Assessing performance in critical care nursing practice using the Benner Novice to expert model: A pilot study

Background It is often believed that by ensuring the ongoing completion of competency documents and life-long learning in nursing practice guarantees quality patient care. This is probably true in most cases where it provides reassurances that the nursing team is maintaining a safe “generalised” level of practice. However, competency does not always promise quality performance. There are a number of studies that have reported differences in what practitioners know and what they actually do despite being deemed competent. Aim The aim of this study was to assess whether our current competency documentation is fit for purpose and to ascertain whether performance assessment needs to be a key component in determining competence. Method 15 nurses within a General ICU who had been on the unit <4 years agreed to participate in this project. Using participant observation and assessing performance against key indicators of the Benner Novice to Expert5 model the participants were supported and assessed over the course of a ‘normal’ nursing shift. Results The results were surprising both positively and negatively. First, the nurses felt more empowered in their clinical decision making skills; second, it identified individual learning needs and milestones in educational development. There were some key challenges identified which included 5 nurses over estimating their level of competence, practice was still very much focused on task acquisition and skill and surprisingly some nurses still felt dominated by the other health professionals within the unit. Conclusion We found that the capacity and capabilities of our nursing workforce needs continual ongoing support especially if we want to move our staff from capable task-doer to competent performers. Using the key novice to expert indicators identified the way forward for us in how we assess performance and competence in practice particularly where promotion to higher grades is based on existing documentation.

Advancing practice in critical care: A model of knowledge integration

Explore and describe a conceptual model of knowledge integration pertinent to the development of individual practitioners in critical care. Discussion of how multiple learning strategies that are embedded in practice can be beneficial in developing knowledge.

GABAAα1 and GABAAρ1 subunits are expressed in cultured human RPE cells and GABAA receptor agents modify the intracellular calcium concentration.

Purpose: Gamma-aminobutyric acid A (GABAA) receptors (GABAARs), which are ionotropic receptors involving chloride channels, have been identified in various neural (e.g., mouse retinal ganglion cells) and nonneural cells (e.g., mouse lens epithelial cells) regulating the intracellular calcium concentration ([Ca(2+)]i). GABAAR β-subunit protein has been isolated in the cultured human and rat RPE, and GABAAα1 and GABAAρ1 mRNAs and proteins are present in the chick RPE. The purpose of this study was to investigate the expression of GABAAα1 and GABAAρ1, two important subunits in forming functional GABAARs, in the cultured human RPE, and further to explore whether altering receptor activation modifies [Ca(2+)]i. Methods: Human RPE cells were separately cultured from five donor eye cups. Real-time PCR, western blots, and immunofluorescence were used to test for GABAAα1 and GABAAρ1 mRNAs and proteins. The effects of the GABAAR agonist muscimol, antagonist picrotoxin, or the specific GABAAρ antagonist 1,2,5,6-tetrahydropyridin-4-yl) methylphosphinic acid (TPMPA) on [Ca(2+)]i in cultured human RPE were demonstrated using Fluo3-AM. Results: Both GABAAα1 and GABAAρ1 mRNAs and proteins were identified in cultured human RPE cells; antibody staining was mainly localized to the cell membrane and was also present in the cytoplasm but not in the nucleus. Muscimol (100 μM) caused a transient increase of the [Ca(2+)]i in RPE cells regardless of whether Ca(2+) was added to the buffer. Muscimol-induced increases in the [Ca(2+)]i were inhibited by pretreatment with picrotoxin (300 μM) or TPMPA (500 μM). Conclusions: GABAAα1 and GABAAρ1 are expressed in cultured human RPE cells, and GABAA agents can modify [Ca(2+)]i.

