50 research outputs found
Cancer prehabilitation: Developing a complex intervention for patients undergoing upper gastrointestinal surgery
No full textPrehabilitation is recommended to improve surgical patient outcomes, but is not offered routinely in
upper gastrointestinal centres across the United Kingdom. Where prehabilitation is offered, the
delivery, and approaches to how it’s delivered and funded are not standardised, resulting in inequity of access and variability in patient outcomes. This thesis explores and identifies best practice components to inform the development of a complex prehabilitation intervention for patients undergoing upper gastrointestinal surgery.
To map and synthesise the current and available evidence for the effectiveness of prehabilitation
interventions on biopsychosocial and service outcomes for patients undergoing upper
gastrointestinal surgery, a systematic review was conducted. Following database searches, 6028 deduplicated records were screened. Prospective experimental studies exploring prehabilitation
interventions in adults undergoing upper gastrointestinal surgery were eligible with 25 studies (from
26 reports) included in the review. The prehabilitation interventions across the studies were
grouped into inspiratory muscle training (five studies n=450); exercise (nine studies n=683);
psychological (one study n=400); and nutritional (ten studies n=487). Study quality was assessed
using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance). The results confirmed a lack of robust, adequately powered clinical trials to inform intervention delivery. High quality studies showed preoperative improvements in directly targeted impairments, but generally these did not translate into functional or postoperative benefits. Included studies that combined more than one intervention showed greater promise of increased efficacy, particularly when exercise was combined with nutritional and/or psychological interventions, which supports the concept of a multimodal multidisciplinary approach in future prehabilitation intervention design.
Patient perspectives of exercise and physical activity were captured through a qualitative study
where four patients undergoing surgery for urological cancer management were interviewed.
Thematic analysis of the interview transcripts revealed the complexity of individual experiences of
patients undergoing surgery, emphasising a need for shared patient goals across the healthcare
team to enhance individual tailoring of interventions and optimise behaviour change. The potential
role for supportive technology and the need for multidisciplinary training for healthcare
professionals was evident, with transferable concepts and insights for all prehabilitation
interventions, including patients undergoing upper gastrointestinal surgery.
A service evaluation exploring the effects of existing preoperative interventions on postoperative
outcomes in 632 patients undergoing upper gastrointestinal surgery was conducted at a local centre over a four-year period. The results broadly demonstrated some useful insights regarding the acceptability of optional supervised exercise from a patient perspective. The use of low intensity preoperative inspiratory muscle training did not improve postoperative outcomes in this service.
A stakeholder consensus study, utilising a modified nominal group technique approach, combined
existing evidence and insight from the previous three studies with expert opinion to establish key
priorities for prehabilitation intervention development. The stakeholder panel (n=8) included
physiotherapists, dietitians with experience in prehabilitation, as well as an experienced patient
advocate. This study achieved a high level of consensus across many aspects of prehabilitation, with eight out of 89 ideas achieving 100% consensus agreement (9%) and 31 out of 89 ideas achieving consensus of 71% or higher (35%). The main findings demonstrated complete consensus that prehabilitation should be delivered as a multimodal, multidisciplinary intervention that combines all three core aspects (exercise, nutrition and psychological support) for patients undergoing upper gastrointestinal surgery.
Together, the findings from these four studies provide the basis for the development of a
prehabilitation intervention for patients undergoing upper gastrointestinal surgery. The intervention
would need further development with relevant stakeholder representation ready for refinement and
feasibility testing, prior to clinical implementation, but provides valuable insights for those currently
developing or delivering prehabilitation services for patients undergoing upper gastrointestinal
surgery in the United Kingdom
Investigating the role of ARNT isoforms as bHLH/PAS transcriptional regulators / Robyn Jane Kewley.
