A mixed methods study of the work patterns of full-time nurse practitioners in nursing homes

Aims and objectives: The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. 

Background: Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. 

Design: The study used a sequential mixed methods design using a national survey followed by case studies. 

Methods: A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. 

Results: Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. 

Conclusion: Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Relevance to clinical practice: Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care.

Do dynamic work instructions provide an advantage over static instructions in a small scale assembly task?

Recent studies exploring the effects of instructional animations on learning compared to static graphics have yielded mixed results. Few studies have explored their effectiveness in portraying procedural-motor information. Opportunities exist within an applied (manufacturing) context for instructional animations to be used to facilitate build performance on an assembly line. The present study compares build time performance across successive builds when using animation, static diagrams or text instructions to convey an assembly sequence for a handheld device. Although an immediate facilitating effect of animation was found, yielding a significantly faster build time for Build 1, this advantage had disappeared by Build 3. (C) 2009 Elsevier Ltd. All rights reserved.

CsF and alumina: A mixed homogeneous-heterogeneous catalytic system for the transesterification of sunflower oil with methanol

The activity and nature (i e heterogeneous and/or homogeneous) of catalysts based on CsF supported on alpha-Al2O3 were investigated for the transesterification of vegetable oil with methanol. The effect of the activation temperature, CsF loading and the reusability in a recirculating reactor were first studied CsF/alpha-Al2O3 exhibited the highest activity for a CsF loading of 0 6 mmol/g and when activated at 120 degrees C An important aspect of this study is the effect of CsF leaching into the reaction mixture, which is attributed to the high solubility of CsF in methanol, leading to a complete loss of activity after one run It was Identified that the activity of the catalyst resulted from a synergy between alumina and dissolved CsF, the presence of both compounds being absolutely necessary to observe any conversion The use of an alumina with a higher surface area resulted in a far greater reaction rate, showing that the concentration of surface site on the oxide (probably surface hydroxyl) was rate-limiting in the case of the experiments using the low surface area alpha-Al2O3 This work emphasizes that combined homogeneous-heterogeneous catalytic systems made from the blending of the respective catalysts can be used to obtain high conversion of vegetable oil to biodiesel. Despite the homogeneous/heterogeneous dual character, such a catalytic system may prove valuable in developing a simple and cost-effective continuous catalytic process for biodiesel production (C) 2010 Elsevier B V All rights reserved

Mixed radix Reed-Muller expansions

The choice of radix is crucial for multi-valued logic synthesis. Practical examples, however, reveal that it is not always possible to find the optimal radix when taking into consideration actual physical parameters of multi-valued operations. In other words, each radix has its advantages and disadvantages. Our proposal is to synthesise logic in different radices, so it may benefit from their combination. The theory presented in this paper is based on Reed-Muller expansions over Galois field arithmetic. The work aims to firstly estimate the potential of the new approach and to secondly analyse its impact on circuit parameters down to the level of physical gates. The presented theory has been applied to real-life examples focusing on cryptographic circuits where Galois Fields find frequent application. The benchmark results show the approach creates a new dimension for the trade-off between circuit parameters and provides information on how the implemented functions are related to different radices.

MIXED-MODEL PRODUCTION SYSTEM DESIGN FOR AIRCRAFT ASSEMBLY

With the advancement of flexible fixture and flexible tooling, mixed production has become possible for aircraft assembly as the manufacturing processes of different aircraft/sub-assembly models are similar. However, it is a great challenge to model the problem and provide a practical solution due to the low volume and complex constraints of aircraft assemblies. To tackle this problem, this work proposes a methodology for designing the mixed production system, and a new scheduling approach is proposed by combined backward and forward scheduling methods. These methods are validated through a real-life industrial case study. Simulation results show that the number of workstations and the cycle time for making a fuselage can be reduced by 50% and 39% respectively with the newly designed mixed-model system.

Does intergenerational contact reduce Ageism: When and How Contact Interventions Actually Work?