Fishery biology and management of Protonibea diacanthus (Sciaenidae) aggregations in far Northern Cape York Peninsula waters

The sciaenid Protonibea diacanthus is a large, long-lived predatory fish of inshore northern Australian waters, which forms annual aggregations that are fished extensively by traditional (subsistence) and recreational fishers. There are now widespread concerns that the resource is being overexploited. Indigenous fishers of the Cape York Northern Peninsula Area (NPA) relate that large adult fish (up to 1500 mm total length (TL)) made up the bulk of the catch from the sciaenid aggregations until about 1994. In contrast, sexually mature P. diacanthus comprised only a small component (12 fish out of 270=4.4%) examined in a 1999–2000 sampling programme that was biased towards the largest individuals available. At 790 mm TL, the minimum size at first maturity for female P. diacanthus in this study is much smaller than the 920 mm TL reported previously in Queensland waters. Developing ovaries were observed in specimens sampled from sciaenid aggregations which formed in NPA waters between May and September 2000. However, no fish with ripe or spent gonads were found in the study, so the current timing and location of the spawning season for P. diacanthus in the region remain unknown. Food items observed in the analysis of the diet of P. diacanthus from the NPA included a variety of teleosts and invertebrates. The range of animal taxa represented in the prey items support the description of an ‘opportunistic predator’ attributed to the species. In our sampling, the stomach contents of fish caught during the time of the aggregation events did not differ from those observed at other times of the year. A total of 114 P. diacanthus were tagged and released at aggregation sites during the study period, and 3 fish (2.6%) were subsequently recaptured. The low rate of tag returns from the wild stock tagging programme, both in this study (2.6%) and from recreational fisher tag/release programmes for the sciaenid elsewhere in Queensland (6.5%), were not explained by tag loss nor mortality, given the high retention rate of tags and the zero mortality seen in tank trials. In response to the biological findings from this study, indigenous community councils of the NPA imposed a 2-year fishing moratorium for P. diacanthus. Surveys at aggregation sites in 2002 and 2003 established that much larger fish (mean size 103.5 cm TL) were again present on the grounds, albeit in very low numbers. These recent preliminary results highlight the critical need for continued monitoring and management of the P. diacanthus fishery in the NPA, if prospects for resource recovery are to be realised. The NPA initiative has provided a rare opportunity to negotiate a co-management strategy, based on scientific data and traditional knowledge, for the recovery of a cultural and economically significant fished resource.

Leaf chlorophyll concentration relates to transpiration efficiency in peanut

Two pot experiments were conducted in two different seasons at the University of Agricultural Science, Bangalore, India, to study (a) the relationship between chlorophyll concentration (by measuring the leaf light-transmittance characteristics using a SPAD metre) and transpiration efficiency (TE) and (b) the effect of leaf N on chlorophyll and TE relationship in peanut. In Experiment (Expt) I, six peanut genotypes with wide genetic variation for the specific leaf area (SLA) were used. In Expt II, three non-nodulating isogenic lines were used to study the effect of N levels on leaf chlorophyll concentration–TE relationship without potential confounding effects in biological nitrogen fixation. Leaf N was manipulated by applying N fertiliser in Expt II. Chlorophyll concentration, TE (g dry matter kg−1 of H2O transpired, measured using gravimetric method), specific leaf nitrogen (g N m−2, SLN), SLA (cm2 g−1), carbon isotope composition (Δ13C) were determined in the leaves sampled during the treatment period (35–55 days after sowing) in the two experiments. Results showed that the leaf chlorophyll concentration expressed as soil plant analytical development (SPAD) chlorophyll metre reading (SCMR) varied significantly among genotypes in Expt I and as a result of N application in Expt II. Changes in leaf N levels were strongly associated with changes in SCMR, TE and Δ13C. In both the experiments, a significant positive relationship between SCMR and TE with similar slopes but differing intercepts was noticed. However, correction of TE for seasonal differences in vapour pressure deficit (VPD) between the two experiments resulted in a single and stronger relationship between SCMR and TE. There was a significant inverse relationship between SCMR and Δ13C, suggesting a close linkage between chlorophyll concentration and Δ13C in peanut. This study provides the first evidence for a significant positive relationship between TE and leaf chlorophyll concentration in peanut. The study also describes the effect of growing environment on the relationships among SLA, SLN and SCMR.

