Detecting and managing depressed patients : palliative care nurses' self-efficacy and perceived barriers to care

Background: Depression is a highly prevalent yet under-recognized and under-treated psychiatric illness in patients receiving palliative care. Nurses are the front-line health care professionals in these settings and are well-positioned to detect depressive symptoms and initiate pathways to care. Previous research suggests, however, that nurses' confidence and skills in relation to this task are low, and there appear to be a number of barriers within these settings that may impede nurses' engagement in this process.

Methods: To further investigate these factors, a quantitative study was carried out with 69 palliative care nurses from three palliative care services in Australia.

Results: A number of issues were identified, including the need for further training in the signs and symptoms of depression, issues around discussing depression with patients and their family members, and difficulty differentiating depressive symptoms from grief.

Conclusion: These findings provide insight into specific areas in which palliative care nurses would benefit from further training to improve detection rates for depression in this vulnerable population.

Techniques used by investigative interviewers to elicit disclosures of abuse from child witnesses : a critique

Eliciting disclosures of abuse from children is a challenging skill that requires considerable practice, feedback, training and instruction. While there is an abundance of literature outlining what constitutes best practice interviewing of children, there has been little discussion, in particular, of investigative interviewers’ limitations when applying best practice interview guidelines to elicit disclosures of abusive acts. This paper assists police by identifying common problems of child investigative interviewers when eliciting disclosures (N = 131) and provides alternate questioning strategies. The results support the need for further training to be developed to ensure better adherence to best practice guidelines in relation to all aspects of eliciting a disclosure from children.

Police officers' perceptions of interviewing offenders on sex offender registries

Police interviews with offenders form an important component of the sex offender registry monitoring process. This study provides an analysis of police professionals’ perceptions of the benefits and process of interviewing offenders on sex offender registries. Participants were a heterogeneous sample of 24 Australian police personnel whose roles were primarily associated with the operation of sex offender registries across three different jurisdictions. Participants’ perceptions of sex offender registry interviews were elicited using non-directive prompts in focus groups of between two and five officers. Transcripts of these focus groups were analysed andkey themes identified. Reported benefits related to the identification and correction of misunderstandings about registry requirements and elicitation of information to assist ongoing management and investigation of new offences. Further, establishing a sound relationship enabled proactive support of the offender in his/her attempt not to re-offend. Interview procedures emphasised the importance of genuine engagement and a relationship based on trust. The findings highlighted several challenges to interviewing and directions for further training, support and research. Participants’ responses underscore the significant role that interviews play in the effective implementation of sex offender registries and emphasise the need for successful engagement of offenders during these interviews to improve the utility of registry schemes. This was the first study to examine the strengths and challenges of interviewing offenders on the registry from a policing perspective.

Uma proposta de metodologia para o ensino de Física usando robótica de baixíssimo custo

This paper presents methodology based on Lev Vigotsky`s social interactionist theory through investigative activities, which integrates the teaching of physics to robotics, directed to students of the Physics degree course, seeking to provide further training for future teachers. The method is organized through educational robotics workshops that addresses concepts of physics through the use of low-cost educational robots along with several activities. The methodology has been presented and discussed and put into practice afterwards in workshops so that these future teachers may be able to take robotics to their classroom. Students from the last and penultimate semester of the Physics degree course of the Federal Institute of Education, Science and Technology of Rio Grande do Norte, Caicó campus participated in this project

Women's contribution to equality in Latin America and the Caribbean

Includes bibliography

Effective Communication and Smooth Administration of Academic Libraries in the 21st Century: a New Paradigm in Nigeria

Effective communication is the soul of any institution. New opportunities are presented by Information and Communication Technology (ICTS). Library managers must adopt a more critical and communication plan that will enhance their skills and allow for further training, as well as allowing stakeholders to have input into decision-making.

What are the components that contribute to variability in echocardiographic measurements in aortic stenosis?

