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Rationale: Occupation-based practice in the neonatal intensive care unit may be impacted by a plethora of contextual factors. There is limited literature of the lived experience mothers have with mothering occupations for the care of premature infants in a Level-IV neonatal intensive care unit. Methodology: A phenomenological design was used to interview mothers of premature infants in a Level-IV neonatal intensive care unit. The eight participants were mothers who had been in the neonatal intensive care unit for at least 1 month. Data was obtained via demographic form, two individual semi-structured interviews for each mother, and fieldnotes. Results: Thematic analysis yielded five themes and two subthemes which were: unanticipated journey to becoming a mother, emotional rollercoaster, mother's lost voice, subtheme cultural influences, roadblocks to mothering, unexpected layer to mothering occupations and subtheme support for mothering occupations. Each theme described a mother's experience with mothering. Conclusion: There is an importance for neonatal occupational therapists to provide support for mothering occupations for mothers from a variety of demographic and cultural backgrounds. Occupation-based practice in the neonatal intensive care unit continues to need attention for inclusion of all mothers. The findings showed that cultural humility should be practiced in family-centred care in the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Clinical guidelines recommend clinicians in skilled nursing facilities (SNFs) monitor body weight and signs and symptoms related to heart failure (HF) and encourage a sodium restricted diet to improve HF outcomes; however, SNFs face considerable challenges in HF disease management (HF-DM). In the current study, we characterized the challenges of HF-DM with data from semi-structured, in-depth interviews with patients, caregivers, staff, and physicians from nine SNFs. Patients receiving skilled nursing care were interviewed together as a dyad with their caregiver. A datadriven, qualitative descriptive approach was used to understand the process and challenges of HF-DM. Coded text was categorized into descriptive themes. Interviews with five dyads (n = 10 individuals), SNF nurses and certified nursing assistants (n = 13), and physicians (n = 2) revealed that, among the sample, HF care was not prioritized above other competing health concerns. Staff operated in the challenging SNF environment largely without protocols or educational materials to prompt HF-DM. [ABSTRACT FROM AUTHOR]

Purpose: Multiple-measure principal evaluation systems have become commonplace in the past decade, but we do not know how principals perceive their evaluations under these regimes. This study analyzes how principals perceive evaluation in a state that was an early adopter of such a system. It describes how attitudes are explained by individual and contextual factors, performance ratings, and elements of the evaluation process. Research Methods: Using data from a statewide survey of Tennessee principals in three consecutive school years, we create an index of principal evaluation perceptions of evaluation, then employ regression analysis to predict principals' attitudes with measures gleaned from survey and administrative data sources. Findings: High school and veteran principals have more negative views of their evaluations. Practice ratings from the principal's supervisor, though not the overall evaluation score, are positively correlated with attitudes. Principals assigned ratings more often view evaluation more positively, even accounting for their rating, as do principals who have worked longer with their evaluator. We find no evidence that racial or gender matching between principals and raters leads to more positive perceptions, and in fact Black principals may perceive evaluation more negatively when their evaluator is Black. Implications: Our results suggest some directions for states and districts seeking to make evaluation more meaningful for principals. Principals appear to value both frequency of feedback and consistency in raters over time. These factors may be especially important for low-rated principals, veteran principals, and those in secondary schools, who may perceive less value from principal evaluation. [ABSTRACT FROM AUTHOR]

Stable carbon isotope fractionation is a valuable tool for monitoring natural attenuation and to establish the fate of groundwater contaminants. In this study, we measured carbon isotope fractionation during aerobic and anaerobic degradation of two chlorinated benzenes: monochlorobenzene (MCB) and 1,2,4-trichlorobenzene (1,2,4-TCB). MCB isotope fractionation was measured in anaerobic methanogenic microcosms, while 1,2,4-TCB isotope experiments were carried out in both aerobic and anaerobic microcosms. Large isotope fractionation was observed in both the anaerobic microcosm experiments. Enrichment factors (ϵ) for anaerobic reductive dechlorination of MCB and 1,2,4-TCB were -5.0‰ ± 0.2‰ and -3.0‰ ± 0.4‰, respectively. In contrast, no significant isotope fractionation was found during aerobic microbial degradation of 1,2,4-TCB. The cleavage of a C-Cl σ bond occurs during anaerobic reductive dechlorination of MCB and 1,2,4-TCB, while no s bond cleavage is involved during aerobic degradation via dioxygenase. The difference in isotope fractionation for aerobic versus anaerobic biodegradation of MCB and 1,2,4-TCB can be explained by the difference in the initial step of aerobic versus anaerobic biodegradation pathways. [ABSTRACT FROM AUTHOR]