998 resultados para mixed incontinence


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HRTEM has been used to examine illite/smectite from the Mancos shale, rectorite from Garland County, Arkansas; illite from Silver Hill, Montana; Na-smectite from Crook County, Wyoming; corrensite from Packwood, Washington; and diagenetic chlorite from the Tuscaloosa formation. Thin specimens were prepared by ion milling, ultra-microtome sectioning and/or grain dispersal on a porous carbon substrate. Some smectite-bearing clays were also examined after intercalation with dodecylamine hydrochloride (DH). Intercalation of smectite with DH proved to be a reliable method of HRTEM imaging of expanded smectite, d(001) 16 A which could then be distinguished from unexpanded illite, d(001) 10 A. Lattice fringes of basal spacings of DH-intercalated rectorite and illite/smectite showed 26 A periodicity. These data support XRD studies which suggest that these samples are ordered, interstratified varieties of illite and smectite. The ion-thinned, unexpanded corrensite sample showed discrete crystallites containing 10 A and 14 A basal spacings corresponding with collapsed smectite and chlorite, respectively. Regions containing disordered layers of chlorite and smectite were also noted. Crystallites containing regular alternations of smectite and chlorite were not common. These HRTEM observations of corrensite did not corroborate XRD data. Particle sizes parallel to the c axis ranged widely for each sample studied, and many particles showed basal dimensions equivalent to > five layers. -J.M.H.

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High resolution transmission electron microscopy of the Mighei carbonaceous chondrite matrix has revealed the presence of a new mixed layer structure material. This mixed-layer material consists of an ordered arrangement of serpentine-type (S) and brucite-type (B) layers in the sequence ... SBBSBB. ... Electron diffraction and imaging techniques show that the basal periodicity is ~ 17 Å. Discrete crystals of SBB-type material are typically curved, of small size (<1 μm) and show structural variations similar to the serpentine group minerals. Mixed-layer material also occurs in association with planar serpentine. Characteristics of SBB-type material are not consistent with known terrestrial mixed-layer clay minerals. Evidence for formation by a condensation event or by subsequent alteration of preexisting material is not yet apparent. © 1982.

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Knowledge has been widely recognised as a determinant of business performance. Business capabilities require an effective share of resource and knowledge. Specifically, knowledge sharing (KS) between different companies and departments can improve manufacturing processes since intangible knowledge plays an enssential role in achieving competitive advantage. This paper presents a mixed method research study into the impact of KS on the effectiveness of new product development (NPD) in achieving desired business performance (BP). Firstly, an empirical study utilising moderated regression analysis was conducted to test whether and to what extent KS has leveraging power on the relationship between NPD and BP constructs and variables. Secondly, this empirically verified hypothesis was validated through explanatory case studies involving two Taiwanese manufacturing companies using a qualitative interaction term pattern matching technique. The study provides evidence that knowledge sharing and management activities are essential for deriving competitive advantage in the manufacturing industry.

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This paper describes an approach to investigate the adoption of Web 2.0 in the classroom using a mixed methods study. By using a combination of qualitative or quantitative data collection and analysis techniques, we attempt to synergize the results and provide a more valid understanding of Web 2.0 adoption for learning by both teachers and students. This approach is expected to yield a better holistic view on the adoption issues associated with the e-learning 2.0 concept in current higher education as opposed to single method studies done previously. This paper also presents some early findings of e-learning 2.0 adoption using this research method

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Metrics such as passengers per square metre have been developed to define optimum or crowded rail passenger density. Whilst such metrics are important to operational procedures, service evaluation and reporting, they fail to fully capture and convey the ways in which passengers experience crowded situations. This paper reports findings from a two year study of rail passenger crowding in five Australian capital cities which involved a novel mixed-methodology including ethnography, focus groups and an online stated preference choice experiment. The resulting data address the following four fundamental research questions: 1) to what extent are Australian rail passengers concerned by crowding, 2) what conditions exacerbate feelings of crowdedness, 3) what conditions mitigate feelings of crowdedness, and 4) how can we usefully understand passengers’ experiences of crowdedness? It concludes with some observations on the significance and implications of these findings for customer service provision. The findings outlined in this paper demonstrate that the experience of crowdedness (including its tolerance) cannot be understood in isolation from other customer services issues such as interior design, quality of environment, safety and public health concerns. It is hypothesised that tolerance of crowding will increase alongside improvements to overall customer service. This was the first comprehensive study of crowding in the Australian rail industry.

