Advancing practice in critical care: A model of knowledge integration

It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individuals practice progressing onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example practice development initiatives can be seen as advancing practice for the masses which ensures that practitioners are following the same level of practice. The question here is; are they developing individually.

Advancing practice in critical care : A model of knowledge integration: A Singaporean context

It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individuals practice progressing onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example practice development initiatives can be seen as advancing practice for the masses which ensures that practitioners are following the same level of practice. The question here is; are they developing individually. To discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. In an attempt to explore the development of leading edge critical care thinking and practice, a new model for advancing practice in critical care is proposed. This paper suggests that reflection may not be the best model for advancing practice unless the individual practitioner has a sound knowledge base both theoretically and experientially. Drawing on the contemporary literature and recent doctoral research, the knowledge integration model presented here uses multiple learning strategies that are focused in practise to develop practice, for example the use of work-based learning and clinical supervision. Ongoing knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.

Advanced practice: A survey of current perspectives of Australian pharmacists

Background An Advanced Pharmacy Practice Framework for Australia (the ‘APPF’) was published in October 2012. Further to the release of the APPF, the Advanced Pharmacy Practice Framework Steering Committee planned to develop an advanced practice recognition model for Australian pharmacists. Aim To gauge the perspectives of the pharmacy profession relating to advanced practice, via an online survey, in order to inform the design of the model. Method A survey was developed and administered to Australian pharmacists through SurveyMonkey . The survey content was based on findings from a review of national and international initiatives for recognition of advanced practice in pharmacy and other health disciplines, including medicine and nursing. Results The results of the survey showed that a high proportion of respondents considered they were already working at, or working towards achieving, an advanced level of practice. The responses relating to the assessment methods showed a clear preference for ‘submission of a professional portfolio’. A ‘written examination’ had a low level of support and in relation to an ‘oral examination by a panel’ there was a marked preference for a panel of multidisciplinary health professionals over a panel of pharmacists. Conclusion The survey outcomes will inform the development of an advanced pharmacy practice recognition model for Australian pharmacists, particularly in relation to the assessment methods. Survey outcomes also demonstrated that there is scope to further enhance the application of the APPF in the development and recognition of advanced practitioners, and to build greater awareness of the breadth of competencies encompassed by ‘advanced practice’.

An Advanced Pharmacy Practice Framework for Australia

The need to develop An Advanced Pharmacy Practice Framework for Australia (the “APPF”) was identified during the 2010 review of the competency standards for Australian pharmacists. The Advanced Pharmacy Practice Framework Steering Committee, a collaborative profession-wide committee comprised of representatives of ten pharmacy organisations, examined and adapted existing advanced practice frameworks, all of which were found to have been based on the Competency Development and Evaluation Group (CoDEG) Advanced and Consultant Level Framework (the “CoDEG Framework”) from the United Kingdom. Its competency standards were also found to align well with the Domains of the National Competency Standards Framework for Pharmacists in Australia (the “National Framework”). Adaptation of the CoDEG Framework created an APPF that is complementary to the National Framework, sufficiently flexible to customise for recognising advanced practice in any area of professional practice and has been approved by the boards/councils of all participating organisations. The primary purpose of the APPF is to assist the development of the profession to meet the changing health care needs of the community. However, it is also a valuable tool for assuring members of the public of the competence of an advanced practice pharmacist and the quality and safety of the services they deliver.

Microstructural control in hot working of IN-718 superalloy using processing map

The hot-working characteristics of IN-718 are studied in the temperature range 900 °C to 1200 °C and strain rate range 0.001 to 100 s−1 using hot compression tests. Processing maps for hot working are developed on the basis of the strain-rate sensitivity variations with temperature and strain rate and interpreted using a dynamic materials model. The map exhibits two domains of dynamic recrystallization (DRX): one occurring at 950 °C and 0.001 s−1 with an efficiency of power dissipation of 37 pct and the other at 1200 °C and 0.1 s−1 with an efficiency of 40 pct. Dynamic recrystallization in the former domain is nucleated by the δ(Ni3Nb) precipitates and results in fine-grained microstructure. In the high-temperature DRX domain, carbides dissolve in the matrix and make interstitial carbon atoms available for increasing the rate of dislocation generation for DRX nucleation. It is recommended that IN-718 may be hot-forged initially at 1200 °C and 0.1 s−1 and finish-forged at 950 °C and 0.001 s−1 so that fine-grained structure may be achieved. The available forging practice validates these results from processing maps. At temperatures lower than 1000 °C and strain rates higher than 1 s−1 the material exhibits adiabatic shear bands. Also, at temperatures higher than 1150°C and strain rates more than 1s−1, IN-718 exhibits intercrystalline cracking. Both these regimes may be avoided in hotworking IN-718.

