How graduate nurses use protocols to manage patients` medications

Aims and objectives. The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications.
Background. Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making
Design. A descriptive prospective qualitative design was used.
Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed.
Results. Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications.
Conclusion. Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved.
Relevance to clinical practice. Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.

Achieving the millennium development goals in the Asia-Pacific region : the role of international assistance

The Millennium Development Goals (MDGs) are a set of international development targets agreed to by members of the United Nations in 2000. The goals aim to improve many of the dimensions of extreme poverty and are to be achieved by 2015. This paper provides an overview of the issues relevant to the achievement of the MDGs in the Asia-Pacific region. The paper begins by discussing the critiques of the MDGs before assessing whether countries in the region are on track to achieve them. Issues relating to data availability and accuracy are discussed and the need to tailor the MDG targets to the special circumstances of some Asia-Pacific countries is examined. The paper proceeds by discussing the role of international assistance via international foreign development aid and non-governmental organisations in the achievement of the MDGs. The paper concludes with some policy implications for the international donor community.

J-Circos: an interactive Circos plotter

Circos plots are graphical outputs that display three dimensional chromosomal interactions and fusion transcripts. However, the Circos plot tool is not an interactive visualization tool, but rather a figure generator. For example, it does not enable data to be added dynamically nor does it provide information for specific data points interactively. Recently, an R-based Circos tool (RCircos) has been developed to integrate Circos to R, but similarly, Rcircos can only be used to generate plots. Thus, we have developed a Circos plot tool (J-Circos) that is an interactive visualization tool that can plot Circos figures, as well as being able to dynamically add data to the figure, and providing information for specific data points using mouse hover display and zoom in/out functions. J-Circos uses the Java computer language to enable, it to be used on most operating systems (Windows, MacOS, Linux). Users can input data into J-Circos using flat data formats, as well as from the Graphical user interface (GUI). J-Circos will enable biologists to better study more complex chromosomal interactions and fusion transcripts that are otherwise difficult to visualize from next-generation sequencing data. Availability and implementation: J-circos and its manual are freely available at http://www.australianprostatecentre.org/research/software/jcircos CONTACT: j.an@qut.edu.au Supplementary information: Supplementary data are available at Bioinformatics online.

Charismatic marine mega-fauna: some recent discoveries and future challenges

 The last 20 years have been exciting times for scientists working with charismatic marine mega-fauna. Here recent advances are reviewed. There have been advances in both data gathering and data-analysis techniques that have allowed new insights into the physiological and behavioural ecology of free-ranging mega-faunal species; some marine mega-faunal species have now become model organisms for cutting edge approaches to identify the underlying mathematical properties of animal search patterns and hence the underlying behavioural processes (e.g. Levy flight versus Brownian motion); the implications of climate change have started to become more apparent with extended time-series of animal movements, abundance and performance; conservation issues have become integrated into marine planning and have resulted in the advent of extended networks of marine protected areas (MPAs) as well as large MPAs that span many 100,000 km2; and collaborative crossdisciplinary teams have started to reveal the importance of ocean currents in animal dispersal, the ontogeny of migration and population genetic structure. Looking to the future, increased data availability (e.g. through data sharing) will likely allow more holistic across-taxa analyses to become routine.
© 2013 Elsevier B.V. All rights reserved.

Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting

BACKGROUND: Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice.

METHODS: A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes.

RESULTS: Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity.

CONCLUSIONS: This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability.

Accounting for habitat and seafloor structure characteristics on southern rock lobster (Jasus edwardsii) assessment in a small marine reserve

Where to place marine protected areas (MPAs) and how much area they should cover are some of the most basic questions when designing MPAs. Based on the theory of island biogeography, larger reserves are likely to protect more species and individuals but smaller reserves have been shown to positively influence populations. In this study, we assess a localised population of the ecologically and economically important southern rock lobster (Jasus edwardsii) inside and outside a small reserve. We used standardised fishery assessment trapping methods to sample J. edwardsii populations inside a reserve and an adjacent area outside the reserve. The population characteristics of the captured individuals were compared inside and outside the reserve using t tests (male size, female size,number of reproductive females, number of individuals and biomass), and we found that there were significantly greater numbers and larger individuals and biomass inside the reserve. However, many assessments of MPA effectiveness are confounded by differences in habitat. To account for possible differences in habitat, we collected multibeam bathymetry data to allow us to characterise seafloor structure and video data to assign each sampling location to a biotope class based on macroalgae assemblages. Then, using generalised linear models (GLMs), we assessed differences in populations while accounting for habitat. The GLMs revealed that there was still a significant difference in populations inside the reserve despite habitat differences inside and outside the reserve. We demonstrate a methodological approach to provide a baseline data set to assess MPA effectiveness through time and measure how habitat may respond to indirect consequences of fishing or other human impacts at the species or ecosystem level. We also highlight some of the limitations in sampling design and data availability common in MPA studies and resulting implications for assessment.

