Prevalence of overweight and obesity among nurses in Scotland: A cross-sectional study using the Scottish Health Survey.

Background Increasing prevalence of overweight and obesity represents a global pandemic. As the largest occupational group in international healthcare systems nurses are at the forefront of health promotion to address this pandemic. However, nurses own health behaviours are known to influence the extent to which they engage in health promotion and the public's confidence in advice offered. Estimating the prevalence of overweight and obesity among nurses is therefore important. However, to date, prevalence estimates have been based on non-representative samples and internationally no studies have compared prevalence of overweight and obesity among nurses to other healthcare professionals using representative data. Objectives To estimate overweight and obesity prevalence among nurses in Scotland, and compare to other healthcare professionals and those working in non-heath related occupations. Design Cross-sectional study using a nationally representative sample of five aggregated annual rounds (2008-2012) of the Scottish Health Survey. Setting Scotland. Participants: 13,483 adults aged 17 to 65 indicating they had worked in the past 4 weeks, classified in four occupational groups: nurses (n = 411), other healthcare professionals (n = 320), unqualified care staff (n = 685), and individuals employed in non-health related occupations (n = 12,067). Main outcome measures: Prevalence of overweight and obesity defined as Body Mass Index ≥ 25.0. Methods Estimates of overweight and obesity prevalence in each occupational group were calculated with 95% confidence intervals (CI). A logistic regression model was then built to compare the odds of being overweight or obese with not being overweight or obese for nurses in comparison to the other occupational categories. Data were analysed using SAS 9.1.3. Results 69.1% (95% CI 64.6,73.6) of Scottish nurses were overweight or obese. Prevalence of overweight and obesity was higher in nurses than other healthcare professionals (51.3%, CI 45.8,56.7), unqualified care staff (68.5%, CI 65.0,72.0) and those in non-health related occupations (68.9%, CI 68.1,69.7). A logistic regression model adjusted for socio-demographic composition indicated that, compared to nurses, the odds of being overweight or obese was statistically significantly lower for other healthcare professionals (Odds Ratio [OR] 0.45, CI 0.33,0.61) and those in non-health related occupations (OR 0.78, CI 0.62,0.97). Conclusions Prevalence of overweight and obesity among Scottish nurses is worryingly high, and significantly higher than those in other healthcare professionals and non-health related occupations. High prevalence of overweight and obesity potentially harms nurses’ own health and hampers the effectiveness of nurses’ health promotion role. Interventions are therefore urgently required to address overweight and obesity among the Scottish nursing workforce.

Understanding nurses’ decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.

Aim and objectives To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Background Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. Design A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Methods Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Results Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Conclusions Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Relevance to clinical practice Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation

Fuzzy Interpolation and Extrapolation: A Practical Approach

Z. Huang and Q. Shen. Fuzzy interpolative and extrapolative reasoning: a practical approach. IEEE Transactions on Fuzzy Systems, 16(1):13-28, 2008.

The parish priest on duty : a practical manual for pastors, curates, and theological students preparing for the mission : being a brief summary of the prescribed manner of administering the sacraments, the service of the dead, and sundry other pastoral functions in accordance with the Roman Ritual (The Sacraments) / by H.J. Heuser.

http://www.archive.org/details/theparishpriesto00heusuoft

Living with Jesus: Practical Christologies in Two Boston American Baptist Churches