No full textBibliography: leaves 111-127.xii, 127 leaves : ill. (some col.) ; 30 cm.The aims of this thesis were to explore novel roles of ARNT as a transcriptional regulator and to investigate possible differential activities of ARNT isoforms. To investigate whether ARNT plays roles as a transcription factor additional to being a partner to known factors such as DR and HIF-a, a search for downstream target genes was planned. Hepa cell lines overexpressing a dominant negative form of ARNT and a Suppression Subtractive Hybridisation PCR approach were used. Complementing these studies was a search for differences in function between two alternatively spliced forms of ARNT, ARNT and Alt ARNT. Specifically, the author sought to determine if ARNT and Alt ARNT could be differentially phosphorylated and whether such phosphorylation could affect DNA-binding properties. --p. 105.Thesis (Ph.D.)--University of Adelaide, Dept. of Molecular Bioscience
Tudor women writers fashioning masculinity
No full textThis thesis contributes to the growing interest in early modern masculinity and its literary representations by introducing texts by women writers into dialogue with their male-authored counterparts. It argues for a more nuanced approach that recognises that the concepts of masculinity and femininity can only be fully understood when studied in relation with each other.
The first chapter explores how, notwithstanding the wisdom of conduct books and marriage guides, the demands of the state may not always be commensurate with those of the domestic realm and shows that this conflict necessitates a rethinking of existing definitions of masculinity by focusing on selected writings of the Tudor sisters Mary and Elizabeth and Jane Fitzalan’s *Tragedie of Iphigeneia*. The second chapter identifies how Elizabeth’s unique discursive strategies were designed to elicit support from her male subjects and subdue the belligerence that simmered under polemic like John Stubbs’ *Gaping Gulf*. In her letters to Anjou, the chapter examines how Elizabeth manoeuvred around her position as a beloved and as a monarch to fashion a husband who would not only be sympathetic but also subordinate to her political authority. This chapter also shows how the fabulous world of John Lyly’s *Galatea* consummates the Queen’s desire for the ideal male subject. The final chapter investigates the construction of martial manhood. It juxtaposes Mary Sidney’s *The Tragedy of Antonie* with William Shakespeare’s *Antony and Cleopatra* to determine how the figure of Cleopatra, common to both plays, challenges and revises the martial code of masculinity as embodied by Antony. By examining the authorial position appropriated by Cleopatra in the plays and its impact on the narrative, this chapter also extends this thesis’ interest in the extent to which female characters within texts compete for diegetic control with male protagonists
'Making its own history': New Zealand historical fiction for children,1862-2008
No full textThis thesis considers historical fiction for children and young people dealing with New Zealand history from the arrival of the first Polynesian settlers to the end of the nineteenth century. It provides both a comprehensive survey of historical novels published between 1862 and the end of 2008, and an analysis of the way the same historical events and periods have been depicted in historical novels written at different times. Individual chapters discuss books set during specific historical periods or dealing with particular events - the pre-European period, early contact, nineteenth century immigration, the New Zealand Wars, the gold rushes, and the colonial period - in chronological order of publication. Since children's literature is particularly adept at reflecting and promoting the dominant ideas of the society in which it is produced, the chronological consideration of these texts reveals contemporary attitudes to such issues as race relations, gender roles, class, war and conflict, and concepts of national identity, as well as the way historical fiction has responded to societal changes since the 1860s.
The predominant themes of historical fiction set prior to 1900 are: the arrival of settlers in New Zealand; encounters with the country's indigenous inhabitants; the taming of the often hostile landscape; the assertion of the settlers' claims to 'belong' in their new land; and the establishment of New Zealand as a nation with distinctive characteristics. There are perceptible nuances and differences in the way these themes are discussed depending on the historical moment in which individual authors are writing. Novels of the Victorian period and early twentieth century reflect the imperialistic and evangelistic ethos of the time, and present the British settlers' right to colonize the land and the ensuing dispossession of Māori as largely unproblematic. Subsequent historical novels, particularly those written since the 1960s, offer a more inclusive version of New Zealand history, although the lack of historical fiction for children by Māori writers means that Eurocentric views of history continue to dominate, and that all representations of Māori and their history are mediated through Pakeha writers.
Shifts in social attitudes have resulted in changes in the treatment of Māori in historical novels for children, and similar changes have occurred in the portrayal of gender, class, and ethnicity. The passage of time has seen increased agency and a wider variety of roles allocated to Māori, female and working class characters, as well as greater ethnic diversity. Developments in New Zealand historiography are also reflected in fiction, although at times historical fiction prefigures written histories, or provides alternative views by depicting the experience of women, children and Māori, who often did not feature in conventional histories. While many historical novels for children, especially the earlier texts, are adventure stories set in the past and are not necessarily concerned with historical verisimilitude, an increasing number attempt to present authentic recreations of historical periods, including accounts of actual people and events, based on extensive research, and reinforced with peritextual material in the form of historical notes, bibliographies, maps and photographs.