Although the past two decades have seen concrete attempts to reduce ethnic and racial prejudice, relatively little has been done to diminish age related prejudice. In this paper, we review intergenerational contact interventions have been applied in a real world setting, the results are mixed. While contact interventions are not a panacea, they do constitute a main plank in efforts to redress ageism. We, therefore, examine the types of interventions that are effective, the processes underlying their enhanced impact, and clarifying when and how intergenerational contact can predict more positive attitudes towards the elderly. Finally, we highlight ways in which findings might be applied to the development of more effective interventions aimed at combating a pervasive stereotype of aging, drawing out lessons for theory and implications for practice.

Delivering Social Work Education on Case Reviews and Inquiry Reports: An Exploratory Study of Students' Perspectives in Northern Ireland

It is self-evident that we live in the age of inquiry where the negative impact of risk has been examined through numerous formal processes. In the wake of such scrutiny, there have been repeated recommendations for better training of the professionals charged with safeguarding the welfare of vulnerable individuals. Yet there has been very little examination of how student social workers, in particular, evaluate this training. This exploratory study responded to this gap through a mixed-methods design centring on the views of qualifying and post-qualifying social work students attending courses within two regional universities in Northern Ireland. The study found that, in the main, the cohorts responded favourably to certain aspects of the curriculum and how they were delivered. That said, the emotive nature of the case review and inquiry reports was inadequately addressed in the classroom and was not processed afterwards through a psycho-social framework. In effect, students were often left with residual anxieties that potentially hampered learning. On the basis of the findings, the study calls for further research into this highly significant area of professional competence.

The Management of Long-Term Sickness Absence in Large Public Sector Healthcare Organisations: A Realist Evaluation Using Mixed Methods

Purpose The success of measures to reduce long-term sickness absence (LTSA) in public sector organisations is contingent on organisational context. This realist evaluation investigates how interventions interact with context to influence successful management of LTSA. Methods Multi-method case study in three Health and Social Care Trusts in Northern Ireland comprising realist literature review, semi-structured interviews (61 participants), Process-Mapping and feedback meetings (59 participants), observation of training, analysis of documents. Results Important activities included early intervention; workplace-based occupational rehabilitation; robust sickness absence policies with clear trigger points for action. Used appropriately, in a context of good interpersonal and interdepartmental communication and shared goals, these are able to increase the motivation of staff to return to work. Line managers are encouraged to take a proactive approach when senior managers provide support and accountability. Hindering factors: delayed intervention; inconsistent implementation of policy and procedure; lack of resources; organisational complexity; stakeholders misunderstanding each other’s goals and motives. Conclusions Different mechanisms have the potential to encourage common motivations for earlier return from LTSA, such as employees feeling that they have the support of their line manager to return to work and having the confidence to do so. Line managers’ proactively engage when they have confidence in the support of seniors and in their own ability to address LTSA. Fostering these motivations calls for a thoughtful, diagnostic process, taking into account the contextual factors (and whether they can be modified) and considering how a given intervention can be used to trigger the appropriate mechanisms.

Density functional theory study of mixed-phase TiO2: heterostructures and electronic properties

In this work, density functional theory calculations have been performed to study the geometric, electronic, and energetic properties of two-phase TiO2 composites built by joining two single-phase TiO2 slabs, aiming at verifying possible improvement of the photo-activities of the composites through phase separation of excitons. We find that such desired electronic properties can be determined by several factors. When both the HOMO and LUMO levels of one of the two single-phase TiO2 slabs are higher than the corresponding ones of the other, the composite may have native electronic structures with phase-separated HOMO-LUMO states, especially when the two slabs exhibit highly matched surface lattices. For those pairs of TiO2 slabs with the HOMO and LUMO levels of one phase being within the range of those of the other, though the energetically favored composite give HOMO-LUMO states within one phase, one may still be able to separate them and move the HOMO state to the interface region by destabilizing the interactions between the two slabs.