Microstructural control in hot working of IN-718 superalloy using processing map

The hot-working characteristics of IN-718 are studied in the temperature range 900 degrees C to 1200 degrees C and strain rate range 0.001 to 100 s(-1) using hot compression tests. Processing maps for hot working are developed on the basis of the strain-rate sensitivity variations with temperature and strain rate and interpreted using a dynamic materials model. The map exhibits two domains of dynamic recrystallization (DRX): one occurring at 950 degrees C and 0.001 s(-1) with an efficiency of power dissipation of 37 pct and the other at 1200 degrees C and 0.1 s(-1) with an efficiency of 40 pct. Dynamic recrystallization in the former domain is nucleated by the delta(Ni3Nb) precipitates and results in fine-grained microstructure. In the high-temperature DRX domain, carbides dissolve in the matrix and make interstitial carbon atoms available for increasing the rate of dislocation generation for DRX nucleation. It is recommended that IN-718 may be hot-forged initially at 1200 degrees C and 0.1 s(-1) and finish-forged at 950 degrees C and 0.001 s(-1) so that fine-grained structure may be achieved. The available forging practice validates these results from processing maps. At temperatures lower than 1000 degrees C and strain rates higher than 1 s(-1), the material exhibits adiabatic shear bands. Also, at temperatures higher than 1150 degrees C and strain rates more than 1 s(-1), IN-718 exhibits intercrystalline cracking. Both these regimes may be avoided in hot-working IN-718.

Some Aspects of the Kobayashi and Carath,odory Metrics on Pseudoconvex Domains

The purpose of this article is to consider two themes, both of which emanate from and involve the Kobayashi and the Carath,odory metric. First, we study the biholomorphic invariant introduced by B. Fridman on strongly pseudoconvex domains, on weakly pseudoconvex domains of finite type in C (2), and on convex finite type domains in C (n) using the scaling method. Applications include an alternate proof of the Wong-Rosay theorem, a characterization of analytic polyhedra with noncompact automorphism group when the orbit accumulates at a singular boundary point, and a description of the Kobayashi balls on weakly pseudoconvex domains of finite type in C (2) and convex finite type domains in C (n) in terms of Euclidean parameters. Second, a version of Vitushkin's theorem about the uniform extendability of a compact subgroup of automorphisms of a real analytic strongly pseudoconvex domain is proved for C (1)-isometries of the Kobayashi and Carath,odory metrics on a smoothly bounded strongly pseudoconvex domain.

The deliberate practice: the sports excellence versus the musical excellence

[ENG] If we look around us, we can observe that there is someone who is the best in each field of activity. We could think that they are exceptional individuals. This Final Project aims to increase knowledge of the effects of Deliberate Practice in the domains of music and sport. This will define you a concept of Deliberate Practice and then focus on the diversity of situations in which it shows us how it is presented in real life. From a questionnaire that has been designed for this study and distributed to the music students, I have expected to obtain a result that allow me to come to the conclusion that exists a relation between the hours of practice and the expertise in the execution. This reality has been linked to the regarding situation in the sport practice, whose information has been provided by the coordinators of the different sports. Taking into account the limited number of references available, this work has focused on a qualitative analysis of the data, interpreted from my point of view and my personal experience, which has been confirmed in the results obtained. The statistics managed allow me to conclude that, although the argument is not definitive, the guide effort through deliberate practice is essential to achieve the excellence.

