What factors influence nurses’ assessment practices? Development of the Barriers to Nurses’ use of Physical Assessment Scale

Aim To develop and psychometrically test the Barriers to Nurses’ use of Physical Assessment Scale. Background There is growing evidence of failure to recognise hospitalised patients at risk of clinical deterioration, in part due to inadequate physical assessment by nurses. Yet, little is known about the barriers to nurses’ use of physical assessment in the acute hospital setting and no validated scales have been published. Design Instrument development study. Method Scale development was based on a comprehensive literature review, focus groups, expert review and psychometric evaluation. The scale was administered to 434 acute care registered nurses working at a large Australian teaching hospital between June and July 2013. Psychometric analysis included factor analysis, model fit statistics and reliability testing. Results The final scale was reduced to 38 items representing seven factors, together accounting for 57.7% of the variance: (1) reliance on others and technology, (2) lack of time and interruptions, (3) ward culture, (4) lack of confidence, (5) lack of nursing role models, (6) lack of influence on patient care, and; (7) specialty area. Internal reliability ranged from .70 to .86. Conclusion Findings provide initial evidence for the validity and reliability of the Barriers to Nurses’ use of Physical Assessment Scale and point to the importance of understanding the organisational determinants of nurses’ assessment practices. The new scale has potential clinical and research applications to support nursing assessment in acute care settings.

Masculinity, sexuality and hate-motivated violence : the case of Darren

In this paper I use the case study of Darren, derived from two interviews in a research study of racism in the city of Stoke, UK (Gadd, Dixon and Jefferson 2005; Gadd and Dixon 2011), to explore how best to approach the topic of hate-motivated violence. This entails discussing the relationships among racism (the original object of study), hate-motivated violence (the more general term) and prejudices of various sorts. Because that discussion, I argue, justifies a psychoanalytic starting point, and since violence has become, almost quintessentially, masculine, this leads on to an exploration of what can be learnt from psychoanalysis about the relations among sexuality, masculinity, hatred and violence. This involves brief discussions of some key psychoanalytic terms, but only what is needed to enable sense to be made of my chosen case, which I shall then interrogate using these psychoanalytic ideas, focused on understanding the origins and nature of Darren’s hatred.

'Too high in human terms' : the costs of high security imprisonment. Review of Imprisoning Resistance by Bree Carlton and Intractable by Bernie Matthews.

The article discusses the issues of resistance; that is resistance by prisoners to the various manifestations of power operating in high security prisons, as well as that of attempted shifts in the regime from physical to psychological control. Other topics highlighted include legitimacy and 'official discourse', mourning and the construction of 'ungrievable lives' and the importance of finding a way out of the cycle of violence, which high security regimes perpetuate.

Underlying beliefs influencing Vietnamese nurses and doctors in screening for victims of domestic violence: An exploratory study

Many health professionals in Vietnam have limited knowledge and experience in coordinating care for victims of Domestic Violence (DV). This qualitative study aimed to elicit the beliefs of nurses and doctors that are influencing the care of victims of DV. Data were collected by semistructured interviews with nineteen nurses and doctors. Data were analyzed by content analysis and organized by three main themes; behavioral beliefs, normative beliefs and control beliefs. The outcomes of this study will inform the development of intervention strategies that will enable health professionals to better respond to and manage care for women who experience domestic violence in Vietnam.

Violence in and around entertainment districts : a longitudinal analysis of the impact of late-night lockout legislation

Violence in entertainment districts is a major problem across urban landscapes throughout the world. Research shows that licensed premises are the third most common location for homicides and serious assaults, accounting for one in ten fatal and nonfatal assaults. One class of interventions that aims to reduce violence in entertainment districts involves the use of civil remedies: a group of strategies that use civil or regulatory measures as legal “levers” to reduce problem behavior. One specific civil remedy used to reduce problematic behavior in entertainment districts involves manipulation of licensed premise trading hours. This article uses generalized linear models to analyze the impact of lockout legislation on recorded violent offences in two entertainment districts in the Australian state of Queensland. Our research shows that 3 a.m. lockout legislation led to a direct and significant reduction in the number of violent incidents inside licensed premises. Indeed, the lockouts cut the level of violent crime inside licensed premises by half. Despite these impressive results for the control of violence inside licensed premises, we found no evidence that the lockout had any impact on violence on streets and footpaths outside licensed premises that were the site for more than 80 percent of entertainment district violence. Overall, however, our analysis suggests that lockouts are an important mechanism that helps to control the level of violence inside licensed premises but that finely grained contextual responses to alcohol-related problems are needed rather than one-size-fits-all solutions.