INTRODUCTION Echocardiography is the standard clinical approach for quantification of the severity of aortic stenosis (AS). A comprehensive examination of its overall reproducibility and the simultaneous estimation of its variance components by multiple operators, readers, probe applications, and beats have not been undertaken. METHOD AND RESULTS Twenty-seven subjects with AS were scanned over 7 months in the echo-department by a median of 3 different operators. From each patient and each operator multiple runs of beats from multiple probe positions were stored for later analysis by multiple readers. The coefficient of variation was 13.3%, 15.9%, 17.6%, and 20.2% for the aortic peak velocity (Vmax), and velocity time integral (VTI), and left ventricular outflow tract (LVOT) Vmax and VTI respectively. The largest individual contributors to the overall variability were the beat-to-beat variability (9.0%, 9.3%, 9.5%, 9.4% respectively) and that of inability of an individual operator to precisely apply the probe to the same position twice (8.3%, 9.4%, 12.9%, 10.7% respectively). The tracing (inter-reader) and reader (inter-reader), and operator (inter-operator) contribution were less important. CONCLUSIONS Reproducibility of measurements in AS is poorer than often reported in the literature. The source of this variability does not appear, as traditionally believed, to result from a lack of training or operator and reader specific factors. Rather the unavoidable beat-to-beat biological variability, and the inherent impossibility of applying the ultrasound probe in exactly the same position each time are the largest contributors. Consequently, guidelines suggesting greater standardisation of procedures and further training for sonographers are unlikely to result in an improvement in precision. Clinicians themselves should be wary of relying on even three-beat averages as their expected coefficient of variance is 10.3% for the peak velocity at the aortic valve.

Fortbildung online: Entwicklung, Erprobung und Evaluation eines tutoriell betreuten Online-Selbstlernangebots für Lehrkräfte

The quality of schools mainly depends on the competence of teachers. Further professional development courses as third and longest period of teacher training play an essential role in maintaining professional skills. In almost every federal state teaching personnel are required to take part in further training courses. A range of courses offered by the State, the churches, and by independent institutions are available.

(Lifelong) learning in your pocket?

Der Beitrag fokussiert die Entwicklung, den Einsatz und die Nutzung von innovativen Technologien zur Unterstützung von Bildungsszenarien in Schule, Hochschule und Weiterbildung. Ausgehend von den verschiedenen Phasen des Corporate Learning, Social Learning, Mobile Learning und Intelligent Learning wird in einem ersten Abschnitt das Nutzungsverhalten von Technologien durch Kinder, Jugendliche und (junge) Erwachsene in Schule, Studium und Lehre betrachtet. Es folgt die Darstellung technologischer Entwicklungen auf Basis des Technology Life Cycle und die Konsequenzen von unterschiedlichen Entwicklungszuständen und Reifegraden von Technologien wie Content Learning Management, sozialen Netzwerken, mobilen Endgeräten, multidimensionalen und -modalen Räumen bis hin zu Anwendungen augmentierter Realität und des Internets der Dinge, Dienste und Daten für den Einsatz und die Nutzung in Bildungsszenarien. Nach der Darstellung von Anforderungen an digitale Technologien hinsichtlich Inhalte, Didaktik und Methodik wie etwa hinsichtlich der Erstellung von Inhalten, deren Wiederverwendung, Digitalisierung und Auffindbarkeit sowie Standards werden methodische Hinweise zur Nutzung digitaler Technologien zur Interaktion von Lernenden, von Lehrenden, sozialer Interaktion, kollaborativem Autorieren, Kommentierung, Evaluation und Begutachtung gegeben. Abschließend werden - differenziert für Schule und Hochschule - Erkenntnisse zu Rahmenbedingungen, Einflussgrößen, hemmenden und fördernden Faktoren sowie Herausförderungen bei der Einführung und nachhaltigen Implementation digitaler Technologien im schulischen Unterricht, in Lehre, Studium und Weiterbildung im Überblick zusammengefasst.