A new protein structure of P-II class snake venom metalloproteinases: it comprises metalloproteinase and disintegrin domains

A new metalloproteinase-disintegrin, named Jerdonitin, was purified from Trimeresurus jerdonii venom with a molecular weight of 36 kDa on SDS-PAGE. It dose-dependently inhibited ADP-induced human platelet aggregation with IC50 of 120 nM. cDNA cloning and sequencing revealed that Jerdonitin belonged to the class II of snake venom metalloproteinases (SVMPs) (P-II class). Different from other P-II class SVMPs, metalloproteinase and disintegrin domains of its natural protein were not separated, confirmed by internal peptide sequencing. Compared to other P-II class SVMPs, Jerdonitin has two additional cysteines (Cys219 and Cys238) located in the spacer domain and disintegrin domain, respectively. They probably form a disulfide bond and therefore the metalloproteinase and disintegrin domains cannot be separated by posttranslationally processing. In summary, comparison of the amino acid sequences of Jerdonitin with those of other P-II class SVMPs by sequence alignment and phylogenetic analysis, in conjunction with natural protein structure data, suggested that it was a new type of P-II class SVMPs. (C) 2003 Elsevier Inc. All rights reserved.

Construction of cytoplasmic molecular markers distinguishing Danio rerio from Gobiocypris rarus at high identity domains based on MP-PCR strategy and Sybr Green I detection

To distinguish the cytoplasm of Danio rerio from that of Gobiocypris rarus, we cloned G. rarus COXI and constructed cytoplasmic molecular markers at the high identity domains of COXI by mutated primer PCR (MP-PCR for short). Then Sybr Green I was used to detect the single amplicon. As a result, we succeeded in getting the cytoplasmic molecular markers, G.M COXI and Z.M COXI, by MP-PCR strategy. They were used to detect the sperm-derived mtDNA in the sexual hybrid embryos (D. rerio female x G. rarus male) before the sphere stage. In the present study, all results demonstrate that MP-PCR approach and Sybr Green I detection are feasible to construct the molecular markers to identify genes that shared high identity.

Negotiating the boundaries between home and work practices: The case of home-workers

When people work from home, the domains of home and work are co-located, often under one roof. Home-workers have to cope with the meeting of two practices that have traditionally been physically separated. In light of this, we need to understand: how do people who work from home negotiate the boundaries between their home and work practices? What kinds of boundaries do people construct? How do boundaries affect the relationship between home and work as domains? What kinds of boundaries are available to home-workers? Are home-workers in charge of their boundaries or do they co-create them with others? How does this position home-workers in their domains? In order to address these questions, I analysed a variety of data, including newspaper columns, online forum discussions, interviews, and personal diary entries, using a discourse analytic approach that lends itself to issues of positioning. Current literature clashes over whether home-workers are in control of their boundaries, and over the relationship between home and work that arises out of boundary negotiations, i.e. whether home and work are dichotomous or layered. I seek to contribute to boundary theory by adopting a practice theory stance (Wenger, 1998) to guide my analysis. By viewing home and work as practices, I show that boundary negotiations depend on how home-workers are positioned, e.g. if they are positioned as peripheral in a domain, they lack influence over boundaries. I demonstrate that home and work constitute a number of different practices, rather than a rigid dichotomy, and that the way home and work are related are not the same for all home-workers. The application of practice concepts further shows how relationships between practices are created. The contribution of this work is a reconceptualisation of current boundary theory away from individual and cognitive notions (Nippert-Eng, 1996) into the realm of positioning.

HDAC6 and Ubp-M BUZ domains recognize specific C-terminal sequences of proteins.

The BUZ/Znf-UBP domain is a protein module found in the cytoplasmic deacetylase HDAC6, E3 ubiquitin ligase BRAP2/IMP, and a subfamily of ubiquitin-specific proteases. Although several BUZ domains have been shown to bind ubiquitin with high affinity by recognizing its C-terminal sequence (RLRGG-COOH), it is currently unknown whether the interaction is sequence-specific or whether the BUZ domains are capable of binding to proteins other than ubiquitin. In this work, the BUZ domains of HDAC6 and Ubp-M were subjected to screening against a one-bead-one-compound (OBOC) peptide library that exhibited random peptide sequences with free C-termini. Sequence analysis of the selected binding peptides as well as alanine scanning studies revealed that the BUZ domains require a C-terminal Gly-Gly motif for binding. At the more N-terminal positions, the two BUZ domains have distinct sequence specificities, allowing them to bind to different peptides and/or proteins. A database search of the human proteome on the basis of the BUZ domain specificities identified 11 and 24 potential partner proteins for Ubp-M and HDAC6 BUZ domains, respectively. Peptides corresponding to the C-terminal sequences of four of the predicted binding partners (FBXO11, histone H4, PTOV1, and FAT10) were synthesized and tested for binding to the BUZ domains by fluorescence polarization. All four peptides bound to the HDAC6 BUZ domain with low micromolar K(D) values and less tightly to the Ubp-M BUZ domain. Finally, in vitro pull-down assays showed that the Ubp-M BUZ domain was capable of binding to the histone H3-histone H4 tetramer protein complex. Our results suggest that BUZ domains are sequence-specific protein-binding modules, with each BUZ domain potentially binding to a different subset of proteins.

