7: Appendix - Nursing organizations’ journal Index
Nursing organizations’ journal Index
Use this index to connect with the organizations and literature associated with various fields of nursing.
Nursing Organization |
Website |
UTA Libraries Journal Link |
|---|---|---|
| Academy of Medical-Surgical Nurses | www.amsn.org | MEDSURG Nursing Journal |
| Academy of Neonatal Nursing | www.academyonline.org | Neonatal Network: The Journal of Neonatal Nursing |
| Air & Surface Transport Nurses Association | www.astna.org | N/A |
| American Academy of Ambulatory Care Nursing | www.aaacn.org | ViewPoint |
| American Academy of Nursing | www.aannet.org | Nursing Outlook |
| American Association for Men in Nursing | www.aamn.org | Nursing History Review |
| American Association for the History of Nursing | www.aahn.org | Nursing History Now |
| American Association of Colleges of Nursing | www.aacnnursing.org | Journal of Professional Nursing |
| American Association of Critical-Care Nurses | www.aacn.org | Critical Care Nurse |
| American Association of Diabetes Educators | www.diabeteseducator.org | ADCES in Practice |
| American Association of Legal Nurse Consultants | www.aalnc.org | Journal of Legal Nurse Consulting |
| American Association of Managed Care Nurses | www.aamcn.org | Journal of Managed Care Nursing |
| American Association of Neuroscience Nurses | www.aann.org | Journal of Neuroscience Nursing |
| American Association of Nurse Anesthetists | www.aana.com | AANA Journal |
| American Association of Nurse Attorneys | www.taana.org | N/A |
| American Association of Spinal Cord Injury Nurses | www.academyscipro.org | Journal of Spinal Cord Medicine |
| American Board of Nursing Specialties | www.nursingcertification.org | N/A |
| American Association on Intellectual and Developmental Disabilities | www.aaidd.org |
American Journal on Intellectual and Developmental Disabilities
Intellectual and Developmental Disabilities
|
| American College of Nurse Midwives | www.midwife.org | Journal of Midwifery & Women’s Health |
| American Holistic Nurses Association | www.ahna.org | Beginnings |
| American Nephrology Nurses’ Association | www.annanurse.org | Nephrology Nursing Journal |
| American Nurses Association | www.nursingworld.org | American Nurse |
| American Nursing Informatics Association | www.ania.org | Journal of Informatics Nursing |
| American Organization of Nurse Executives | www.aone.org | Nurse Leader |
| American Psychiatric Nurses Association | www.apna.org | Journal of the American Psychiatric Nurses Association |
| American Public Health Association | www.apha.org | American Journal of Public Health |
| American Society of Ophthalmic Registered Nurses | www.asorn.org | InSight |
| American Society for Pain Management Nursing | www.aspmn.org | Pain Management Nursing |
| American Society of Paranesthesia Nurses | www.aspan.org | Journal of PeriAnesthesia Nurses |
| Association for Professionals in Infection Control and Epidemiology | www.apic.org | American Journal of Infection Control |
| Association for Nursing Professional Development | www.anpd.org | Journal for Nurses in Professional Development |
| Association for Radiologic and Imaging Nursing | www.arinursing.org | Journal of Radiology Nursing |
| Association for Vascular Access | www.avainfo.org | Journal of the Association for Vascular Access |
| Association of Camp Nurses | www.campnurse.org | CompassPoint |
| Association of Community Health Nursing Educators | www.achne.org | N/A |
| Association of Nurses in AIDS Care | www.nursesinaidscare.org | Journal of the Association Of Nurses in AIDS Care |
| Association of Pediatric Hematology/Oncology Nurses | www.aphon.org | N/A |
| Association of Perioperative Registered Nurses | www.aorn.org | AORN Journal |
| Association of Rehabilitation Nurses | www.rehabnurse.org | Rehabilitation Nursing Journal |
| Association of Women’s Health, Obstetric and Neonatal Nurses | www.awhonn.org | Journal of Obstetric, Gynecologic, & Neonatal Nursing |
| Commission on Graduates of Foreign Nursing Schools | www.cgfns.org | N/A |
| Dermatology Nurses’ Association | www.dnanurse.org | Journal of the Dermatology Nurses’ Association |
| Developmental Disabilities Nurses Association | www.ddna.org | International Journal of Nursing in Intellectual and Developmental Disabilities |
| Emergency Nurses Association | www.ena.org | Journal of Emergency Nursing |
| Endocrine Nurses Association | www.endo-nurses.org | Endocrine News |
| Gerontological Advanced Practice Nurses Association | www.gapna.org | Geriatric Nursing |
| Hospice and Palliative Nurses Association | www.hpna.org | Journal of Hospice and Palliative Care Nursing |
| Infusion Nurses Society | www.ins1.org | Journal of Infusion Nursing |
| International Council of Nurses | www.icn.ch | N/A |
| International Nurses Society on Addictions | www.intnsa.org | Journal of Addictions Nursing |
| International Organization of Multiple Sclerosis Nurses | www.iomsn.org | International Journal of MS Care |
| International Society of Nurses in Genetics | www.isong.org | N/A |
| International Society of Plastic and Aesthetic Nurses | www.ispan.org | Plastic Surgical Nursing |
| International Society of Psychiatric-Mental Health Nurses | www.ispn-psych.org | Archives of Psychiatric Nursing |
| National Association Directors of Nursing Administration/ Long Term Care | www.nadona.org | The Director: Journal of the National Association of Directors of Nursing Administration in Long Term Care |
| National Association for Home Care and Hospice | www.nahc.org | N/A |
| National Association of Clinical Nurse Specialists | www.nacns.org | Clinical Nurse Specialist: The International Journal for Advanced Nursing |
| National Association of Hispanic Nurses | www.thehispanicnurses.org | Hispanic Health Care International |
| National Association of Neonatal Nurses | www.nann.org | Advances in Neonatal Care |
| National Association of Nurse Practitioners in Women’s Health | www.npwh.org | Women’s Healthcare: A Clinical Journal for NPs |
| National Association of Orthopaedic Nurses | www.orthonurse.org | Orthopaedic Nursing |
| National Association of Pediatric Nurse Practitioners | www.napnap.org | Journal of Pediatric Health Care |
| National Association of School Nurses | www.nasn.org | The Journal of School Nursing |
| National League for Nursing | www.nln.org | Nursing Education Perspectives |
| National Organization of Nurse Practitioner Faculties | www.nonpf.com | Nurse Educator |
| National Student Nurses Association | www.nsna.org | Imprint |
| North American Nursing Diagnosis Association International | www.nanda.org | International Journal of Nursing Knowledge |
| Oncology Nursing Society | www.ons.org | Clinical Journal of Oncology Nursing |
| Organization for Associate Degree Nursing | www.oadn.org | Teaching and Learning in Nursing |
| Pediatric Endocrinology Nursing Society | www.pens.org | Journal of Pediatric Nursing |
| Preventive Cardiovascular Nurses Association | www.pcna.net | Journal of Cardiovascular Nursing |
| Respiratory Nursing Society | www.respiratorynursingsociety.org | Perspectives in Respiratory Nursing |
| Society of Gastroenterology Nurses & Association, Inc. | www.sgna.org | Gastroenerology Nursing |
| Society of Otorhinolaryngology and Head-Neck Nurses, Inc. | www.sohnnurse.com | ORL – Head and Neck Nursing Journal |
| Society of Pediatric Nurses | www.pedsnurses.org | Journal of Pediatric Nursing |
| Society of Trauma Nurses | www.traumanurses.org | Journal of Trauma Nursing |
| Society of Urologic Nurses and Associates | www.suna.org | Urologic Nursing |
| Society for Vascular Nursing | www.svnnet.org | Journal of Vascular Nursing |
| Texas Nursing Association | www.texasnurses.org | Texas Nursing |
| Transcultural Nursing Society | www.tcns.org | Journal of Transcultural Nursing |
| Wound, Ostomy, and Continence Nurses Society | www.wocn.org | Journal of Wound, Ostomy and Continence Nursing |


13.6: Other Forms of Religious Practice
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- Jennifer Hasty, David G. Lewis, & Marjorie M. Snipes
- OpenStax
Learning Objectives
By the end of this section, you will be able to:
- Identify utopian religious communities.
- Explain the historical and social importance of the Shakers.
- Identify secular religion.
- Give an example of secular religion.
Utopian Religious Communities
While the most typical form of religious community today is a group of people who share a common faith and set of beliefs and meet periodically to worship, there are other ways of creating religious community. One example, widespread in the United States during the 19th century, is utopian religious communities. A utopian community is a community intentionally established by a group of people seeking to live out their ideas of an ideal society. Utopian communities may be secular or religious. The utopian communities that are most successful share certain characteristics: they are physically separate from the larger society; establish a degree of economic self-sufficiency, through either agriculture or industry; and have a clear authority structure and ideology, or shared set of beliefs.
There have been dozens of utopian religious communities in American history. In the 19th century, many people in Europe viewed the United States as a blank slate, a country unburdened by history or tradition. The forced removal of Indigenous peoples opened up vast areas of land and natural resources to White settlers and new religious groups seeking autonomy. While many of these societies were short-lived, impractical, and troubled by discord, they were home to thousands of Americans during the 19th and 20th centuries. Today, we still find small utopian communities throughout the United States, some based primarily on religion (such as the Bruderhof) and others on sustainable economics (e.g., Serenbe in Fulton County, Georgia).
