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ObjectiveThe Word Cloud is a frequent wish in the 3 Wishes Project developed to nurture peace and ease the grieving process for dying critically ill patients. The objective was to examine whether Word Clouds can act as a heuristic approach to encourage a narrative orientation to medicine. Narrative medicine is an approach which can strengthen relationships, compassion and resilience.DesignWord Clouds were created for 42 dying patients, and we interviewed 37 family members and 73 clinicians about their impact. We conducted a directed qualitative content analysis, using the 3 stages of narrative medicine (attention, representation, affiliation) to examine the narrative medicine potential of Word Clouds.ResultsThe elicitation of stories for the Word Cloud promotes narrative attention to the patient as a whole person. The distillation of these stories into a list of words and the prioritisation of those words for arrangement in the collage encourages a representation that did not enforce a beginning, middle or end to the story of the patient's life. Strong affiliative connections were achieved through the honouring of patients, caring for families and sharing of memories encouraged through the creation, sharing and discussion of Word Clouds.ConclusionsIn the 3 Wishes Project, Word Clouds are 1 way that families and clinicians honour a dying patient. Engaging in the process of making a Word Cloud can promote a narrative orientation to medicine, forging connections, making meaning through reminiscence and leaving a legacy of a loved one. Documenting and displaying words to remember someone in death reaffirms their life.

Chronic obstructive pulmonary disease is one of the most significant chronic illnesses of adults. Comprehensive care of the affected patient requires the medical-surgical nurse to have knowledge of the disease process, collaborative management, and nursing care based on research and current practice guidelines., Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. While deaths from heart disease, cancer, and stroke have declined, COPD is on the [...]

Nurses in adult patient care will see increasing numbers of adult cystic fibrosis patients (CF) as such patients are living longer. CF is caused by a fairly common genetic defect that produces excess secretions in the gastrointestinal, respiratory and reproductive systems, as well as the sweat glands. Respiratory problems due to lung congestion require chest percussive therapy, DNase treatment, and frequent mucus clearance. Other problems include pancreatic insufficiency, glucose intolerance, poor digestion, dehydration, salt imbalance, reproductive problems and psychosocial difficulties.

I am new to the service plumbing/drain cleaning industry after spending 30 years in the dental field. I have been very frustrated trying to find contractors who will share information [...]

The article reports on the adoption of pedagogical strategies to achieve a basic understanding of sustainability, integrate the academic and experiential modes of learning, and foster a sense of civic engagement among high school students. The Learn, Experience, Navigate, Solve (LENS) program of the Wake Forest University (WFU) is presented along with the learning outcomes and core competencies of the LENS curriculum. The LENS curriculum is explained together with the tools to support students.

Abstract: William Faulkner's non-chronological story tellingstyle has long been a challenge to critics and apuzzle to beginning literature students. ``A Rose forEmily,'' one of Faulkner's most frequently anthologizedstories, exemplifies the complexity of Faulkner'streatment of time. In this paper, we apply aconstraint-based problem solving method to an analysisof the chronology of ``A Rose for Emily.'' Constraintlogic programming is a declarative programminglanguage paradigm that solves problems by enforcingconstraints among variables. CLP's ability to sortnumeric variables that do not yet have definite valuesmakes it possible to sort the events of ``A Rose forEmily'' with only fragmented and relative timeinformation. In attempting to sort the events of thestory, we find an inconsistency in the temporalreferences scattered throughout the narrative. Afterremoving this inconsistency, we are able to compareour chronology with earlier ones and discuss thethematic relevance of Faulkner's nonlinear plots.

IMPORTANCE: Although family members of patients who die in the intensive care unit commonly experience long-term psychological distress, end-of-life bereavement support programs for such relatives are uncommon. Whether art influences the grief experience of families is largely unexplored. OBJECTIVE: To explore the influence of personalized paintings created to honor deceased critically ill patients on family members’ bereavement experience. DESIGN, SETTING, AND PARTICIPANTS: A qualitative descriptive analysis was conducted of semistructured interviews of grieving relatives who received a painting after the death of their loved one. The deceased patients were from a 21-bed medical-surgical intensive care unit. Eleven families were invited to receive a painting, of whom 1 family declined. A total of 22 family members of 10 patients who died in the intensive care unit were interviewed in the study between July 11, 2017, and May 19, 2019. INTERVENTIONS: Patients were enrolled in an end-of-life care program that elicits and implements wishes of patients and their families to bring peace during the dying process. Selected families of 10 decedents were invited to receive a painting to honor their loved one 1 to 10 months after the patient’s death. Using details about the patient’s life story, the artist created individualized paintings to commemorate each patient. MAIN OUTCOMES AND MEASURES: The experiences of family members receiving a personalized painting and its reported influence on their grieving experience. RESULTS: The family members of 10 decedents (mean [SD] age, 60 [14] years; 5 women [50%]; 8 White patients [80%]) were interviewed. The central theme of art to facilitate healing was illustrated through the following domains: the cocreation process, painting narratives, postmortem connections, and legacy. The process of cocreating the paintings with the artist and family members involved reminiscing, storytelling, and creativity. Family members emphasized the role of art to facilitate healing, exemplified through connections with images portrayed that deeply resonated with memories of their loved one. Participants indicated that the paintings validated that the patient was remembered, helped families feel less alone during a time of grief, honored the loved one’s life, and enhanced connections between family members and clinicians. CONCLUSIONS AND RELEVANCE: This qualitative study’s findings suggest that the creation of personalized paintings commemorating the lives of patients may help foster legacy and postmortem connections with clinicians and may help family members in their healing process.

A letter to the editor and a reply are presented in response to the article "Understanding barometric dampers" by Ray Wohlfarth in the January 2013 issue and another letter expressing her appreciation with the information disseminated by the magazine about service plumbing/drain cleaning industry.

Several letters to the editor are presented in response to articles in the September 2009 issue including "Ultimate Italy," by Anya von Bremzen, "Smart Traveler," by Mark Orwoll and "Opinion: Unhappy to Serve You."