A neutron diffraction investigation of residual stresses in rail ends after severe deformation of rail surfaces

Insulated rail joints (IRJs) are a primary component of the rail track safety and signalling systems. Rails are supported by two fishplates which are fastened by bolts and nuts and, with the support of sleepers and track ballast, form an integrated assembly. IRJ failure can result from progressive defects, the propagation of which is influenced by residual stresses in the rail. Residual stresses change significantly during service due to the complex deformation and damage effects associated with wheel rolling, sliding and impact. IRJ failures can occur when metal flows over the insulated rail gap (typically 6-8 mm width), breaks the electrically isolated section of track and results in malfunction of the track signalling system. In this investigation, residual stress measurements were obtained from rail-ends which had undergone controlled amounts of surface plastic deformation using a full scale wheel-on-track simulation test rig. Results were compared with those obtained from similar investigations performed on rail ends associated with ex-service IRJs. Residual stresses were measured by neutron diffraction at the Australian Nuclear Science and Technology Organisation (ANSTO). Measurements with constant gauge volume 3x3x3 mm3 were carried in the central vertical plane on 5mm thick sliced rail samples cut by an electric discharge machine (EDM). Stress evolution at the rail ends was found to exhibit characteristics similar to those of the ex-service rails, with a compressive zone of 5mm deep that is counterbalanced by a tension zone beneath, extending to a depth of around 15mm. However, in contrast to the ex-service rails, the type of stress distribution in the test-rig deformed samples was apparently different due to the localization of load under the particular test conditions. In the latter, in contrast with clear stress evolution, there was no obvious evolution of d0. Since d0 reflects rather long-term accumulation of crystal lattice damage and microstructural changes due to service load, the loading history of the test rig samples has not reached the same level as the ex-service rails. It is concluded that the wheel-on-rail simulation rig provides the potential capability for testing the wheel-rail rolling contact conditions in rails, rail ends and insulated rail joints.

Anatomy of sand beach ridges : evidence from severe Tropical Cyclone Yasi and its predecessors, northeast Queensland, Australia

[1] Four well-identified tropical cyclones over the past century have been responsible for depositing distinct units of predominantly quartzose sand and gravel to form the most seaward beach ridge at several locations along the wet tropical coast of northeast Queensland, Australia. These units deposited by tropical cyclones display a key sedimentary signature characterized by a sharp basal erosional contact, a coarser grain size than the underlying facies and a coarse-skewed trend toward the base. Coarse-skewed distributions with minimal change in mean grain size also characterize the upper levels of the high-energy deposited units at locations within the zone of maximum onshore winds during the tropical cyclone. These same coarse skew distributions are not apparent in sediments deposited at locations where predominantly offshore winds occurred during the cyclone, which in the case of northeast Australia is north of the eye-crossing location. These sedimentary signatures, along with the geochemical indicators and the degraded nature of the microfossil assemblages, have proven to be useful proxies to identify storm-deposited units within the study site and can also provide useful proxies in older beach ridges where advanced pedogenesis has obscured visual stratigraphic markers. As a consequence, more detailed long-term histories of storms and tropical cyclones can now be developed.

Psychosocial and communication variables involved in mediating the individual experience of older adults following a severe weather event

The recent floods in south-east Queensland have focused policy, academic and community attention on the challenges associated with severe weather events (SWE), specifically pre-disaster preparation, disaster-response and post-disaster community resilience. Financially, the cost of SWE was $9 billion in the 2011 Australian Federal Budget (Swan 2011); psychologically and emotionally, the impact on individual mental health and community wellbeing is also significant but more difficult to quantify. However, recent estimates suggest that as many as one in five will subsequently experience major emotional distress (Bonanno et al. 2010). With climate change predicted to increase the frequency and intensity of a wide range of SWE in Australia (Garnaut 2011; The Climate Institute 2011), there is an urgent and critical need to ensure that the unique psychological and social needs of more vulnerable community members - such as older residents - are better understood and integrated into disaster preparedness and response policy, planning and protocols. Navigating the complex dynamics of SWE can be particularly challenging for older adults and their disaster experience is frequently magnified by a wide array of cumulative and interactive stressors, which intertwine to make them uniquely vulnerable to significant short and long-term adverse effects. This current article provides a brief introduction to the current literature in this area and highlights a gap in the research relating to communication tools during and after severe weather events.