The role of New Zealand historical fiction for children and young people has been not only to entertain young readers and inform them about their country's past, but to create and foster a sense of national identity
UAS Literary & Arts Journal
No full textProof copy provided by Tidal Echoes.Tidal Echoes presents an annual showcase of writers and artists who share one thing in common: a life surrounded by the rainforests and waterways of Southeast Alaska.Collage design of Jane Terzis paintings / Fisk, Chalise -- A Note from Chalise Fisk / Fisk, Chalice -- A Note from Kaleigh Lambert / Lambert, Kaleigh -- A Note from Emily Wall / Wall, Emily -- A Note from Katie Spielberger / Spielberger, Katie -- The Sacred and the Profane/ Terzis, Jane -- Wild Polaroid / Laster, Kate -- Reflecting on the Old Dock on Auke Lake / Bausler, Katie -- Dating Myself / Dauenhauer, Richard -- Forwarding John Updike's "Baseball" on The Writer's Almanac, June 22, 2009 / Dauenhauer, Richard -- Thoughts after Working on Salmon Eggs from our Grandson / Dauenhauer, Richard -- Burnt the Tea / Harris, Chelsie -- I Was in Love with a Boy Who Loved Dog-Sledding / Prescott, Vivian Faith -- The Last Word / Prescott, Vivian Faith -- Salmon Woman /Prescott, Vivian Faith -- At First Sight / Miller, Alexis Ross -- Organ Donor / Randall, SueAnna -- The Dichotomy of Dog Salmon / Miller, Alexis Ross -- Winter in Lingit Aani Brings Magpies and Ravens / Hayes, Ernestine -- To My Father, After My Last Summer Crewing on the Katrina Louise / Ross, Margaret -- Damp / Hughes-Skandijs, Kirsa -- Art 105 / Reed, Jennifer -- Portrait of a Man / Roys, Rob -- An Interview with Jane Terzis, Featured Artist / Kitchin, Hollis -- I Have the Capacity for Patience Terzis, Jane -- 4-H / Terzis, Jane -- Wildthing at the Glacier / Terzis, Jane -- I Have the Capacity for Honesty / Terzis, Jane -- I Have the Capacity for Obsessive Neatness / Terzis, Jane -- I Have the Capacity for Stubbornness / Terzis, Jane -- I Have the Capacity for Meanness / Terzis, Jane -- I Have the Capacity to Kill / Terzis, Jane -- Zora’s / Holloway, Robyn -- Thursdays after dinner / Holloway, Robyn -- Nixon’s reelection day / Holloway, Robyn -- They Break Not His Legs / Radford, Richard -- The girl / Eriksen, Christy NaMee -- How a mother remembers / Eriksen, Christy NaMee -- Atonement / Randall, SueAnn -- Romance in the Newsprint (strangely devised personal ads) / Laster, Kate -- Earthbound / Randall, SueAnn -- Memories of Winter / Lumba, Grace P. -- Metamorphosis / McQuitty, Christine -- Rivers in Washington / McQuitty, Christine -- Light at the End of the Tunnel / Bausler, Katie -- Sisters’ Islands / McQuitty, Christine -- Distress Signal / McQuitty, Christine -- Ice Caves and a Warm Wind / Bausler, Katie -- Coke Train / McCauley, Roberta -- My Backyard’s Winter Anatomy / Eckhout, Laurie -- Sunny With Chance of Feathers / Eckhout, Laurie -- Milky Way / Eckhout, Laurie -- Tag / Kiffer, Dave -- Islands / Kiffer, Dave -- Such Great Heights / Tomlinson, Elise -- The Seaweed Holt / Kirkwood, Daniel -- Sockeye / Elsensohn, Bonnie -- Insider/Outsider / Terzis, Jane -- Little Bitch / Terzis, Jane -- Pinocchio / Terzis, Jane -- Taylor, Home Depot, Tampa, 2001 / Terzis, Jane -- Danielle and Zouzou / Terzis, Jane -- My Father / Terzis, Jane -- Nine-Year-Old Kid / Terzis, Jane -- A Little Bit of Everything: Interview with Nick Jans, Featured Writer / Lambert, Kaleigh -- Crossing Sawyer / Wendel, Courtney -- Summer’s Drift / Rose, Chris -- Waterline / Ostrander, Brierley -- Ghost Meat, from the novel in process Nakolik / Jans, Nick -- The Giant’s Hand / Jans, Nick -- Rain Country / Jans, Nick -- The Stone Kyrielle / Bradac, Michael -- Autograph / Christiansen, Jack -- Shards / Chordas, Nina -- In Her Yellow Docs, She Shines / Christiansen, Summer -- Claudius Maximus / Richardson, Lacie -- Tracing Constellations / Benedict, Teslin -- Chasing the Promised Land / Lounsbury, Andy -- My Favorite Story About Elizabeth / Pasley, George R. -- The Destruction of the Russian Fort at New