Developing a protocol for the use of telenursing in community health in Australia

As the first step in developing a protocol for the use of video-phones in community health, we carried out a feasibility study among clients with a range of health needs. Clients were equipped with a commercially available video-phone connected using the client's home telephone line. A hands-free speaker-phone and a miniature video-camera (for close-up views) were connected to the video-phone. Ten clients participated: five required wound care, two palliative care, two long-term therapy monitoring and one was a rural client. All but two were aged 75 years or more. Each client had a video-phone for an average of two to three weeks. During the six months of the study, 43 client calls were made, of which 36 (84%) were converted to video-calls. The speaker-phone was used on 24 occasions (56%) and the close-up camera on 23 occasions (53%). Both clients and nurses rated the equipment as satisfactory or better in questionnaires. None of the nurses felt that the equipment was difficult to use, including unpacking it and setting it up; only one client found it difficult. Taking into account the clients' responses, including their free-text comments, a judgement was made as to whether the video-phone had been useful to their nursing care. In seven cases it was felt to be unhelpful and in three cases it was judged helpful. Although the study sample was small, the results suggest that home telenursing is likely to be useful for rural clients in Australia, unsurprisingly, because of the distances involved.

Editorial : which weight loss diet?

Full editorial: A recent study evaluating the long-term (2 yr) weight reducing efficacy of different types of diets – high or low in carbohydrates (CHOs), protein or fat - confirmed that it is calorie deficit not dietary composition that determines the loss and maintenance of body weight.1 Is there any advantage in following a specific weight loss diet? Short-term use of nutritionally complete commercially available (very) low calorie diets has benefited people with diabetes when  supported by education programmes.2 Initial weight loss has been encouraging with some fad diets eg the Atkins and the South Beach diets, but these diets are difficult to maintain and there are safety issues regarding their short- and long-term use – especially in people with diabetes.3 The types of macronutrients consumed can have a considerable impact on glycaemic control and energy metabolism. Although a low CHO diet additionally enhances initial weight loss by reducing cellular water content, if fat is not proportionally reduced the diet may not benefit the lipid profile for vascular disease risk. High fat and high protein diets – which are simultaneously low in CHOs – increase vulnerability to hypoglycaemia in people taking insulin secretagogues or on insulin therapy, and may promote excess fat metabolism and ketogenesis, particularly in people vulnerable to lack of insulin. Very low protein diets are not recommended as lean body mass tends to be reduced in diabetes. Altering the macronutrient balance has implications for the micronutrient mix: deficiencies are higher if more foods are excluded and conversely specific micronutrient excess can occur with some fad diets. The altered nutrient mix affects intestinal fauna and flora, and gut motility and glycaemic control are influenced by the quantity and type of fibre consumed. Support programmes help individuals achieve long term weight loss and there is mounting evidence that community schemes which educate and promote lifestyle changes may stem the rising tide of obesity and consequent type 2 diabetes.4 Consuming smaller portions of a balanced diet (and adjusting antidiabetic medications accordingly) will create an energy deficit to promote healthy weight loss. Increased movement/exercise will enhance this energy deficit. Knowledge (eg 1g fat has 2.25 times more energy than 1g CHO) allows sensible food choices and compensation for inclusion of small volumes of  ‘naughty but nice’ foods. Ultimately weight control requires self control. References 1. Sacks FM, Bray GA, Carey VJ et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360:859–73. 2. Bennett P. Obesity, diabetes and VLCD. Br J Diabetes Vasc Dis 2004;4:328–30. 3. Baldwin EJ. Fad diets in diabetes. Br J Diabetes Vasc DIs 2004;4:333–7. 4. Romon M, Lommoz A, Tafflet M et al. Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes. Public Health Nutr 2008; Dec 28, 1–8 [Epub ahead of print].