Religious utopian communities make particular religious beliefs the center of the community. Some such communities separate themselves completely from secular society, while others establish an enclave, a so-called heaven on Earth within the larger society, that members hope will spread outward and attract more converts. Although utopian religious communities are relatively rare today, they do exist. The Amish, found throughout the United States but primarily in Pennsylvania, Ohio, and Indiana, live in small, self-contained farming communities built around very traditional Swiss German and Protestant roots. The Amish have what they call a plain lifestyle based on simple technology, and they tend to separate themselves from the non-Amish communities around them. The Hutterites, now located primarily in Canada, are also from German Protestant roots and are much like the Amish, except they typically are more interactive with their non-Hutterite neighbors and do not prohibit more modern technology. The Bruderhof are more recent utopian religious communities, originating in the 1920s, also with German Protestant roots but now found in many different places, including South America, Africa, Europe, Australia, and the United States. The Bruderhof have a communal lifestyle based on biblical ideals, though they interact with communities around them. While they do have Bruderhof industries, such as a furniture industry for special-needs children, they also work and study in secular society.
Among the most successful of the 19th-century American religious utopian communities was the United Society of Believers in Christ’s Second Appearing, commonly known as the Shakers. Although they first formed near the city of Manchester in England in the mid-1700s, the group did not become a self-sustaining utopian community until after members immigrated to the United States in 1774. Their first settlement was established at Watervliet, New York, in 1776 under the leadership of an Englishwoman, Ann Lee. Mother Ann, as Shakers called her, and her original eight English followers traveled throughout New England seeking converts to join the community at Watervliet. Following Mother Ann’s death in 1784, caused by beatings she received during her period of itinerant evangelism, the Shaker society began to develop a more formal structure that codified beliefs, social expectations, and a strict work ethic. By 1790, new members were required to sign covenants in which they pledged to consecrate all of their property to the society, work for the communal good of the group, follow a celibate life (with those who were already married ending their marriages prior to formally becoming a Shaker), and adhere to Shaker principles and beliefs. From a single, small settlement at Watervliet, Shaker societies grew and spread over 10 U.S. states—New York, Connecticut, Maine, Massachusetts, New Hampshire, Ohio, Indiana, Kentucky, Florida, and Georgia—with a membership at its height in excess of 6,000 individuals. Today, the Shakers survive as a single remaining society at Sabbathday Lake, Maine. There are now two remaining covenanted Shakers.
The Shakers are a millennialist Christian faith, meaning that they believe that Christ has already returned and is present now on Earth as the Holy Spirit within believers. With Christ within them, Shakers believe that it is their duty to establish a heaven on Earth. The Shaker principles of faith historically encompass a range of social and religious tenets. They believe that God is dual, both male and female, and they practice gender equality, vesting leadership in both men and women since their beginnings in the late 18th century. They also embrace a commitment to racial equality. Even during the 19th century, as the Civil War raged throughout the United States, this included the practice of housing Black people and White people within the same community with equal access to resources. Shakers are dedicated pacifists, refusing to engage in warfare, and they commit to hard physical labor and self-improvement, taking as their motto a phrase attributed to Mother Ann: “Hands to work and hearts to God.”
The Shakers contributed a great deal to the material culture of the United States. Examples of products developed and successfully marketed by the group include paper seed packets (now used throughout the seed industry worldwide), their simple and graceful furniture, an improved washing machine, waterproof clothing, the circular saw, and medicinal herbs. Their artifacts, architecture, and music continue to be widely recognized and highly regarded. The Shaker song “Simple Gifts” (1848), borrowed and used by Aaron Copland in his ballet score Appalachian Spring (1944), has been performed at three U.S. presidential inaugurations.
While there are few Shakers left today, they remind us of the importance of religion as an enduring institution, the power of religion to bind people together into common cause, and the rich diversities embedded in the heart of faith traditions.
Secular Religion
Secular religion is a system of beliefs held by a society that elevates social ideas, qualities, or commodities to a metaphysical, semidivine status. Often, the group sees itself in terms of a divine image, creating a situation in which, as Émile Durkheim famously said, “society = God.” Various types and degrees of nationalism are a form of secular religion in which a group shows honor, respect, and allegiance to the nation itself as a sacred entity. For large and diverse societies, secular religion can create a powerful and enduring bond among otherwise very different groups of people. Often, philosophical ideas and materialism itself have been at the center of secular religion.
One of the most prominent examples of secular religion is nationalism, the belief that the nation-state and its interests are more important than those of local groups. U.S. sociologist Robert Bellah (1967) studied secular religion in the United States and documented the many ways that American society uses religious practices, such as myth, ritual, and sacred space, to elevate the idea of the nation-state. During occasions such as presidential inaugurations and the convocation of Congress, for example, it is routine to use sacred language and prayer, elevating the nation-state to a privileged, sacred status, blessed, ordained, and legitimized by religious imagery. Rituals such as raising the national flag while saying a pledge to the nation-state, flying flags at full versus half-mast, and draping flags over the coffins of deceased service members are practices of secular religion. Burials at nation-state cemeteries such as Arlington National Cemetery may be filled with imagery of secular religion, including a caisson, a bugler, a drummer, and gun salutes.
Ethnographic Sketches
Día de los Muertos
Experience of Marjorie Snipes, chapter author
In the Andean highlands of Argentina, most communities celebrate All Souls’ Day, or Día de los Muertos (Day of the Dead), on November 1 and 2 every year. While this Catholic ritual commemorates the recently departed, usually those who have died in the past three years, it also includes elements of Indigenous religious practices and beliefs centered on Pachamama (Mother Earth). This integration of beliefs from more than one religious system is common across cultures and is called syncretism .
The practice of Día de los Muertos is a solemn occasion. Families prepare a favorite meal or food items that they associate with the recently departed and set a place setting for their soul ( alma ). Candles and flowers adorn the elaborately decorated family table. The meal remains available for the soul of the departed from the evening of November 1 until the evening of November 2. During that time, family members meet periodically around the table to offer prayers and to share remembrances of the deceased, and souls are invited to eat and prepare themselves for the journey to the spirit world. Souls of the departed are believed to remain strongly attached to their families and unwilling to leave the living world for three years following death. They must be coaxed by surviving family members to make a peaceful transition to the spirit world, where they can rest. In the southern Andes, many people believe that moths are visual symbols of the soul’s presence. With candles lit throughout the night of November 1, families in rural Andean households often encounter moths. This serves as ritual affirmation.
On the evening of November 2, after a last prayer of departure, Andean families in El Angosto will gather the favorite foods of their departed and offer them to Pachamama by piling or burying the food into an altar of rocks. Each household has a family altar near their house, called a mojon , dedicated to Pachamama. It is a cairn predominantly consisting of white rocks, each believed to symbolize the goddess. The rocks may be naturally white, consisting of milky quartz, a common rock in the area, or they may be calcified or even painted white. During fieldwork, I asked people about the importance of the color white, but their answers were similar to the types of answers many of us would give to questions about our traditions: “This is her special color,” “It’s just this way,” or “This is our custom.” These truthful responses represent enculturation. As a scientist, though, I seek connections between the color white, stones, and Pachamama.  Understanding symbolism is important because it gives anthropologists a window into what matters most to those we are studying.
Mini-Fieldwork Activity
Participant Observation: Analysis of a Religious Service
Do fieldwork and an analysis of a religious service of your choice. With permission from the religious leader(s), attend the service and practice participant observation. Using what you have learned about sacred place and ritual, analyze the physical environment where the service is occurring. Where is/are the threshold(s)? Where is the axis mundi? How does the built environment contribute to the practice of religion and spiritual exercises? In the service itself, what are the primary themes, and how do different participant constituencies respond to these? Does the service conform to any of the rituals that you studied in this chapter? If so, how? After analyzing the service, reflect on your experience of doing this mini-fieldwork activity.