Re-dispersion of gold supported on a ‘mixed’ oxide support

The ability to reactivate, stabilize and increase the lifetime of gold catalysts by dispersing large, inactive gold nanoparticles to smaller nanoparticles provides an opportunity to make gold catalysts more practical for industrial applications. Previously it has been demonstrated that mild treatment with iodomethane (CH3I) (J. Am. Chem. Soc., 2009, 131, 6973; Angew. Chem. Int. Ed., 2011, 50, 8912) was able to re-disperse gold on carbon and metal oxide supports. In the current work, we show that this technique can be applied to re-disperse gold on a ‘mixed’ metal oxide, namely a mechanical mixture of ceria, zirconia and titania. Characterization was conducted to gage the impact of the iodomethane (CH3I) treatment on a previously sintered catalyst.

Development and testing of an intermediate temperature glass sealant for use in mixed ionic and electronic conducting membrane reactors

High temperature ceramic membranes have interesting possibilities for application in areas of new and developing technologies such as hydrocarbon combustion with carbon dioxide capture and electrochemical promotion of catalysis (EPOC). However, membrane module sealing remains a significant technical challenge. In this work a borosilicate glass sealant (50SiO₂·25B₂O₃·25Na₂O, mol%) was developed to fit the requirements of sealing an air separation membrane system at intermediate temperatures (300-600 °C). The seal was assessed by testing the leak rates under a range of conditions. The parameters tested included the effect of flowrate on the leak rate, the heating and cooling rates of the reactor and the range of temperatures under which the system could operate. Tests for durability and reliability were also performed. It was found that the most favourable reactor configuration employed a reactor with the ceramic pellet placed underneath the inner chamber alumina tube (inverted configuration), using a quartz wool support to keep the membrane in place prior to sealing. Using this configuration the new glass-based seal was found to be a more suitable sealant than traditional alternatives; it produced lower leak rates at all desirable flowrates, with the potential for rapid heating and cooling and multiple cycling, allowing for prolonged usage. © 2010 Elsevier B.V. All rights reserved.

Remote control of the activity of a Pt catalyst supported on a mixed ionic electronic conducting membrane

A novel configuration for the in situ control of the catalytic activity of a polycrystalline Pt catalyst supported on a mixed ionic electronic conducting (MIEC) substrate is investigated. The modification of the catalytic activity is achieved by inducing the reverse spillover of oxygen promoting species from the support onto the catalyst surface, thus modifying the chemisorptive bond energy of the gas phase adsorbed reactants. This phenomenon is known as Electrochemical Promotion of Catalysis (EPOC). In this work we investigate the use of a wireless system that takes advantage of the mixed ionic electronic conductivity of the catalyst support (internally short-circuiting the system) in a dual chamber reactor. In this wireless configuration, the reaction takes place in one chamber of the membrane reactor while introduction of the promoting species is achieved by the use of an appropriate sweep gas (and therefore control of the oxygen chemical potential difference across the membrane) on the other chamber. Experimental results have shown that the catalytic rate can be enhanced by using an oxygen sweep, while a hydrogen sweep can reverse the changes. Total rate enhancement ratios of up to 3.5 were measured. © 2008 Elsevier B.V. All rights reserved.

Mixed Messages: American Correspondences in Visual and Verbal Practices

Mixed Messages presents and interrogates ten distinct moments from the arts of nineteenth, twentieth and twenty-first century America where visual and verbal forms blend and clash. Charting correspondences concerned with the expression and meaning of human experience, this volume moves beyond standard interdisciplinary theoretical approaches to consider the written and visual artwork in embodied, cognitive, and contextual terms.

Offering a genuinely interdisciplinary contribution to the intersecting fields of art history, avant-garde studies, word-image relations, and literary studies, Mixed Messages takes in architecture, notebooks, poetry, painting, conceptual art, contemporary art, comic books, photographs and installations, ending with a speculative conclusion on the role of the body in the experience of digital mixed media. Each of the ten case studies explores the juxtaposition of visual and verbal forms in a manner that moves away from treating verbal and visual symbols as operating in binary or oppositional systems, and towards a consideration of mixed media, multi-media and intermedia work as brought together in acts of creation, exhibition, reading, viewing, and immersion. The collection advances research into embodiment theory, affect, pragmatist aesthetics, as well as into the continuing legacy of romanticism and of dada, conceptual art and surrealism in an American context.