Clinical Learning Environment and Supervision. Development and Validation of the CLES Evaluation Scale

The purpose of the study is: (1) to describe how nursing students' experienced their clinical learning environment and the supervision given by staff nurses working in hospital settings; and (2) to develop and test an evaluation scale of Clinical Learning Environment and Supervision (CLES). The study has been carried out in different phases. The pilot study (n=163) explored the association between the characteristics of a ward and its evaluation as a learning environment by students. The second version of research instrument (which was developed by the results of this pilot study) were tested by an expert panel (n=9 nurse teachers) and test-retest group formed by student nurses (n=38). After this evaluative phase, the CLES was formed as the basic research instrument for this study and it was tested with the Finnish main sample (n=416). In this phase, a concurrent validity instrument (Dunn & Burnett 1995) was used to confirm the validation process of CLES. The international comparative study was made by comparing the Finnish main sample with a British sample (n=142). The international comparative study was necessary for two reasons. In the instrument developing process, there is a need to test the new instrument in some other nursing culture. Other reason for comparative international study is the reflecting the impact of open employment markets in the European Union (EU) on the need to evaluate and to integrate EU health care educational systems. The results showed that the individualised supervision system is the most used supervision model and the supervisory relationship with personal mentor is the most meaningful single element of supervision evaluated by nursing students. The ward atmosphere and the management style of ward manager are the most important environmental factors of the clinical ward. The study integrates two theoretical elements - learning environment and supervision - in developing a preliminary theoretical model. The comparative international study showed that, Finnish students were more satisfied and evaluated their clinical placements and supervision with higher scores than students in the United Kingdom (UK). The difference between groups was statistical highly significant (p= 0.000). In the UK, clinical placements were longer but students met their nurse teachers less frequently than students in Finland. Arrangements for supervision were similar. This research process has produced the evaluation scale (CLES), which can be used in research and quality assessments of clinical learning environment and supervision in Finland and in the UK. CLES consists of 27 items and it is sub-divided into five sub-dimensions. Cronbach's alpha coefficient varied from high 0.94 to marginal 0.73. CLES is a compact evaluation scale and user-friendliness makes it suitable for continuing evaluation.

Executive Order Number Four, June 1966

Executive Orders from Governor Hughes. Compact for education.

Secreted proteases from dermatophytes

Dermatophytes are highly specialized pathogenic fungi that exclusively infect the stratum corneum, nails or hair, and it is evident that secreted proteolytic activity is important for their virulence. Endo- and exoproteases-secreted by dermatophytes are similar to those of species of the genus Aspergillus. However, in contrast to Aspergillus spp., dermatophyte-secreted endoproteases are multiple and are members of two large protein families, the subtilisins (serine proteases) and the fungalysins (metalloproteases). In addition, dermatophytes excrete sulphite as a reducing agent. In the presence of sulphite, disulphide bounds of the keratin substrate are directly cleaved to cysteine and S-sulphocysteine, and reduced proteins become accessible for further digestion by various endo- and exoproteases secreted by the fungi. Sulphitolysis is likely to be an essential step in the digestion of compact keratinized tissues which precedes the action of all proteases.

Clients of sex workers in Switzerland: it makes sense to counsel and propose rapid test for HIV on the street, a preliminary report.

BACKGROUND: Clients of street sex workers may be at higher risk for HIV infection than the general population. Furthermore, there is a lack of knowledge regarding HIV testing of clients of sex workers in developed countries. METHOD: This pilot study assessed the feasibility and acceptance of rapid HIV testing by the clients of street-based sex workers in Lausanne, Switzerland. For 5 evenings, clients in cars were stopped by trained field staff for face-to-face interviews focusing on sex-related HIV risk behaviors and HIV testing history. The clients were then offered a free anonymous rapid HIV test in a bus parked nearby. Rapid HIV testing and counselling were performed by experienced nurse practitioners. Clients with reactive tests were offered confirmatory testing, medical evaluation, and care in our HIV clinic. RESULT: We intercepted 144 men, 112 (77.8%) agreed to be interviewed. Among them, 50 (46.6%) had never been tested for HIV. A total of 31 (27.7%) rapid HIV tests were performed, 16 (51.6%) in clients who had not previously been tested. None were reactive. Initially, 19 (16.9%) additional clients agreed to HIV testing but later declined due to the 40-minute queue for testing. CONCLUSION: This pilot study showed that rapid HIV testing in the red light district of Lausanne was feasible, and that the clients of sex workers accepted testing at an unexpectedly high rate. This setting seems particularly appropriate for targeted HIV screening, since more than 40% of the clients had not previously been tested for HIV even though they engaged in sex-related HIV risk behaviour.