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401(k) plan
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common retirement plan in the United States, in which employers match employees’ contributions but individuals are responsible for investing their own retirement account
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activity of daily living (ADL)
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action required to care for yourself, such as feeding yourself, bathing, dressing, using the toilet, and moving around your environment
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activity theory
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theory that suggests being more active and socially engaged is beneficial for older adults
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adult daycare
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facility that provides supervision and activities for older adults who are not capable of safely staying at home unsupervised
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ageism
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discrimination against or different treatment of someone solely due to their age
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aging in place
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effort to live safely and comfortably at home while maintaining as much independence as possible
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assisted living
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institutional housing for individuals who have physical and/or cognitive limitations that prevent them from living independently or at home
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bridge employment
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paid work after retirement, either in a similar job as before or in a new profession
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caregiver
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individual who looks after and assists those with health problems and functional needs such as ADLs and IADLs
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congregate housing
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residential community or facility that offers older adults more access to resources, including common areas, that typical independent living communities may not provide
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continuing care community
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housing facility that provides a wide range of types of care for older adults, often ranging from independent living to nursing home care
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disengagement theory
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theory that describes shrinking social networks as evidence that separating yourself from your social ties is a normal part of aging
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elder abuse
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mistreatment or neglect of older adults
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home health aide
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individual who travels to older adults’ homes and provides assistance with health care, ADLs, IADLs, and other tasks needed to help the individual live at home
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instrumental activity of daily living (IADL)
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task essential to functioning independently, such as using the phone, shopping, preparing meals, performing home maintenance and housekeeping, doing laundry, using transportation, managing medications, and dealing with finances
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integrity versus despair
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[definition needed]
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kinkeeper
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family member who takes on the responsibility of organizing family events, maintaining family traditions, and helping family members stay in touch
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life review
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someone’s reflection on the life they have lived, their behaviors, accomplishments, relationships, and decisions
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locus of control
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extent to which we believe we have personal control over our own life and life outcomes
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negative affect
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extent to which someone experiences negative emotions such as anger or sorrow
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nursing home
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institutional housing similar to assisted living but for residents who need medical care and supervision, including skilled nursing care
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pension plan
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traditional retirement plan in the United States, in which employers provide a lifelong financial benefit to retired employees
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phased retirement
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process of decreasing hours and responsibilities at work to retire gradually over a period of time
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positive affect
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extent to which someone experiences positive emotions such as joy
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selection, optimization, and compensation (SOC) theory
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theory suggesting that older adults become more selective in the activities they pursue, engage in activities to enhance their performance, and change their strategy to adjust for declines
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social convoy
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analogy for the way in which social networks change over time as some new members join and others fall away
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social network
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complex variety of people with whom individuals are socially engaged
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social support
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practical or emotional support provided by people with whom we interact socially
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socioemotional selectivity theory
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theory suggesting that increased focus on emotional goals makes older adults more selective in their social partners, leading to a smaller social network that is more emotionally satisfying


5: Rational Number Arithmetic Last updated Save as PDF Page ID 35004 Illustrative Mathematics OpenUp Resources 5.1: Interpreting Negative Numbers 5.1.1: Interpreting Negative Numbers 5.2: Adding and Subtracting Rational Numbers 5.2.1: Changing Temperatures 5.2.2: Changing Elevation 5.2.3: Money and Debts 5.2.4: Representing Subtraction 5.2.5: Subtracting Rational Numbers 5.2.6: Adding and Subtracting to Solve Problems 5.3: Multiplying and Dividing Rational Numbers 5.3.1: Position, Speed, and Direction 5.3.2: Multiplying Rational Numbers 5.3.3: Multiply! 5.3.4: Dividing Rational Numbers 5.3.5: Negative Rates 5.4: Four Operations with Rational Numbers 5.4.1: Expressions with Rational Numbers 5.4.2: Solving Problems with Rational Numbers 5.5: Solving Equations When There Are Negative Numbers 5.5.1: Solving Equations with Rational Numbers 5.5.2: Representing Contexts with Equations 5.6: Let's Put It to Work 5.6.1: The Stock Market


11.2: Sea Level Terminology
When talking about “sea level”, it's important to make sure that we define some important terms:
Water Depth
Water depth is the distance between the sediment surfaces and the water surface. This is an instantaneous measurement that is location specific.
Eustatic Sea Level
Eustatic sea level is the distance between the center of the Earth and the sea surface. Given that the center of the Earth is a universal datum, this allows this value to be measured or calculated globally. You can change global sea level by changing the amount of water in the oceans or changing the amount of water the ocean basins can hold. Drivers of eustatic change include:
- Thermohaline changes – changes in the volume of water in the ocean because of temperature changes. Over a scale of decades, changes in the temperature of the shallow ocean can change eustatic sea level by centimeters to tens of centimeters. Over centuries to millennia, circulation can warm the deep ocean as well and cause several meters of eustatic change.
- Glacial ice volume – when large amounts of glacial ice accumulate on land, sea level falls. When glacial ice on land melts and runs back to the oceans, eustatic sea level rises. Because it's largely contained in the ocean already, the amount of floating sea ice has much less of an effect. Changes in the volume of glacial ice have the potential to cause very large changes in eustatic sea level over relatively short periods of time (many tens of meters over a few millennia).
- Volume of terrestrial aquifers – this is the amount of groundwater stored on land. It has a relatively minor and gradual contribution, something on the order of a few meters over tens of millennia.
- Volume of the ocean basins – Long term tectonic changes can change the amount of water held in the ocean basins. Although it is potentially a very large amount of water, these changes take a very long time (hundreds of meters over tens of millions of years).
Relative Sea Level (RSL)
Relative sea level is the distance between a local datum and the sea surface. It’s a function of tectonism (subsidence or uplift) and eustasy and allows us to track the difference between them through time. You increase relative sea level when the distance between the two increases; you decrease relative sea level when the two get closer together.
Relative sea level (RSL) is a useful concept to consider with regards to transgressions because it determines “ accommodation (A)”, which is the room available for sediment to accumulate. An increase in RSL increases accommodation and gives us the potential to preserve sediment. An overall decrease in RSL gives us less (or removes) accommodation because there is less space for sediment to accumulate. In terms of what causes transgressions and regressions, accommodation is a useful concept, but it alone is not enough to control transgression versus regression. We must also consider sediment supply (S) which is the amount of sediment that is delivered to an area (which is a function of climate, tectonism, etc.).
Given all of that, we can revisit the definitions of transgression and regression that we talked about at the beginning of this section to think about how the balance between sediment supply and accommodation controls transgressions and regressions. In cases where the the sediment supply (S) is greater than accommodation (A), a regression occurs and the shoreline is pushed in a seaward direction (overall shallowing). In cases where the sediment supply is less than accommodation, a transgression occurs and the shoreline migrates in a landward direction (progressive deepening).


15.3: External Environments and Industries
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- Identify contemporary external forces pressuring organizations.
Industry and organizational leaders monitor environments to identify, predict, and manage trends, issues, and opportunities that their organizations and industries face. Some corporations, such as Amazon, anticipate and even create trends in their environments. Most, however, must adapt. External environments, as identified in the previous section, can be understood by identifying the uncertainty of the environmental forces. Figure \(\PageIndex{1}\) illustrates a classic and relevant depiction of how scholars portray environment-industry-organization “fit,” that is, how well industries and organizations align with and perform in different types of environments.
The two dimensions of this figure represent “environmental complexity” (i.e., the number of elements in the environment, such a competitors, suppliers, and customers), which is characterized as either simple or complex, and “environmental change,” described as stable or unstable. How available monetary and financial resources are to support an organization’s growth is also an important element in this framework. Certain industries—soft drink bottlers, beer distributors, food processors, and container manufacturers—would, hypothetically, fit and align more effectively in a stable (i.e., relative unchanging), simple, and low-uncertainty (i.e., has mostly similar elements) external environment—cell 1 in Figure \(\PageIndex{1}\). This is referred to when organizations are in a simple-stable environment . Of course unpredicted conditions, such as global and international turmoil, economic downturns, and so on, could affect these industries, but generally, these alignments have served as an ideal type and starting point for understanding the “fit” between environment and industries. In a stable but complex, low- to moderate-uncertainty environment, cell 2 in Figure \(\PageIndex{1}\), universities, appliance manufacturers, chemical companies, and insurances companies would generally prosper. This is referred to when organizations are in a complex-stable environment . When the external environment has simple but high to moderate uncertainty, cell 3 of Figure \(\PageIndex{1}\), e-commerce, music, and fashion clothing industries would operate effectively. This is referred to when organizations are in a simple-unstable environment . Whereas in cell 4 of Figure \(\PageIndex{1}\), an environment characterized by a high degree of uncertainty with complex and unstable elements, industries and firms such as computer, aerospace, airlines, and telecommunications firms would operate more effectively. This is referred to when organizations are in a complex-unstable environment .
Figure \(\PageIndex{1}\) is a starting point for diagnosing the “fit” between types of external environments and industries. As conditions change, industries and organizations must adapt or face consequences. For example, educational institutions that traditionally have been seen to operate best in low- to moderate-uncertainty environments, cell 4 of Figure \(\PageIndex{1}\), have during this past decade experienced more high to moderate uncertainty (cell 2)—and even high uncertainty (cell 1). For example, for-profit educational institutions such the University of Phoenix and others—as compared to not-for-profit universities and colleges, such as public state institutions, community colleges, and private nonprofit ones—have undergone more unstable and complex forces in the external environment over the past decade. Under the Obama administration, for-profit universities faced greater scrutiny regarding questionable advertising, graduation rates, and accreditation issues; lawsuits and claims against several of these institutions went forward, and a few of the colleges had to close. The Trump administration has shown signs of alleviating aggressive governmental control and monitoring in this sector. Still, higher educational institutions in general currently face increasingly complex and unstable environments given higher tuition rates, increased competition from less-expensive and online programs, fewer student enrollments, and an overabundance of such institutions. Several private, not-for-profit higher educational institutions have merged and also ceased to exist. Adapting to increasingly rapid external change has become a rallying call for most industries and organizations as the 21st century evolves.
Organizational Complexity
It is important to point out here that external (and internal) organizational complexity is not often as simple as it may seem. It has been defined as “…the amount of complexity derived from the environment where the organization operates, such as the country, the markets, suppliers, customers and stakeholders; while internal complexity is the amount of complexity that is internal to the organization itself, i.e. products, technologies, human resources, processes and organizational structure. Therefore, different aspects compose internal and external complexities.”
The dilemma that organizational leaders and managers sometimes face is how to deal with external, and internal, complexity? Do you grow and nurture it or reduce it? Some strategies call for reducing and managing it at the local level while nurturing it at the global level—depending on the organization’s size, business model, and the nature of the environments. Without going into complicated detail, it is fair to say at the beginning of the chapter that you may want to read through the chapter first, then return here afterward.