Effect Of Different Hydrological Model Structures On The Assimilation Of Distributed Uncertain Observations

The reliable evaluation of the flood forecasting is a crucial problem for assessing flood risk and consequent damages. Different hydrological models (distributed, semi-distributed or lumped) have been proposed in order to deal with this issue. The choice of the proper model structure has been investigated by many authors and it is one of the main sources of uncertainty for a correct evaluation of the outflow hydrograph. In addition, the recent increasing of data availability makes possible to update hydrological models as response of real-time observations. For these reasons, the aim of this work it is to evaluate the effect of different structure of a semi-distributed hydrological model in the assimilation of distributed uncertain discharge observations. The study was applied to the Bacchiglione catchment, located in Italy. The first methodological step was to divide the basin in different sub-basins according to topographic characteristics. Secondly, two different structures of the semi-distributed hydrological model were implemented in order to estimate the outflow hydrograph. Then, synthetic observations of uncertain value of discharge were generated, as a function of the observed and simulated value of flow at the basin outlet, and assimilated in the semi-distributed models using a Kalman Filter. Finally, different spatial patterns of sensors location were assumed to update the model state as response of the uncertain discharge observations. The results of this work pointed out that, overall, the assimilation of uncertain observations can improve the hydrologic model performance. In particular, it was found that the model structure is an important factor, of difficult characterization, since can induce different forecasts in terms of outflow discharge. This study is partly supported by the FP7 EU Project WeSenseIt.

Comparando a saúde no Brasil com os países da OCDE: explorando dados de saúde pública

A atenção à saúde da população no Brasil gera um grande volume de dados sobre os serviços de saúde prestados. O tratamento adequado destes dados com técnicas de acesso à grande massa de dados pode permitir a extração de informações importantes para um melhor conhecimento do setor saúde. Avaliar o desempenho dos sistemas de saúde através da utilização da massa de dados produzida tem sido uma tendência mundial, uma vez que vários países já mantêm programas de avaliação baseados em dados e indicadores. Neste contexto, A OCDE – Organização para Cooperação e Desenvolvimento Econômico, que é uma organização internacional que avalia as políticas econômicas de seus 34 países membros, possui uma publicação bienal, chamada Health at a Glance, que tem por objetivo fazer a comparação dos sistemas de saúde dos países membros da OCDE. Embora o Brasil não seja um membro, a OCDE procura incluí-lo no cálculo de alguns indicadores, quando os dados estão disponíveis, pois considera o Brasil como uma das maiores economias que não é um país membro. O presente estudo tem por objetivo propor e implementar, com base na metodologia da publicação Health at a Glance de 2015, o cálculo para o Brasil de 22 indicadores em saúde que compõem o domínio “utilização de serviços em saúde” da publicação da OCDE. Para isto foi feito um levantamento das principais bases de dados nacionais em saúde disponíveis que posteriormente foram capturadas, conforme necessidade, através de técnicas para acessar e tratar o grande volume de dados em saúde no Brasil. As bases de dados utilizadas são provenientes de três principais fontes remuneração: SUS, planos privados de saúde e outras fontes de remuneração como, por exemplo, planos públicos de saúde, DPVAT e particular. A realização deste trabalho permitiu verificar que os dados em saúde disponíveis publicamente no Brasil podem ser usados na avaliação do desempenho do sistema de saúde, e além de incluir o Brasil no benchmark internacional dos países da OCDE nestes 22 indicadores, promoveu a comparação destes indicadores entre o setor público de saúde do Brasil, o SUS, e o setor de planos privados de saúde, a chamada saúde suplementar. Além disso, também foi possível comparar os indicadores calculados para o SUS para cada UF, demonstrando assim as diferenças na prestação de serviços de saúde nos estados do Brasil para o setor público. A análise dos resultados demonstrou que, em geral, o Brasil comparado com os países da OCDE apresenta um desempenho abaixo da média dos demais países, o que indica necessidade de esforços para atingir um nível mais alto na prestação de serviços em saúde que estão no âmbito de avaliação dos indicadores calculados. Quando segmentado entre SUS e saúde suplementar, a análise dos resultados dos indicadores do Brasil aponta para uma aproximação do desempenho do setor de saúde suplementar em relação à média dos demais países da OCDE, e por outro lado um distanciamento do SUS em relação a esta média. Isto evidencia a diferença no nível de prestação de serviços dentro do Brasil entre o SUS e a saúde suplementar. Por fim, como proposta de melhoria na qualidade dos resultados obtidos neste estudo sugere-se o uso da base de dados do TISS/ANS para as informações provenientes do setor de saúde suplementar, uma vez que o TISS reflete toda a troca de informações entre os prestadores de serviços de saúde e as operadoras de planos privados de saúde para fins de pagamento dos serviços prestados.

