Too much knowledge for a nurse? Use of physical assessment by final-semester nursing students

There is debate around the scope of physical assessment skills that should be taught in undergraduate nursing programs. Yet this debate is largely uninformed by evidence on what is learned and practiced by nursing students. This study examined the pattern and correlates of physical assessment skill utilization by 208 graduating nursing students at an Australian university, including measures of knowledge, frequency of use and perceived barriers to physical assessment skills during clinical practice. Of the 126 skills surveyed, on average only five were used every time students practiced. Core skills reflected inspection or general observation of the patient; none involved complex palpation, percussion or auscultation. Skill utilization was also shaped by specialty area. Most skills (70%) were, on average, never performed or learned and students perceived nursing physical assessment was marginalized in both university and workplace contexts. Lack of confidence was thus a significant barrier to use of skills. Based on these findings we argue that the current debate must shift to how we might best support students to integrate comprehensive physical assessment into nursing practice.

Quality of discharge summaries sent by a regional hospital to general practitioners

Background A comprehensive hospital discharge summary sent to the patient's general practitioner in a timely manner can ease patient transition between care settings. Aim To investigate the quality of discharge summaries sent by a regional hospital to GPs; and to evaluate GPs' satisfaction with the medication list contained in the discharge summary. Method A questionnaire was mailed to a sample of 80 Gold Coast GPs who had made more than five referrals to the Gold Coast Hospital during June 2009. Results 18 responses (23% response rate) were received from September to October 2009. The majority (67%) of GPs received discharge summaries from the hospital and they were mostly in an electronic format with attached medication lists. The reasons for changing medications were not well explained and the timeframe for receiving summaries was considered unsatisfactory. Overall, the majority of GPs were satisfied with the quality of the discharge summaries. Conclusion GPs mostly received the discharge summaries and the majority received them electronically. The majority of GPs indicated that the medication lists were often attached to the discharge summaries and changes to medications recorded.

Solo holiday travellers: Motivators and drivers of satisfaction and dissatisfaction

A growing number of people are travelling alone for holidays, yet limited research addresses this topic. This paper explores the main motivators and drivers of satisfaction and dissatisfaction for solo holiday travellers using a critical incident technique (CIT) to collect and analyse data. The findings show that drivers of satisfaction for solo holiday travellers are more related to personal feelings of freedom, relaxation and discovery (personal factors), and interaction with other people (human interaction factors), than with holiday destination factors. Safety (a destination factor) and unfriendly service providers (a human interaction factor) are the main sources of dissatisfaction for solo holiday travellers.

Burden attributable to child maltreatment in Australia

Child maltreatment is a complex phenomenon, with four main types (childhood sexual abuse, physical abuse, emotional abuse, and neglect) highly interrelated. All types of maltreatment have been linked to adverse health consequences and exposure to multiple forms of maltreatment increases risk. In Australia to date, only burden attributable to childhood sexual abuse has been estimated. This study synthesized the national evidence and quantified the burden attributable to the four main types of child maltreatment. Meta-analyses, based on quality-effects models, generated pooled prevalence estimates for each maltreatment type. Exposure to child maltreatment was examined as a risk factor for depressive disorders, anxiety disorders and intentional self-harm using counterfactual estimation and comparative risk assessment methods. Adjustments were made for co-occurrence of multiple forms of child maltreatment. Overall, an estimated 23.5% of self-harm, 20.9% of anxiety disorders and 15.7% of depressive disorders burden in males; and 33.0% of self-harm, 30.6% of anxiety disorders and 22.8% of depressive disorders burden in females was attributable to child maltreatment. Child maltreatment was estimated to cause 1.4% (95% uncertainty interval 0.4–2.3%) of all disability-adjusted life years (DALYs) in males, and 2.4% (0.7–4.1%) of all DALYs in females in Australia in 2010. Child maltreatment contributes to a substantial proportion of burden from depressive and anxiety disorders and intentional self-harm in Australia. This study demonstrates the importance of including all forms of child maltreatment as risk factors in future burden of disease studies.