In the meantime, here are some simple rules from organizational practitioners De Toni and De Zan to keep in mind for managing high levels of complexity from the external environment, internally, after you have diagnosed the nature of the external complexity—as we discuss throughout in this chapter: first, assemble “…a set of self-managing teams or autonomous business units,[known as modularized units] with an entrepreneurial responsibility to the larger organization.” These focused self-organizing teams use creative methods to deal with the diversity to the advantage of the organization. A second method when facing high external environmental complexity when you want to gain value from it is to find and develop “…simple rules to drive out creativity and innovation … to keep the infrastructure and processes simple, while permitting complex outputs and behaviours.” An example offered is found in the rules of the Legos company: “(1) does the proposed product have the Lego look? (2) Will children learn while having fun? (3) Will parents approve? (4) Does the product maintain high quality standards? (5) Does it stimulate creativity?”
A third strategy for dealing with external complexity involves companies’ building on their own capabilities manage too much complexity, which otherwise lead to chaos. Some of those strategies include creating open networks internal and outside the organization to promote cooperation and integration and to develop brand and reputation. Also, sharing “…values, vision, strategy, organizational processes and knowledge, through the development of trust and incorporation and promotion of leaders at all levels” can help internal teams exploit external complexity to the organization’s advantage. Keep these ideas in mind as you read through the chapter and think about how leaders, managers, employees, and you can learn to read external environmental clues that organizations can use to creatively and proactively use organizational resources to be more competitive, effective, and successful.
concept check
- Why do change and shifts and technological developments create both challenges and new opportunities for business?


1.7: Summary of Key Concepts
Summary of Key Concepts
Number / Numeral
A
number
is a concept. It exists only in the mind. A
numeral
is a symbol that represents a number. It is customary not to distinguish between the two (but we should remain aware of the difference).
Hindu-Arabic Numeration System
In our society, we use the
Hindu-Arabic
numeration system. It was invented by the Hindus shortly before the third century and popularized by the Arabs about a thousand years later.
Digits
The numbers 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 are called
digits
.
Base Ten Positional System
The Hindu-Arabic numeration system is a positional number system with
base ten
. Each position has value that is ten times the value of the position to its right.
Commas / Periods
Commas
are used to separate digits into groups of three. Each group of three is called a
period
. Each period has a name. From right to left, they are ones, thousands, millions, billions, etc.
Whole Numbers
A
whole number
is any number that is formed using only the digits (0, 1, 2, 3, 4, 5, 6, 7, 8, 9).
Number Line
The
number line
allows us to visually display the whole numbers.
Graphing
Graphing
a whole number is a term used for visually displaying the whole number. The graph of 4 appears below.
Reading Whole Numbers
To express a whole number as a verbal phrase:
- Begin at the right and, working right to left, separate the number into distinct periods by inserting commas every three digits.
- Begin at the left, and read each period individually.
Writing Whole Numbers
To rename a number that is expressed in words to a number expressed in digits:
- Notice that a number expressed as a verbal phrase will have its periods set off by commas.
- Start at the beginning of the sentence, and write each period of numbers individually.
- Use commas to separate periods, and combine the periods to form one number.
Rounding
Rounding
is the process of approximating the number of a group of objects by mentally "seeing" the collection as occurring in groups of tens, hundreds, thousands, etc.
Addition
Addition
is the process of combining two or more objects (real or intuitive) to form a new, third object, the total, or sum.
Addends / Sum
In addition, the numbers being added are called
addends
and the result, or total, the
sum
.
Subtraction
Subtraction
is the process of determining the remainder when part of the total is removed.
Minuend / Subtrahend Difference
Commutative Property of Addition
If two whole numbers are added in either of two orders, the sum will not change.
3 + 5 = 5 + 3
Associative Property of Addition
If three whole numbers are to be added, the sum will be the same if the first two are added and that sum is then added to the third, or if the second two are added and the first is added to that sum.
(3 + 5) + 2 = 3 + (5 + 2)
Parentheses in Addition
Parentheses in addition
indicate which numbers are to be added first.
Additive Identity
The whole number 0 is called the
additive identity
since, when it is added to any particular whole number, the sum is identical to that whole number.
0 + 7 = 7
7 + 0 = 7


22.3: Physiological Adaptation and Transition
By the end of this section, you will be able to:
- Describe the newborn’s physiologic adaptation to extrauterine life
- Identify cardiac and respiratory physiologic adaptation changes that occur during the transition to extrauterine life and stabilization
- Compare and contrast neonatal periods of reactivity in the immediate period post birth
For the nurse to understand and recognize abnormal events in the newborn immediate period after birth, they must first understand the normal changes in physiology that occur within the first several hours of life. In those first hours, tremendous respiratory and circulatory adaptations occur to allow the newborn to transition from intrauterine life to extrauterine life. This transition is the most complex physiologic adaptation that occurs in any human body system in their lifetime. The nurse responsible for monitoring the newborn needs to have a solid knowledge base about normal physiologic adaptation and accurate assessment skills to recognize any alteration in normal adaptation.
Fetal Circulation
While the fetus is in utero, the placenta acts as a gas-exchange organ. The fetal lungs are bypassed during development in the womb. Oxygen from the birthing person’s blood crosses the placenta and enters the fetal bloodstream through the umbilical vein. The oxygenated blood in the umbilical vein bypasses hepatic circulation and is delivered to the inferior vena cava (IVC) via the ductus venosus. The ductus venosus is a fetal shunt allowing oxygenated blood in the umbilical vein to bypass the liver. The oxygenated blood is then shunted from the right atrium to the left atrium through a second shunt called the foramen ovale (Elshazzly et al., 2022). From the left atrium, the oxygenated blood then travels to the left ventricle and into coronary arteries and the aorta (Elshazzly et al., 2022). A tiny amount of blood from the right atrium bypasses the foramen ovale and flows through the right atrium to the right ventricle into the pulmonary artery to perfuse the fetal lungs and promote lung development. Most of the blood goes from the pulmonary artery directly to the aorta via a third shunt, the ductus arteriosus. From there, the oxygenated blood is delivered to the fetus’s systemic circulation (Elshazzly et al., 2022). Figure 10.18 summarizes fetal circulation .
Many changes occur at the time of birth. The fetal circulation structures become unnecessary as the birthing person draws closer to the actual birthing event. Two main triggers induce the structural changes: cessation of blood flow within the placenta and initiation of respiration. The structural changes that occur are listed in Table 22.2, and Figure 22.5 compares fetal and neonatal circulation .
| Structure | Structural Change Occurring | Pathophysiology of Change |
|---|---|---|
| Systemic circulation | Lung expansion |
|
| Ductus venosus |
This duct stays open at the time of birth, which allows umbilical vein catheterization, if needed.
Shortly after birth, this duct will begin to narrow and shrink. The duct will close completely during the first week of life in most full-term neonates but will take longer in preterm neonates. |
Once the umbilical cord is cut, the process of duct closing begins. Mechanical pressure and a redistribution of blood in the neonate’s body and changes in the cardiac output occur.
In simpler terms, closure of this duct forces perfusion of the fetal liver. Anatomic closure of this duct occurs within 2 weeks after birth, at which time the structure is known as the ligamentum venosum connected to the round ligaments of the liver. |
| Foramen ovale | Increased pressure in the left atrium attempts to reverse blood flow and closes this shunt, making it a one-way valve. | In utero, pressure is greater in the right atrium, with the foramen ovale open, allowing blood to shunt from the right atrium to the left. Decreased pulmonary vascular resistance and decreased umbilical venous return to the right atrium also cause a decrease in right atrial pressure. Pressure gradients are now reversed, allowing left atrial pressure to be greater than right atrial pressure, causing the foramen ovale to close 1–2 hours after birth. Anatomic closure occurs in about half of all 6-month-olds, while one-quarter of the adult population have a patent foramen ovale (PFO), though they are unaware of it. |
| Ductus arteriosus | Due to increased systemic vascular pressures and increased left atrial pressure, a reversal of blood flow and aorta–to–pulmonary artery (or left-to- right) shunting occurs, closing the shunt. It will functionally close within a few days after birth. |
|
Ductus Venosus
The primary function of the ductus venosus is to direct oxygenated blood from the umbilical vein to the inferior vena cava and eventually to the left heart for circulation. This duct also supplies oxygenated blood to the fetal liver (Pradbit & Forshing, 2022). Fetal hydrops, chromosomal aberration, in utero heart failure, and portal vein absence can be caused by absence or dysfunction of the ductus venosus (Pradbit & Forshing, 2022).
Ductus Arteriosus
The ductus arteriosus is a shunt that allows the fetal circulation to avoid the lungs by shunting blood from the right ventricle, bypassing pulmonary circulation and entering the descending aorta. Progressive increase in oxygenation (increased partial pressure of oxygen [PO 2 ]) and elimination of prostaglandin as a ductal relaxant cause the functional closure of the ductus arteriosus. At the time of birth, the newborn’s lungs fill with air, causing pulmonary vascular resistance and leading to blood flowing from the right ventricle to the lungs for oxygenation. The shunt then constricts due to increased arterial oxygen tension and the decreased flow-through, causing anatomic closure within 2 to 3 weeks.
Foramen Ovale
The foramen ovale directs intra-arterial blood flow from right to left in the fetal heart, bypassing the fetal lungs from the right atrium directly into the left atrium. The blood travels through the foramen ovale to the left atrium through the mitral valve to the left ventricle and out to the aorta and body. It finally flows to the ascending aorta, entering the systemic circulation.
Neonatal Circulation
Neonatal circulation is the same as adult circulation, once the newborn has completed the transition to extrauterine life . However, some things can go wrong, and the nurse needs to be able to identify those issues through assessment and accurate history taking. Some cardiac defects that a newborn might experience can be congenital (i.e., related to family history), so it is important that the nurse knows to assess for family congenital defects, cardiac issues, or issues during the pregnancy. During the postpartum period, the nurse must monitor the newborn for any signs or symptoms of cardiopulmonary dysfunction, such as apnea, cyanosis, and respiratory distress.
