Designing the future in wound care : the role of the nurse practitioner

The nurse practitioner is emerging as a new level and type of health care. Increasing specialisation and advanced educational opportunities in nursing and the inequality in access to health care for sectors of the community have established the conditions under which the nurse practitioner movement has strengthened both nationally and internationally. The boundaries of responsibility for nurses are changing, not only because of increased demands but also because nurses have demonstrated their competence in varied extended and expanded practice roles. The nurse practitioner role reflects the continuing development of the nursing profession and substantially extends the career path for clinical nurses. This paper describes an aspect of a large-scale investigation into the feasibility of the role of the nurse practitioner in the Australian Capital Territory (ACT) health care system. The paper reports on the trial of practice for a wound care nurse practitioner model in a tertiary institution. In the trial the wound care nurse practitioner worked in an extended practice role for 10 months. The nurse practitioner practice was supported, monitored and mentored by a clinical support team. Data were collected relating to a range of outcomes including definition of the scope of practice for the model, description of patient demographics and outcomes and the efficacy of the nurse practitioner service. The findings informed the development of clinical protocols that define the scope of practice and the parameters of the wound care nurse practitioner model and provided information on the efficacy of this model of health care for the tertiary care environment. The findings further suggest that this model brings expert wound care and case management to an at-risk patient population. Recommendations are made relating to ongoing research into the role of the wound care nurse practitioner model in the ACT health care system.

Language and utilisation of emergency care in Queensland

Objective: To compare access and utilisation of EDs in Queensland public hospitals between people who speak only English at home and those who speak another language at home. Methods: A retrospective analysis of a Queensland statewide hospital ED dataset (ED Information System) from 1 January 2008 to 31 December 2010 was conducted. Access to ED care was measured by the proportion of the state’s population attending EDs. Logistic regression analyses were performed to determine the relationships between ambulance use and language, and between hospital admission and language, both after adjusting for age, sex and triage category. Results: The ED utilisation rate was highest in English only speakers (290 per 1000 population), followed by Arabic speakers (105), and lowest among German speakers (30). Compared with English speakers, there were lower rates of ambulance use in Chinese (odds ratio 0.50, 95% confidence interval, 0.47–0.54), Vietnamese (0.87, 0.79–0.95), Arabic (0.87, 0.78–0.97), Spanish (0.56, 0.50–0.62), Italian (0.88, 0.80–0.96), Hindi (0.61, 0.53–0.70) and German (0.87, 0.79–0.90) speakers. Compared with English speakers, German speakers had higher admission rates (odds ratio 1.17, 95% confidence interval, 1.02–1.34), whereas there were lower admission rates in Chinese (0.90, 0.86–0.99), Arabic (0.76, 0.67–0.85) and Spanish (0.83, 0.75–0.93) speakers. Conclusion: This study showed that there was a significant association between lower utilisation of emergency care and speaking languages other than English at home. Further researches are needed using in-depth methodology to investigate if there are language barriers in accessing emergency care in Queensland.

Preservice teachers’ perceptions of their middle schooling teacher preparation : a sample of the Australian context