Análise de séries temporais de coordenadas estimadas com GPS: uma proposta metodológica para eliminação de efeitos sazonais

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estimativa da vulnerabilidade natural do aquífero livre no município de Rio Claro/SP

Pós-graduação em Geociências e Meio Ambiente - IGCE

Construção de um software para avaliação do risco de úlcera por pressão em Unidade Terapia Intensiva

Pós-graduação em Enfermagem (mestrado profissional) - FMB

The use of databases of social and gender statistics in the development of policies and programmes

The unavailability of data to inform policy planning and formulation has been repeatedly cited as the main challenge to economic and social progress in the Caribbean. Furthermore, even in instances when data is produced, broader gaps exist between its production and eventual use for evidence-based policy formulation. Owing to those challenges, this report explores the use of databases of social and gender statistics in the development of policies and programmes in the Caribbean subregion. The report offers a general appraisal of databases against two main considerations: (i) maximizing the use of existing databases in relevant policies and programmes; and (ii) bridging the gaps in data availability of relevant statistical databases and their analyses. The assessment entailed an inventory of social and gender databases maintained by data producers in the region and analysis of the extent to which the databases are used for policy formulation. To that end, a literature search as well as consultations with a number of knowledgeable persons active in the field of statistics and data provision was conducted. Based on the review, a set of recommendations were produced to improve current practices within the region with respect evidence based policy formulation.

An assessment of the economic impact of climate change on the water sector in Saint Vincent and The Grenadines

Water security which is essential to life and livelihood, health and sanitation, is determined not only by the water resource, but also by the quality of water, the ability to store surplus from precipitation and runoff, as well as access to and affordability of supply. All of these measures have financial implications for national budgets. The water sector in the context of the assessment and discussion on the impact of climate change in this paper includes consideration of the existing as well as the projected available water resource and the demand in terms of: quantity and quality of surface and ground water, water supply infrastructure - collection, storage, treatment, distribution, and potential for adaptation. Wastewater management infrastructure is also considered a component of the water sector. Saint Vincent and the Grenadines has two distinct hydrological regimes: mainland St Vincent is one of the wetter islands of the eastern Caribbean whereas the Grenadines have a drier climate than St Vincent. Surface water is the primary source of water supply on St Vincent, whereas the Grenadines depend on man-made catchments, rainwater harvesting, wells, and desalination. The island state is considered already water stressed as marked seasonality in rainfall, inadequate supply infrastructure, and institutional capacity constrains water supply. Economic modelling approaches were implemented to estimate sectoral demand and supply between 2011 and 2050. Residential, tourism and domestic demand were analysed for the A2, B2 and BAU scenarios. In each of the three scenarios – A2, B2 and BAU Saint Vincent and the Grenadines will have a water gap represented by the difference between the two curves during the forecast period of 2011 and 2050. The amount of water required increases steadily between 2011 and 2050 implying an increasing demand on the country‘s resources as reflected by the fact that the water supply that is available cannot respond adequately to the demand. The Global Water Partnership in its 2005 policy brief suggested that the best way for countries to build the capacity to adapt to climate change will be to improve their ability to cope with today‘s climate variability (GWP, 2005). This suggestion is most applicable for St Vincent and the Grenadines, as the variability being experienced has already placed the island nation under water stress. Strategic priorities should therefore be adopted to increase water production, increase efficiency, strengthen the institutional framework, and decrease wastage. Cost benefit analysis was stymied by data availability, but the ―no-regrets approach‖ which intimates that adaptation measures will be beneficial to the land, people and economy of Saint Vincent and the Grenadines with or without climate change should be adopted.

Performance measurement and indicators for water supply management: review and international cases

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Framework para integração semântica de dados geoespaciais: integração de dados geológicos

Pós-graduação em Ciência da Computação - IBILCE