Comparing nurses’ and doctors’ views of nurse prescribing: a questionnaire survey

Nurses have successfully adopted the role of prescriber in numerous health care settings in the UK. Existing research has not addressed how Nurse Independent and Nurse Supplementary Prescribers compare with doctors in terms of the perceived advantages and disadvantages of nurse prescribing, nor has the perceived importance of nurses providing patients with an explanation about their medicines been established. The current study utilized a random sample of 31 qualified Nurse Independent and Nurse Supplementary Prescribers and 30 general practitioners who self-completed a written questionnaire in an independent groups design. The study establishes nurses’ and doctors’ perceptions of the advantages and disadvantages of independent and supplementary nurse prescribing and provides some indication of the importance that nurses and doctors place on nurses providing an explanation about medicines, and the categories of information perceived to be important.

Construction contracts: law and management (3rd edition)

This book is aimed primarily at students for whom the study of building or civil engineering contracts forms part of a construction-based course. We have had in mind the syllabus requirements for first degrees in Building, Civil Engineering, Architecture, Quantity Surveying and Building Surveying, as well as those of postgraduate courses in Construction Management and Project Management. We have also assumed that such students will already have been introduced to the general principles of English law, especially those relating to contract and tort. As a result, while aspects of those subjects that are of particular relevance to construction are dealt with here, the reader must look elsewhere for the general legal background. In producing this third edition, we have again been greatly assisted by the many helpful comments made by reviewers and users of its predecessor. Nonetheless, our basic aim is identical to that which underpinned the first edition: to provide an explanation of the fundamental principles of construction contract law, rather than a clause-by-clause analysis of any particular standard-form contract. As a result, while we draw most frequently upon JCT 98 for our illustrations of particular points, this merely reflects the pre-eminent position occupied by that particular form of contract in the UK construction industry. We conclude by repeating our previous warning as to the dangers inherent in a little learning. Neither this book, nor the courses for which it is intended, seek to produce construction lawyers. The objective is rather to enable those who are not lawyers to resolve simple construction disputes before they become litigious, and to recognize when matters require professional legal advice. It should be the aim of every construction student to understand the legal framework sufficiently that they can instruct and brief specialist lawyers, and this book is designed to help them towards that understanding.

Conservation and sustainable use of wild species as sources of new ornamentals

While only about 1-200 species are used intensively in commercial floriculture (e.g. carnations, chrysanthemums, gerbera, narcissus, orchids, tulips, lilies, roses, pansies and violas, saintpaulias, etc.) and 4-500 as house plants, several thousand species of herbs, shrubs and trees are traded commercially by nurseries and garden centres as ornamentals or amenity species. Most of these have been introduced from the wild with little selection or breeding. In Europe alone, 12 000 species are found in cultivation in general garden collections (i.e. excluding specialist collections and botanic gardens). In addition, specialist collections (often very large) of many other species and/or cultivars of groups such as orchids, bromeliads, cacti and succulents, primulas, rhododendrons, conifers and cycads are maintained in several centres such as botanic gardens and specialist nurseries, as are 'national collections' of cultivated species and cultivars in some countries. Specialist growers, both professional and amateur, also maintain collections of plants for cultivation, including, increasingly, native plants. The trade in ornamental and amenity horticulture cannot be fully estimated but runs into many billions of dollars annually and there is considerable potential for further development and the introduction of many new species into the trade. Despite this, most of the collections are ad hoc and no co-ordinated efforts have been made to ensure that adequate germplasm samples of these species are maintained for conservation purposes and few of them are represented at all adequately in seed banks. Few countries have paid much attention to germplasm needs of ornamentals and the Ornamental Plant Germplasm Center in conjunction with the USDA National Plant Germplasm System at The Ohio State University is an exception. Generally there is a serious gap in national and international germplasm strategies, which have tended to focus primarily on food plants and some forage and industrial crops. Adequate arrangements need to be put in place to ensure the long- and medium-term conservation of representative samples of the genetic diversity of ornamental species. The problems of achieving this will be discussed. In addition, a policy for the conservation of old cultivars or 'heritage' varieties of ornamentals needs to be formulated. The considerable potential for introduction of new ornamental species needs to be assessed. Consideration needs to be given to setting up a co-ordinating structure with overall responsibility for the conservation of germplasm of ornamental and amenity plants.

Ontological modelling of content management and provision

Information provision to address the changing requirements can be best supported by content management. The Current information technology enables information to be stored and provided from various distributed sources. To identify and retrieve relevant information requires effective mechanisms for information discovery and assembly. This paper presents a method, which enables the design of such mechanisms, with a set of techniques for articulating and profiling users' requirements, formulating information provision specifications, realising management of information content in repositories, and facilitating response to the user's requirements dynamically during the process of knowledge construction. These functions are represented in an ontology which integrates the capability of the mechanisms. The ontological modelling in this paper has adopted semiotics principles with embedded norms to ensure coherent course of actions represented in these mechanisms. (C) 2008 Elsevier B.V. All rights reserved.