Patent Ductus Arteriosus and Murmur
When the ductus arteriosus of the newborn remains open after birth, it is called a patent ductus arteriosus (PDA) (Figure 22.6). As a result, blood flows from the descending aorta, across the PDA, and into pulmonary circulation, which can cause pulmonary edema (Gillam-Krakauer & Mahajan, 2022). The nurse will hear a murmur upon assessment of a newborn with a PDA, which will sound like a continuous, machine-like rumble below the clavicle, radiating to the back. Clinical manifestations will appear as tachycardia, bounding peripheral pulses, possible increased respiratory distress, and hypoxia, if pulmonary edema is present (Gillam-Krakauer & Mahajan, 2022).
Patent Foramen Ovale and Murmur
The foramen ovale closes completely in only about 75 percent of newborns (Marty et al., 2022). In the other 25 percent, a patent foramen ovale occurs. A patent foramen ovale (PFO) appears as a flap-like opening between the atrial septum secundum and primum at the fossa ovalis (Hampton et al., 2022) (Figure 22.7). Because left atrial pressure in the heart is higher than right atrial pressure, only a minuscule amount of blood may be shunted back to the right atrium, usually without any clinical significance for the newborn. This is generally a benign finding during the newborn period. However, if it persists into adulthood, it can lead to right-to-left shunting of deoxygenated blood and be symptomatic or asymptomatic.
However, the nurse may hear a murmur upon auscultation during a cardiac assessment that sounds like a quiet, muffled extra heart sound at the apex. Neonates have a 75 percent chance that these are transient and not associated with any other anomalies (Children’s Hospital of Philadelphia, 2022). Nonetheless, the nurse will report this finding to the health-care provider on call for the newborn.
Patent Ductus Venosus and Murmur
Failure of the ductus venosus to close leads to a condition called patent ductus venosus, which causes galactosemia , or galactose in the blood. This is an inherited disorder preventing the newborn from breaking down the sugar galactose, causing a buildup to toxic levels in their bloodstream. These newborns must avoid dairy products, breast milk, and most baby formulas. Additional problems from lack of closure of the ductus arteriosus are hypoxia, hepatic dysfunction, and encephalopathy with hyperammonemia , high levels of ammonia in the blood that cause brain damage (Marty et al., 2022).
This video from the Khan Academy shows a visual interpretation of the fetal to neonatal transition in circulation , including all the changes that happen during the moments immediately after birth.
Cardiopulmonary Adaptation
Many additional changes occur in the cardiopulmonary system after birth of the newborn. Late in gestation, the newborn completes lung development, fluid secretion in the lungs decreases, and surfactant production increases. In the lungs, surfactant is a phospholipid that lowers alveolar surface tension, prevents alveolar collapse at expiration, and maintains functional residual capacity. Production of catecholamines, causing fetal pulmonary epithelial cells to reabsorb fluid from alveolar spaces, is caused by the onset of labor (Rehman & Bacha, 2022). The first breath of air initiates a sequence of events that helps to expand the lungs, establish lung volume, clear the airways of amniotic fluid, and help the newborn transition from fetal circulation to newborn circulation. The first breath generates a high negative pressure system, filling the alveoli with air and removing any fluid in those spaces. Once the neonatal lungs expand fully with high concentrations of room air, pulmonary vascular resistance falls, which triggers pulmonary vasodilation increasing blood flow to the newly inflated lungs (Rehman & Bacha, 2022).
Approximately 10 percent of neonates do not sustain effective respiratory effort in the immediate transition period. Respiratory distress is a common complication seen in the neonatal period and is a major cause of morbidity and mortality (Reuter et al., 2014). The cause of neonatal respiratory distress varies, but the result is inadequate ventilation and impaired oxygenation, accompanied by retained carbon dioxide and alterations in acid-base balance. Respiratory distress syndrome can be an isolated incident that requires supportive care, or it can be a product of a functional abnormality of the pulmonary system that requires more intensive care. Table 22.3 shows common causes of neonatal respiratory distress, clinical findings, and their causes.
| Diagnosis | Cause | Incidence | Clinical Signs |
|---|---|---|---|
|
Meconium aspiration
syndrome (MAS) |
Aspiration of meconium during vaginal or cesarean birth that interferes with surfactant activity | 2%–10% of term and postterm infants exposed to meconium-stained amniotic fluid; 5%–30% of postterm and term births have meconium-stained amniotic fluid |
|
| Transient tachypnea of the newborn (TTN) | Failure to clear lung fluid by usual mechanism |
0.3%–0.5% of term and late-preterm infants
Onset within the first 24 hours of life |
Self-limiting condition presenting with tachypnea and no other abnormalities, lasting 12–72 hours |
| Respiratory distress syndrome (RDS) | Insufficient surfactant production |
Inversely related to gestational age:
Less than 28 weeks: 60% Older than 34 weeks: 5% |
Tachypnea, grunting, nasal flaring, retracting, hypoxemia, hypercarbia, respiratory acidosis beginning soon after birth |
| Persistent pulmonary hypertension of the newborn (PPHN) | Failure to relax the pulmonary vasculature after breathing oxygen at birth |
1:500–1:5000 live births
Affects term and postterm newborns due to pulmonary and nonpulmonary issues, though many times is idiopathic in nature |
Tachypnea, grunting, nasal flaring, retracting, hypoxemia, hypercarbia, respiratory acidosis; often hypoxic and intractable |
Nurse:
Clare, BSN
Years in practice:
5
Clinical Setting:
OBGYN unit of an academic medical center hospital
Geographic location:
Urban center
I was assigned to be the baby nurse for a scheduled cesarean section of a 35-year-old cisgender woman G1P0 at 36 weeks and zero days’ gestation. She had placenta previa with an active bleed over the prior 48 hours.
Upon arrival in the preoperative area, the fetal heart tones were 130 to 135 bpm, with moderate variability, no accelerations, and no decelerations. The patient, Kelsey, was experiencing no contractions. The clinical team determined that a cesarean section was necessary, and the patient agreed.
I helped my coworker Kaitlyn, a labor and delivery nurse, prepare the patient for the cesarean section by educating the patient and her partner about all the things they might see and hear in the operating room. My coworker placed Kelsey into a hospital gown, started an 18-gauge intravenous line in her right antecubital space, and initiated lactated Ringer’s solution at 125 mL/hour. Kelsey received consultations from the anesthetist and her obstetrical surgeon, and then it was time to deliver the baby.
In the operating room, the decision was made that there should be two nurses responsible for the neonate because of the preterm gestational age of the baby. In addition, the main nurse called the neonatal intensive care unit to notify them that there was a preterm delivery happening in labor and delivery just in case they were needed. Furthermore, because the presence of placenta previa increases the risk of postpartum hemorrhage, I called my charge nurse and asked her to come to the cesarean section with a postpartum hemorrhage kit. I also asked the blood bank for two units of packed red blood cells in Kelsey’s correct blood type to be placed on hold for her following the provider’s orders.
Once the surgery was underway, I monitored the fetal heart tones, watching for any signs of distress, and prepared the radiant warmer for the arrival of the baby. I made sure to have all the equipment that I would need, including the following: suction connected to the wall; oxygen with bag-valve mask and neonatal-size mask; nasal bulb; warm blankets; laryngoscope and ET tubes appropriate for a 35-week fetus; pulse oximetry ; temperature sensor ; hat; and diaper.
The baby arrived, was given to me, and placed under the radiant warmer. The neonate was very small, had very poor tone, was pale and cyanotic, gasping for breaths, had shallow breathing, but responded to stimulation and had a heartbeat of 140. I immediately started stimulating and drying the baby off while my coworker auscultated for breath sounds and placed a pulse oximeter on the neonate’s foot. After getting a pulse ox reading of 40 percent, my coworker rolled a baby blanket into a log and placed it under the neonate’s neck to point the chin of the neonate toward the ceiling. This allowed the infant’s jaw and airway to fall open, which facilitated more efficient breathing. The airway was assessed and cleared using a bulb syringe . At that point, Apgar scores for the neonate were 7. Blow-by oxygen was provided, and I continued stimulating and drying the baby. The baby continued to gasp for breaths, was still pale, and had poor tone; the heart rate was 145, and the newborn responded to stimulation. At 5 minutes, the Apgar scoring total was still 7, and I called the NICU for additional assistance. The baby was placed in an incubator and taken to the NICU for help with transition. The neonate’s distress was likely due to early gestational age and being small. The infant is 5 pounds, 3 ounces and named Genevieve.
Hematologic Adaptation
The hematologic adaptations of the newborn happen because of the dramatic changes in circulation and oxygenation that occur after placental detachment. Mean hemoglobin levels in cord blood are 15 g/dL (Eslami et al., 2012), and hemoglobin and hematocrit levels in the newborn will continue to rise in the first several hours post birth. Higher than normal hemoglobin and hematocrit levels will usually self-correct by day 3 to 5. This is when the movement of plasma from intravascular to extravascular spaces is completed (Eslami et al., 2012).
