ended interviews were conducted with each of the participants. Data analysis included a three-phase process of description, reduction and interpretation. The findings from this study revealed that participants perceived that their involvement in the school’s character education program decreased the tendency to violence, improved their conduct and ethical sensibility, enhanced their ability to engage in decision-making concerning social relationships and their impact on others, brought to their attention the emerging global awareness of moral deficiency, and fostered incremental progress from practice and recognition of vices to their acquisition of virtues. The findings, therefore, provide a model for teaching character education from a Seventh-day Adventist perspective. The model is also relevant for non-Seventh day Adventists who aspire to teach character education as a means to improving social and moral conditions in schools.

Give Us This Day

GIVE US THIS DAY is a collection of poetry grounded in the lyrical tradition that speaks to the conflicting need for structure and the inherent desire to be free. It focuses on those moments of rupture, when the structure, whether physical, emotional, psychological or political, is broken. The title poem sets the tone for the collection, capturing the idea that today is all one can truly know. Throughout the five sections of the collection, one comes to understand a complex family story, where right and wrong is blurred in the reality of existence. The sections, representing various parts of the day, are a parallel to the individual stories, speaking to the idea that a single day contains both times of light and darkness, similar to a life. The collection takes place in several cityscapes from Moscow to Delhi, Washington, D.C. to Miami. There are correlations drawn between familial settings and political unrest and tension. Often the political atmosphere is alluded to and drawn into context through the use of intimate personal vignettes. In contrast to the urban noise, there is pervasive natural imagery of gardens and tropical locales which mimic the physical life cycle, climaxing in the blossom.