Diallyl disulphide, a beneficial component of garlic oil, causes a redistribution of cell-cycle growth phases, induces apoptosis and enhances butyrate-induced apoptosis in colorectal adenocarcinoma cells (HT-29)

Colon cancer is a leading and expanding cause of death worldwide. A major contributory factor to this disease is diet composition; some components are beneficial (e.g. dietary fibre) whilst others are detrimental (e.g. alcohol). Garlic oil is a prominent dietary constituent that prevents the development of colorectal cancer. This effect is believed to be mainly due to diallyl disulphide (DADS), which selectively induces redox stress in cancerous (rather than normal) cells which leads to apoptotic cell death. However, the detailed mechanism by which DADS causes apoptosis remains unclear. We show that DADS-treatment of colonic adenocarcinoma cells (HT-29) initiates a cascade of molecular events characteristic of apoptosis. These include a decrease in cellular proliferation, translocation of phosphatidylserine to the plasma-membrane outer-layer, activation of caspase-3, genomic-DNA fragmentation and G2/M phase cell-cycle arrest. Short-chain fatty acids (SCFAs), particularly butyrate (abundantly produced in the gut by bacterial fermentation of dietary polysaccharides), enhance colonic cell integrity but, in contrast, inhibit colonic-cancer cell growth. Combining DADS with butyrate augmented the effect of butyrate on HT-29 cells. These results suggest that the anti-cancerous properties of DADS afford greater benefit when supplied with other favourable dietary factors (SCFA/polysaccharides) that likewise reduce colonic tumour development.

Application of the Lighthill-Ford theory of spontaneous imbalance to clear-air turbulence forecasting

A new method of clear-air turbulence (CAT) forecasting based on the Lighthill–Ford theory of spontaneous imbalance and emission of inertia–gravity waves has been derived and applied on episodic and seasonal time scales. A scale analysis of this shallow-water theory for midlatitude synoptic-scale flows identifies advection of relative vorticity as the leading-order source term. Examination of leading- and second-order terms elucidates previous, more empirically inspired CAT forecast diagnostics. Application of the Lighthill–Ford theory to the Upper Mississippi and Ohio Valleys CAT outbreak of 9 March 2006 results in good agreement with pilot reports of turbulence. Application of Lighthill–Ford theory to CAT forecasting for the 3 November 2005–26 March 2006 period using 1-h forecasts of the Rapid Update Cycle (RUC) 2 1500 UTC model run leads to superior forecasts compared to the current operational version of the Graphical Turbulence Guidance (GTG1) algorithm, the most skillful operational CAT forecasting method in existence. The results suggest that major improvements in CAT forecasting could result if the methods presented herein become operational.

Training drama teachers: a perspective from England

In England, drama is embedded into the National Curriculum as a part of the programmes of study for the subject of English. This means that all children aged between 5 - 16 in state funded schools have an entitlement to be taught some aspects of the subject. While the manifestation of drama in primary schools is diverse, in a great many schools for students aged between 11 – 19, drama and theatre art is taught as a discrete subject in the same way that the visual arts and music are. Students may opt for public examination courses in the subject at ages 16 and 18. In order to satisfy the specifications laid down for such examinations many schools recognise the need for specialist teachers and indeed specialist teaching rooms and equipment. This chapter outlines how drama is taught in secondary schools in England (there being subtle variations in the education systems in the other countries that make up the United Kingdom) and the theories that underpin drama’s place in the curriculum as a subject in its own right and as a vehicle for delivering other aspects of the prescribed curriculum are discussed. The paper goes on to review the way in which drama is taught articulates with the requirements and current initiatives laid down by the government. Given this context, the chapter moves on to explore what specialist subject and pedagogical knowledge secondary school drama teachers need. Furthermore, consideration is made of the tensions that may be seen to exist between the way drama teachers perceive their own identity as subject specialists and the restrictions and demands placed upon them by the education system within which they work. An insight into the backgrounds of those who become drama teachers in England is provided and the reasons for choosing such a career and the expectations and concerns that underpin their training are identified and analysed.

Laughter in the Dark: ethical aspects of drama education

This chapter considers two questions. Firstly, in what ways might drama be an effective medium through which to explore difficult and sensitive issues that concern teenagers? And secondly, what ethical questions surround the use of drama to explore such issues? A practical workshop on teenage suicide is used as a platform for a discussion on the use and implications of different drama strategies and the role of humour as a critical lens and distancing device. The work of actual teenagers is used to illustrate the effectiveness of the techniques in both raising awareness and facilitating both critical and creative responses to the delicate issue explored in the workshop.