Reviews into teacher education and reform measures, such as implementing professional standards for teachers, are designed to raise the quality of education. Such reviews and reforms also target preservice teachers; hence universities examine their teacher education programs to address these issues, including developing programs that are current with the literature. Over the past fifteen years, concerns have arisen about Australian early adolescents and their disengagement from the schooling system, their “at risk” behaviour and their need for social, emotional and academic support. These concerns have prompted a middle schooling movement in Australia with the literature recognising a need for specialised middle school teachers. As a result, various universities have responded by developing courses specifically designed to graduate teachers who possess the theoretical and pedagogical knowledge for engaging early adolescent learners. This mixed-method study analysed the responses of preservice teachers from three universities across two states in Australia near the completion of their middle years teacher preparation program. The three aims of the study were to: (1) investigate final-year preservice teachers’ perceptions of their confidence to teach in the middle years of schooling; (2) analyse the experiences included in their teacher preparation course that made them feel confident; and (3) describe strategies for enhancing middle schooling teacher education preparation. Data were gathered from final-year preservice teachers (n=142) using a survey that was developed in response to middle schooling literature and the Professional Standards for Queensland Teachers (Queensland College of Teachers, 2006). A questionnaire collected extended information about the participants’ (n=142) experiences that made them feel confident. It also gathered information about strategies for enhancing middle years teacher preparation. One-to-one, 45-minute interviews (n=10) were conducted to elicit in-depth responses aligned with the research aims. Quantitative results indicated that the majority of preservice teachers (n=142) claimed confidence associated with survey items relating to creating a positive classroom environment (range: 70-97%), developing positive relationships for teaching (71-98%), pedagogical knowledge for teaching (72-95%), and implementation of teaching (70-91%). Qualitative findings suggested that the experiences that assisted them to be confident for teaching were practicum and associated field studies coursework, a positive mentor teacher, specifically designed middle years subjects, the pedagogical approaches of university staff, and other real-world experiences such as volunteering in schools and participating in professional development alongside their mentors. This study demonstrated that universities presenting middle years teacher preparation need to consider: the quality of the practicum experience; the suitability of mentor teachers; the significance and practicalities of middle years subjects; university lecturers’ modelling of pedagogical practices; and the inclusion of real-world learning experiences. Although the findings of this study provided evidence as to how preservice teacher confidence for teaching has been influenced by their middle schooling teacher preparation, further research is required to investigate how confidence translates into practice within their first years of teaching.

Recruitment and results of a pilot trial of vitamin D supplementation in the general population of Australia

Context: The benefits of high serum levels of 25-hydroxyvitamin D [25(OH)D] are unclear. Trials are needed to establish an appropriate evidence base. Objective: We plan to conduct a large-scale trial of vitamin D supplementation for the reduction of cancer incidence and overall mortality and report here the methods and results of a pilot trial established to inform its design. Design: Pilot D-Health was a randomized trial carried out in a general community setting with 12 months intervention and follow-up. Participants: Participants were 60- to 84-yr-old residents of one of the four eastern Australian states who did not have any vitamin D-related disorders and who were not taking more than 400 IU supplementary vitamin D per day. A total of 644 participants were randomized, and 615 completed the study (two persons withdrew because of nonserious adverse events). Interventions: The interventions were monthly doses of placebo or 30,000 or 60,000 IU vitamin D3. Main Outcomes: The main outcomes were the recruitment rate and changes in serum 25(OH)D. Results: Ten percent of those approached were recruited. At baseline, the mean 25(OH)D was 42 nmol/liter in all three study arms. The mean change in 25(OH)D in the placebo group was 0.12 nmol/liter, compared with changes of 22 and 36 nmol/liter in the 30,000- and 60,000-IU groups, respectively. Conclusions: The D-Health pilot has shown that a large trial is feasible in Australia and that a dose of 2000 IU/d will be needed to ensure that a large proportion of the population reaches the target serum 25(OH)D level. Copyright © 2012 by The Endocrine Society.

Binder effect on microstructure and properties of YBa2Cu3O7-x extruded wires

YBa2Cu3O7-x wires have been extruded with 2 and 5 wt.% of hydroxy propyl methylcellulose (HPMC) as binder. Both sets of wires sintered below 930°C have equiaxed grains while the wires sintered above this temperature have elongated grains. In the temperature range which gives equiaxed grains, the wires extruded with 5 wt.% HPMC have higher grain size and density. Cracks along the grain boundaries are often observed in the wires having elongated grains. Critical current density, Jc, increases initially, reaches a peak and then decreases with the sintering temperature. The sintering temperature giving a peak in Jc strongly depends on the heat treatment scheme for the wires extruded with 5 wt.% HPMC. TEM studies show that defective layers are formed along grain boundaries for the wires extruded with 5 wt.% HPMC after 5 h oxygenation. After 55 h oxygenation, the defective layers become more localised and grain boundaries adopt an overall cleaner appearance. Densification with equiaxed grains and clean grain boundaries produces the highest Jc's for polycrystalline YBa2Cu3O7 wires.