Archangel / Girardot, Dennis -- Jack of Hearts / Ostrander, Brierley K. -- Beached / Elsensohn, Bonnie -- Autumn Reflection / Blefgen, Linda M. -- JoJo / Miller, Linda -- Guardian / Miller, Linda -- King of the Jungle / Miller, Linda -- Child in the Woods / Stokes, Richard -- Respite / Strong, Daniel -- Burial at Sea / Radzilowski, John -- Gold / Slemmons, Mary Anne -- Geared for Drinking / Parker, Boni -- First Contact / Buffalo, T.M. -- Fish Story / Campbell, Jack -- Winter Mornings / Benedict, Helena -- Downpour / Stanway, Sondra -- Feather / Stanway, Sondra -- Snowbirds / Johnson, Tina M. -- The Sushi Chef Takes his Break During a Snowstorm on Lincoln Street / Johnson, Tina M. -- Author and Artist Biographies -- Wash Day in Cobh, Ireland / Blefgen, Linda M. -- Alaska Fisherman’s Building / Bornstein, Tom -- Bleed / Ostrander, Brierly K. -- Auke Lake Tree / Girven, Wend
Memorable Messages in Professional Female Athletes
No full textabstract: The present study explored memorable messages that professional female athletes have recalled throughout their careers. This study sought to understand what types of memorable messages are recalled by female athletes that have made it to the top of their sports at the professional level and to understand whether the recalled memorable messages were gendered or not. Respondents were asked via a survey questionnaire to recall a memorable message, describe the meaning and context of the message and finally what effect, if any, the message had on them. Qualitative survey questionnaire responses were analyzed using thematic analysis. Results indicated that memorable messages were not gendered in any way but there were several relevant themes, which included: wisdom, performance, instruction, motivation, dedication and identity. These results are new to the field of memorable messages within the field of sport and hold significance for future research.Dissertation/ThesisMasters Thesis Communication Studies 201
Twitter and E-Leadership in a Postsecondary Setting
No full textThe purpose of this article is to describe student experiences when incorporating Twitter into a Bachelor of Education (BEd) course. Participants were 8 first year BEd students who provided written answers to open-ended questions and participated in two focus group interviews. Findings showed that, after participants completed a Twitter assignment, their view of Twitter and its usage changed. Analyzed through the emerging concept of e-leadership, the learning experienced by students enhanced collaboration and communication between them and their instructor. An implication is that if BEd students are to effectively incorporate technology into future Kindergarten to Grade 12 classrooms, they need to experience digital literacy during undergraduate courses
A guide for Finnish textile companies entering Nigeria
No full textFinding new territories to expand a business is a common goal for many. Many markets are flooded with such a variety of products it is sometimes hard for an entering business to be noticed. Entering a virgin market that is not yet saturated with the mass companies is an ideal situation for a business. They would be new, fresh and desired. There are many countries that are considered to be up and coming economies. The factors in making these countries virtually untouched are many, some including poverty, crime, corruption and even terrorism.
The objective of this thesis is to show Nigeria as a lucrative target market and to create a guide for entry. There are barriers to entry and fears of terrorism that keep many businesses away. In this work, it will unveil some of the people in Nigeria, lessening the mystery to this culture. The Nigerian culture is very business orientated and worldwide, business is business, and this is a common bond that foreign businesses have with their Nigerian counterparts. This thesis is written jointly with a Nigerian author and an American author, giving the knowledge of a native Nigerian as well as the questions of an outsider.
