Understanding the role of knowledge in the practice of expert nephrology nurses in Australia

This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the role of knowledge in expert practice. Using grounded theory methodology, the study involved 17 registered nurses who were practicing in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participants' observations and interviews. Having extensive nephrology nursing knowledge was a striking characteristic of a nursing expert. Expert nurses clearly relied on and utilized extensive nephrology nursing knowledge to practice. Of importance for nursing, the results of this study indicate that domain-specific knowledge is a crucial feature of expert practice.

A new model to study healing of a complex femur fracture with concurrent soft tissue injury in sheep

High energy bone fractures resulting from impact trauma are often accompanied by subcutaneous soft tissue injuries, even if the skin remains intact. There is evidence that such closed soft tissue injuries affect the healing of bone fractures, and vice versa. Despite this knowledge, most impact trauma studies in animals have focussed on bone fractures or soft tissue trauma in isolation. However, given the simultaneous impact on both tissues a better understanding of the interaction between these two injuries is necessary to optimise clinical treatment. The aim of this study was therefore to develop a new experimental model and characterise, for the first time, the healing of a complex fracture with concurrent closed soft tissue trauma in sheep. A pendulum impact device was designed to deliver a defined and standardised impact to the distal thigh of sheep, causing a reproducible contusion injury to the subcutaneous soft tissues. In a subsequent procedure, a reproducible femoral butterfly fracture (AO C3-type) was created at the sheep’s femur, which was initially stabilised for 5 days by an external fixator construct to allow for soft tissue swelling to recede, and ultimately in a bridging construct using locking plates. The combined injuries were applied to twelve sheep and the healing observed for four or eight weeks (six animals per group) until sacrifice. The pendulum impact led to a moderate to severe circumferential soft tissue injury with significant bruising, haematomas and partial muscle disruptions. Posttraumatic measurements showed elevated intra-compartmental pressure and circulatory tissue breakdown markers, with recovery to normal, pre-injury values within four days. Clinically, no neurovascular deficiencies were observed. Bi-weekly radiological analysis of the healing fractures showed progressive callus healing over time, with the average number of callus bridges increasing from 0.4 at two weeks to 4.2 at eight weeks. Biomechanical testing after sacrifice showed increasing torsional stiffness between four and eight weeks healing time from 10% to 100%, and increasing ultimate torsional strength from 10% to 64% (relative to the contralateral control limb). Our results demonstrate the robust healing of a complex femur fracture in the presence of a severe soft tissue contusion injury in sheep and demonstrate the establishment of a clinically relevant experimental model, for research aimed at improving the treatment of bone fractures accompanied by closed soft tissue injuries.

Advancing nursing practice : redefining the theoretical and practical integration of knowledge

Aim The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. Background The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. Design The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. Method A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. Conclusion There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. Relevance to clinical practice What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is pattern recognition, which became the focus of Benner’s work on expert practice. Therefore, if this is included into the knowing-how knowing-that framework, the knowing-how becomes the knowledge that contributes to advancing and advanced practice and the knowing-that becomes the governing action based on a deeper understanding of the problem or issue.

Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: A protocol for a pilot trial

Background: Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study. Methods/design: A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status. Discussion: This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial.

Zero carbon manufacturing facility - Towards integrating material, energy, and waste process flows

The increasing pressure on material availability, energy prices, as well as emerging environmental legislation is leading manufacturers to adopt solutions to reduce their material and energy consumption as well as their carbon footprint, thereby becoming more sustainable. Ultimately manufacturers could potentially become zero carbon by having zero net energy demand and zero waste across the supply chain. The literature on zero carbon manufacturing and the technologies that underpin it are growing, but there is little available on how a manufacturer undertakes the transition. Additionally, the work in this area is fragmented and clustered around technologies rather than around processes that link the technologies together. There is a need to better understand material, energy, and waste process flows in a manufacturing facility from a holistic viewpoint. With knowledge of the potential flows, design methodologies can be developed to enable zero carbon manufacturing facility creation. This paper explores the challenges faced when attempting to design a zero carbon manufacturing facility. A broad scope is adopted from legislation to technology and from low waste to consuming waste. A generic material, energy, and waste flow model is developed and presented to show the material, energy, and waste inputs and outputs for the manufacturing system and the supporting facility and, importantly, how they can potentially interact. Finally the application of the flow model in industrial applications is demonstrated to select appropriate technologies and configure them in an integrated way. © 2009 IMechE.