Diaspora identification and long-distance nationalism among Tamil migrants of diverse state origins in the UK

Accounts of Tamil long-distance nationalism have focused on Sri Lankan Tamil migrants. But the UK is also home to Tamils of non-Sri Lankan state origins. While these migrants may be nominally incorporated into a 'Tamil diaspora', they are seldom present in scholarly accounts. Framed by Werbner's (2002) conception of diasporas as 'aesthetic' and 'moral' communities, this article explores whether engagement with a Tamil diaspora and long-distance nationalism is expressed by Tamil migrants of diverse state origins. While migrants identify with an aesthetic community, 'membership' of the moral community is contested between those who hold direct experience of suffering as central to belonging, and those who imagine the boundaries of belonging more fluidly - based upon primordial understandings of essential ethnicity and a narrative of Tamil 'victimhood' that incorporates experiences of being Tamil in Sri Lanka, India and in other sites, despite obvious differences in these experiences. © 2013 Taylor & Francis.

Non-invasive respiratory monitoring using long-period fiber grating sensors

In non-invasive ventilation, continuous monitoring of respiratory volumes is essential. Here, we present a method for the measurement of respiratory volumes by a single fiber-grating sensor of bending and provide the proof-of-principle by applying a calibration-test measurement procedure on a set of 18 healthy volunteers. Results establish a linear correlation between a change in lung volume and the corresponding change in a local thorax curvature. They also show good sensor accuracy in measurements of tidal and minute respiratory volumes for different types of breathing. The proposed technique does not rely on the air flow through an oronasal mask or the observation of chest movement by a clinician, which distinguishes it from the current clinical practice. © 2014 Optical Society of America.

The Ecumenical movement and the making of the European Community

The European Community has largely been considered a predominantly secular project, bringing together the economic and political realms, while failing to mobilise the public voice and imagination of churchmen and the faithful. Drawing on a wide range of archival sources, this is the first study to assess the political history of religious dialogue in the European Community. It challenges the widespread perception that churches started to engage with European institutions only after the 1979 elections to the European Parliament, by detailing close relations between churchmen and high-ranking officials in European institutions, immediately after the 1950 Schuman Declaration. Lucian N. Leustean demonstrates that Cold War divisions between East and West, and the very nature of the ecumenical movement, had a direct impact on the ways in which churches approached the European Community. He brings to light events and issues which have not previously been examined, such as the response of churches to the Schuman Plan, and the political mobilisation of church representations in Brussels, Strasbourg and Luxembourg. Leustean argues that the concept of a 'united Europe' has been impeded by competing national differences between religious and political institutions, having a long-standing legacy on the making of a fragmented European Community.

Medicines optimisation for young people with juvenile arthritis and other long-term conditions:system-level barriers to engagement

To explore the views of pharmacy and rheumatology stakeholders about system-related barriers to medicines optimisation activities with young people with long-term conditions. A three-phase consensus-building study comprising (1) focus groups with community and hospital pharmacists; (2) semi-structured telephone interviews with lay and professional adolescent rheumatology stakeholders and pharmacy policymakers, and (3) multidisciplinary discussion groups with community and hospital pharmacists and rheumatology staff. Qualitative verbatim transcripts from phases 1 and 2 were subjected to framework analysis. Themes from phase 1 underpinned a briefing for phase 2 interviewees. Themes from phases 1 and 2 generated elements of good pharmacy practice and current/future pharmacy roles for ranking in phase 3. Results from phase 3 prioritisation and ranking exercises were captured on self-completion data collection forms, entered into an Excel spreadsheet and subjected to descriptive statistical analysis. Institutional ethical approval was given by Aston University Health and Life Sciences Research Ethics Committee. Four focus groups were conducted with 18 pharmacists across England, Scotland and Wales (7 hospital, 10 community and 1 community/public health). Fifteen stakeholders took part in telephone interviews (3 pharmacist commissioners; 2 pharmacist policymakers; 2 pharmacy staff members (1 community and 1 hospital); 4 rheumatologists; 1 specialist nurse, and 3 lay juvenile arthritis advocates). Twenty-five participants took part in three discussion groups in adolescent rheumatology centres across England and Scotland (9 community pharmacists; 4 hospital pharmacists; 6 rheumatologists; 5 specialist nurses, and 1 physiotherapist). In all phases of the study, system-level issues were acknowledged as barriers to more engagement with young people and families. Community pharmacists in the focus groups reported that opportunities for engaging with young people were low if parents collected prescriptions alone, which was agreed by other stakeholders. Moreover, institutional/company prescription collection policies – an activity largely disallowed for a young person under 16 without an accompanying parent - were identified by hospital and community pharmacists as barriers to open discussion and engagement. Few community pharmacists reported using Medicines Use Review (England/Wales) or Chronic Medication Service (Scotland) as a medicines optimisation activity with young people; many were unsure about consent procedures. Despite these limitations, rheumatology stakeholders ranked highly the potential of pharmacists empowering young people with general health care skills, such as repeat prescription ordering. The pharmacy profession lacks vision for its role in the care of young people with long-term conditions. Pharmacists and rheumatology stakeholders identified system-level barriers to more engagement with young people who take medicines regularly. We acknowledge that the modest number of participants may have had a specific interest and thus bias for the topic, but this underscores their frank admission of the challenges. Professional guidance and policy, practice frameworks and institutional/company policies must promote flexibility for pharmacy staff to recognise and empower young people who are able to give consent and take responsibility for medicines activities. This will increase mutual confidence and trust, and foster pharmacy’s role in teaching general health care skills. In this way, pharmacists will be able to build long-term relationships with young people and families.