This dissertation, an exercise in practical theology, undertakes two tasks. First, it examines how the story of Jesus is appropriated and embodied in the corporate practices of worship and mission (congregational christology) and in the daily lives of ordinary believers (everyday christology) at First Baptist Church in Jamaica Plain and Ruggles Baptist Church in Boston, Massachusetts. Second, it places these practical christologies in dialogue with the academic christology of James McClendon to see what creative and critical insights emerge. A key assumption of the study is that doctrinal reflection is precipitated when the story of Jesus interacts with human stories in both autobiographical and public domains. "Living with Jesus" contends that the understandings of Jesus present in the everyday lives of believers and in a congregation's worship and mission merit the attention of scholars in the disciplines of sociology and theology. This dissertation demonstrates that scholarly research on the visible church, everyday religion, and Christian doctrine pays limited attention to the theologies operative in the everyday lives of believers and congregational practices. A gap exists in scholarly knowledge, which "Living with Jesus" attempts to redress. The empirical results of qualitative research fieldwork are set in the context of historical overviews and contemporary snapshots of First Baptist Church in Jamaica Plain and Ruggles Baptist Church. "Living with Jesus" identifies three types of practical christology operative across the two congregations in corporate practices and the everyday lives of individuals: evangelical christology; exemplarist christology; and prophetic christology. The empirical research shows that for a significant minority of people in the sample, the prevailing understanding of Jesus can best be described as a hybrid christology. By paying attention to McClendon's treatment of the Jesus story and placing the three identified practical christologies in dialogue with his christology, it becomes apparent that each practical christology is simultaneously liberating and limiting. This dissertation argues that evaluating a particular practical christology in relation to the Gospel requires an intentional and disciplined effort on the part of congregations, ordinary believers, and theologians. Questions are proposed to assist further christological reflection on worship, mission, pastoral care, and Christian education.

The Practice and Understanding of the Eucharist in the United Church of Christ: A Practical Theological Study

This dissertation explores the complexity of the understanding and practice of the Eucharist in the United Church of Christ as revealed in a textual analysis of the UCC Book of Worship (1986) and a qualitative study of five representative UCC congregations. Little has been written on this topic, save for several brief articles on the history of the theology of the sacrament in the two bodies that merged to form the UCC in 1957: the Congregational Christian Churches (CC) and the Evangelical and Reformed Church (E&R). This dissertation advances the topic through a practical-theological study that brings into critical conversation contemporary eucharistic practices in five congregations and a historical theological analysis of liturgical traditions in the UCC and antecedent denominations. Through this conversation, the study articulates common themes of a UCC eucharistic theology and explores implications for ongoing theology and practice in the denomination. The introduction explicates the methodology employed in this study, guided by Don Browning's work. The first two chapters present the findings of the focus group interviews and an interpretation of those results respectively. Chapter three analyzes the eucharistic liturgies in three historic books of worship used in the E&R heritage. In chapter four, two of the antecedent resources utilized in the CC tradition are analyzed. The short-lived Hymnal of the United Church of Christ, published in 1974, includes liturgies that would find fuller expression in the 1986 Book of Worship. That hymnal is examined in chapter five. Chapter six interprets the two services of "Word and Sacrament" found in the Book of Worship. Chapter seven offers a comparative analysis of the focus group findings and the theology inherent in the Book of Worship. The final chapter offers strategic recommendations for revised theory and practice. The conclusion points toward areas for further research: it propels a critical conversation around the notion of covenant, Christ's presence in the meal, and who can receive and officiate at the Eucharist. This dissertation concludes that the UCC lives within a balance of multiple, complementary theologies and challenges the denomination to make stronger connections between the meal and mission, reconciliation, and tradition.

Making Sadza with Deaf Zimbabwean Women: A Missiological Reorientation of Practical Theological Method toward Self-Theologizing Agency among Subaltern Communities

Missiological calls for self-theologizing among faith communities present the field of practical theology with a challenge to develop methodological approaches that address the complexities of cross-cultural, practical theological research. Although a variety of approaches can be considered critical correlative practical theology, existing methods are often built on assumptions that limit their use in subaltern contexts. This study seeks to address these concerns by analyzing existing theological methodologies with sustained attention to a community of Deaf Zimbabwean women struggling to develop their own agency in relation to child rearing practices. This dilemma serves as an entry point to an examination of the limitations of existing methodologies and a constructive, interdisciplinary theological exploration. The use of theological modeling methodology employs my experience of learning to cook sadza, a staple dish of Zimbabwe, as a guide for analyzing and reorienting practical theological methodology. The study explores a variety of theological approaches from practical theology, mission oriented theologians, theology among Deaf communities, and African women’s theology in relationship to the challenges presented by subaltern communities such as Deaf Zimbabwean women. Analysis reveals that although there is much to commend in these existing methodologies, questions about who does the critical correlation, whose interests are guiding the study, and consideration for the cross-cultural and power dynamics between researchers and faith communities remain problematic for developing self-theologizing agency. Rather than frame a comprehensive methodology, this study proposes three attitudes and guideposts to reorient practical theological researchers who wish to engender self-theologizing agency in subaltern communities. The creativity of enacted theology, the humility of using checks and balances in research methods, and the grace of finding strategies to build bridges of commonality and community offer ways to reorient practical theological methodologies toward the development of self-theologizing agency among subaltern people. This study concludes with discussion of how these guideposts can not only benefit particular work with a community of Deaf Zimbabwean women, but also provide research and theological reflection in other subaltern contexts.