Oxygen Saturation Levels in the Newborn
Blood oxygen in the immediate newborn is significantly lower than in a newborn that is 24 hours old (Lara-Canton, et al., 2022). Partial pressures of the oxygen gradient between maternal, placental, and fetal blood are thought to be the driving force that regulates fetal oxygen supply. In the uterus, the fetus grew in a relatively low oxygen environment due to fetal hemoglobin’s high affinity for oxygen (Lara-Canton, et al., 2022) and due to the mixing nature of the fetal circulatory system. Delayed cord clamping has been associated with improved fetal-to-neonatal transition and increased newborn oxygen saturation levels by 85 percent to 90 percent (Lara-Canton, et al., 2022). Delayed cord clamping at birth can also lead to fewer episodes of tachycardia in the immediate transition period for the newborn. As seen in Table 22.4, in the period immediately following birth, oxygen saturation rates of 60 percent to 65 percent are expected in the newborn, rising to 85 percent to 90 percent at 10 minutes post birth, according to the American Academy of Pediatrics (AAP) , American Heart Association (AHA) , and the Guidelines for Neonatal Resuscitation (NRP) (Hammer, 2021).
| Time after Birth | Oxygen Saturation Level |
|---|---|
| 1 min | 60%–65% |
| 2 min | 65%–70% |
| 3 min | 70%–75% |
| 4 min | 75%–80% |
| 5 min | 80%–85% |
| 10 min | 85%–95% |
American Academy of Pediatrics, American Heart Association and Guidelines for Neonatal Resuscitation (NRP) all agree that the guidelines for saturation of peripheral oxygen (SpO 2 ) should be used to determine the need for initiating supplemental oxygen or increasing/decreasing its concentration (Hammer, 2021).
The Vitamin K Injection
Neonates do not have enough vitamin K stored in their bodies at birth because very little of it passes from the birthing person through the placenta. Therefore, newborns need a supplement to increase clotting factors and to prevent hemorrhagic disasters and vitamin K deficiency bleeding. The American Academy of Pediatrics recommends that all newborns receive a one-time intramuscular shot of vitamin K within 6 hours after birth. Neonates who do not receive the vitamin K injection are at 81 times greater risk of developing vitamin K deficiency bleeding than neonates who receive this intramuscular injection, compared to 1/100,000 when vitamin K is given at birth (Hand & Noble, 2022)
Generic Name: phytonadine, phytomenadione
Trade Name: Mephyton
Class/Action: vitamin, fat soluble
-
Route/Dosage:
oral, subcutaneous (SubQ; administer undiluted), intramuscular (IM; 1 mg/0.5 mL), intravenous (IV; 1 mg/minute)
- Oral: May be administered with or without food in older children and adults. Parenteral formula may also be used for small oral doses or situations in which tablets cannot be swallowed.
- Parenteral: Limit IV administration to situations where an alternative route of administration is not feasible and the benefit of therapy outweighs the risk of hypersensitivity reactions. Allergic reactions have occurred with IM and SubQ injections.
- High Alert/Black Box Warning:
- Indications: Prophylaxis and treatment of vitamin K deficiency bleeding (formerly known as hemorrhagic disease of the newborn (injection only).
- Mechanism of Action: Promotes liver synthesis of clotting factors (II, VII, IX, X): however, the exact mechanism of this stimulation is unknown. Menadiol is a water-soluble form of vitamin K; phytonadione has a more rapid and prolonged effect than menadione; menadiol sodium diphosphonate (K4) is half as potent as menadione (K3).
- Contraindications: Hypersensitivity to phytonadione or any component of the formula.
-
Adverse Reactions/Side Effects:
Table 22.5 lists adverse drug reactions derived from product labeling unless otherwise specified.
Category Adverse Reaction Cardiovascular Chest pain, flushing, hypotension, tachycardia, weak pulse Central nervous system Dizziness Dermatologic Diaphoresis, eczematous rash, erythema, erythematous rash, pruritic plaques of the skin, urticaria Gastrointestinal Dysgeusia Hepatic Hyperbilirubinemia Hypersensitivity Anaphylactic reaction (anaphylaxis) Local Injection site reaction (pain, swelling, tenderness) Respiratory Cyanosis, dyspnea Miscellaneous Lesion (scleroderma-like)
- Nursing Implications: Witness parental consent. Review patient education with the family. Administer the IM injection in the middle vastus lateralis muscle. Document in the patient’s chart.
- Parent/Family Education: The nurse will provide education to the parents before providing intramuscular injection to neonate. It is mandatory that while providing this information to the parents the nurse provide a written information statement to them so that they can follow along and make an informed decision.
Newborn Coagulation
Platelet values in a neonate are comparable to those of an adult patient; however, the neonate is at risk for complications with platelet function. If the neonate was born to a birthing person who experienced severe hypertension or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), or a birthing person with idiopathic isoimmune thrombocytopenia, the newborn is at increased risk for a platelet dysfunction called transient neonatal thrombocytopenia , or thrombocytopenia (decreased platelets) that develops in neonates. (See Chapter 19 Complications of Labor and Birth for a discussion of HELLP syndrome in depth.) The absence of vitamin K in the newborn gut causes a quick decrease in coagulation factors II, VII, IX, and X after birth. Vitamin K levels do slowly increase but do not reach adult levels for several weeks, which is one reason a vitamin K injection in the immediate period after birth is recommended. The American Academy of Pediatrics recommends that all newborns receive a one-time intramuscular injection of vitamin K within 6 hours after birth. The intramuscular administration of vitamin K (Aquamephyton) effectively prevents vitamin K deficiency disease of the newborn, as well as excessive bleeding after circumcision for the newborn males who have this procedure. (Hand & Noble, 2022).
Newborn Transitional Period
The neonate shows a very predictable pattern of behavior during the first several hours after birth. Based on these periods of reactivity, the nurse plans activities with the birthing person and the neonate to maximize the attachment between them. The three periods of reactivity the neonate will experience are the first period of reactivity, the period of decreased responsiveness, and the second period of reactivity (Hernandez & Thilo, 2005).
First Period of Reactivity
The first period of reactivity begins with birth and lasts around 30 minutes. In this period, the nurse can expect to see alertness, activity, and responsiveness to interaction from the neonate to the birthing person, their partner, nurses, clinicians, and anyone else who interacts with them (Hernandez & Thilo, 2005). This is an optimal time for the nurse to teach the birthing person about breast-feeding. The neonate is often rooting for food, very interested in their environment, and open to attempting the first latch session during this time. (Hernandez & Thilo, 2005). When this period is over, the neonate will fall into a deep sleep.
The Period of Decreased Responsiveness
In the period of decreased responsiveness , the neonate will be in a deep sleep or have marked decrease in activity for 30 minutes to 2 hours. Their muscle tone will return to normal; they will have fast, shallow respirations (60 breaths per minute) with no dyspnea occurring. The nurse will note that the color of the neonate is pink with excellent perfusion and capillary refill of less than 3 seconds. During assessment, the nurse will note a heart rate between 100 and 120 beats per minute, and the neonate will be less responsive to external stimuli (Hernandez & Thilo, 2005). Additionally, the nurse may assess spontaneous jerks and twitches or an occasional Moro reflex; however, the neonate will return to rest very quickly (Hernandez & Thilo, 2005).
The Second Period of Reactivity
The third and final stage of newborn transition is called the second period of reactivity . This is when the nurse will note the return of responsiveness from the neonate, lasting from 2 to 8 hours. The neonate will experience periods of tachycardia and abrupt changes in tone, color, and bowel sounds. The neonate can experience an excess of oral mucus, sometimes appearing as vomiting, gagging, and choking on amniotic fluid left over from birth. This is an expected finding, and the nurse will reassure the parents and educate them that this may occur for the next 7 days as the newborn clears their airways. Upon assessment during this time, the nurse will note that the neonate often has passed their first meconium stool. During this final stage of reactivity, the nurse will also notice that the neonate demonstrates increased hunger cues, making this an excellent time for another breast-feeding session. During increased alert periods, parent-infant bonding can be established.
Abnormal Transition
Neonatal assessment findings indicating abnormal transition include the following:
- Persistent tachycardia, longer than the first hour of life; fixed bradycardia
- Diffuse and persistent rales upon auscultation, retractions, grunting, nasal flaring lasting longer than the first hour of life
- Persistent cyanosis and pulse oximetry less than 90 percent on room air and requirements for supplemental oxygen after the first hour of life
- Episodes of prolonged apnea (longer than 20 seconds) and bradycardia (less than 80 beats/min)
- Marked pallor
- Temperature instability persistently after 2 to 3 hours of life lower than 36.5º C (97.7º F)
- Poor capillary refill (greater than 3 seconds)
- Unusual neurologic behavior (lethargy, hypotonia, excessive tremors, jitteriness, inconsolable crying, poor feeding)
- Excessive oral secretions (choking, excessive drooling, cyanosis with coughing) (Fraser, 2002)
When the nurse identifies a neonate who is experiencing abnormal transition, they must support the newborn in whatever area the newborn is having difficulty moving through. Suctioning for an open airway, maintaining a stable neutral temperature, or encouraging skin-to-skin would all be independent nursing interventions, while persistent desaturations and marked pallor may require a specialist and further diagnostic evaluation. The nurse needs to know when the newborn requires interventions beyond independent nursing interventions.


5.9: Capacitors
Capacitors (Figure \(\PageIndex{1}\)) are devices used to absorb and store electric current to prevent damage to components. These components are made of two-conductor plates with a non-conducting material between them. Capacitors will store energy if the circuit is broken and will remain charged until the circuit is restored.
Capacitors are useful for absorbing stray currents and preventing arcing across opening contacts. Variable capacitors are called trimmers or tuners and are used only in very sensitive circuits with low current flow.
Capacitors are also used to shift the phasing inside electric motors. Depending upon their application, this can give electric motors greater starting torque (Figure \(\PageIndex{2}\)), increased efficiency, or both.