Long-term dynamic patterns and diversity of phytoplankton communities in a large eutrophic river (the case of River Danube, Hungary)

In this paper we present the composition, seasonal dynamics and fluctuations in diversity of the phytoplankton in the Danube River over 24 years. Weekly samplings were conducted at one section of the river at Göd, in the 1669 river kilometer segment. The change in the phytoplankton community structure was analyzed in relation of water temperature and discharge means. Our findings support the opinion that the Danube is very rich in species, although many of the species are rare and could be described only as coloring species. Results indicate trends in the phytoplankton abundance, which are only detectable in long-term studies. By the help of diversity indices we have observed an increase in the phytoplankton community diversity. With the relevant information, an explanation of the significant changes in diversity and richness was formed. Our goals were a construction of a solid database of the phytoplankton, examining the seasonal dynamics of the phytoplankton through a 24 year long study and to see the most important changing factors of the community. The results of this study are to assist and help future model developments to predict the phytoplankton seasonal dynamic patterns.

The effects of a creative movement program on long-term incarcerated women

The Multicultural Communication Bridge Program, an ongoing project at the Broward Correctional Institution, utilizes creative movement, writing, and drawing as treatment modalities with long-term incarcerated women. This type of programming is new in the prison system thus literature and research supporting the outcomes with this population are lacking. Therefore, a qualitative study was conducted to determine the efficacy of the program. Nine inmates, who have been involved in the program for at least one year, were interviewed to gather information about their personal experiences as a result of their participation. Common themes that were noted include an increase in trust, the expression of emotions, an increase in self esteem, and an improvement in interactions with others. These attributes are believed to be beneficial to these women to ensure a successful community reintegration upon their release from prison. ^

Supplemental instruction, study habits, and the community college student

The purpose of this study was to demonstrate if the academic assistance program Supplemental Instruction (SI) facilitates the acquisition of effective study behaviors through strategies that transcend simple double-exposure to the course material. Its advocates claim it increases academic achievement using learner-centered knowledge and acquisition of effective study behaviors. SI sessions are specifically related to particular courses that students are taking. Sessions are facilitated by the SI leader who has taken the subject matter course in the past. Students review the content of the previous subject matter class using collaborative learning strategies coordinated by a SI leader. In addition, the SI leader models appropriate study behaviors in his or her interactions with the students. ^ An instructor at a large Florida community college who taught five classes of an Anatomy & Physiology I course (traditionally supported by SI) was identified. Two of the classes were randomly selected to participate in SI activities, and two classes were random chosen to participate in alternate, computer-based activities that dealt with the course content, but did not include work in developing students' study behaviors. These treatments were carried out over the course of an entire semester. Participation was mandatory. ^ Data were collected on two variables. Academic achievement in anatomy and physiology content was measured both pre- and post-treatment using an instructor developed examination. Student study behaviors were measured using pre- and post-treatment administration of the Study Behavior Inventory, a valid and reliable instrument that provides scores on three categories of study behaviors: (a) Academic self-efficacy, (b) Preparation for routine academic tasks, and (c) Preparation for long range academic tasks. Measures obtained at the end of the semester of treatment revealed no significant differences between the SI and alternative treatment groups in post-treatment achievement test score and the post-treatment scores on the three study behaviors categories when adjusted for pre-treatment scores. ^ These results suggest that the development of appropriate study behaviors requires more time than SI, as it is now implemented, can provide. In addition, results indicate that improved academic achievement may be attained through any number of means that include repeated exposure to course material. ^