Qualitative analysis of the interdisciplinary interaction between data analysis specialists and novice clinical researchers.

BACKGROUND: The inherent complexity of statistical methods and clinical phenomena compel researchers with diverse domains of expertise to work in interdisciplinary teams, where none of them have a complete knowledge in their counterpart's field. As a result, knowledge exchange may often be characterized by miscommunication leading to misinterpretation, ultimately resulting in errors in research and even clinical practice. Though communication has a central role in interdisciplinary collaboration and since miscommunication can have a negative impact on research processes, to the best of our knowledge, no study has yet explored how data analysis specialists and clinical researchers communicate over time. METHODS/PRINCIPAL FINDINGS: We conducted qualitative analysis of encounters between clinical researchers and data analysis specialists (epidemiologist, clinical epidemiologist, and data mining specialist). These encounters were recorded and systematically analyzed using a grounded theory methodology for extraction of emerging themes, followed by data triangulation and analysis of negative cases for validation. A policy analysis was then performed using a system dynamics methodology looking for potential interventions to improve this process. Four major emerging themes were found. Definitions using lay language were frequently employed as a way to bridge the language gap between the specialties. Thought experiments presented a series of "what if" situations that helped clarify how the method or information from the other field would behave, if exposed to alternative situations, ultimately aiding in explaining their main objective. Metaphors and analogies were used to translate concepts across fields, from the unfamiliar to the familiar. Prolepsis was used to anticipate study outcomes, thus helping specialists understand the current context based on an understanding of their final goal. CONCLUSION/SIGNIFICANCE: The communication between clinical researchers and data analysis specialists presents multiple challenges that can lead to errors.

The Influence of Child Protection Orientation on Child Welfare Practice

This article reports the findings of the second part of a two-part research project examining the potential for social workers to make changes in their work with families and children. While social workers in the United Kingdom have been encouraged to shift from a child protection to a child welfare orientation in their practice, such changes have been hampered by professional and organisational concern to manage risk. The research explores the influence of a child protection orientation on practice in child welfare cases. The findings, from two file analyses and interviews with twenty-six social workers, indicate that such an influence is indeed apparent. This is evidenced in two ways; firstly patterns of practice in child welfare cases are similar to those in child protection cases. Secondly, while the majority of social workers express an attitudinal desire to move towards a child welfare orientation, they still prioritise the management of risk in their practice. It is argued that social workers need permission from their employing organisations to make changes in their practice. This, in turn, requires such organisations to state clear goals in line with a child welfare orientation and develop holistic strategies to achieve these.

'Work and Emancipatory Practice: Towards a Recovery of Human Beings' Productive Capacities,'

This article argues that productive work represents a mode of human flourishing unfortunately neglected in much current political theorizing. Focusing on Habermasian critical theory, I contend that Habermas’s dualist theory of society, on account of the communicative versus instrumental reason binary which underpins it, excludes work and the economy from ethical reflection. To avoid this uncritical turn, we need a concept of work that retains a core emancipatory referent. This, I claim, is provided by Alasdair MacIntyre’s notion of ‘practice’. The notion of ‘practice’ is significant in suggesting an alternative conception of human productivity that is neither purely instrumental nor purely communicative, but rather both simultaneously, a form of activity which issues in material products and yet presumes a community of workers engaged in intersubjective self-transformation. However, we can endorse MacIntyre’s notion of ‘practice’ only if we reject his totalizing anti-modernism and insist on the emancipatory potentialities of modern institutions.