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This paper addresses the problem of scheduling a cane transport system involving both rail transport and road transport, where the road transport operates from several sidings in the rail network. An iterative approach for scheduling the rail transport system has been developed using existing rail transport scheduling tools. The assumption that harvesters serviced by road transport are effectively operating from the rail siding from which their bins are supplied seems a reasonable starting point for the analysis. There is a need to manually modify the schedule to take into account the road transport schedule to ensure that full bins are not collected before the road transport system delivers them back to the rail siding.

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Bus Rapid Transit (BRT) station is the interface between passenger and service. The station is crucial to line operation as it is typically the only location where buses can pass each other. Congestion may occur here when buses maneuvering into and out of the platform lane interfere with bus flow, or when a queue of buses forms upstream of the platform lane blocking the passing lane. However, some systems include operation where express buses pass the critical station, resulting in a proportion of non stopping buses. It is important to understand the operation of the critical busway station under this type of operation, as it affects busway line capacity. This study uses micro simulation to treat the BRT station operation and to analyze the relationship between station Limit state bus capacity (B_ls), Total Bus Capacity (B_ttl). First, the simulation model is developed for Limit state scenario and then a mathematical model is defined, calibrated for a specified range of controlled scenarios of mean and coefficient of variation of dwell time. Thereafter, the proposed B_ls model is extended to consider non stopping buses and B_ttlmodel is defined. The proposed models provides better understanding to the BRT line capacity and is useful for transit authorities for designing better BRT operation.

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Overview: - Development of mixed methods research - Benefits and challenges of “mixing” - Different models - Good design - Two examples - How to report? - Have a go!