The socialization of adjunct faculty into the academic culture of a public community college campus

This study investigated the socialization of adjunct faculty into the academic culture of a community college campus. Because of the increased utilization of adjunct faculty, the need to socialize them to effectively function within the organizational culture has become more acute. A review of the literature revealed that when employees are socialized, they are more committed to the goals and welfare of the organization, are less likely to leave the organization, and are more productive and innovative. Therefore, it is important that administrators have programs and practices in place that would help to integrate adjunct faculty into the academic culture. The model of organizational socialization (Chao, O'Leary-Kelly, Wolf, Klein, & Gardner, 1994) formed the framework for this study, which was guided by the following research questions: How do adjunct faculty members describe their socialization into the culture of their college campus? How do administrators describe their roles and that of the organization in the socialization of adjunct faculty members? What organizational programs and activities are in place for the socialization of adjunct faculty? The North Campus of Miami Dade College was the site for this study, as it is a campus with a long history of utilizing adjunct faculty members and one that has a clearly-stated mission of adjunct faculty socialization. A qualitative case study method was used, and data collection included interviews and the review and analysis of institutional documents. The participants included 11 adjunct faculty members, 4 department chairpersons, the campus president, and the college training and development coordinator. The study revealed that there were structured and consistent professional development programs, but these conflicted with the schedules of adjunct faculty. Overall, adjunct faculty found support from the leadership; however, they revealed a need for more mentoring, more interactions with full-time faculty, and more input in decision making concerning textbooks and curricula. Implications and recommendations for practice include making professional development more accessible and relevant to adjunct faculty, developing a formal mentoring program where full-time faculty and veteran adjunct faculty mentor novice adjunct faculty, and involving adjuncts in decisions regarding curriculum and textbook selection.

Engagement experiences of Hispanic Generation 1.5 English language learners at a Massachusetts community college

Hispanic Generation 1.5 students are foreign-born, U.S. high school graduates who are socialized in the English dominant K-12 school system while still maintaining the native language and culture at home (Allison, 2006; Blumenthal, 2002; Harklau, Siegal, & Losey, 1999; Rumbault & Ima, 1988). When transitioning from high school to college, these students sometimes assess into ESL courses based on their English language abilities, and because of this ESL placement, Hispanic Generation 1.5 students might have different engagement experiences than their mainstream peers. Engagement is a critical factor in student success and long-term retention because students’ positive and negative engagement experiences affect their membership and sense of belonging at the institution. The purpose of this study was to describe the engagement and membership experiences of Hispanic Generation 1.5 students’ at a Massachusetts community college. This study employed naturalistic inquiry within an embedded descriptive case study design that included three units of analysis: the students’ engagement experiences in (a) ESL courses, (b) developmental courses, and (c) mainstream courses. The main source of data was in-depth interviews with Hispanic Generation 1.5 students at Commonwealth of Massachusetts Community College. Criterion sampling was used to select the interview participants, ensuring that all participants were native Spanish speakers and were taking or had taken at least one ESL course at the institution. The study findings show that these Hispanic Generation 1.5 students at the college did not perceive peer engagement as critical to academic success. Most times the participants avoided peer engagement outside of the classroom, especially with fellow Hispanic students, who they felt would deter them from their English language development and general academic work. Engagement with ESL faculty and ESL academic support staff played the most critical role in the participants’ sense of belonging and success, and students who were required to engage with faculty and academic support staff outside of the classroom were the most satisfied with their educational experiences. While the participants were all disappointed with some aspect of their ESL placement, they valued the ESL engagement experiences more than the engagement experiences while completing developmental and credit coursework.