Learning -dependent plasticity of movement representations in the primate primary motor cortex

Primary motor cortex (M1) is involved in the production of voluntary movement and contains a complete functional representation, or map, of the skeletal musculature. This functional map can be altered by pathological experiences, such as peripheral nerve injury or stroke, by pharmacological manipulation, and by behavioral experience. The process by which experience-dependent alterations of cortical function occur is termed plasticity. In this thesis, plasticity of M1 functional organization as a consequence of behavioral experience was examined in adult primates (squirrel monkeys). Maps of movement representations were derived under anesthesia using intracortical microstimulation, whereby a microelectrode was inserted into the cortex to electrically stimulate corticospinal neurons at low current levels and evoke movements of the forelimb, principally of the hand. Movement representations were examined before and at several times after training on behavioral tasks that emphasized use of the fingers. Two behavioral tasks were utilized that dissociated the repetition of motor activity from the acquisition of motor skills. One task was easy to perform, and as such promoted repetitive motor activity without learning. The other task was more difficult, requiring the acquisition of motor skills for successful performance. Kinematic analysis indicated that monkeys used a consistent set of forelimb movements during pellet extractions. Functional mapping revealed that repetitive motor activity during the easier task did not produce plastic changes in movement representations. Instead, map plasticity, in the form of selective expansions of task-related movement representations, was only produced following skill acquisition on the difficult task. Additional studies revealed that, in general, map plasticity persisted without further training for up to three months, in parallel with the retention of task-related motor skills. Also, extensive additional training on the small well task produced further improvements in performance, and further changes in movement maps. In sum, these experiments support the following three conclusions regarding the role of M1 in motor learning. First, behaviorally-driven plasticity is learning-dependent, not activity-dependent. Second, plastic changes in M1 functional representations represent a neural correlate of acquired motor skills. Third, the persistence of map plasticity suggests that M1 is part of the neural substrate for the memory of motor skills. ^

Glutamate infused posttraining into the hippocampus or caudate-putamen differentially strengthens place and response learning

A cross-maze task that can be acquired through either place or response learning was used to examine the hypothesis that posttraining neurochemical manipulation of the hippocampus or caudate-putamen can bias an animal toward the use of a specific memory system. Male Long-Evans rats received four trials per day for 7 days, a probe trial on day 8, further training on days 9–15, and an additional probe trial on day 16. Training occurred in a cross-maze task in which rats started from a consistent start-box (south), and obtained food from a consistent goal-arm (west). On days 4–6 of training, rats received posttraining intrahippocampal (1 μg/0.5 μl) or intracaudate (2 μg/0.5 μl) injections of either glutamate or saline (0.5 μl). On days 8 and 16, a probe trial was given in which rats were placed in a novel start-box (north). Rats selecting the west goal-arm were designated “place” learners, and those selecting the east goal-arm were designated “response” learners. Saline-treated rats predominantly displayed place learning on day 8 and response learning on day 16, indicating a shift in control of learned behavior with extended training. Rats receiving intrahippocampal injections of glutamate predominantly displayed place learning on days 8 and 16, indicating that manipulation of the hippocampus produced a blockade of the shift to response learning. Rats receiving intracaudate injections of glutamate displayed response learning on days 8 and 16, indicating an accelerated shift to response learning. The findings suggest that posttraining intracerebral glutamate infusions can (i) modulate the distinct memory processes mediated by the hippocampus and caudate-putamen and (ii) bias the brain toward the use of a specific memory system to control learned behavior and thereby influence the timing of the switch from the use of cognitive memory to habit learning to guide behavior.

Statusreproduktion und Mobilitätseffekte beruflicher Weiterbildung

Es wird für Westdeutschland untersucht, ob sowohl der intergenerationale Abstieg als auch der intergenerationale Statuserhalt Beweggründe für berufliche Weiterbildung sind. Des Weiteren wird untersucht, ob mit beruflicher Weiterbildung ein intergenerationaler Abstieg ausgeglichen oder das Risiko für intergenerationale Abwärtsmobilität minimiert werden kann. Mit Längsschnittdaten der Deutschen Lebensverlaufsstudie finden sich für westdeutsche Frauen und Männer in fünf aufeinander folgenden Geburtskohorten im Zeitraum von 1949 bis 1999 Indizien dafür, dass das Statuserhaltmotiv ein Weiterbildungsmotiv für Personen sein könnte, die einen intergenerationalen Statusverlust erfahren haben. Mit Weiterbildungsanstrengungen können im weiteren Berufsverlauf intergenerationale Abstiege ausgeglichen werden. Ferner haben statuskonsistente Teilnehmer geringere Risiken für einen intergenerationalen Abstieg als Nichtteilnehmer. Berufliche Weiterbildung hat statusreproduzierende Wirkungen im Berufsverlauf.