Effect of patient age on management decisions in breast cancer: consensus from a national consultation

This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, participated in a virtual consultation using e-mailed questionnaires and open-ended discussion documents, culminating in the development of proposed consensus statements sent to participants for validation. A strong consensus was seen in favor of incorporating minimum standards of diagnostic services, treatment, and care for older patients with breast cancer into relevant national guidance, endorsed by professional bodies. Similarly, an overwhelming majority of participants agreed that simple, evidence-based protocols or guidelines on standardizing assessment of biological and chronological age should be produced by the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, developed in collaboration with specialist oncogeriatricians, and endorsed by professional bodies. A further recommendation that all breast cancer patient treatment and diagnostic procedures be undertaken in light of up-to-date, relevant scientific data met with majority support. This study was successful in gauging national specialist opinion regarding the effect of patient age on management decisions in breast cancer in the U.K.

Early modern Oxford bindings in twenty-first century markup

Purpose – The Bodleian Binders Book contains nearly 150 pages of seventeenth century library records, revealing information about the binders used by the library and the thousands of bindings they produced. The purpose of this paper is to explore a pilot project to survey and record bindings information contained in the Binders Book. Design/methodology/approach – A sample size of seven pages (91 works, 65 identifiable bindings) to develop a methodology for surveying and recording bindings listed in the manuscript. To create a successful product that would be useful to bindings researchers, it addressed questions of bindings terminology and the role of the library in the knowledge creation process within the context that text encoding is changing the landscape of library functions. Text encoding formats were examined, and a basic TEI (Text Encoding Initiative) transcription was produced. This facilitates tagging of names and titles and the display of transcriptions with text images. Findings – Encoding was found not only to make the manuscript content more accessible, but to allow for the construction of new knowledge: characteristic Oxford binding traits were revealed and bindings were matched to binders. Plans for added functionality were formed. Originality/value – This research presents a “big picture” analysis of Oxford bindings as a result of text encoding and the foundation for qualitative and statistical analysis. It exemplifies the benefits of interdisciplinary methods – in this case from Digital Humanities – to enhance access to and interpretation of specialist materials and the library's provenance record.

Design patterns for promoting peer interaction in discussion forums in MOOCs

Design patterns are a way of sharing evidence-based solutions to educational design problems. The design patterns presented in this paper were produced through a series of workshops, which aimed to identify Massive Open Online Course (MOOC) design principles from workshop participants’ experiences of designing, teaching and learning on these courses. MOOCs present a challenge for the existing pedagogy of online learning, particularly as it relates to promoting peer interaction and discussion. MOOC cohort sizes, participation patterns and diversity of learners mean that discussions can remain superficial, become difficult to navigate, or never develop beyond isolated posts. In addition, MOOC platforms may not provide sufficient tools to support moderation. This paper draws on four case studies of designing and teaching on a range of MOOCs presenting seven design narratives relating to the experience in these MOOCs. Evidence presented in the narratives is abstracted in the form of three design patterns created through a collaborative process using techniques similar to those used in collective autoethnography. The patterns: “Special Interest Discussions”, “Celebrity Touch” and “Look and Engage”, draw together shared lessons and present possible solutions to the problem of creating, managing and facilitating meaningful discussion in MOOCs through the careful use of staged learning activities and facilitation strategies.

Patients' attitudes towards, and information needs in relation to, nurse prescribing in rheumatology

Aims and objectives: To assess the level of confidence that rheumatology patients would have in nurse prescribing, the effects on likely adherence and particular concerns that these patients have. In addition, given that information provision has been cited as a potential benefit of nurse prescribing, the present study assessed the extent to which these patients would want an explanation for the selected medicine, as well as which types of information should be included in such an explanation. Background: Nurse prescribing has been successfully implemented in the UK in several healthcare settings. Existing research has not addressed the effects on patients' confidence and likely adherence, nor have patients' information needs been established. However, we know that inadequate medicines information provision by health professionals is one of the largest causes of patient dissatisfaction. Methods: Fifty-four patients taking disease-modifying drugs for inflammatory joint disease attending a specialist rheumatology clinic self-completed a written questionnaire. Results: Patients indicated a relatively high level of confidence in nurse prescribing and stated that they would be very likely to take the selected medication. The level of concern was relatively low and the majority of concerns raised did not relate to the nurse's status. Strong support was expressed for the nurse providing an explanation for medicine choice. Conclusion: This research provides support for the prescription of medicines by nurses working in the area of rheumatology, the importance of nurses providing a full explanation about the selected medicines they prescribe for these patients and some indication as to which categories of information should be included. Relevance to clinical practice: Rheumatology patients who have not yet experienced nurse prescribing are, in general, positive about nurses adopting this role. It is important that nurses provide appropriate information about the prescribed medicines, in a form that can be understood.