A Cyber-Physical System Simulator for risk-free transport studies

The article introduces a novel platform for conducting controlled and risk-free driving and traveling behavior studies, called Cyber-Physical System Simulator (CPSS). The key features of CPSS are: (1) simulation of multiuser immersive driving in a threedimensional (3D) virtual environment; (2) integration of traffic and communication simulators with human driving based on dedicated middleware; and (3) accessibility of multiuser driving simulator on popular software and hardware platforms. This combination of features allows us to easily collect large-scale data on interesting phenomena regarding the interaction between multiple user drivers, which is not possible with current single-user driving simulators. The core original contribution of this article is threefold: (1) we introduce a multiuser driving simulator based on DiVE, our original massively multiuser networked 3D virtual environment; (2) we introduce OpenV2X, a middleware for simulating vehicle-to-vehicle and vehicle to infrastructure communication; and (3) we present two experiments based on our CPSS platform. The first experiment investigates the “rubbernecking” phenomenon, where a platoon of four user drivers experiences an accident in the oncoming direction of traffic. Second, we report on a pilot study about the effectiveness of a Cooperative Intelligent Transport Systems advisory system.

Promoting active lifestyles in young children: investigating mothers’ decisions about their child’s physical activity and screen time behaviours

Objectives Given increasing trends of obesity being noted from early in life and that active lifestyles track across time, it is important that children at a very young age be active to combat a foundation of unhealthy behaviours forming. This study investigated, within a theory of planned behaviour (TPB) framework, factors which influence mothers’ decisions about their child’s 1) adequate physical activity (PA) and 2) limited screen time behaviours. Methods Mothers (N = 162) completed a main questionnaire, via on-line or paper-based administration, which comprised standard TPB items in addition to measures of planning and background demographic variables. One week later, consenting mothers completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their child’s PA and screen time behaviours during the previous week. Results Hierarchical multiple regression analyses revealed support for the predictive model, explaining an overall 73% and 78% of the variance in mothers’ intention and 38% and 53% of the variance in mothers’ decisions to ensure their child engages in adequate PA and limited screen time, respectively. Attitude and subjective norms predicted intention in both target behaviours, as did intentions with behaviour. Contrary to predictions, perceived behavioural control (PBC) in PA behaviour and planning in screen time behaviour were not significant predictors of intention, neither was PBC a predictor of either behaviour. Conclusions The findings illustrate the various roles that psycho-social factors play in mothers’ decisions to ensure their child engages in active lifestyle behaviours which can help to inform future intervention programs aimed at combating very young children’s inactivity.

Do community-wide interventions increase physical activity? S1TEP

Background Not getting enough physical activity leads to poorer health. Regular physical activity can reduce the risk of chronic disease and improve one’s health and well-being. The lack of physical activity is a common and growing problem in many countries. We sought to evaluate the effects of community wide, multi-strategic interventions upon the physical activity patterns of populations. Method We undertook a Cochrane Systematic Review which included an extensive search of databases, including studies which met pre-determined criteria, and conducted independent risk of bias assessment and data extraction. Results After the selection process, 25 studies were included in the review. The strategies varied by the number and type of components and their intensity. No studies were identified as low risk of bias. Sixteen studies were identified as having a high risk of bias and thus untrustworthy. Nine studies were of considered to have an unclear risk of bias and some studies held back data they collected. The effects reported were inconsistent across the studies and the measures. Some of the better designed studies showed no improvement in measures of physical activity. Interventions which have an environmental change component seemed to be a promising direction. Those interventions which were primarily a mass media campaign were less likely to be successful. Conclusions Although numerous studies have been undertaken, there is considerable inconsistency in the findings of the available studies and this is confounded by serious methodological issues within the included studies. Simply combining interventions does not necessarily result in increased physical activity as many such studies, including some long term programs, failed to demonstrate efficacy. There is a clear need for well-designed studies and these studies should focus on the quality of measurement of physical activity. The review is currently being updated with newer studies.