Open innovation in small and medium-sized enterprises (SMEs): External knowledge sourcing strategies and internal organizational facilitators

In this paper we explore how small and medium-sized enterprises (SMEs) engage in external knowledge sourcing, a form of inbound open innovation. We draw upon a sample of 1,411 SMEs and empirically conceptualize a typology of strategic types of external knowledge sourcing, namely minimal, supply-chain, technology-oriented, application-oriented, and full-scope sourcing. Each strategy reflects the nature of external interactions and is linked to a distinct mixture of four internal practices for managing innovation. Both full-scope and application-oriented sourcing offer performance benefits and are associated with a stronger focus on managing innovation. However, they differ in their managerial focus on strategic and operational aspects.

The exhaustive reduction of formylporphyrins to methylporphyrins using dimethylformamide/water as reductant under microwave irradiation

The reduction of meso-formyl derivatives of 5,15-diaryl- and 5,10,15-triphenylporphyrin (and their nickel(II) complexes) to the corresponding meso-methyl porphyrins is achieved in high yield by microwave heating of the substrate in dimethylformamide (DMF) in the presence of acids such as trifluoroacetic acid, or even just with added water. The reactions are complete in less than 30 min at 250 °C. The reaction is strongly suppressed in very dry DMF in the absence of added acid. The meso-hydroxymethyl porphyrins are also reduced to the methyl derivatives, suggesting the primary alcohols may be intermediates in the exhaustive reduction. UV-visible spectra taken at intervals during reaction at 240 °C indicated that at least one other intermediate is present, but it was not identified. In d7-DMF, the methylporphyrin isolated was mainly Por-CD2H, showing that both of the added hydrogens arise from the solvent, and not from the added water or acid.

Particle emissions from biodiesels with different physical properties and chemical composition

Biodiesels produced from different feedstocks usually have wide variations in their fatty acid methyl ester (FAME) so that their physical properties and chemical composition are also different. The aim of this study is to investigate the effect of the physical properties and chemical composition of biodiesels on engine exhaust particle emissions. Alongside with neat diesel, four biodiesels with variations in carbon chain length and degree of unsaturation have been used at three blending ratios (B100, B50, B20) in a common rail engine. It is found that particle emission increased with the increase of carbon chain length. However, for similar carbon chain length, particle emissions from biodiesel having relatively high average unsaturation are found to be slightly less than that of low average unsaturation. Particle size is also found to be dependent on fuel type. The fuel or fuel mix responsible for higher particle mass (PM) and particle number (PN) emissions is also found responsible for larger particle median size. Particle emissions reduced consistently with fuel oxygen content regardless of the proportion of biodiesel in the blends, whereas it increased with fuel viscosity and surface tension only for higher diesel–biodiesel blend percentages (B100, B50). However, since fuel oxygen content increases with the decreasing carbon chain length, it is not clear which of these factors drives the lower particle emission. Overall, it is evident from the results presented here that chemical composition of biodiesel is more important than its physical properties in controlling exhaust particle emissions.

The effects of high temperature on cardiovascular admissions in the most populous tropical city in Vietnam

This study examined the short-term effects of temperature on cardiovascular hospital admissions (CHA) in the largest tropical city in Southern Vietnam. We applied Poisson time-series regression models with Distributed Lag Non-Linear Model (DLNM) to examine the temperature-CHA association while adjusting for seasonal and long-term trends, day of the week, holidays, and humidity. The threshold temperature and added effects of heat waves were also evaluated. The exposure-response curve of temperature-CHA reveals a J-shape relationship with a threshold temperature of 29.6 °C. The delayed effects temperature-CHA lasted for a week (0–5 days). The overall risk of CHA increased 12.9% (RR, 1.129; 95%CI, 0.972–1.311) during heatwave events, which were defined as temperature ≥ the 99th percentile for ≥2 consecutive days. The modification roles of gender and age were inconsistent and non-significant in this study. An additional prevention program that reduces the risk of cardiovascular disease in relation to high temperatures should be developed.