Synthesis and characterisation of nanoscale magnesium oxide powders and their application in thick films of Bi2Sr2CaCu2O8

Nanoscale MgO powder was synthesized from magnesite ore by a wet chemical method. Acid dissolution was used to obtain a solution from which magnesium containing complexes were precipitated by either oxalic acid or ammonium hydroxide, The transformation of precipitates to the oxide was monitored by thermal analysis and XRD and the transformed powders were studied by electron microscopy. The MgO powders were added as dopants to Bi2SrCa2CuO8 powders and high temperature superconductor thick films were deposited on silver. Addition of suitable MgO powder resulted in increase of critical current density, J(c), from 8,900 Acm(-2) to 13,900 Acm(-2) measured at 77 K and 0 T. The effect of MgO addition was evaluated by XRD, electron microscopy and critical current density measurements. (C) 1998 Elsevier Science B.V.

Microstructural studies of quenched partially-melted Y-123 materials and Y-123 with Y-211, PtO2 and CeO2 additions

The microstructure of YBa2Cu3O7-delta (Y-123) materials partially-melted in air and quenched from the temperature range 900-1100 degrees C, has been characterized using a combination of X-ray diffractometry, optical microscopy, scanning electron microscopy, electron microprobe analyses, transmission electron microscopy and energy and wave dispersive X-ray spectrometries. The microstructural studies reveal significant changes in the character of the quenched partial-melt as a function of temperature and time before quenching. BaCu2O2 and BaCuO2 are found to co-exist in stoichiometric samples quenched from the temperature range 920-960 degrees C. Under suitable cooling conditions, large pockets of melt cristallize as BaCuO2 with an exsolution of BaCu2O2 in the form of thin plates (approximate to 50-100 nm thick) along facets. Y2BaCuO5 (Y-211) additions are associated with the formation of BaCu2O2 at 1100 degrees C. Preliminary results on the effects of PtO2 and CeO2 additions to Y-123 (and Y-123 with Y-211 additions) show that these enhace the formation of BaCu2O2 at the melting temperature of 1100 degrees C. (C) 1998 Elsevier Science S.A. All rights reserved.

Electronic transport properties of hot-pressed B6Si

Measurements of the electrical conductivity, Seebeck coefficient and Hall mobility from -300K to -1300K have been carried out on multiphase hotpressed samples of the nominal composition B6Si. In all samples the conductivity and the p-type Seebeck coefficient both increase smoothly with increasing temperature. By themselves, these facts suggest small-polaronic hopping between inequivalent sites. The measured Hall mobilities are always low, but vary in sign. A possible explanation is offered for this anomalous behavior.

Chemical vapor deposited boron carbide : growth by a vapor-liquid-solid process

Detailed analytical electron microscope (AEM) studies of yellow whiskers produced by chemical vapor deposition (CVD)1 show that two basic types of whiskers are produced at low temperatures (between 1200°C and 1400°C) and low boron to carbon gas ratios. Both whisker types show planar microstructures such as twin planes and stacking faults oriented parallel to, or at a rhombohedral angle to, the growth direction. For both whisker types, the presence of droplet-like terminations containing both Si and Ni indicate that the growth process during CVD is via a vapor-liquid-solid (VLS) mechanism.

