The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams

Since the 1970s breast cancer services have witnessed considerable changes in the management of patients. One significant change was the introduction of specialist core personnel, including the breast care nurse (BCN). The role of the BCN has been gaining credence rapidly in the British NHS and this service is perhaps the paradigm of care for other services. With the lack of specific evidence of the role of specialist nurses in the breast care team, the current study aims to explore this area by in-depth interviews with core team members, and observations of 16 multi-disciplinary teams in England. The study explores the following themes: Nurses' unique informal management leadership role in ensuring the co-ordination, communication and planning of the team work; nurses' innovatory role in making the bureaucracy respond to patients and their relatives needs; nurses supportive role in the provision of expert advice and guidance to other members of the team; nurses confidence and humour in well-performing teams; and the limitations of the professional role of the breast cancer nurse. This study indicates that there is evidence that the BCN is practicing at an advanced level of practice. However, there is a severe lack of evidence-based description of that advanced practice. Cancer nurses including the BCNs should develop and participate in programmes of research in line with cancer legislation in order to build an evidence base that ultimately supports their unique role. © 2004 Elsevier Ltd. All rights reserved.

Analyse de l’implantation d’un plan d’action pour le renforcement du rôle professionnel de la sage-femme dans le Royaume du Maroc

Dans le cadre d’une stratégie nationale visant les objectifs du Millénaire pour le développement 4 et 5 au Maroc - réduire la mortalité maternelle et infantile -, un plan d’action a été développé au sein des trois systèmes (socioculturel, éducationnel, disciplinaire) dans lesquels évolue un rôle professionnel de la santé et ce, pour renforcer le rôle professionnel de la sage-femme. La présente thèse vise à évaluer le niveau d’implantation du plan d’action et à comprendre les facteurs contextuels ayant affecté son implantation et susceptibles d’empêcher l’atteinte de ses effets. Le cadre conceptuel adopté dérive du modèle de Hatem-Asmar (1997) concernant l’interaction entre les systèmes éducationnel, disciplinaire et socioculturel pour changer un rôle professionnel de la santé; et le cadre de Damschroder et al. (2009) pour l’analyse de l’implantation d’une intervention en santé. Le devis est une étude de cas unique à trois niveaux d’analyse. Les données sont recueillies à partir de multiples sources de données : 11 entrevues individuelles semi-structurées, 20 groupes de discussion, observations d’activités de formation, analyse de documents. Les résultats ont montré des déficits notables au niveau de l’implantation. Seize barrières et sept facilitateurs ont été catégorisés sous les construits du cadre de Damschroder et al. (2009) et sous les dimensions des trois systèmes. Un alignement inadéquat entre les dimensions (valeurs, méthodes, acteurs et finalités) du système socioculturel et celles (valeurs, méthodes, acteurs) des systèmes éducationnel et disciplinaire d’une part, avec le plan d’action d’autre part empêche son implantation globale. La structure bureaucratique et le manque de préparation du système socioculturel ont constitué les barrières les plus influentes sur: la diffusion de l’information; l’implication des acteurs du terrain dans le processus; et l’état de préparation du système éducationnel. Les principaux facilitateurs étaient : les valeurs promues à l’égard des droits humains et le mouvement politique pour renforcer le rôle professionnel de la sage-femme et réduire la mortalité maternelle. Quant au plan, il a été perçu comme étant bénéfique mais complexe et émanant d’une source externe. Les résultats mettent l’accent sur la nécessité de contourner les barrières identifiées dans les trois systèmes afin d’obtenir des contextes propices à la production des effets. Par ailleurs, les résultats ont soulevé aussi sept barrières qui risquent de compromettre l’atteinte des effets désirés. Elles concernent: le cadre légal, les représentations sociales et le support médiatique au niveau du système socioculturel; le réseautage et les mécanismes de communication, les caractéristiques liées au rôle, à l’environnement de pratique, et le niveau de préparation du système disciplinaire. Notre recherche confirme qu’un changement visant le système éducationnel isolément représente une vision réductrice pour le renforcement du rôle des sages-femmes. Une combinaison des conditions contextuelles favorables au niveau des dimensions des trois systèmes est requise pour atteindre le but de la stratégie gouvernementale, soit fournir des sages-femmes qualifiées selon les normes globales de la Confédération Internationale des sages-femmes, capables d’offrir des soins de qualité en santé de la reproduction qui permettront de contribuer à réduire la mortalité maternelle et néonatale.