A randomized concave programming method for choice network revenue management

Models incorporating more realistic models of customer behavior, as customers choosing froman offer set, have recently become popular in assortment optimization and revenue management.The dynamic program for these models is intractable and approximated by a deterministiclinear program called the CDLP which has an exponential number of columns. However, whenthe segment consideration sets overlap, the CDLP is difficult to solve. Column generationhas been proposed but finding an entering column has been shown to be NP-hard. In thispaper we propose a new approach called SDCP to solving CDLP based on segments and theirconsideration sets. SDCP is a relaxation of CDLP and hence forms a looser upper bound onthe dynamic program but coincides with CDLP for the case of non-overlapping segments. Ifthe number of elements in a consideration set for a segment is not very large (SDCP) can beapplied to any discrete-choice model of consumer behavior. We tighten the SDCP bound by(i) simulations, called the randomized concave programming (RCP) method, and (ii) by addingcuts to a recent compact formulation of the problem for a latent multinomial-choice model ofdemand (SBLP+). This latter approach turns out to be very effective, essentially obtainingCDLP value, and excellent revenue performance in simulations, even for overlapping segments.By formulating the problem as a separation problem, we give insight into why CDLP is easyfor the MNL with non-overlapping considerations sets and why generalizations of MNL posedifficulties. We perform numerical simulations to determine the revenue performance of all themethods on reference data sets in the literature.

A problemática do risco cambial na importação estudo de caso: Empresas Importadoras de Automóveis em Cabo Verde

A problemática do risco cambial surge a partir do momento em que agentes económicos decidem efectuar as suas transacções internacionais em divisas. Neste contexto, a necessidade de conhecer e compreender o mercado cambial é peremptório. Como forma de se protegerem das exposições de taxas de câmbio, os agentes sentem necessidade de recorrer a instrumentos de protecção cambial, de forma a proporcionar uma maior segurança à negociação. O presente trabalho teve como objectivo identificar e avaliar o risco cambial nas empresas de importação de automóveis em Cabo Verde, bem como estudar o mercado cambial Cabo-verdiano, procurando, simultaneamente identificar os instrumentos de protecção disponíveis na nossa praça. No entanto, observou-se que no mercado nacional não há utilização dos derivados financeiros, embora, já seja prevista a sua implementação. Deste modo, as empresas de importação de automóveis encontram-se totalmente expostas a esse risco de mercado, e sem qualquer experiência em lidar com os instrumentos de protecção cambial. Para a consecução dos objectivos propostos, realizou-se um estudo de caso, com o propósito de estudar a problemática do risco cambial nas empresas de importação de automóveis em Cabo Verde. A colecta de dados foi realizada por meio de questionários aplicados às empresas importadoras de automóveis e foi complementada com uma entrevista não estruturada aplicada a um especialista com know-how na área. Com o estudo foi possível descrever todas as etapas do processo de importação de automóveis e analisar a expressividade dos riscos cambiais nessas empresas. The problem of currency risk arises from the moment when economic agents decide to perform their international transactions in any foreign exchange. In this respect, the need to know and understand the exchange market is peremptory. As a way to protect themselves from the exposure of rates exchange, agents feel the need to resort to cambial instruments of protection, to provide a greater security to negotiations. This present work had as objectives to identify and survey the currency risk in importing cars companies in Cape Verde, as well as studying the Cape Verdean exchange market to, simultaneously, identify the instruments of protection existent. However, it was observed that in the national market there is no use of financial derivatives, although its implementation is decided. Thus, importing cars companies are entirely exposed to this market risk and without any experience in dealing with the hedging risks these transactions imply. To the attainment of the proposed objectives, we performed a case study with the purpose of studying the problem of currency risk in the importing cars companies in Cape Verde. The data collection was held through questionnaires to the cars importing companies and was complemented with an unstructured interview applied to a specialist with expertise in the area. With the study it was possible to describe all the stages of importing cars process and analyze the expressiveness of currency risks in these companies.

Comparison of information structures

We introduce two ways of comparing information structures, say ${\cal I}$ and${\cal J}$. First we say that ${\cal I}$ is richer than ${\cal J}$ when forevery compact game $G$, all correlated equilibrium distributions of $G$ inducedby ${\cal J}$ are also induced by ${\cal I}$. Second, we say that ${\cal J}$is faithfully reproducable from ${\cal I}$ when all the players can computefrom their information in ${\cal I}$ ``new information'' that they could havereceived from ${\cal J}$. We prove that ${\cal I}$ is richer than ${\cal J}$if and only if ${\cal J}$ is faithfully reproducable from ${\cal I}$.

La chaîne des secours: le modèle vaudois [An efficient example of a Swiss pre-hospital chain of survival: the state of Vaud model].