A comparison of calculated and experimental HRTEM images of twinned boron carbide

High resolution TEM images of boron carbide (B13C2) have been recorded and compared with images calculated using the multislice method as implemented by M. A. O'Keefe in the SHRLI programs. Images calculated for the [010] zone, using machine parameters for the JEOL 2000FX AEM operating at 200 keV, indicate that for the structure model of Will et al., the optimum defocus image can be interpreted such that white spots correspond to B12 icosahedra for thin specimens and to low density channels through the structure adjacent to the direct inter-icosahedral bonds for specimens of intermediate thickness (-40 > t > -100 nm). With this information, and from the symmetry observed in the TEM images, it is likely that the (101) twin plane passes through the center of icosahedron located at the origin. This model was tested using the method of periodic continuation. Resulting images compare favorably with experimental images, thus supporting the structural model. The introduction of a (101) twin plane through the origin creates distortions to the icosahedral linkages as well as to the intra-icosahedral bonding. This increases the inequivalence of adjacent icosahedral sites along the twin plane, and thereby increases the likelihood of bipolaron hopping.

Anomalous Seebeck coefficient in boron carbides

Boron carbides exhibit an anomalously large Seebeck coefficient with a temperature coefficient that is characteristic of polaronic hopping between inequivalent sites. The inequivalence in the sites is associated with disorder in the solid. The temperature dependence of the Seebeck coefficient for materials prepared by different techniques provides insight into the nature of the disorder.

Resting metabolic rate is associated with hunger, self-determined meal size, and daily energy intake and may represent a marker for appetite

Background: There are strong logical reasons why energy expended in metabolism should influence the energy acquired in food-intake behavior. However, the relation has never been established, and it is not known why certain people experience hunger in the presence of large amounts of body energy. Objective: We investigated the effect of the resting metabolic rate (RMR) on objective measures of whole-day food intake and hunger. Design: We carried out a 12-wk intervention that involved 41 overweight and obese men and women [mean ± SD age: 43.1 ± 7.5 y; BMI (in kg/m2): 30.7 ± 3.9] who were tested under conditions of physical activity (sedentary or active) and dietary energy density (17 or 10 kJ/g). RMR, daily energy intake, meal size, and hunger were assessed within the same day and across each condition. Results: We obtained evidence that RMR is correlated with meal size and daily energy intake in overweight and obese individuals. Participants with high RMRs showed increased levels of hunger across the day (P < 0.0001) and greater food intake (P < 0.00001) than did individuals with lower RMRs. These effects were independent of sex and food energy density. The change in RMR was also related to energy intake (P < 0.0001). Conclusions: We propose that RMR (largely determined by fat-free mass) may be a marker of energy intake and could represent a physiologic signal for hunger. These results may have implications for additional research possibilities in appetite, energy homeostasis, and obesity. This trial was registered under international standard identification for controlled trials as ISRCTN47291569.

Raman and infrared spectroscopic characterization of beryllonite, a sodium and beryllium phosphate mineral : implications for mineral collectors

The mineral beryllonite has been characterized by the combination of Raman spectroscopy and infrared spectroscopy. SEM–EDX was used for the chemical analysis of the mineral. The intense sharp Raman band at 1011 cm-1, was assigned to the phosphate symmetric stretching mode. Raman bands at 1046, 1053, 1068 and the low intensity bands at 1147, 1160 and 1175 cm-1 are attributed to the phosphate antisymmetric stretching vibrations. The number of bands in the antisymmetric stretching region supports the concept of symmetry reduction of the phosphate anion in the beryllonite structure. This concept is supported by the number of bands found in the out-of-plane bending region. Multiple bands are also found in the in-plane bending region with Raman bands at 399, 418, 431 and 466 cm-1. Strong Raman bands at 304 and 354 cm-1 are attributed to metal oxygen vibrations. Vibrational spectroscopy served to determine the molecular structure of the mineral. The pegmatitic phosphate minerals such as beryllonite are more readily studied by Raman spectroscopy than infrared spectroscopy.