STAIR: Practical AIMD Multirate Congestion Control

Existing approaches for multirate multicast congestion control are either friendly to TCP only over large time scales or introduce unfortunate side effects, such as significant control traffic, wasted bandwidth, or the need for modifications to existing routers. We advocate a layered multicast approach in which steady-state receiver reception rates emulate the classical TCP sawtooth derived from additive-increase, multiplicative decrease (AIMD) principles. Our approach introduces the concept of dynamic stair layers to simulate various rates of additive increase for receivers with heterogeneous round-trip times (RTTs), facilitated by a minimal amount of IGMP control traffic. We employ a mix of cumulative and non-cumulative layering to minimize the amount of excess bandwidth consumed by receivers operating asynchronously behind a shared bottleneck. We integrate these techniques together into a congestion control scheme called STAIR which is amenable to those multicast applications which can make effective use of arbitrary and time-varying subscription levels.

Basis Token Consistency: A Practical Mechanism for Strong Web Cache Consistency

With web caching and cache-related services like CDNs and edge services playing an increasingly significant role in the modern internet, the problem of the weak consistency and coherence provisions in current web protocols is becoming increasingly significant and drawing the attention of the standards community [LCD01]. Toward this end, we present definitions of consistency and coherence for web-like environments, that is, distributed client-server information systems where the semantics of interactions with resource are more general than the read/write operations found in memory hierarchies and distributed file systems. We then present a brief review of proposed mechanisms which strengthen the consistency of caches in the web, focusing upon their conceptual contributions and their weaknesses in real-world practice. These insights motivate a new mechanism, which we call "Basis Token Consistency" or BTC; when implemented at the server, this mechanism allows any client (independent of the presence and conformity of any intermediaries) to maintain a self-consistent view of the server's state. This is accomplished by annotating responses with additional per-resource application information which allows client caches to recognize the obsolescence of currently cached entities and identify responses from other caches which are already stale in light of what has already been seen. The mechanism requires no deviation from the existing client-server communication model, and does not require servers to maintain any additional per-client state. We discuss how our mechanism could be integrated into a fragment-assembling Content Management System (CMS), and present a simulation-driven performance comparison between the BTC algorithm and the use of the Time-To-Live (TTL) heuristic.

Practical assessment of hardware limitations on power aware wireless sensor networks - An anti-windup approach

This work considers the effect of hardware constraints that typically arise in practical power-aware wireless sensor network systems. A rigorous methodology is presented that quantifies the effect of output power limit and quantization constraints on bit error rate performance. The approach uses a novel, intuitively appealing means of addressing the output power constraint, wherein the attendant saturation block is mapped from the output of the plant to its input and compensation is then achieved using a robust anti-windup scheme. A priori levels of system performance are attained using a quantitative feedback theory approach on the initial, linear stage of the design paradigm. This hybrid design is assessed experimentally using a fully compliant 802.15.4 testbed where mobility is introduced through the use of autonomous robots. A benchmark comparison between the new approach and a number of existing strategies is also presented.