The state of Vaud model of the pre-hospital chain of survival is an example of an efficient way to deal with pre-hospital emergencies. It revolves around a centrally located dispatch center managing emergencies according to specific key words, allowing dispatchers to send out resources among which we find general practitioners, ambulances, physician staffed fast response cars or physician staffed helicopters and specific equipment. The Vaud pre-hospital chain of survival has been tailored according to geographical, demographical and political necessities. It undergoes constant reassessment and needs continuous adaptations to the ever changing demographics and epidemiology of pre-hospital medicine.

State and industry in the 1940s: The Spanish automobile industry

The decade of the 1940s was one of the darkest periods in the country's history, with years of famine, repression, general misery, and impoverishment of all aspects of national life ranging from culture to the economy. During those years plans were made to establish a Spanish motor industry once the Civil War had come to an end in 1939. It seemed a propitious moment for private enterprise and various foreign motor companies presented proposals for manufacturing their entire vehicle range, from cars to trucks. However, the government plans were for a State monopoly, a policy which meant that any private projects which did not contemplate the regime taking management decisions were rejected out of hand. From 1941 onwards, any new initiative was required to meet the plans set by INI. The main argument running through this paper is that one can only understand the development of the modern Spanish motor industry if one grasps the haggling between motor companies and government regarding market entry and the impact of the regime's autarchic policies in the 1940s.

Characterization of intonation in Karṇāṭaka music by parametrizing context-based Svara Distributions

Intonation is a fundamental music concept that has a special relevance in Indian art music. It is characteristic of the rāga and intrinsic to the musical expression of the performer. Describing intonation is of importance to several information retrieval tasks like the development of rāga and artist similarity measures. In our previous work, we proposed a compact representation of intonation based on the parametrization of the pitch histogram of a performance and demonstrated the usefulness of this representation through an explorative rāga recognition task in which we classified 42 vocal performances belonging to 3 rāgas using parameters of a single svara. In this paper, we extend this representation to employ context-based svara distributions, which are obtained with a different approach to find the pitches belonging to each svara. We quantitatively compare this method to our previous one, discuss the advantages, and the necessary melodic analysis to be carried out in future.

Toxic effects of brake wear particles on epithelial lung cells in vitro

Background: Fine particulate matter originating from traffic correlates with increased morbidity and mortality. An important source of traffic particles is brake wear of cars which contributes up to 20% of the total traffic emissions. The aim of this study was to evaluate potential toxicological effects of human epithelial lung cells exposed to freshly generated brake wear particles. Results: An exposure box was mounted around a car's braking system. Lung cells cultured at the air-liquid interface were then exposed to particles emitted from two typical braking behaviours ("full stop" and "normal deceleration"). The particle size distribution as well as the brake emission components like metals and carbons was measured on-line, and the particles deposited on grids for transmission electron microscopy were counted. The tight junction arrangement was observed by laser scanning microscopy. Cellular responses were assessed by measurement of lactate dehydrogenase (cytotoxicity), by investigating the production of reactive oxidative species and the release of the pro-inflammatory mediator interleukin-8. The tight junction protein occludin density decreased significantly (p < 0.05) with increasing concentrations of metals on the particles (iron, copper and manganese, which were all strongly correlated with each other). Occludin was also negatively correlated with the intensity of reactive oxidative species. The concentrations of interleukin-8 were significantly correlated with increasing organic carbon concentrations. No correlation was observed between occludin and interleukin-8, nor between reactive oxidative species and interleukin-8. Conclusion: These findings suggest that the metals on brake wear particles damage tight junctions with a mechanism involving oxidative stress. Brake wear particles also increase pro-inflammatory responses. However, this might be due to another mechanism than via oxidative stress. [Authors]

Densidade do solo, atributos químicos e sistema radicular do milho afetados pelo pastejo e manejo do solo