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The cardiac catheterisation laboratory (CCL) is a specialised medical radiology facility where both chronic-stable and life-threatening cardiovascular illness is evaluated and treated. Although there are many potential sources of discomfort and distress associated with procedures performed in the CCL, a general anaesthetic is not usually required. For this reason, an anaesthetist is not routinely assigned to the CCL. Instead, to manage pain, discomfort and anxiety during the procedure, nurses administer a combination of sedative and analgesic medications according to direction from the cardiologist performing the procedure. This practice is referred to as nurse-administered procedural sedation and analgesia (PSA). While anecdotal evidence suggested that nurse-administered PSA was commonly used in the CCL, it was clear from the limited information available that current nurse-led PSA administration and monitoring practices varied and that there was contention around some aspects of practice including the type of medications that were suitable to be used and the depth of sedation that could be safely induced without an anaesthetist present. The overall aim of the program of research presented in this thesis was to establish an evidence base for nurse-led sedation practices in the CCL context. A sequential mixed methods design was used over three phases. The objective of the first phase was to appraise the existing evidence for nurse-administered PSA in the CCL. Two studies were conducted. The first study was an integrative review of empirical research studies and clinical practice guidelines focused on nurse-administered PSA in the CCL as well as in other similar procedural settings. This was the first review to systematically appraise the available evidence supporting the use of nurse-administered PSA in the CCL. A major finding was that, overall, nurse-administered PSA in the CCL was generally deemed to be safe. However, it was concluded from the analysis of the studies and the guidelines that were included in the review, that the management of sedation in the CCL was impacted by a variety of contextual factors including local hospital policy, workforce constraints and cardiologists’ preferences for the type of sedation used. The second study in the first phase was conducted to identify a sedation scale that could be used to monitor level of sedation during nurse-administered PSA in the CCL. It involved a structured literature review and psychometric analysis of scale properties. However, only one scale was found that was developed specifically for the CCL, which had not undergone psychometric testing. Several weaknesses were identified in its item structure. Other sedation scales that were identified were developed for the ICU. Although these scales have demonstrated validity and reliability in the ICU, weaknesses in their item structure precluded their use in the CCL. As findings indicated that no existing sedation scale should be applied to practice in the CCL, recommendations for the development and psychometric testing of a new sedation scale were developed. The objective of the second phase of the program of research was to explore current practice. Three studies were conducted in this phase using both quantitative and qualitative research methods. The first was a qualitative explorative study of nurses’ perceptions of the issues and challenges associated with nurse-administered PSA in the CCL. Major themes emerged from analysis of the qualitative data regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. The second study in Phase Two was a cross-sectional survey of nurse-administered PSA practice in Australian and New Zealand CCLs. This was the first study to quantify the frequency that nurse-administered PSA was used in the CCL setting and to characterise associated nursing practices. It was found that nearly all CCLs utilise nurse-administered PSA (94%). Of note, by characterising nurse-administered PSA in Australian and New Zealand CCLs, several strategies to improve practice, such as setting up protocols for patient monitoring and establishing comprehensive PSA education for CCL nurses, were identified. The third study in Phase Two was a matched case-control study of risk factors for impaired respiratory function during nurse-administered PSA in the CCL setting. Patients with acute illness were found to be nearly twice as likely to experience impaired respiratory function during nurse-administered PSA (OR=1.78; 95%CI=1.19-2.67; p=0.005). These significant findings can now be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered PSA in the CCL. The objective of the third and final phase of the program of research was to develop recommendations for practice. To achieve this objective, a synthesis of findings from the previous phases of the program of research informed a modified Delphi study, which was conducted to develop a set of clinical practice guidelines for nurse-administered PSA in the CCL. The clinical practice guidelines that were developed set current best practice standards for pre-procedural patient assessment and risk screening practices as well as the intra and post-procedural patient monitoring practices that nurses who administer PSA in the CCL should undertake in order to deliver safe, evidence-based and consistent care to the many patients who undergo procedures in this setting. In summary, the mixed methods approach that was used clearly enabled the research objectives to be comprehensively addressed in an informed sequential manner, and, as a consequence, this thesis has generated a substantial amount of new knowledge to inform and support nurse-led sedation practice in the CCL context. However, a limitation of the research to note is that the comprehensive appraisal of the evidence conducted, combined with the guideline development process, highlighted that there were numerous deficiencies in the evidence base. As such, rather than being based on high-level evidence, many of the recommendations for practice were produced by consensus. For this reason, further research is required in order to ascertain which specific practices result in the most optimal patient and health service outcomes. Therefore, along with necessary guideline implementation and evaluation projects, post-doctoral research is planned to follow up on the research gaps identified, which are planned to form part of a continuing program of research in this field.

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Modernized GPS and GLONASS, together with new GNSS systems, BeiDou and Galileo, offer code and phase ranging signals in three or more carriers. Traditionally, dual-frequency code and/or phase GPS measurements are linearly combined to eliminate effects of ionosphere delays in various positioning and analysis. This typical treatment method has imitations in processing signals at three or more frequencies from more than one system and can be hardly adapted itself to cope with the booming of various receivers with a broad variety of singles. In this contribution, a generalized-positioning model that the navigation system independent and the carrier number unrelated is promoted, which is suitable for both single- and multi-sites data processing. For the synchronization of different signals, uncalibrated signal delays (USD) are more generally defined to compensate the signal specific offsets in code and phase signals respectively. In addition, the ionospheric delays are included in the parameterization with an elaborate consideration. Based on the analysis of the algebraic structures, this generalized-positioning model is further refined with a set of proper constrains to regularize the datum deficiency of the observation equation system. With this new model, uncalibrated signal delays (USD) and ionospheric delays are derived for both GPS and BeiDou with a large dada set. Numerical results demonstrate that, with a limited number of stations, the uncalibrated code delays (UCD) are determinate to a precision of about 0.1 ns for GPS and 0.4 ns for BeiDou signals, while the uncalibrated phase delays (UPD) for L1 and L2 are generated with 37 stations evenly distributed in China for GPS with a consistency of about 0.3 cycle. Extra experiments concerning the performance of this novel model in point positioning with mixed-frequencies of mixed-constellations is analyzed, in which the USD parameters are fixed with our generated values. The results are evaluated in terms of both positioning accuracy and convergence time.