A workbook-based methodology for implementing concurrent engineering

Concurrent Engineering demands a new way of working and many organisations experience difficulty during implementation. The research described in this paper has the aim to develop a paper-based workbook style methodology that companies can use to increase the benefits generated by Concurrent Engineering, while reducing implementation costs, risk and time. The three-stage methodology provides guidance based on knowledge accumulated from implementation experience and best practitioners. It encourages companies to learn to manage their Concurrent Engineering implementation by taking actions which expose them to new and valuable experiences. This helps to continuously improve understanding of how to maximise the benefits from Concurrent Engineering. The methodology is particularly designed to cater for organisational and contextual uniqueness, as Concurrent Engineering implementations will vary from company to company. Using key actions which improve the Concurrent Engineering implementation process, individual companies can develop their own 'best practice' for product development. The methodology ensures that key implementation issues, which are primarily human and organisational, are addressed using simple but proven techniques. This paper describes the key issues that the majority of companies face when implementing Concurrent Engineering. The structure of the methodology is described to show how the issues are addressed and resolved. The key actions used to improve the Concurrent Engineering implementation process are explained and their inclusion in the implementation methodology described. Relevance to industry. Implementation of Concurrent Engineering concepts in manufacturing industry has not been a straightforward process. This paper describes a workbook-style tool that manufacturing companies can use to accelerate and improve their Concurrent Engineering implementation. © 1995.

Representing temporal knowledge in legal discourse

This paper presents a formalism for representing temporal knowledge in legal discourse that allows an explicit expression of time and event occurrences. The fundamental time structure is characterized as a well‐ordered discrete set of primitive times, i.e. non‐decomposable intervals with positive duration or points with zero duration), from which decomposable intervals can be constructed. The formalism supports a full representation of both absolute and relative temporal knowledge, and a formal mechanism for checking the temporal consistency of a given set of legal statements is provided. The general consistency checking algorithm which addresses both absolute and relative temporal knowledge turns out to be a linear programming problem, while in the special case where only relative temporal relations are involved, it becomes a simple question of searching for cycles in the graphical representation of the corresponding legal text.

Best Practice for Providing Social Care and Support to People Living with Concurrent Sight Loss and Dementia: Professional Perspectives

Purpose-Approximately 100,000 people in the UK aged 75 and over have concurrent dementia and sight loss, but current understanding of their experiences, needs and preferences is limited. The purpose of this paper is to report on a research project that explored the provision of social care and support for older people with both conditions. Design/methodology/approach-The project was a collaboration between the universities of York, Worcester, Bournemouth and Cambridge, supported by the Thomas Pocklington Trust and the Housing and Dementia Research Consortium. Data for this paper were drawn from focus groups held in 2013 involving 47 professionals across the dementia, sight loss and housing sectors. Findings-Thematic analysis identified five main barriers to providing high-quality, cost-effective social care and support: time constraints; financial limitations; insufficient professional knowledge; a lack of joint working; and inconsistency of services. The requirements of dementia and sight loss often conflict, which can limit the usefulness of equipment, aids and adaptations. Support and information needs to address individual needs and preferences. Research limitations/implications-Unless professionals consider dementia and sight loss together, they are unlikely to think about the impact of both conditions and the potential of their own services to provide effective support for individuals and their informal carers. Failing to consider both conditions together can also limit the availability and accessibility of social care and support services. This paper is based on input from a small sample of self-selecting professionals across three geographical regions of England. More research is needed in this area. Practical implications-There are growing numbers of people living with concurrent dementia and sight loss, many of whom wish to remain living in their own homes. There is limited awareness of the experiences and needs of this group and limited provision of appropriate services aids/adaptations. A range of measures should be implemented in order to support independence and well-being for people living with both conditions and their family carers. These include increased awareness, improved assessment, more training and greater joint working. Social implications-People living with dementia or sight loss are at high risk of social isolation, increasingly so for those with both conditions. Services that take an inclusive approach to both conditions can provide crucial opportunities for social interaction. Extra care housing has the potential to provide a supportive, community-based environment that can help residents to maintain social contact. Originality/value-This paper adds much-needed evidence to the limited existing literature, and reflects the views of diverse professionals across housing, health and social care