Managing diversity in practical ambient assisted living ecosystems

Though the motivation for developing Ambient Assisted Living (AAL) systems is incontestable, significant challenges exist in realizing the ambience that is essential to the success of such systems. By definition, an AAL system must be omnipresent, tracking occupant activities in the home and identifying those situations where assistance is needed or would be welcomed. Embedded sensors offer an attractive mechanism for realizing ambience as their form factor and harnessing of wireless technologies aid in their seamless integration into pre-existing environments. However, the heterogeneity of the end-user population, their disparate needs and the differing environments in which they inhabit, all pose particular problems regarding sensor integration and management

Practical wireless sensor networks power consumption metrics for building energy management applications

The power consumption of wireless sensor networks (WSN) module is an important practical concern in building energy management (BEM) system deployments. A set of metrics are created to assess the power profiles of WSN in real world condition. The aim of this work is to understand and eventually eliminate the uncertainties in WSN power consumption during long term deployments and the compatibility with existing and emerging energy harvesting technologies. This paper investigates the key metrics in data processing, wireless data transmission, data sensing and duty cycle parameter to understand the system power profile from a practical deployment prospective. Based on the proposed analysis, the impacts of individual metric on power consumption in a typical BEM application are presented and the subsequent low power solutions are investigated.

Practical programming for static average-case analysis: the MOQA investigation

This work considers the static calculation of a program’s average-case time. The number of systems that currently tackle this research problem is quite small due to the difficulties inherent in average-case analysis. While each of these systems make a pertinent contribution, and are individually discussed in this work, only one of them forms the basis of this research. That particular system is known as MOQA. The MOQA system consists of the MOQA language and the MOQA static analysis tool. Its technique for statically determining average-case behaviour centres on maintaining strict control over both the data structure type and the labeling distribution. This research develops and evaluates the MOQA language implementation, and adds to the functions already available in this language. Furthermore, the theory that backs MOQA is generalised and the range of data structures for which the MOQA static analysis tool can determine average-case behaviour is increased. Also, some of the MOQA applications and extensions suggested in other works are logically examined here. For example, the accuracy of classifying the MOQA language as reversible is investigated, along with the feasibility of incorporating duplicate labels into the MOQA theory. Finally, the analyses that take place during the course of this research reveal some of the MOQA strengths and weaknesses. This thesis aims to be pragmatic when evaluating the current MOQA theory, the advancements set forth in the following work and the benefits of MOQA when compared to similar systems. Succinctly, this work’s significant expansion of the MOQA theory is accompanied by a realistic assessment of MOQA’s accomplishments and a serious deliberation of the opportunities available to MOQA in the future.

Clinical autonomy and nurse/physician collaboration in emergency nurses

Aim: To investigate clinical autonomy and Nurse/Physician collaboration among emergency nurses and the relationship between these concepts, personal characteristics and organisational influences. Background: Nurses have been identified as having a significant role in addressing the challenges of providing modern healthcare. Emergency nurses have reported competence in a wide range of emergency care skills. However, there is evidence that Emergency Department (ED) nurses may have lower levels of clinical autonomy than other areas of practice. Levels of clinical autonomy appear to be influenced by levels of collaboration with physicians and the organisations in which nurses work Methods: A descriptive correlational study using a survey design with a purposive convenience sample of 141 ED staff nurses (response 70.9%) from 3 EDs in Ireland. Data were collected using the Dempster Practice Behaviours Scale (DPBS) the Nurse/Physician Collaboration Scale (NPCS) and the newly developed Organisational Influences on Nursing Scale. Demographic information was also sought from participants. Results: Participants were largely female (87%), relatively young (mean age 35.57, SD=7.83) and educated to degree level (48%) or higher (31%) with 40% posessing specialist emergency nursing qualifications. Participants reported moderate levels of clinical autonomy and Nurse/Physician collaboration. No relationships were found between sample characteristics and clinical autonomy and Nurse/Physician collaboration among emergency nurses. Relationships were found between levels of clinical autonomy and Nurse/Physician collaboration (r=-0.395, n=100, p<0.001), and organisational influence on nursing (r=0.455, p<0.001) and also between Nurse/Physician collaboration and organisational influence on nursing (r=-0.413, p<0.001). Discussion: Clinical autonomy of nurses has been linked with quality outcomes in healthcare. The quest for quality in modern healthcare in a challenging environment should acknowledge that strategies need to focus beyond education and skills provision and include essential elements such as Nurse/Physician collaboration and the organisational influence on nursing to ensure the greater involvement of nurses in patient care.