Living positive: Life in community among Puerto Rican men living with HIV in Boston

Negative experiences of stigmatization, discrimination, and rejection are common among people living with HIV in the United States, and particularly when they are also members of a minority group. Some three decades after the first cases of AIDS were identified, people infected with HIV continue to be perceived and characterized negatively. While an HIV/AIDS diagnosis is typically associated with negativity, this study investigates the extent to which collective experiences among HIV-positive people result in healthy responses and positive social adjustment. This study is focused on the ways in which HIV-positive Puerto Rican men in Boston live positive despite being diagnosed with HIV. Rather than wrapping themselves in the social stigma of HIV and the isolation that entails, they participate in processes that affirm themselves and their peers. In so doing, they help generate both healthy and meaningful lives for themselves and others. The study examines the process in which Puerto Rican men living with HIV in Boston participate, promote, and reaffirm an HIV community, la comunidad, as a social entity with a unique culture and identity. This study also investigates how this community influences, supports, and encourages the adoption of positive transformations for living long term with HIV. On the basis of nine months of field research, this qualitative study employed both focus groups and interviews with fifty HIV-positive Puerto Rican men in Boston. These men were recruited, using convenience sampling, from different community-based organizations (CBOs) that provide HIV/AIDS services in Boston. The study finds that HIV-positive Puerto Rican men in Boston build community, not in response to social exclusion, but built on shared positive practices and strategies for living healthy with HIV. These men come together to negotiate and form a unique cultural community expressed in norms, beliefs, and practices that, although centered on HIV, are designed for living healthy. These expressions reaffirm a sense of community in everyday settings and transform the lives of these men with positive behaviors and healthy lifestyles. The findings reveal that this transformation takes place in the context of a community, with the support, encouragement, and at times, policing of others. La comunidad is where the lives of these men are transformed as they learn, adopt, and experience living positive with HIV.

Long-Term Effects of Adding Nutrients to an Oligotrophic Coastal Environment

Management of ecological disturbances requires an understanding of the time scale and dynamics of community responses to disturbance events. To characterize long-term seagrass bed responses to nutrient enrichment, we established six study sites in Florida Bay, USA. In 24 plots (0.25 m2) at each site, we regularly added nitrogen (N) and phosphorus (P) in a factorial design for 7 years. Five of the six sites exhibited strong P limitation. Over the first 2 years, P enrichment increased Thalassia testudinum cover in the three most P-limited sites. After 3 years, Halodule wrightii began to colonize many of the P-addition plots, but the degree of colonization was variable among sites, possibly due to differences in the supply of viable propagules. Thalassia increased its allocation to aboveground tissue in response to P enrichment; Halodule increased in total biomass but did not appear to change its aboveground: belowground tissue allocation. Nutrient enrichment did not cause macroalgal or epiphytic overgrowth of the seagrass. Nitrogen retention in the study plots was variable but relatively low, whereas phosphorus retention was very high, often exceeding 100% of the P added as fertilizer over the course of our experiments. Phosphorus retentions exceeding 100% may have been facilitated by increases in Thalassia aboveground biomass, which promoted the settlement of suspended particulate matter containing phosphorus. Our study demonstrated that lowintensity press disturbance events such as phosphorus enrichment can initiate a slow, ramped successional process that may alter community structure over many years.

Hydrological drivers of wetland vegetation community distribution within Everglades National Park, Florida

The influence of hydrological dynamics on vegetation distribution and the structuring of wetland environments is of growing interest as wetlands are modified by human action and the increasing threat from climate change. Hydrological properties have long been considered a driving force in structuring wetland communities. We link hydrological dynamics with vegetation distribution across Everglades National Park (ENP) using two publicly available datasets to study the probability structure of the frequency, duration, and depth of inundation events along with their relationship to vegetation distribution. This study is among the first to show hydrologic structuring of vegetation communities at wide spatial and temporal scales, as results indicate that the percentage of time a location is inundated and its mean depth are the principal structuring variables to which individual communities respond. For example, sawgrass, the most abundant vegetation type within the ENP, is found across a wide range of time inundated percentages and mean depths. Meanwhile, other communities like pine savanna or red mangrove scrub are more restricted in their distribution and found disproportionately at particular depths and inundations. These results, along with the probabilistic structure of hydropatterns, potentially allow for the evaluation of climate change impacts on wetland vegetation community structure and distribution.