Pronoun-dropping or zero anaphora in translation from german into portuguese

In this article I will analyse anaphoric references in German texts and their transaltion into Portuguese. I will take as main corpus Heinrich Böll's novel Haus ohne Hüter and its translation into Portuguese by Jorge Rosa with the title Casa Indefesa. I will concentrate on the use of personal pronouns and possessives in references to both people and objects in source text and target text and I will present patterns of symmetries and asymmetries. I will claim that asymmetries in the translation of such anaphoric references can be accounted for mainly by differences in the pronominal systems and verbal systems of both languages and by differences in the way each language marks theme/topic continuity/discontinuity in discourse. Issues related to style and the translation of anaphors will also be addressed. I will finally raise some questions related to ambiguous references which can not be solved within the scope of syntax or semantics, thus requiring pragmatic interpretation based on cultural knowledge/world knowledge.

Application of green zero-valent iron nanoparticles to the remediation of soils contaminated with ibuprofen

Zero-valent iron nanoparticles (nZVIs) are often used in environmental remediation. Their high surface area that is associated with their high reactivity makes them an excellent agent capable of transforming/degrading contaminants in soils and waters. Due to the recent development of green methods for the production of nZVIs, the use of this material became even more attractive. However, the knowledge of its capacity to degrade distinct types of contaminants is still scarce. The present work describes the study of the application of green nZVIs to the remediation of soils contaminated with a common anti-inflammatory drug, ibuprofen. The main objectives of this work were to produce nZVIs using extracts of grape marc, black tea and vine leaves, to verify the degradation of ibuprofen in aqueous solutions by the nZVIs, to study the remediation process of a sandy soil contaminated with ibuprofen using the nZVIs, and to compare the experiments with other common chemical oxidants. The produced nZVIs had nanometric sizes and were able to degrade ibuprofen (54 to 66% of the initial amount) in aqueous solutions. Similar remediation efficiencies were obtained in sandy soils. In this case the remediation could be enhanced (achieving degradation efficiencies above 95%) through the complementation of the process with a catalyzed nZVI Fenton-like reaction. These results indicate that this remediation technology represents a good alternative to traditional and more aggressive technologies.

When zero doesn't mean it and other geomathematical mischief

There is almost not a case in exploration geology, where the studied data doesn’t includes below detection limits and/or zero values, and since most of the geological data responds to lognormal distributions, these “zero data” represent a mathematical challenge for the interpretation. We need to start by recognizing that there are zero values in geology. For example the amount of quartz in a foyaite (nepheline syenite) is zero, since quartz cannot co-exists with nepheline. Another common essential zero is a North azimuth, however we can always change that zero for the value of 360°. These are known as “Essential zeros”, but what can we do with “Rounded zeros” that are the result of below the detection limit of the equipment? Amalgamation, e.g. adding Na2O and K2O, as total alkalis is a solution, but sometimes we need to differentiate between a sodic and a potassic alteration. Pre-classification into groups requires a good knowledge of the distribution of the data and the geochemical characteristics of the groups which is not always available. Considering the zero values equal to the limit of detection of the used equipment will generate spurious distributions, especially in ternary diagrams. Same situation will occur if we replace the zero values by a small amount using non-parametric or parametric techniques (imputation). The method that we are proposing takes into consideration the well known relationships between some elements. For example, in copper porphyry deposits, there is always a good direct correlation between the copper values and the molybdenum ones, but while copper will always be above the limit of detection, many of the molybdenum values will be “rounded zeros”. So, we will take the lower quartile of the real molybdenum values and establish a regression equation with copper, and then we will estimate the “rounded” zero values of molybdenum by their corresponding copper values. The method could be applied to any type of data, provided we establish first their correlation dependency. One of the main advantages of this method is that we do not obtain a fixed value for the “rounded zeros”, but one that depends on the value of the other variable. Key words: compositional data analysis, treatment of zeros, essential zeros, rounded zeros, correlation dependency