High subsoil chloride concentrations reduce soil water extraction and crop yield on Vertosols in north-eastern Australia

Salinity, sodicity, acidity, and phytotoxic levels of chloride (Cl) in subsoils are major constraints to crop production in many soils of north-eastern Australia because they reduce the ability of crop roots to extract water and nutrients from the soil. The complex interactions and correlations among soil properties result in multi-colinearity between soil properties and crop yield that makes it difficult to determine which constraint is the major limitation. We used ridge-regression analysis to overcome colinearity to evaluate the contribution of soil factors and water supply to the variation in the yields of 5 winter crops on soils with various levels and combinations of subsoil constraints in the region. Subsoil constraints measured were soil Cl, electrical conductivity of the saturation extract (ECse), and exchangeable sodium percentage (ESP). The ridge regression procedure selected several of the variables used in a descriptive model, which included in-crop rainfall, plant-available soil water at sowing in the 0.90-1.10 m soil layer, and soil Cl in the 0.90-1.10 m soil layer, and accounted for 77-85% of the variation in the grain yields of the 5 winter crops. Inclusion of ESP of the top soil (0.0-0.10 m soil layer) marginally increased the descriptive capability of the models for bread wheat, barley and durum wheat. Subsoil Cl concentration was found to be an effective substitute for subsoil water extraction. The estimates of the critical levels of subsoil Cl for a 10% reduction in the grain yield were 492 mg cl/kg for chickpea, 662 mg Cl/kg for durum wheat, 854 mg Cl/kg for bread wheat, 980 mg Cl/kg for canola, and 1012 mg Cl/kg for barley, thus suggesting that chickpea and durum wheat were more sensitive to subsoil Cl than bread wheat, barley, and canola.

Subsoil constraints in Vertosols: Crop water use nutrient concentration, and grain yields of bread wheat, durum wheat, barley, chickpea and canola

Single or multiple factors implicated in subsoil constraints including salinity, sodicity, and phytotoxic concentrations of chloride (Cl) are present in many Vertosols including those occurring in Queensland, Australia. The variable distribution and the complex interactions that exist between these constraints limit the agronomic or management options available to manage the soil with these subsoil constraints. The identification of crops and cultivars adapted to these adverse subsoil conditions and/or able to exploit subsoil water may be an option to maintain productivity of these soils. We evaluated relative performance of 5 winter crop species, in terms of grain yields, nutrient concentration, and ability to extract soil water, grown on soils with various levels and combinations of subsoil constraints in 19 field experiments over 2 years. Subsoil constraints were measured by levels of soil Cl, electrical conductivity of the saturation extract (ECse), and exchangeable sodium percentage (ESP). Increasing levels of subsoil constraints significantly decreased maximum depth of water extraction, grain yield, and plant-available water capacity for all the 5 crops and more so for chickpea and durum wheat than bread wheat, barley, or canola. Increasing soil Cl levels had a greater restricting effect on water availability than did ECse and ESP. We developed empirical relationships between soil Cl, ECse, and ESP and crop lower limit (CLL) for estimating subsoil water extraction by 5 winter crops. However, the presence of gypsum influenced the ability to predict CLL based on the levels of ECse. Stronger relationships between apparent unused plant-available water (CLL - LL15; LL15 is lower limit at -1.5 MPa) and soil Cl concentrations than ESP or ECse suggested that the presence of high Cl in these soils most likely inhibited the subsoil water extraction by the crops. This was supported by increased sodium (Na) and Cl concentration with a corresponding decrease in calcium (Ca) and potassium (K) in young mature leaf of bread wheat, durum wheat, and chickpea with increasing levels of subsoil constraints. Of the 2 ions, Na and Cl, the latter appears to be more damaging than the former, resulting in plant dieback and reduced grain yields.

Stress Concentration in Post-Tensioned Prestressed Concrete Beams

The use of the multiple Fourier method to analyses the stress distribution in the and regions of as a post-tensioned prestressed concrete beam had shown. The multiple Fourier method demonstrated have is a relatively new method for solving those problems for which the “Saint Vansant principle” is not applicable, The actual three-dimensional problem and a two-dimensional simplified representation of it are treated. The two-dimensional case is treated first and rather completely to gain further experience with multiple Fourier procedure, the appropriate Galerkin Vector for the three-dimensional case is found and the required relations between the arbitrary functions are stated.