Role of interface states associated with transitional nanophase precipitates in the photoluminescence enhancement of SrTiO3 : Pr3+,Al3+

SrTiO3:Pr3+,Al3+ phosphor samples with varying ratios of Sr/Ti/Al were prepared by the gel-carbonate method and the mechanism of enhancement of the red photoluminescence intensity therein was investigated. The photoluminescence (PL) spectra of SrTiO3:Pr3+ show both D-1(2) --> H-3(4) and P-3(0) --> H-3(4) emission in the red and blue spectral regions, respectively, with comparable intensity. The emission intensity of D-1(2) --> H-3(4) is drastically enhanced by the incorporation of Al3+ and excess Ti4+ in the compositional range Sr(Ti,Al-y)(O3+3y/2):Pr3+ (0.2 less than or equal to y less than or equal to 0.4) and SrTi1+xAlyO3+z:Pr3+ (0.2 less than or equal to x less than or equal to 0.5; 0.05 less than or equal to y less than or equal to 0.1; z = 2x + 3y/2) with the complete disappearance of the blue band. This cannot be explained by the simple point defect model as the EPR studies do not show any evidence for the presence of electron or hole centers. TEM investigations show the presence of exsolved nanophases of SrAl12O19 and/or TiO2 in the grain boundary region as well as grain interiors as lamellae which, in turn, form the solid-state defects, namely, dislocation networks, stacking faults and crystallographic shear planes whereby the framework of corner shared TiO6 octehedra changes over to edge-sharing TiO5-AlO5 strands as indicated from the Al-27 MAS NMR studies. The presence of transitional nanophases and the associated defects modify the excitation-emission processes by way of formation of electronic sub-levels at 3.40 and 4.43 eV, leading to magnetic-dipole related red emission with enhanced intensity. This is evidenced by the fact that SrAl12O19:Pr3+,Ti4+ shows bright red emission whereas SrAl12O19:Pr3+ does not show red photoluminescence.

Supramolecular polymer for explosives sensing: role of H-bonding in enhancement of sensitivity in the solid state

A pi-electron rich supramolecular polymer as an efficient fluorescent sensor for electron deficient nitroaromatic explosives has been synthesized, and the role of H-bonding in dramatic amplification of sensitivity/fluorescence quenching efficiency in the solid state has been established.

Role of silica nanoparticles in conductivity enhancement of nanocomposite solid polymer electrolytes: (PEG(x) NaBr): ySiO(2)

Nanocomposite solid polymer electrolytes (NCSPEs) with conducting species other than Li ions are being investigated for solid-state battery applications. Pristine solid polymer electrolytes (SPEs) do not show ionic conductivity suitable for batteries. Addition of inert fillers to SPEs is known to enhance the ionic conductivity. In this paper, we present the role of silica nanoparticles in enhancing the ionic conductivity in NCSPEs with sodium as conducting species. Sodium bromide is complexed with the host polyethylene glycol polymer by solution cast method and silica nanoparticles (SiO2, average particle size 7 nm) are incorporated into the complex in small amounts. The composites are characterized by powder XRD and IR spectroscopy. Conductivity measurements are undertaken as a function of concentration of salt and also as a function of temperature using impedance spectroscopy. Addition of silica nanoparticles shows an enhancement in conductivity by 1-2 orders of magnitude. The results are discussed in terms of interaction of nanoparticles with the nonconducting anions.

Explosives Sensing by Using Electron-Rich Supramolecular Polymers: Role of Intermolecular Hydrogen Bonding in Significant Enhancement of Sensitivity

We demonstrate here that supramolecular interactions enhance the sensitivity towards detection of electron-deficient nitro-aromatic compounds (NACs) over discrete analogues. NACs are the most commonly used explosive ingredients and are common constituents of many unexploded landmines used during World WarII. In this study, we have synthesised a series of pyrene-based polycarboxylic acids along with their corresponding discrete esters. Due to the electron richness and the fluorescent behaviour of the pyrene moiety, all the compounds act as sensors for electron-deficient NACs through a fluorescence quenching mechanism. A Stern-Volmer quenching constant determination revealed that the carboxylic acids are more sensitive than the corresponding esters towards NACs in solution. The high sensitivity of the acids was attributed to supramolecular polymer formation through hydrogen bonding in the case of the acids, and the enhancement mechanism is based on an exciton energy migration upon excitation along the hydrogen-bond backbone. The presence of intermolecular hydrogen bonding in the acids in solution was established by solvent-dependent fluorescence studies and dynamic light scattering (DLS) experiments. In addition, the importance of intermolecular hydrogen bonds in solid-state sensing was further explored by scanning tunnelling microscopy (STM) experiments at the liquid-solid interface, in which structures of self-assembled monolayer of the acids and the corresponding esters were compared. The sensitivity tests revealed that these supramolecular sensors can even detect picric acid and trinitrotoluene in solution at levels as low as parts per trillion (ppt), which is much below the recommended permissible level of these constituents in drinking water.

The role of the Professional Engineer in the 21st century

In light of the current world economic and environmental crisis due in part to
unsustainable development and poor financial planning, 21st Century engineers are faced with unprecedented challenges of developing a sustainable world in balance with the forces of nature to combat global environmental, social and economic crises. The European Union, the United States of America and a number of other countries have identified that smart solutions and highly skilled professionals are needed to survive climate change and create long-term prosperity. In this paper the evolution of the changing career of the engineer will be presented. The policy background to the current system of engineering education at bachelor’s and graduate level in Ireland will be introduced and perceptions of engineering as a profession by society in general, and by
school leavers selecting third level courses will be discussed. The role of the engineer as a specialist, expert or generalist will also be studied in terms of the changing demands and needs of society. Finally the responsibility of universities, through broad-based multidisciplinary teaching and training, to prepare the next crop of engineers will be examined.