10.6: Conclusion
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In June 1987, American president Ronald Reagan stood at the Berlin Wall and demanded that Soviet premier Mikhail Gorbachev “Tear down this wall!” Less than three years later, amid civil unrest in November 1989, East German authorities announced that their citizens were free to travel to and from West Berlin. The concrete curtain would be lifted and East Berlin would be opened to the world. Within months, the Berlin Wall was reduced to rubble by jubilant crowds anticipating the reunification of their city and their nation, which took place on October 3, 1990. By July 1991 the Warsaw Pact had crumbled, and on December 25 of that year, the Soviet Union was officially dissolved. Hungary, Poland, Czechoslovakia, and the Baltic States (Latvia, Estonia, and Lithuania) were freed from Russian domination.
Partisans fought to claim responsibility for the breakup of the Soviet Union and the ending of the Cold War. Whether it was the triumphalist rhetoric and militaristic pressure of conservatives or the internal fracturing of ossified bureaucracies and work of Russian reformers that shaped the ending of the Cold War is a question of later decades. Questions about the Cold War’s end must pause before appreciations of the Cold War’s impact at home and abroad. Whether measured by the tens of millions killed in Cold War–related conflicts, in the reshaping of American politics and culture, or in the transformation of America’s role in the world, the Cold War pushed American history upon a new path, one that it has yet to yield.


7: Scale Reliability and Validity
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The previous chapter examined some of the difficulties with measuring constructs in social science research. For instance, how do we know whether we are measuring “compassion” and not the “empathy”, since both constructs are somewhat similar in meaning? Or is compassion the same thing as empathy? What makes it more complex is that sometimes these constructs are imaginary concepts (i.e., they don’t exist in reality), and multi-dimensional (in which case, we have the added problem of identifying their constituent dimensions). Hence, it is not adequate just to measure social science constructs using any scale that we prefer. We also must test these scales to ensure that: (1) these scales indeed measure the unobservable construct that we wanted to measure (i.e., the scales are “valid”), and (2) they measure the intended construct consistently and precisely (i.e., the scales are “reliable”). Reliability and validity, jointly called the “psychometric properties” of measurement scales, are the yardsticks against which the adequacy and accuracy of our measurement procedures are evaluated in scientific research.
A measure can be reliable but not valid, if it is measuring something very consistently but is consistently measuring the wrong construct. Likewise, a measure can be valid but not reliable if it is measuring the right construct, but not doing so in a consistent manner. Using the analogy of a shooting target, as shown in Figure 7.1, a multiple-item measure of a construct that is both reliable and valid consists of shots that clustered within a narrow range near the center of the target. A measure that is valid but not reliable will consist of shots centered on the target but not clustered within a narrow range, but rather scattered around the target. Finally, a measure that is reliable but not valid will consist of shots clustered within a narrow range but off from the target. Hence, reliability and validity are both needed to assure adequate measurement of the constructs of interest.


4.5: Common Decision-Making Tools
Learning Objectives
- Discuss decision making tools
One thing almost everyone has in common is that we all want to make good decisions. That’s been the motivation of many a decision making tool. Over time, people have created and refined tools for every type of decision.
Almost all charts, diagrams and reports lend themselves to decision making in one way or another. But here in this section, we’re going to take a look at some of the tools that are most specifically devoted to the decision making process.
Pareto Diagram
What it does for you: It identifies beneficial opportunities and issues.
A Pareto chart contains both bars and a line graph, where individual values are represented in descending order by bars, and the cumulative total is represented by the line. The chart below outlines titanium investment casting defects. The chart is meant to highlight the most important among a list of factors. The bar chart is the frequency of occurrence, and the line graph shows the cumulative percentage of time these issues occur. Looking at this bar chart, if we wanted to decrease titanium investment casting defects by 80%, we’d need to tackle the first two issues on the chart. The Pareto chart helps you define and tackle the issues that have the most impact on your problem.
The Pareto chart below depicts titanium investment casting defects. Various defects are shown across the x-axis of the chart. The y-axes show the defect frequency and cumulative percentages. Shrink has approximately a 67 defect frequency. Porosity has approximately a 15 defect frequency. Weld LOF has approximately a 8 defect frequency. Shell inclusion has approximately an 5 defect frequency. Hard alpha inclusion has approximately a 3 defect frequency. Tungsten inclusion has approximately a 1 defect frequency. There is a line showing the cumulative percentages of defect frequency. Shrink and porosity account for 82 of defects. Shrink, porosity, and Weld LOF account for 90 of defects. Shrink, porosity, Weld LOF, and Shell inclusion account for 95 of defects. Shrink, porosity, Weld LOF, Shell inclusion, and Hard alpha inclusion account for 98 of defects. Shrink, porosity, Weld LOF, Shell inclusion, Hard alpha inclusion, and Tungsten inclusion account for 99 of defects.
Cause and Effect or Ishikawa Diagram
What It Does For You: Helps you hone in on the exact cause of an issue.
As you can see from the cause and effect diagram below (or fishbone diagram, because it looks very much like the bones of a fish), the user needs to list all the possible causes of a particular issue, by category. Each category is a “bone” of the fish. The issue is listed in the fish’s head. In this instance, the group is looking at why so much staff is required for a particular process. The answers are divided into categories, like “policies” and “procedures” below.
The Ishikawa Diagram below shows the factors that contribute to defect XXX. There is a horizontal arrow in the middle of the diagram pointing toward Defect XXX. There are three diagonal lines on either side of the arrow indicating factors. The first line includes the measurement factors, and has three subfactors: calibration, microscopes, and inspectors. The second line includes the materials factors, and has three subfactors: alloys, lubricants, and suppliers. The third line includes the personnel factors, and has three subfactors: shifts, training, and operators. The fourth line includes the environmental factors, and has two subfactors: humidity and temperature. The fifth line includes the methods factors, and has three subfactors: angle, engager, and brake. The sixth line includes the machine factors, and has two subfactors: blade wear and speed.
This is commonly used with product design and quality issues, and, as a very visual brainstorming tool, can spark many more ideas for cause/effect issues. On the other hand, bigger issues can start to look cluttered, and interrelationships between causes are hard to identify using this method.
Feasibility Reporting
What it does for you: It lets you know the rate of return on the investment of your project.
Now we’re doing math! (It was inevitable). Feasibility reporting, packed with things like cost-benefit analysis and payback calculations, allows an organization to see all the details of a particular project: when it will start paying back, what the rate of return is on the investment, and so on.
Benefit cost ratio and payback are just a portion of a feasibility report, but this short video shows you the kind of information you’re likely to see and thus, the kinds of decisions it can help you make.
A link to an interactive elements can be found at the bottom of this page.
SWOT Analysis
As seen in the diagram below, a SWOT Analysis is made of external and internal factors. External factors are opportunities and threats. They include technology, competition, economic, political, legal, social trends. Internal factors are strengths and weaknesses. They include financial, technical, competition position, human resources, product line.
SWOT stands for strengths, weaknesses, opportunities and threats. SWOT analysis helps you identify the internal strengths and weaknesses of your organization that give you an advantage over others of your kind, and reminds you to look for external opportunities and threats at the same time. It helps an organization identify its objectives and determine which environmental and non-environmental factors are favorable to that success.
This sample SWOT analysis shows the considerations of a particular organization as they went through their strategic planning process.
A SWOT analysis can be used any time a business or individual wants to determine if a particular objective is achievable. Limitations of the SWOT analysis have also been noted, chief among them that the list weighs heavily on perception rather than actual assessment of strengths and weaknesses.
Decision Making Diagrams
The decision making diagram below shows a choice of vendors. The diagram shows branching choices, stemming from choice of vendor. The choice is between Vendor 1 and Vendor 2. Vendor 1 shows that there is a 70% probability of success. The impact of success will be $10,000. The cost of success will be $3,000. There is a 30% chance of failure with Vendor 1. The impact of failure will be $30,000. The cost of failure will be $21,000. Vendor 2 shows that there is a 80% probability of success. The impact of success will be $12,000. The cost of success will be $2,400. There is an 20% chance of failure with Vendor 2. The impact of failure will be $25,000. The cost of failure will be $20,000.
What they do for you: They help you see all the alternatives and the associated costs.
The decision making diagram allows you to map out all the possible alternatives to each decision, their costs and even chances of success or failure. In the diagram above, an individual is trying to decide between Vendor 1 and Vendor 2. As you can see in the diagram, Vendor 2’s probability of failure is only 20%, at a cost of $2,400, but would have an impact of $12,000 total, compared with Vendor 1’s $10,000 total impact in the case of failure. Looks like Vendor 1 is a bigger risk with a bigger payoff. Which would you choose?
Decision Making Software
What it does for you: Allows for collaborative decision making and parsing large amounts of data.
There are a variety of decision making software solutions on the market today to help in any situation you might find yourself in. These software solutions allow for collaborative decision making, analysis and reporting of substantial amounts of data.