A integração lavoura-pecuária é uma alternativa de renda dos produtores no sul do Brasil. Entretanto, o pisoteio animal e, ou, o preparo de solo podem compactá-lo, prejudicando o crescimento radicular e a produtividade das plantas. Estudaram-se os efeitos do pisoteio animal em regime de pastejo contínuo durante o inverno/primavera e do impacto do plantio direto e do preparo convencional de solo no estado de compactação, atributos químicos e distribuição radicular. Em Podzólico Vermelho-Amarelo de textura superficial franca, foi implantada uma pastagem de estação fria composta por aveia (Avena strigosa Schreb) e azevém (Lolium multiflorum L.). A carga animal variou conforme o crescimento da pastagem. Em dezembro de 1996, foi implantada a cultura do milho (Zea mays L.) para a produção de silagem, usando os seguintes tratamentos: plantio direto na área não pastejada, plantio direto após o pastejo, preparo convencional de solo na área não pastejada e preparo convencional de solo após pastejo. As avaliações apresentadas neste estudo são referentes ao terceiro ano de cultivo, no qual houve um período de pastejo de 107 dias. Aos 45 dias da emergência do milho, foram abertas trincheiras (100 x 40 cm) para visualizar a distribuição do sistema radicular e coletar amostras de solo, a cada 5 cm, para caracterização química e determinação da densidade do solo e de raízes. Ao longo do perfil (0-40 cm), o desenho da distribuição de raízes indicou maior quantidade de raízes no preparo convencional de solo, concordando com os resultados de densidade de raízes. O pisoteio animal não teve efeito sobre as características físicas, possivelmente pelo fato de o resíduo da pastagem permanecer próximo a 1,0 Mg ha-1 de matéria seca. A densidade do solo no plantio direto, na camada de 5-10 cm, foi de 1,41 Mg m-3, tanto na área pastejada como na não pastejada. No preparo convencional de solo, esses valores foram de 1,15 Mg m-3, na área pastejada e de 1,12 Mg m-3, na área não pastejada. A produtividade de grãos de milho (4,55 Mg ha-1) e de silagem (34,66 Mg ha-1) não foi afetada pelo pastejo ou pelo preparo do solo. O sistema de manejo do solo teve maior influência na densidade do solo do que o pisoteio animal, considerando o controle da carga animal ajustado ao crescimento da pastagem.

Motifs de consultation en médecine du travail [Reasons for consultation in occupational medicine].

The inability to characterize more precisely the extent of occupational diseases limits the implementation of an effective preventive policy. Furthermore, not all work-related conditions are reported by the Swiss workers' compensation system. A seven-year (1986 to 1992) retrospective study of medical visits in an Institute of Occupational Health Sciences is presented. The objective of this study is to expand data on occupational diseases for clinical and public health intervention. 298 patients have been examined for a possible work-related condition. In 140 cases (47%), an occupational disease according to the Swiss Law was found. Respiratory tract was the main target of industrial pollutants. Respiratory irritation , solvent intoxications, contact dermatitis and asthma were the most frequent conditions seen. 97 workplace visits (32% of all medical visits) were necessary for diagnostic purposes. Painters (construction, cars) and other solvent exposed workers were at particular risk. Rare alpha-1-antitrypsin phenotypes were found several times in workers with respiratory diseases confirming the value of this test in occupational medicine. Despite many referral biases, direct clinical and public health applications of the data are possible. This study confirms the hypothesis that occupational respiratory diseases and intoxications are probably underreported in the workers' compensation statistics. Activities with an increased risk of work-related diseases have been identified so workplace intervention could be highly targeted. This study shows also that a more intense collaboration between primary care physicians, hospital services and occupational medical specialists is necessary to improve clinical and epidemiological surveillance of work-related health conditions.

Reprisals remembered: German-Greek conflict and car sales during the Euro crisis

During the Greek debt crisis after 2010, the German government insisted on harshausterity measures. This led to a rapid cooling of relations between the Greekand German governments. We compile a new index of public acrimony betweenGermany and Greece based on newspaper reports and internet search terms. Thisinformation is combined with historical maps on German war crimes during theoccupation between 1941 and 1944. During months of open conflict between Germanand Greek politicians, German car sales fell markedly more than those of cars fromother countries. This was especially true in areas affected by German reprisals duringWorldWar II: areas where German troops committed massacres and destroyed entirevillages curtailed their purchases of German cars to a greater extent during conflictmonths than other parts of Greece. We conclude that cultural aversion was a keydeterminant of purchasing behavior, and that memories of past conflict can affecteconomic choices in a time-varying fashion. These findings are compatible withbehavioral models emphasizing the importance of salience for individual decision-making.

A search for microquasar candidates at low galactic latitudes

Recent studies of relativistic jet sources in the Galaxy, also known as microquasars, have been very useful in trying to understand the accretion/ejection processes that take place near compact objects. However, the number of sources involved in such studies is still small. In an attempt to increase the number of known microquasars we have carried out a search for new Radio Emitting X-ray Binaries (REXBs). These sources are the ones to be observed later with VLBI techniques to unveil their possible microquasar nature. To this end, we have performed a cross-identification between the X-ray ROSAT all sky survey Bright Source Catalog (RBSC) and the radio NRAO VLA Sky Survey (NVSS) catalogs under very restrictive selection criteria for sources with |b|<5 degrees. We have also conducted a deep observational radio and optical study for six of the selected candidates. At the end of this process two of the candidates appear to be promising, and deserve additional observations aimed to confirm their proposed microquasar nature.