Common variants in the HLA-DRB1-HLA-DQA1 HLA class II region are associated with susceptibility to visceral leishmaniasis

To identify susceptibility loci for visceral leishmaniasis, we undertook genome-wide association studies in two populations: 989 cases and 1,089 controls from India and 357 cases in 308 Brazilian families (1,970 individuals). The HLA-DRB1-HLA-DQA1 locus was the only region to show strong evidence of association in both populations. Replication at this region was undertaken in a second Indian population comprising 941 cases and 990 controls, and combined analysis across the three cohorts for rs9271858 at this locus showed P combined = 2.76 × 10 -17 and odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.30-1.52. A conditional analysis provided evidence for multiple associations within the HLA-DRB1-HLA-DQA1 region, and a model in which risk differed between three groups of haplotypes better explained the signal and was significant in the Indian discovery and replication cohorts. In conclusion, the HLA-DRB1-HLA-DQA1 HLA class II region contributes to visceral leishmaniasis susceptibility in India and Brazil, suggesting shared genetic risk factors for visceral leishmaniasis that cross the epidemiological divides of geography and parasite species. © 2013 Nature America, Inc. All rights reserved.

Semi-supervised document clustering via loci

Document clustering is one of the prominent methods for mining important information from the vast amount of data available on the web. However, document clustering generally suffers from the curse of dimensionality. Providentially in high dimensional space, data points tend to be more concentrated in some areas of clusters. We take advantage of this phenomenon by introducing a novel concept of dynamic cluster representation named as loci. Clusters’ loci are efficiently calculated using documents’ ranking scores generated from a search engine. We propose a fast loci-based semi-supervised document clustering algorithm that uses clusters’ loci instead of conventional centroids for assigning documents to clusters. Empirical analysis on real-world datasets shows that the proposed method produces cluster solutions with promising quality and is substantially faster than several benchmarked centroid-based semi-supervised document clustering methods.

Estimating equations for removal data analysis

We consider the problem of estimating a population size from successive catches taken during a removal experiment and propose two estimating functions approaches, the traditional quasi-likelihood (TQL) approach for dependent observations and the conditional quasi-likelihood (CQL) approach using the conditional mean and conditional variance of the catch given previous catches. Asymptotic covariance of the estimates and the relationship between the two methods are derived. Simulation results and application to the catch data from smallmouth bass show that the proposed estimating functions perform better than other existing methods, especially in the presence of overdispersion.

Parameterizing Unconditional Skewness in Models for Financial Time Series

In this paper we consider the third-moment structure of a class of time series models. It is often argued that the marginal distribution of financial time series such as returns is skewed. Therefore it is of importance to know what properties a model should possess if it is to accommodate unconditional skewness. We consider modeling the unconditional mean and variance using models that respond nonlinearly or asymmetrically to shocks. We investigate the implications of these models on the third-moment structure of the marginal distribution as well as conditions under which the unconditional distribution exhibits skewness and nonzero third-order autocovariance structure. In this respect, an asymmetric or nonlinear specification of the conditional mean is found to be of greater importance than the properties of the conditional variance. Several examples are discussed and, whenever possible, explicit analytical expressions provided for all third-order moments and cross-moments. Finally, we introduce a new tool, the shock impact curve, for investigating the impact of shocks on the conditional mean squared error of return series.

Book Review "Selling sex: a hidden history of prostitution", R. Frances, UNSW Press, Sydney, 2007

In the opening pages of Selling Sex we are introduced to 'Joy', a statue of a young female sex worker which stood in East Sydney for eighteen months during 1995- 1997. Following complaints by local residents, the statue was removed from public view and returned to its owner. Evidently, Joy was considered a reminder of the community's 'bad old days', when it was better known for prostitution than restaurants. In a nation in which almost every sizable community has proudly erected monuments to military men, the removal of Joy reveals much about labour and gender relations in Australia. For Frances, the removal of Joy is symbolic, our historical treatment of sex workers having parallels with our treatment of the convicts. This work sets out to give these women (male prostitutes do not figure in this history) a voice and break with the stereotypes of 'abandoned whores' or 'sad victims'. It also sets out to place the sex industry in the broader national and international context in which it has historically operated...