Evidence of effectiveness : high level synthesis of research to prevent obesity and increase physical activity in children

Background Prevention of childhood obesity is a public health priority for Malaysia and many other countries. Physical activity for children is also decreasing at an alarming rate. Both conditions are associated with non-communicable diseases and with significant morbidity and mortality in later life. Systematic reviews of public health interventions provide a useful summary to inform public health practice by combining the results of a range of research studies on a specific intervention into a single report. Systematic reviews are deemed most valuable for health program development and evidence based practice. Unfortunately, many policy makers and practitioners are simply unaware of the evidence: which strategies which are most likely to provide benefit; and which strategies are known to be harmful or useless. This presentation provides a “birds eye” overview based upon recent (since 2007 to present) high quality systematic reviews of public health interventions. Method HealthEvidece.org and the Cochrane Library were searched for systematic reviews which evaluated interventions targeting obesity prevention and increasing physical activity for children. The findings of the included reviews were themed and summarized. Results Seven reviews were identified addressing obesity in the early years, and fifteen reviews addressing obesity more broadly in childhood. Additional reviews were identified aimed at increasing physical activity. The synthesis shows several strategies to be effective, however many popular strategies clearly are not. Several of the reviews were inconclusive due to an absence of robust primary studies. Amongst the findings, interventions undertaken in the school setting appear very promising. Conclusions There is significant evidence from systematic reviews to guide public health practice and policy, and to inform future research.

A standing vehicle occupant is likely to sustain a more severe injury than one who has flexed knees in an under‐vehicle explosion : a cadaveric study

The lower limb of military vehicle occupants has been the most injured body part due to undervehicle explosions in recent conflicts. Understanding the injury mechanism and causality of injury severity could aid in developing better protection. Therefore, we tested 4 different occupant postures (seated, brace, standing, standing with knee locked in hyper‐extension) in a simulated under‐vehicle explosion (solid blast) using our traumatic injury simulator in the laboratory; we hypothesised that occupant posture would affect injury severity. No skeletal injury was observed in the specimens in seated and braced postures. Severe, impairing injuries were observed in the foot of standing and hyper‐extended specimens. These results demonstrate that a vehicle occupant whose posture at the time of the attack incorporates knee flexion is more likely to be protected against severe skeletal injury to the lower leg.

Prospects for studying how high-intensity compression waves cause damage in human blast injuries

Since World War I, explosions have accounted for over 70% of all injuries in conflict. With the development of improved personnel protection of the torso, improved medical care and faster aeromedical evacuation, casualties are surviving with more severe injuries to the extremities. Understanding the processes involved in the transfer of blast-induced shock waves through biological tissues is essential for supporting efforts aimed at mitigating and treating blast injury. Given the inherent heterogeneities in the human body, we argue that studying these processes demands a highly integrated approach requiring expertise in shock physics, biomechanics and fundamental biological processes. This multidisciplinary systems approach enables one to develop the experimental framework for investigating the material properties of human tissues that are subjected to high compression waves in blast conditions and the fundamental cellular processes altered by this type of stimuli. Ultimately, we hope to use the information gained from these studies in translational research aimed at developing improved protection for those at risk and improved clinical outcomes for those who have been injured from a blast wave.

Hybrid genetic algorithm for elimination of severe stress concentration in railhead ends

This paper presents a computational method for eliminating severe stress concentration at the unsupported railhead ends in rail joints through innovative shape optimization of the contact zone, which is complex due to near field nonlinear contact. With a view to minimizing the computational efforts, hybrid genetic algorithm method coupled with parametric finite element has been developed and compared with the traditional genetic algorithm (GA). The shape of railhead top surface where the wheel contacts nonlinearly was optimized using the hybridized GA method. Comparative study of the optimal result and the search efficiency between the traditional and hybrid GA methods has shown that the hybridized GA provides the optimal shape in fewer computational cycles without losing accuracy. The method will be beneficial to solving complex engineering problems involving contact nonlinearity.