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Background and Objectives Obesity and some dietary related diseases are emerging health problems among Chinese immigrants and their children in developed countries. These health problems are closely linked to eating habits, which are established in the early years of life. Young children’s eating habits are likely to persist into later childhood and youth. Family environment and parental feeding practices have a strong effect on young children’s eating habits. Little information is available on the early feeding practices of Chinese mothers in Australia. The aim of this study was to understand the dietary beliefs, feeding attitudes and practices of Chinese mothers with young children who were recent immigrants to Australia. Methods Using a sequential explanatory design, this mixed methods study consisted of two distinct phases. Phase 1 (quantitative): 254 Chinese immigrant mothers of children aged 12 to 59 months completed a cross-sectional survey. The psychometric properties and factor structure of a Chinese version of the Child Feeding Questionnaire (CFQ, by Birch et al. 2001) were assessed and used to measure specific maternal feeding attitudes and controlling feeding practices. Other questions were developed from the literature and used to explore maternal traditional dietary beliefs and feeding practices related to their beliefs, perceptions of picky eating in children and a range of socioeconomic and acculturation factors. Phase 2 (qualitative): 21 mothers took part in a follow-up telephone interview to assist in explaining and interpreting some significant findings obtained in the first phase. Results Chinese mothers held strong traditional dietary beliefs and fed their children according to these beliefs. However, children’s consumption of non-core foods was high. Both traditional Chinese and Australian style foods were consumed by their children. Confirmatory factor analysis revealed that the original 7-factor model of the CFQ provided an acceptable fit to the data with minor modification. However, an alternative model with eight constructs in which two items related to using food rewards were separated from the original restriction construct, not only provided an acceptable fit to the data, but also improved the conceptual clarity of the constructs. The latter model included 24 items loading onto the following eight constructs: restriction, pressure to eat, monitoring, use of food rewards, perceived responsibility, perception of own weight, perception of child’s weight, and concern about child becoming overweight. The internal consistency of the constructs was acceptable or desirable (Cronbach’s α = .60 - .93). Mothers reported low levels of concern about their child overeating or becoming overweight, but high levels of controlling feeding practices: restriction, monitoring, pressure to eat and use of food rewards. More than one quarter of mothers misinterpreted their child’s weight status (based on mothers’ self-reported data). In addition, mothers’ controlling feeding practices independently predicted half of the variance and explained 16% of the variance in child weight status: pressuring the child to eat was negatively associated with child weight status (β = -0.30, p < .01) and using food rewards was positively associated with child weight status (β = 0.20, p < .05) after adjusting for maternal and child covariates. Monitoring and restriction were not associated with child weight status. Mothers’ perceptions of their child’s weight were positively associated with child weight status (β = 0.33, p < .01). Moreover, mothers reported that they mostly decided what (65%) and how much (80%) food their child ate. Mothers who decided what food their child ate were more likely to monitor (β = -0.17, p < .05) and restrict (β = -0.17, p < .05) their child’s food consumption. Mothers who let their child decide how much food their child ate were less likely to pressure their child to eat (β = -0.38, p < .01) and use food rewards (β = -0.24, p < .01). Mothers’ perceptions of picky eating behaviour were positively associated with their use of pressure (β = 0.21, p < .01) and negatively associated with monitoring (β = -0.16, p < .05) and perceptions of their child’s weight status (β = -0.13, p < .05). Qualitative data showed that pressuring to eat, monitoring and restriction of the child’s food consumption were common practices among these mothers. However, mothers stated that their motivation for monitoring and restricting was to ensure the child’s general health. Mothers’ understandings of picky eating behaviour in their children were consistent with the literature and they reported multiple feeding strategies to deal with it. Conclusion Chinese immigrant mothers demonstrated strong traditional dietary beliefs, a low level of concern for child weight, misperceptions of child weight status, and a high overall level of control in child feeding in this study. The Chinese version of the CFQ, which consists of eight constructs and distinguishes between the constructs using food rewards and restriction, is an appropriate instrument to assess feeding attitudes and controlling feeding practices among Chinese immigrant mothers of young children in Australia. Mothers’ feeding attitudes and practices were associated with children’s weight status and mothers’ perceptions of picky eating behaviour in children after adjusting for a range of socio-demographic maternal and child characteristics. Monitoring and restriction of children’s food consumption according to food selection may be positive feeding practices, whereas pressuring to eat and using food rewards appeared to be negative feeding practices in this study. In addition, the results suggest that these young children have high exposure to energy-dense, nutrient-poor food. There is a need to develop and implement nutrition interventions to improve maternal feeding practices and the dietary quality among children of Chinese immigrant mothers in Australia.

