The effect of transition to specialty practice programs on Australian emergency nurses' professional development, recruitment and retention

BACKGROUND: To date, emergency nursing Transition to Specialty Practice Program (TSPP) evaluations have been single-site observational studies. The aim of this paper was to examine the professional development, recruitment and retention outcomes of Australian emergency nursing TSPPs. METHODS: An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Unit Managers and Nurse Educators. Survey data from EDs with TSPPs and EDs without TSPPs were compared. Qualitative data were analysed using content analysis. RESULTS: Data were collected from 118 EDs, and 13 interviews. TSPPs were offered in 72.1% of EDs. EDs with TSPPs had higher proportions of nurses with postgraduate qualifications (Mdn 28.3% vs. 22.1%, p=0.45) and Clinical Specialists (Mdn 16.4% vs. 6.3%, p=0.04). The median proportion of currently rostered nurses with TSPP completion was 34.2% in EDs with TSPPs introduced in 2000-2005 indicating ED high levels of retention. CONCLUSION: Emergency nursing TSPPs have had a positive effect on nursing professional development, recruitment and retention. To ensure consistency in outcomes and optimise reliability of emergency nursing skills and knowledge, a national emergency nursing TSPP framework is needed.

The factors influencing the decision making of operative treatment for proximal humeral fractures

Background:
The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations.
Methods: A total of 238 surgeons of the Science of Variation Group rated 40 radiographs of patients with proximal humerus fractures. Participants were randomized to receive information about the patient and mechanism of injury. The response variables included the choice of treatment (operative vs nonoperative) and the percentage of matches with the actual treatment.
Results: Participants who received patient information recommended operative treatment less than those who received no information. The patient information that had the greatest influence on treatment recommendations included age (55%) and fracture me chanism (32%). The only other factor associated with a recommendation for operative treatment was region of practice. There was no significant difference between participants who were and were not provided with information regarding agreement with the actual treatment (operative vs nonoperative) provided by the treating surgeon.
Conclusion: Patient information - older age in particular - is associated with a higher likelihood of recommending nonoperative treatment than radiographs alone. Clinical information did not improve agreement of the Science of Variation Group with the actual treatment or the generally poor interobserver agreement on treatment recommendations

Analytical modeling of partially shaded photovoltaic systems

As of today, the considerable influence of select environmental variables, especially irradiance intensity, must still be accounted for whenever discussing the performance of a solar system. Therefore, an extensive, dependable modeling method is required in investigating the most suitable Maximum Power Point Tracking (MPPT) method under different conditions. Following these requirements, MATLAB-programmed modeling and simulation of photovoltaic systems is presented here, by focusing on the effects of partial shading on the output of the photovoltaic (PV) systems. End results prove the reliability of the proposed model in replicating the aforementioned output characteristics in the prescribed setting. The proposed model is chosen because it can, conveniently, simulate the behavior of different ranges of PV systems from a single PV module through the multidimensional PV structure.

How many days of monitoring are needed to reliably assess SenseWear Armband outcomes in primary school-aged children?

OBJECTIVES: To identify the number of hours and days or nights of monitoring required to reliably estimate energy expenditure (EE), steps, waking sedentary time, light- (LPA), moderate- (MPA), vigorous- (VPA), moderate- to vigorous-intensity physical activity (MVPA), time in bed and total sleep time using the SenseWear Armband. DESIGN: Cross-sectional study. METHODS: One hundred and two children (50% boys) aged 8-11 years from six schools wore a SenseWear Armband (BodyMedia Inc, USA) for eight consecutive days (seven consecutive nights). Hourly increments of valid day wear time criteria were examined (days/week; 8h/day-14h/day). Intra-class correlation coefficients estimated the reliability for any individual day for each wear time criteria. The Spearman-Brown prophecy formula was used to determine the number of days/nights of monitoring needed to achieve reliability estimates of 0.7, 0.8 and 0.9. RESULTS: Fewer monitoring days were needed as the valid day criteria became more stringent. For example, at least 12h of wear time on at least 2 days was required to achieve a reliability of 0.7 for EE. In contrast, at least 8h/day on 5 days resulted in reliable estimates (0.7) for MPA, VPA and MVPA. Between 6 and 7 nights of monitoring were required to reliably estimate children's time in bed and total sleep time, respectively. CONCLUSIONS: A 7-day monitoring protocol in primary school-aged children would provide acceptable reliability for the assessment of EE, waking sedentary time, LPA, MPA, VPA, MVPA, time in bed and total sleep time, as assessed by the SenseWear Armband.

Research to practice: application of an evidence building framework to a childhood obesity prevention initiative in New South Wales, Australia

Issue addressed: Building evidence-based health promotion programs involves a number of steps. This paper aims to develop a set of criteria for assessing the evidence available according to a five-stage evidence-building framework, and apply these criteria to current child obesity prevention programs in NSW to determine the usefulness of the framework in identifying gaps in evidence and opportunities for future research and evaluation. Methods: A set of scoring criteria were developed for application within the five stages of an 'evidence-building' framework: problem definition, solution generation, intervention testing (efficacy), intervention replication, and dissemination research. The research evidence surrounding the 10 childhood obesity prevention programs planned for state-wide implementation in the New South Wales Healthy Children Initiative (HCI) was identified and examined using these criteria within the framework. Results: The evidence for the component programs of the HCI is at different stages of development. While problem definition and, to a lesser extent, solution generation was thoroughly addressed across all programs, there were a number of evidence gaps, indicating research opportunities for efficacy testing and intervention replication across a variety of settings and populations. Conclusions: The five-stage evidence-building framework helped identify important research and evaluation opportunities that could improve health promotion practice in NSW. More work is needed to determine the validity and reliability of the criteria for rating the extent and quality of the evidence for each stage.