Organisational slack resources, the definitions and consequences for business flexibility and performance : an empirical investigation

Slack resources are recognised to be those spare capabilities and assets of the organisation that are variable reclaimable for re-deployment. They represent under utilised and hidden spare energies within a company that may be recaptured and employed for a variety of tasks. However their positive contribution to organisational success has been a contentious claim that has provoked the intuitive argument that slack resources are inefficiency and are to be eradicated. The counter argument has been that very efficient organisations are inflexible and therefore incapable of being responsive to an increasingly dynamic environment. Therefore this work compares and contrasts three distinctive industries in a holistic manner and maps the impact of environmental flux on the firm, its subsequent disruptive ripples through the organisation and its absorption by slack resources. Through this process it is demonstrated that slack resources do positively contribute to organisational performance and subsequently the ability of slack to promote sustained competitive advantage is also identified. The major findings of this work are listed. 1. This work has developed and perfected a new research model that aids the investigation of the internal behaviours and consequences of Slack Resources. 2. Supported by argument a new variable of Soft Slack was developed. Its validity was demonstrated in its ability to capture the contribution of intangible assets, such as education, experience, spare management time and further training, to the extant levels of Organisational Hard Slack resources. 3. The validity of Soft Slack was further supported when its contribution to organisational Flexibility was also established. 4. The original argument that Slack Resources enhance organisational Performance has been further developed. It is now evidenced that Slack Resources facilitate Organisational Flexibility and by this process enhances Organisational Performance.

Auto plant closures, policy responses and labour market outcomes:a comparison of MG Rover in the UK and Mitsubishi in Australia

This paper provides a preliminary comparative longitudinal analysis of the impact on workers made redundant due to the closure of the Mitsubishi plant in Adelaide and the MG Rover plant in Birmingham. Longitudinal surveys of ex-workers from both firms were undertaken over a 12-month period in order to assess the process of labour market adjustment. In the Mitsubishi case, given the skills shortage the state of Adelaide was facing, together with the considerable growth in mining and defence industries, it would have been more appropriate if policy intervention had been redirected to further training or re-skilling opportunities for redundant workers. This opportunity was effectively missed and as a result more workers left the workforce, most notably for retirement, than could have otherwise been the case. The MG Rover case was seen as a more successful example of policy intervention, with greater funding assistance available and targeted support available, and with more emphasis on re-training needs to assist adjustment. However, despite the assistance offered and the rhetoric of successful adjustment in both cases, the majority of workers have nevertheless experienced deterioration in their circumstances particularly in the Australian case where casual and part-time work were often the only work that could be obtained. Even in the UK case, where more funding assistance was offered, a majority of workers reported a decline in earnings and a rise in job insecurity. This suggests that a reliance on the flexible labour market is insufficient to promote adjustment, and that more active policy intervention is needed especially in regard to further up-skilling.

The potential for pharmacists to manage children attending emergency departments

AIM: There have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 The aim of this study was to determine if Emergency Department attendees aged from 0-16 years could be managed by community pharmacists or hospital independent prescriber pharmacists with or without further advanced clinical practice training. METHOD: A prospective, 48 site, cross-sectional, observational study of patients attending Emergency Departments (ED) in England, UK was conducted. Pharmacists at each site collected up to 400 admissions and paediatric patients were included in the data collection. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases-age, weight, presenting complaint, clinical grouping (e.g. medicine, orthopaedics), and categorise each presentation into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP-cases that could be managed at ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training-cases which could be managed at ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only-cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index=percentage of the total workload of the clinical grouping multiplied by the percentage ability of pharmacists to manage that clinical group. RESULTS: 1623 out of 18,229 (9%) attendees, from 45 of the 48 sites, were children aged from 0 to 16 years of age (median 8 yrs, range 0-16), 749 were female and 874 were male. Of the 1623 admissions, 9% of the cases were judged to be suitable for clinical management by a community pharmacist (CP), 4% suitable for a hospital pharmacist independent prescriber (IP), 32% suitable for a hospital independent pharmacist prescriber with additional training (IPT); and the remaining 55% were only suitable for the Medical Team (MT). The most frequent clinical groups and impact index for the attendees were General Medicine=10.78 and orthopaedics=10.60. CONCLUSION: Paediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics.