Nursing Home-Acquired Pneumonia Presenting at the Emergency Department

Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old (IQR 77-90). Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age ≥ 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillin-resistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

Knowledge and attitudes of Registered Nurses toward pain /

This research provided relevant data to support pain research literature that finds nurses do not have the knowledge base that they require to sufficiently provide effective pain management. The data demonstrated that nurses have mixed attitudes toward pain. These two findings have been observed in the literature for more than 20 years, but were important results for the hospitals and the nurses involved in the study. The purposes of this study were to identify the level of knowledge and attitudes in a sample of nurses fi-om the surgical and medical units in three hospitals, and determine whether a difference between these two groups existed. The institutional resources to support pain relief practices provided by each hospital were also documented. Data were collected using a convenience sample from the medical and surgical units of three hospitals. Ofthe 1 13 nurses who volunteered to participate, 78 worked in surgical units and 35 worked in medical units. Demographic data were collected about the participants. The established instruments used to obtain data about knowledge and attitude included: (a) Nurses Knowledge of Pain Issues Survey, (b)Attitude to Pain Control Scale, and (c) Andrew and Robert Vignette. Data collected were quantitative along with two open-ended questions for a rich, qualitative section. Inadequate knowledge and outdated attitudes were very evident in the responses. Data from the open-ended questions described how nurses assessed pain and the most conmion problems caring for patients in pain. Nursing practice implications for these hospitals involve initiating a process to develop an educational pain program for nurses throughout the hospital. Utilizing findings from other studies, the program should have an interdisciplinary approach to the planning, implementation, evaluation, and ongoing support. This study supports the belief that inadequate pain management has been attributed to many factors, most importantly to a lack of knowledge. Pain is a costly, unnecessary complication for the patient as well as the hospital. It follows then, that it is in the best interest of all involved to implement an educational pain program in order to influence practice.

Self-directed learning, stress and the adult learner /

The purpose of this correlational study was to investigate the relationship between the degree of self-directed learning readiness and stress for level one nursing students and level two nursing students. One hundred female nursing students participated in the study who were attending an Ontario Community College. Data were collected from the main nursing campus and the satellite nursing campus using the random sample method. Instruments used were said to be valid and reliable for testing self-directed learning readiness and stress respectively. Data were analyzed using frequency response to each item, means and standard deviation, and the Pearson product correlation between selfdirected learning readiness and stress. The results of the study show that there is a difference in the relationship between the degree of self-directed learning readiness and stress between the level one nursing students and the level two nursing students. Such results will be of particular interest to nursing instructors and administrators when planning for delivery of programs to such students.

Method and truth in MÄ dhyamika

Abstract The study was undertaken to identify what motivates registered nurses to participate in continuing education activities. The primary questions were whether basic nursing education, employment status, clinical area, and position, as well as readiness for selfdirected learning influenced Canadian nurses' motivational orientations when deciding to participate in continuing education activities. Other individual differences (e.g., age) were also examined. The sample included 142 registered nurses employed at an urban community hospital. Three instruments were used for data collection: the Education Participation Scale, the Self-Directed Learning Readiness Scale, and a nursing survey consisting of demographic questions. Basic nursing education and employment status did not effect motivational orientation or self-directed learning readiness. Clinical area and level of position significantly influenced nurses' decisions to participate in continuing education activities. Motivational orientation had a significant relationship with selfdirected learning readiness. Implications for practice as a result of this study involves program planning and delivery. The identification of the motivational orientations of participants may assist in the development and delivery of continuing education programs that are beneficial, relevant, and address the identified learning needs of participants. Implications for future research also exist in relation to studying different groups of nurses, for example, registered nursing assistants, and investigating related issues, for example, what are the deterrents to participation in continuing education?

La transformation du rôle de représentante d’aidantes familiales pendant l’hébergement de leur parent atteint de démence : une théorisation ancrée

RÉSUMÉ L‘hébergement en centre de soins de longue durée d'un parent âgé atteint de démence marque une transition pour les personnes qui occupent un rôle d’aidant familial principal. Ces personnes, principalement des femmes, poursuivent leur engagement après l’hébergement et souhaitent être impliquées dans les décisions concernant les soins offerts à leur parent. Souvent l'hébergement survient au moment où la personne âgée n'est plus en mesure, compte tenu de ses déficiences cognitives, d'exprimer clairement ses besoins; les aidantes accordent alors une place centrale au rôle de représentante de leur proche hébergé. Cette étude avait pour but d’expliquer la transformation du rôle de représentante chez des aidantes familiales dont le parent atteint de démence vit dans un centre d’hébergement et de soins de longue durée (CHSLD). La méthode qualitative de la théorisation ancrée a été retenue pour expliquer ce processus social. Les résultats obtenus reposent sur 14 entrevues en profondeur réalisées auprès de filles dont le parent atteint de démence était hébergé depuis plus de six mois dans un CHSLD. Ces aidantes ont été sélectionnées selon une procédure d’échantillonnage théorique et l’analyse des données a été réalisée à partir de la transcription intégrale des entrevues en suivant trois niveaux d'analyse, soit la codification ouverte, axiale et sélective. Une proposition théorique, générée par voie inductive, met en lumière trois processus intermédiaires interreliés expliquant la transformation du rôle de représentante pendant l’hébergement du proche : 1) l’intégration dans le milieu ; 2) l’évaluation de la qualité des soins et 3) le développement de la confiance envers le milieu d’hébergement. Plus précisément, les aidantes déploient différentes stratégies d’intégration dans le milieu d’hébergement, soit l’établissement de relations de réciprocité et d’une collaboration avec le personnel soignant, ainsi que l’utilisation d’un style de communication diplomatique. Parallèlement, elles évaluent la qualité des soins en trois étapes : jugement, pondération et action. Finalement, une relation de confiance avec les membres du personnel de l’établissement se développe en lien avec cinq facteurs spécifiques, soit les premières impressions, la comparaison avec d’autres CHSLD, l’intérêt démontré par le personnel envers le proche, le fait d’être entendue et prise au sérieux et la transparence du milieu d’hébergement. Ces trois processus contribuent au bien-être du parent hébergé et à celui de l’aidante. Le développement de la confiance étant associé aux deux autres processus intermédiaires ainsi qu’au bien-être de l’aidante, il est le processus central de la théorie contextuelle qui émerge de cette recherche. Cette étude contribue au développement des connaissances, notamment en fournissant plusieurs éléments inédits de compréhension du processus de transformation du rôle de représentante des aidantes familiales, de même que des pistes pour soutenir ces aidantes dont le parent, souffrant de démence, n’est plus en mesure de prendre des décisions. La théorie contextuelle proposée dans le cadre de cette étude constitue les prémices d’une théorie de niveau intermédiaire portant sur le rôle de représentant des aidants familiaux dans le contexte plus général du système de santé. Des études réalisées dans d’autres contextes de soins et auprès d’aidants de proches vulnérables ayant d’autres types d’affections sont ainsi recommandées.

Land Restitution and Prevention of Forced Displacement in Colombia

The armed conflict in Colombia, which has generated over three million internally displaced persons, has dramatic humanitarian consequences and raises serious issues regarding the protection of displaced peoples’ rights. The underlying reasons for the displacement often lie in the dynamics associated with territorial control and land seizures undertaken for strategic, military or purely economic purposes. Domestic and international legal provisions have established the victims’ right to the restitution of their homes and property as the “preferred remedy” in cases of displacement. However, policies dealing with displacement, both those of the Colombian government and of several international institutions, fail to take this sufficiently into account. A comprehensive reparation policy for victims must necessarily entail the reversion of lands, territories and goods seized in Colombia under the pretext of the internal armed conflict.

Envelhecimento de Idosos Institucionalizados : Formação de Auxiliares de Ação Direta na Associação Casapiana de Solidariedade

Esta tese que agora se apresenta sob a forma de projeto profissional tem como objetivo reforçar o processo de formação e qualificação em exercício de auxiliares de ação direta da Associação Casapiana de Solidariedade (ACS) reportando-se a uma prática nela levada a cabo. Esta é uma questão de extrema pertinência no âmbito do envelhecimento e do envelhecimento com dependência de idosos institucionalizados. Atualmente os lares de idosos são espaços de convivência, das mais variadas proveniências culturais e com necessidades múltiplas. Estes idosos necessitam de apoio para as atividades da vida diária. As auxiliares de ação direta são os profissionais mais aptos à realização desta função, as mesmas prestam cuidados básicos e pessoais aos idosos, essenciais à sua qualidade de vida diária. A ACS preocupa-se com a melhoria dos cuidados e por isso promove o acesso a formações, inclusive prestadas em contexto de trabalho. Neste projeto profissional evidenciamos o trabalho exercido por estas profissionais e a necessidade de formação das mesmas. Analisamos a formação em exercício realizada na ACS considerando-a como uma boa prática a ser desenvolvida pelas IPSS. Verificamos que esta prática é um dos meios para melhorar as competências destes profissionais e promover a qualidade de serviços aos mais velhos.

Architecture for Living Neuronal Network Control of a mobile robot

The intelligent controlling mechanism of a typical mobile robot is usually a computer system. Research is however now ongoing in which biological neural networks are being cultured and trained to act as the brain of an interactive real world robot – thereby either completely replacing or operating in a cooperative fashion with a computer system. Studying such neural systems can give a distinct insight into biological neural structures and therefore such research has immediate medical implications. The principal aims of the present research are to assess the computational and learning capacity of dissociated cultured neuronal networks with a view to advancing network level processing of artificial neural networks. This will be approached by the creation of an artificial hybrid system (animat) involving closed loop control of a mobile robot by a dissociated culture of rat neurons. This paper details the components of the overall animat closed loop system architecture and reports on the evaluation of the results from preliminary real-life and simulated robot experiments.

The four major N- and C-terminal splice variants of the excitatory amino acid transporter GLT-1 form cell surface homomeric and heteromeric assemblies

The L-glutamate transporter GLT-1 is an abundant CNS membrane protein of the excitatory amino acid transporter (EAAT) family which controls extracellular L-glutamate levels and is important in limiting excitotoxic neuronal death. Using RT-PCR, we have determined that four mRNAs encoding GLT-1 exist in mouse brain, with the potential to encode four GLT-1 isoforms that differ in their N- and C-termini. We expressed all four isoforms (termed MAST-KREK, MPK-KREK, MAST-DIETCI and MPK-DIETCI according to amino acid sequence) in a range of cell lines and primary astrocytes and show that each isoform can reach the cell surface. In transfected HEK-293 or COS-7 cells, all four isoforms support high-affinity sodium-dependent L-glutamate uptake with identical pharmacological and kinetic properties. Inserting a viral epitope (V5, HA or FLAG) into the second extracellular domain of each isoform allowed co-immunoprecipitation and tr-FRET studies using transfected HEK-293 cells. Here we show for the first time that each of the four isoforms are able to combine to form homomeric and heteromeric assemblies, each of which are expressed at the cell surface of primary astrocytes. After activation of protein kinase C by phorbol ester, V5-tagged GLT-1 is rapidly removed from the cell surface of HEK-293 cells and degraded. This study provides direct biochemical evidence for oligomeric assembly of GLT-1 and reports the development of novel tools to provide insight into the trafficking of GLT-1.

The comfort, energy and health implications of London’s urban heat island

The urban heat island (UHI) is a well-known effect of urbanisation and is particularly important in world megacities. Overheating in such cities is expected to be exacerbated in the future as a result of further urban growth and climate change. Demonstrating and quantifying the impact of individual design interventions on the UHI is currently difficult using available software tools. The tools developed in the LUCID (‘The Development of a Local Urban Climate Model and its Application to the Intelligent Design of Cities’) research project will enable the related impacts to be better understood, quantified and addressed. This article summarises the relevant literature and reports on the ongoing work of the project.

Virtual reality as a visualisation tool: benefits and constraints

The benefits and applications of virtual reality (VR) in the construction industry have been investigated for almost a decade. However, the practical implementation of VR in the construction industry has yet to reach maturity owing to technical constraints. The need for effective information management presents challenges: both transfer of building data to, and organisation of building information within, the virtual environment require consideration. This paper reviews the applications and benefits of VR in the built environment field and reports on a collaboration between Loughborough University and South Bank University to overcome constraints on the use of the overall VR model for whole lifecycle visualisation. The work at each research centre is concerned with an aspect of information management within VR applications for the built environment, and both data transfer and internal data organisation have been investigated. In this paper, similarities and differences between computer-aided design (CAD) and VR packages are first discussed. Three different approaches to the creation of VR models during the design stage are identified and described, with a view to providing sharing understanding across the interdiscipliary groups involved. The suitable organisation of building information within the virtual environment is then further investigated. This work focused on the visualisation of the degradation of a building, through its lifespan, with the view to provide a visual aid for developing an effective and economic project maintenance programme. Finally consideration is given to the potential of emerging standards to facilitate an integrated use of VR. The convergence towards similar data structures in VR and other construction packages may enable visualisation to be better utilised in the overall lifecycle model.

Private investment in the countryside: an assessment of the role of new houses and estates in sustaining the rural economy and environment

The British countryside has been shaped and sustained over the years by the establishment of landed estates. Some of our best known, and now most protected, landmarks derive from this tradition by which money, that was often sourced from outside the rural economy, was invested in land. Whilst there was some reversal in this trend during the last century, there is again a widespread desire among people of means to invest in new country property. Paragraph 3.21 of Planning Policy Guidance Note 7: The Countryside - Environmental Quality and Economic and Social Development was introduced in 1997 as a means of perpetuating the historic tradition of innovation in the countryside through the construction of fine individual houses in landscaped grounds. That it was considered necessary to use a special provision of this kind reflects the prevailing presumption of planning authorities against allowing private residential development in open countryside. The Government is currently reviewing rural planning policy and is focusing on higher density housing, affordable homes and the use of brownfield sites. There is an underlying conception that individual private house developments contribute nothing and are seen as the least attractive option for most development sites. The purpose of paragraph 3.21 lies outside the government’s priorities and its particular provisions may therefore be excluded in forthcoming ‘policy statements’. This paper seeks to examine the role of private investors wishing to build new houses in the countryside, and the impact that that might have on local economies. It explores the interpretation placed on PPG7 through an investigation of appeal sites, and concludes by making recommendations for the review process, including the retention of some form of exceptions policy for new build houses.

Architecture, sedentism, and social complexity at Pre-Pottery Neolithic A WF16, Southern Jordan

Recent excavations at Pre-Pottery Neolithic A (PPNA) WF16 in southern Jordan have revealed remarkable evidence of architectural developments in the early Neolithic. This sheds light on both special purpose structures and “domestic” settlement, allowing fresh insights into the development of increasingly sedentary communities and the social systems they supported. The development of sedentary communities is a central part of the Neolithic process in Southwest Asia. Architecture and ideas of homes and households have been important to the debate, although there has also been considerable discussion on the role of communal buildings and the organization of early sedentarizing communities since the discovery of the tower at Jericho. Recently, the focus has been on either northern Levantine PPNA sites, such as Jerf el Ahmar, or the emergence of ritual buildings in the Pre-Pottery Neolithic B of the southern Levant. Much of the debate revolves around a division between what is interpreted as domestic space, contrasted with “special purpose” buildings. Our recent evidence allows a fresh examination of the nature of early Neolithic communities.

Traditional Chinese medicine research in the post-genomic era: good practice, priorities, challenges and opportunities

Background and aims: GP-TCM is the 1st EU-funded Coordination Action consortium dedicated to traditional Chinese medicine (TCM) research. This paper aims to summarise the objectives, structure and activities of the consortium and introduces the position of the consortium regarding good practice, priorities, challenges and opportunities in TCM research. Serving as the introductory paper for the GPTCM Journal of Ethnopharmacology special issue, this paper describes the roadmap of this special issue and reports how the main outputs of the ten GP-TCM work packages are integrated, and have led to consortium-wide conclusions. Materials and methods: Literature studies, opinion polls and discussions among consortium members and stakeholders. Results: By January 2012, through 3 years of team building, the GP-TCM consortium had grown into a large collaborative network involving ∼200 scientists from 24 countries and 107 institutions. Consortium members had worked closely to address good practice issues related to various aspects of Chinese herbal medicine (CHM) and acupuncture research, the focus of this Journal of Ethnopharmacology special issue, leading to state-of-the-art reports, guidelines and consensus on the application of omics technologies in TCM research. In addition, through an online survey open to GP-TCM members and non-members, we polled opinions on grand priorities, challenges and opportunities in TCM research. Based on the poll, although consortium members and non-members had diverse opinions on the major challenges in the field, both groups agreed that high-quality efficacy/effectiveness and mechanistic studies are grand priorities and that the TCM legacy in general and its management of chronic diseases in particular represent grand opportunities. Consortium members cast their votes of confidence in omics and systems biology approaches to TCM research and believed that quality and pharmacovigilance of TCM products are not only grand priorities, but also grand challenges. Non-members, however, gave priority to integrative medicine, concerned on the impact of regulation of TCM practitioners and emphasised intersectoral collaborations in funding TCM research, especially clinical trials. Conclusions: The GP-TCM consortium made great efforts to address some fundamental issues in TCM research, including developing guidelines, as well as identifying priorities, challenges and opportunities. These consortium guidelines and consensus will need dissemination, validation and further development through continued interregional, interdisciplinary and intersectoral collaborations. To promote this, a new consortium, known as the GP-TCM Research Association, is being established to succeed the 3-year fixed term FP7 GP-TCM consortium and will be officially launched at the Final GP-TCM Congress in Leiden, the Netherlands, in April 2012.