Near infrared (NIR) absorption spectra correlates with subchondral bone micro-CT parameters in osteoarthritic rat models

Determining the properties and integrity of subchondral bone in the developmental stages of osteoarthritis, especially in a form that can facilitate real-time characterization for diagnostic and decision-making purposes, is still a matter for research and development. This paper presents relationships between near infrared absorption spectra and properties of subchondral bone obtained from 3 models of osteoarthritic degeneration induced in laboratory rats via: (i) menisectomy (MSX); (ii) anterior cruciate ligament transaction (ACL); and (iii) intra-articular injection of mono-ido-acetate (1 mg) (MIA), in the right knee joint, with 12 rats per model group (N = 36). After 8 weeks, the animals were sacrificed and knee joints were collected. A custom-made diffuse reflectance NIR probe of diameter 5 mm was placed on the tibial surface and spectral data were acquired from each specimen in the wavenumber range 4000–12 500 cm− 1. After spectral acquisition, micro computed tomography (micro-CT) was performed on the samples and subchondral bone parameters namely: bone volume (BV) and bone mineral density (BMD) were extracted from the micro-CT data. Statistical correlation was then conducted between these parameters and regions of the near infrared spectra using multivariate techniques including principal component analysis (PCA), discriminant analysis (DA), and partial least squares (PLS) regression. Statistically significant linear correlations were found between the near infrared absorption spectra and subchondral bone BMD (R2 = 98.84%) and BV (R2 = 97.87%). In conclusion, near infrared spectroscopic probing can be used to detect, qualify and quantify changes in the composition of the subchondral bone, and could potentially assist in distinguishing healthy from OA bone as demonstrated with our laboratory rat models.

The relationship between CFH and ARMS2 genotypes and neuroretinal function in persons without age-related macular degeneration

Purpose: To determine whether neuroretinal function differs in healthy persons with and without common risk gene variants for age- related macular degeneration (AMD) and no ophthalmoscopic signs of AMD, and to compare those findings in persons with manifest early AMD. Methods and Participants: Neuroretinal function was assessed with the multifocal electroretinogram (mfERG) (VERIS, Redwood City, CA,) in 32 participants (22 healthy persons with no clinical signs of AMD and 10 early AMD patients). The 22 healthy participants with no AMD were risk genotypes for either the CFH (rs380390) and/or ARMS2 (rs10490920). We used a slow flash mfERG paradigm (3 inserted frames) and a 103 hexagon stimulus array. Recordings were made with DTL electrodes; fixation and eye movements were monitored online. Trough N1 to peak P1 (N1P1) response densities and P1-implicit times (IT) were analysed in 5 concentric rings. Results: N1P1 response densities (mean ± SD) for concentric rings 1-3 were on average significantly higher in at-risk genotypes (ring 1: 17.97 nV/deg2 ± 1.9, ring 2: 11.7 nV/deg2 ±1.3, ring 3: 8.7 nV/deg2 ± 0.7) compared to those without risk (ring 1: 13.7 nV/deg2 ± 1.9, ring 2: 9.2 nV/deg2 ±0.8, ring 3: 7.3 nV/deg2 ± 1.1) and compared to persons with early AMD (ring 1: 15.3 nV/deg2 ± 4.8, ring 2: 9.1 nV/deg2 ±2.3, ring 3 nV/deg2: 7.3± 1.3) (p<0.5). The group implicit times, P1-ITs for ring 1 were on average delayed in the early AMD patients (36.4 ms ± 1.0) compared to healthy participants with (35.1 ms ± 1.1) or without risk genotypes (34.8 ms ±1.3), although these differences were not significant. Conclusion: Neuroretinal function in persons with normal fundi can be differentiated into subgroups based on their genetics. Increased neuroretinal activity in persons who carry AMD risk genotypes may be due to genetically determined subclinical inflammatory and/or histological changes in the retina. Assessment of neuroretinal function in healthy persons genetically susceptible to AMD may be a useful early biomarker before there is clinical manifestation of AMD.