The commissioners for this thesis are also used as the case companies. The first commissioner/case company is Vallila Interior, a Finnish interior design company and the focus will be on their brightly colored textiles. The second commissioner/case company will be Altretes Enterprises, a Nigerian interior design company wishing to import foreign textiles to meet their clientele’s demand. This thesis will be a guide on connecting the two companies and easing some fears the Finnish company might have about entering the Nigerian market
Disnarration, unnarration and circumnarration: a neonarrative study of Jane Austen's Novels
No full textThis project maintains that Jane Austen demonstrates modern spirit through those seemingly traditional works because her way of writing challenges the conventional concept of narration and incorporates fresh techniques that can be termed neonarrative strategy. As a developing branch of postclassical narratology first proposed by Gerald Prince and then expanded by Robyn Warhol and Brian Richardson, neonarrative theory includes such enlightening concepts as disnarration (narrative that refers to events that do not happen), unnarration (narrative that omits certain information out of narrative incapability or narrative choice) and circumnarration (narrative that indirectly narrates what happens). Austen's narrative practice of imagination, misconception and deception comprise the narrative domain of disnarration. Her characters are always defined and redefined by how they are positioned in relation to narration and disnarration, and at the same time the truth is constructed from a gradual development of false or hypothetical narrative. It is fair to say that her novels are narratives about the dangers of narratives, since truth is never what is appears to be and narrative can be illusory, misleading and deceptive. Austen's application of unnarratable silence or narrative refusal breaks from the tradition that only focuses on what is narrated. No matter if it is narrative incapability or narrative choice, the strategy of unnarration leads her to the narrative domain of possibility and infinity, and a consistent articulation of the relationship between what is narrated/voice and what is not narrated/silence strengthens the collaboration between the narrator/author and her narratee/reader. Austen manages the issues of passion and sexuality through circumnarration. She assimilates the erotic implications into the public activities of courtship and flirtation or the social issues of elopement and adultery, which highlights the passionate interactions between men and iii women without violating social conventions and destroys the fallacy that her novels are unpolluted in terms of corporeal reality. It is fair to say that Austen's narrative world is constructed in narration, and deconstructed and reconstructed in disnarration, unnarration, and circumnarration. The significance of what is revealed by looking at her novels through the neonarrative lens consists in her modern spirit of fluidity, possibility and infinity, which will be a new addition to the Austen study in the days of booming Janeite culture
Impact of health information technology on delivery and quality of patient care
No full textAdverse events in hospitalized patients are catastrophic and costly to individuals, hospitals and society. The use of electronic health records (EHR) is one promising system-level initiative that may improve provider performance, interdisciplinary communication, reduce adverse patient events, improve the overall quality of patient care, and ultimately improve patient satisfaction with hospital care. The study purpose was to examine the relationships among: (1) EHR adoption stage, (2) missed nursing care and (3) nursing practice environment, on hospitalized patient adverse outcomes and satisfaction. This secondary analysis of cross sectional data was compiled from four sources: (1) the State Inpatient Database, (2) Healthcare Information and Management Systems Society Dorenfest Institute database of EHR adoption, (3) Hospital Consumer Assessment of Healthcare Providers and Systems Survey, and (4) a survey of New Jersey hospital-based nurses. The analytic approach used ordinary least squares and multiple regression models to estimate the effects of EHR adoption on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. Robust procedures with Huber-White sandwich variance estimators and clustered means were used to account for the clustering of patients within hospitals. The final analytic sample consisted of 854,258 patients and 7,679 nurses in 70 New Jersey hospitals. Significant findings from this study indicate positive relationships between nursing practice environment and patient satisfaction, and inverse relationships between: (a) advanced EHR adoption and adverse outcome of prolonged length of stay, (b) nursing practice environment and missed nursing care and (c) missed nursing care and patient satisfaction. Among the subscales of the nursing practice environment tested, staffing and resource adequacy was the strongest predictor of missed nursing care and patient satisfaction. Further, findings indicate strong, significant relationships among staffing and resource adequacy, missed nursing care and patient satisfaction, and that these strong relationships are not confounding the effects of EHR adoption stage on patient satisfaction. These important findings suggest that sufficient staffing and resources is essential for advanced EHR adoption and patient reported outcomes of satisfaction. These findings may also signify that the patient benefits of advanced technology will only be realized in context of sufficient human resources.Ph. D.Includes bibliographical referencesIncludes vitaby Amanda Jane Hessel