Implicit and explicit knowledge bases in artificial grammar learning

Two experiments examined the claim for distinct implicit and explicit learning modes in the artificial grammar-learning task (Reber, 1967, 1989). Subjects initially attempted to memorize strings of letters generated by a finite-state grammar and then classified new grammatical and nongrammatical strings. Experiment 1 showed that subjects' assessment of isolated parts of strings was sufficient to account for their classification performance but that the rules elicited in free report were not sufficient. Experiment 2 showed that performing a concurrent random number generation task under different priorities interfered with free report and classification performance equally. Furthermore, giving different groups of subjects incidental or intentional learning instructions did not affect classification or free report.

Concurrent recordings of bladder afferents from multiple nerves using a microfabricated PDMS microchannel electrode array

In this paper we present a compliant neural interface designed to record bladder afferent activity. We developed the implant's microfabrication process using multiple layers of silicone rubber and thin metal so that a gold microelectrode array is embedded within four parallel polydimethylsiloxane (PDMS) microchannels (5 mm long, 100 μm wide, 100 μm deep). Electrode impedance at 1 kHz was optimized using a reactive ion etching (RIE) step, which increased the porosity of the electrode surface. The electrodes did not deteriorate after a 3 month immersion in phosphate buffered saline (PBS) at 37 °C. Due to the unique microscopic topography of the metal film on PDMS, the electrodes are extremely compliant and can withstand handling during implantation (twisting and bending) without electrical failure. The device was transplanted acutely to anaesthetized rats, and strands of the dorsal branch of roots L6 and S1 were surgically teased and inserted in three microchannels under saline immersion to allow for simultaneous in vivo recordings in an acute setting. We utilized a tripole electrode configuration to maintain background noise low and improve the signal to noise ratio. The device could distinguish two types of afferent nerve activity related to increasing bladder filling and contraction. To our knowledge, this is the first report of multichannel recordings of bladder afferent activity.

An investigation of the required skills for the delivery of low and zero carbon buildings within a region

The United Kingdom is committed to a raft of requirements to create a low-carbon economy. Buildings consume approximately 40% of UK energy demand. Any improvement on the energy performance of buildings therefore can significantly contribute to the delivery of a low-carbon economy. The challenge for the construction sector and its clients is how to meet the policy requirements to deliver low and zero carbon (LZC) buildings, which spans broader than the individual building level, to requirements at the local and regional levels, and wider sustainability pressures. Further, the construction sector is reporting skills shortages coupled with the need for ‘new skills’ for the delivery of LZC buildings. The aim of this paper is to identify, and better understand, the skills required by the construction sector and its clients for the delivery of LZC buildings within a region. The theoretical framing for this research is regional innovation system (RIS) using a socio-technical network analysis (STNA) methodology. A case study of a local authority region is presented. Data is drawn from a review of relevant local authority documentation, observations and semi-structured interviews from one (project 1) of five school retrofit projects within the region. The initial findings highlight the complexity surrounding the form and operation of the LZC network for project 1. The skills required by the construction sector and its clients are connected to different actor roles surrounding the delivery of the project. The key actors involved and their required skills are: project management and energy management skills required by local authority; project management skills (in particular project planning), communication and research skills required by school end-users; and a ‘technical skill’ relating to knowledge of a particular energy efficient measure (EEM) and use of equipment to implement the EEM is required by the EEM contractors.