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Queensland, Australia has one of the highest rates of skin cancer in the world. Outdoor workers are regularly exposed to high doses of ultraviolet radiation, and are at increased risk to develop non-melanoma and melanoma skin cancers. In 2010, a health promotion intervention to improve sun protection among outdoor workers in Queensland commenced. The intervention employed a mixed methods approach and a participatory action research framework. Fourteen workplaces were recruited from building and construction, rural and farming, local government, and public sector organisations. Management and workers were engaged in cycles of assessment, reflection and discussion, planning, implementation and reassessing, over a 14-month intervention period. Overall, at least one workplace representative from each workplace (range 1-3) and in depth focus groups were held with a subset of workers (range 3-16) to assess sun safe behaviours pre and post intervention. Workers’ attitudes, beliefs, knowledge and willingness to engage in sun protection differed depending on workplace characteristics and support. A familiar theme among workers spoke of sun safety as being “common sense” and the “workers individual responsibility”. Often there was a discrepancy in the perceptions of the workers, compared to the view of workplace representatives and the workplaces position or policy on sun safety. In larger workplaces, especially Government Departments, workers were more aware and followed sun safe practices compared to smaller workplaces where sun safety was not a high priority. These results indicate that a workplace culture which places high values on safety and polices more broadly may also have a positive effect on sun safety among outdoor workers as well. In addition, the specific characteristics of the workplace and the outdoor work tasks influence workers willingness to engage in sun safety measures.

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Particles of carrot red leaf virus (CRLV; luteovirus group) purified from chervil (Anthriscus cerefolium) contain a single ssRNA species of mol. wt. about 1.8 x 106 and a major protein of mol. wt. about 25000. CRLV acts as a helper for aphid transmission of carrot mottle virus (CMotV; ungrouped) from mixedly infected plants. Virus preparations purified from such plants possess the infectivity of both viruses but contain particles indistinguishable from those of CRLV; some of the particles are therefore thought to consist of CMotV RNA packaged in CRLV coat protein. When RNA from such preparations was electrophoresed in agarose/polyacrylamide gels, CMotV infectivity was associated with an RNA band that migrated ahead of the CRLV RNA band and had an estimated mol. wt. of about 1.5 x 106, similar to that previously found for the infective ssRNA extracted directly from Nicotiana clevelandii leaves infected with CMotV alone. Preparations of dsRNA from CMotV-infected N. clevelandii leaves contained two species: one of mol. wt. about 3.2 x 106, presumably the replicative form of the infective ssRNA, and the other, mol. wt. about 0.9 x 106, of unknown origin and function. The infective agent in buffer extracts of CMotV-infected N. clevelandii was resistant to RNase (although the enzyme acted as a reversible inhibitor of infection at high concentrations) and is therefore not unprotected RNA. It may be protected within the approximately 52 nm enveloped structures previously reported.

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OBJECTIVE: To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison. DESIGN: Systematic review and mixed treatment comparison. SETTING: Hospital and other healthcare settings. PARTICIPANTS: Patients undergoing THR. PRIMARY AND SECONDARY OUTCOME MEASURES: The number of THR-related SSIs occurring following the surgical operation. RESULTS: 12 studies involving 123 788 THRs and 9 infection control strategies were identified. The strategy of 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation' significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03-0.35), and had the highest probability (47-64%) and highest median rank of being the most effective strategy. There was some evidence to suggest that 'systemic antibiotics+antibiotic-impregnated cement+laminar airflow' could potentially increase infection risk compared with 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation', 1.96 (95% CrI 0.52-5.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38-3.38). CONCLUSIONS: We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation'. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.