Vroom-Yetton-Jago Decision Making Model [1]
The Diagram of the Vroom-Yetton-Jago Model depicts the five different ways to make decisions based on these questions: A1, A2, C1, C2, and G. You will make an A1 decision if the answer to questions 1 and 2 is no. You will make an A1 decision if the answers to Questions 1 and 3 is yes, but the answer to question 2 is no. You will make an A1 decision if the answer to questions 1 is no, question 2 is yes, and question 5 is yes. You will make an A2 decision if the answer to questions 1, 2, 3, and 5 is yes. You will make an A2 decision if you answer question 1 yes, question 2 no, question 3 no, question 4 yes, question 5 yes, and question 6 no. You will make an A2 decision if you answer question 1 yes, question 2 no, question 3 no, question 4 yes, question 6 yes, and question 7 no. You will make a C1 decision if you answer question 1 yes, question 2 no, question 3 no, question 4 yes, question 6 yes, and question 7 yes. You will make a C2 decision if you answer question 1 yes, question 2 no, question 3 no, and question 4 no. You will make a C2 decision if you answer question 1 yes, question 2 yes, question 3 no, question 4 yes, question 5 no, question 6 yes, and question 7 no. You will make a C2 decision if the answer to questions 1, 2, and 3 yes, the answer to question 5 is no, and the answer to question 6 is no. You will make G decision if the answer to questions 1, 2, and 3 yes, the answer to question 5 is no, and the answer to question 6 is yes. You will make a G decision if you answer question 1 yes, question 2 yes, question 3 no, question 4 yes, question 5 no, question 6 yes, and question 7 yes. You will make a G decision if the answer to question 1 is no, question 2 is yes, and question 5 is no.
What it does for you: Helps you figure out the best method to make a decision and who to involve.
Vroom, Yetton, and Jago created a decision model to help you decide how you were going to make a decision. Should you make a decision individually or assemble the group and make a decision together? These are the questions you should ask yourself, according to Victor Vroom and his compatriots:
- Is the quality of the decision important?
- Is team commitment important for the decision?
- Do you have enough information to make the decision on your own?
- Is the problem well-structured?
- Would the team support you if you made the decision alone?
- Does the team share the organizational goals?
- Is conflict among the team over the decision likely?
Note the significance of the annotations on the chart:
- Autocratic (A1): The leader makes the decision by himself using existing information without any communication with the team.
- Autocratic (A2): The leader consults with team members to get information, but makes the decision by himself or herself without informing the group.
- Consultative (C1): The leader consults the team members to get their opinion about the situation, but he or she makes the decision for themselves.
- Consultative (C2): The leader consults the team members seeking opinions and suggestions, but he or she makes the decision for himself or herself. In this type of leadership style, the leader is open to suggestions and ideas.
- Collaborative (G): The leader shares the decision making process with team members. He or she supports the team in making the decision and finding an answer that everyone agrees on.
The model doesn’t allow for the personality characteristics of the leader, allow for large group use, or provide questions that are precise enough. That said, it’s very flexible and allows the leader the ability to make a good decision in a variety of different situations. It can also be shared and duplicated.
There are many more tools out there, ranging from complex software to back-of-the-napkin “T charts” that help an individual weigh the pros and cons of any given situation. The idea here is to understand that you don’t have to go into the decision making process alone and confused – there are tools and processes that can help you make decisions the right way!
- Vroom, Victor H., and Philip W. Yetton. Leadership and Decision-Making . Pittsburgh, PA: University of Pittsburgh Press, 1973. ↵
Contributors and Attributions
- Decision Making Tools. Authored by : Freedom Learning Group. Provided by : Lumen Learning. License : CC BY: Attribution
- Image: Decision Making Diagrams. Provided by : Lumen Learning. License : CC BY: Attribution
- Image: Vroom-Yetton-Jago Model. Provided by : Lumen Learning. License : CC BY: Attribution
- Pareto chart. Authored by : Daniel Penfield. Provided by : Wikimedia Commons. Located at : https://commons.wikimedia.org/wiki/File:Pareto_chart_of_titanium_investment_casting_defects.svg . License : CC BY-SA: Attribution-ShareAlike
- Cause and effect diagram. Authored by : Daniel Penfield. Provided by : Wikimedia Commons. Located at : https://commons.wikimedia.org/wiki/File:Cause_and_effect_diagram_for_defect_XXX.svg . License : CC BY-SA: Attribution-ShareAlike
- SWOT Analysis. Provided by : Lumen Learning. Located at : https://courses.lumenlearning.com/wmopen-introductiontobusiness/chapter/introduction-to-planning/ . License : CC BY: Attribution
- Benefit Cost Ratio and Payback. Authored by : Conservation Strategy Fund. Located at : https://youtu.be/X5yaXdTwfLE . License : All Rights Reserved . License Terms : Standard YouTube License


11.29: Assignment- Hydrology
This assessment consists of two parts: a virtual lab with lab report and a list of questions on groundwater and related features.
In the Virtual Lab, you will investigate how different types of soil hold water and which ones would make the best aquifer. You will collect data and use it to make observations about the relationship of soil porosity to soil permeability.
The list of questions follows the lab activity.
Basic Requirements (assignment criteria):
Visit the following website
- To select a type of soil, change the percentages of sand, silt, and clay by sliding the bars on the Soil Meter.
- Click the Test This Soil button to move 100 mL of the soil mixture to the funnel.
- Click the Pour Water button to begin pouring water on the soil. The water will automatically stop when the first drop of water begins to form at the bottom of the funnel.
- Observe the readout that displays how much water was poured. This is the volume of water the soil held.
- To find the porosity of the soil, divide the volume of water the soil held by the total volume of the soil. Multiply the decimal by 100 and type this percentage in the Table. In the formula below, V w stands for the volume of water and V s stands for the volume of soil. V w V s x 100 = % Porosity
- Click Reset and repeat steps 1 through 5 for at least 10 of the 13 soil types.
- Please enter your values in a table (you can use the one provided on the website by clicking on the icon at the bottom).
- Save this table for your lab report (you can print it by clicking on the print button or take a screen shot or create your own table in word or excel).
For the lab report, use the data and procedures you have completed so far. Make sure you include ALL components that are necessary. The graph can simple be a bar graph showing the type of soil and its porosity.
The following are components must be included:
- Cover page with name, date & lab title
- Introduction
- Data Section
- Calculations and Interpretations
- Discussion—make sure you include a discussion on the role of the water cycle (including processes), how permeability and porosity are affected by soil types and the role of different aquifers (are there specific types of aquifers that are more suited to pumping for example)?
- Conclusion
- Reference page should include all resources cited.
In addition to the above virtual lab, please complete the following questions on groundwater and groundwater related features.
- If channel shape and water volumes are the same, which river below would have the greater transport velocity?
A B
2. If you looked at the bottom of stream A, you would see:
A B
C D
3. Which of the above would you see at the bottom of River B?
4. The greater the velocity the greater the energy. The greater the energy, the ______ the particle size that can be carried.
a) smaller b) larger c) will be the same d) can’t tell this way
5. Shale is mostly made of clay. In which depositional environment would you expect it to form:
a) mountain streams b) braided rivers c) lake bottoms d) fast moving rivers
6. With time, sediment transport by a fluvial system:
a) becomes rounded b) becomes smaller c) becomes rounded and smaller d) becomes angular e) none of the above
A
B
7. In which of the above pictures of rock, has the sediment been carried the shortest distance?
8. Groundwater often produces some pretty spectacular features. Please provide a brief description for each of the following: geyser, sinkhole, karst topography, springs and disappearing streams.
Tips and hints can be found here .
The virtual assessment is adapted from “Virtual Lab” by M. Poarch, originally found here .
The question assessment is adapted from “Sediment Transport” by Austin Boyd, originally found here .
Contributors and Attributions
- Hydrology Assessment. Authored by : Kimberly Schulte. Provided by : SBCTC. Located at : http://www.columbiabasin.edu . License : CC BY: Attribution


10.4: Additional Resources
Background and Interpretation
Poets.org’s article on “John Milton”
Read this brief biography of John Milton from poets.org.
Paradiselost.org ‘s article on “Paradise Lost ~ A Brief Overview”
Read this brief overview of the work from from paradiselost.org which provides a general context and information about the poetic form of the work.
Audio Files
You may find it helpful to listen to an audio recording of the work while you read along.
LibraVox’s recordings for Paradise Lost
From this LibraVox page, find the links to each of Books 1, 4, and 9. Note that each of the books has two audio sections.
- Survey of English Literature I. Authored by : Wendy Howard Gray. Provided by : Reynolds Community College. Located at : http://www.reynolds.edu/ . License : CC BY: Attribution


35.2: Phase Shifting
Minimalist composer Steve Reich conceived of phase shifting in his early work in tape music, noting that tape loops of slightly differing lengths containing the same idea went slowly out of phase and very gradually back into phase when they were repeated incessantly (see It’s Gonna Rain from 1965 and Come Out from 1966). Reich applied this phase–shifting process to live performance in Piano Phase (1967), Violin Phase (1967), and Clapping Music (1972).
Below is the basic twelve–note pattern of Piano Phase along with a video demonstrating the phase–shifting.
During the phase–shifting process, one can think of the lower voices in the examples above as going through rotation. The example below shows rotation of a five–note pattern. The pattern rotates one note to the left, meaning the second note begins the pattern on the second line, the third note begins the pattern on the third line, etc., until the first note starts the pattern again to complete the phase–shifting process.
In a piece of music, the process would play out similar to the manner below, where one part maintains the original pattern while the second goes out of phase by continually rotating the original pattern one note to the left. In Piano Phase, Reich has the second pianist gradually increase in speed so the patterns go slowly out of phase, while in Clapping Music, Reich has the musicians change to the next rotation on the downbeat of a measure, without gradually speeding up.
One hears phase shifting in numerous works by Reich, including the second movement of his Three Movements.
It is worth mentioning that composers like Stravinsky applied rotation to serialism, which Joseph Straus details in Chapter 6 of his Introduction to Post–Tonal Analysis (4th edition).