Influence of concentration, temperature and humidity on the toxicity of phosphine to the strongly phosphine-resistant psocid Liposcelis bostrychophila Badonnel (Psocoptera: Liposcelididae)

BACKGROUND: The psocid Liposcelis bostrychophila Badonnel, is a widespread, significant pest of stored commodities, has developed strong resistance to phosphine, the major grain disinfestant. The aim was to develop effective fumigation protocols to control this resistant pest. RESULTS: Time to population extinction of all life stages (TPE) in days was evaluated at a series of phosphine concentrations and temperatures at two relative humidities. Regression analysis showed that temperature, concentration and relative humidity all contributed significantly to describing TPE (P < 0.001, R2 = 0.95), with temperature being the dominant variable, accounting for 74.4% of the variation. Irrespective of phosphine concentration, TPE was longer at lower temperatures and high humidity (70% RH) and shorter at higher temperatures and low humidity (55% RH). At any concentration of phosphine, a combination of higher temperature and lower humidity provides the shortest fumigation period to control resistant L. bostrychophila. For example, 19 and 11 days of fumigation are required at 15 °C and 70% RH at 0.1 and 1.0 mg L-1 of phosphine respectively, whereas only 4 and 2 days are required at 35 °C and 55% RH for the same respective concentrations. CONCLUSIONS: The developed fumigation protocols will provide industry with flexibility in application of phosphine.

Effects of environmental heat on conception rates in lactating dairy cows: Critical periods of exposure

Environmental heat can reduce conception rates (the proportion of services that result in pregnancy) in lactating dairy cows. The study objectives were to identify periods of exposure relative to the service date in which environmental heat is most closely associated with conception rates, and to assess whether the total time cows are exposed to high environmental heat within each 24-h period is more closely associated with conception rates than is the maximum environmental heat for each 24-h period. A retrospective observational study was conducted in 25 predominantly Holstein-Friesian commercial dairy herds located in Australia. Associations between weather and conception rates were assessed using 16,878 services performed over a 21-mo period. Services were classified as successful based on rectal palpation. Two measures of heat load were defined for each 24-h period: the maximum temperature-humidity index (THI) for the period, and the number of hours in the 24-h period when the THI was >72. Conception rates were reduced when cows were exposed to a high heat load from the day of service to 6 d after service, and in wk -1. Heat loads in wk -3 to -5 were also associated with reduced conception rates. Thus, management interventions to ameliorate the effects of heat load on conception rates should be implemented at least 5 wk before anticipated service and should continue until at least 1 wk after service. High autocorrelations existed between successive daily values in both measures, and associations between day of heat load relative to service day and conception rates differed substantially when ridge regression was used to account for this autocorrelation. This indicates that when assessing the effects of heat load on conception rates, the autocorrelation in heat load between days should be accounted for in analyses. The results suggest that either weekly averages or totals summarizing the daily heat load are adequate to describe heat load when assessing effects on conception rates in lactating dairy cows.

Effect of Crowding Agents, Signal Peptide, and Chaperone SecB on the Folding and Aggregation of E. coli Maltose Binding Protein

SecB, a soluble cytosolic chaperone component of the Secexport pathway, binds to newly synthesized precursor proteins and prevents their premature aggregation and folding and subsequently targets them to the translocation machinery on the membrane. PreMBP, the precursor form of maltose binding protein, has a 26-residue signal sequence attached to the N-terminus of MBP and is a physiological substrate of SecB. We examine the effect of macromolecular crowding and SecB on the stability and refolding of denatured preMBP and MBP. PreMBP was less stable than MBP (ΔTm =7( 0.5 K) in both crowded and uncrowded solutions. Crowding did not cause any substantial changes in the thermal stability ofMBP(ΔTm=1(0.4 K) or preMBP (ΔTm=0(0.6 K), as observed in spectroscopically monitored thermal unfolding experiments. However, both MBP and preMBP were prone to aggregation while refolding under crowded conditions. In contrast to MBP aggregates, which were amorphous, preMBP aggregates form amyloid fibrils.Under uncrowded conditions, a molar excess of SecB was able to completely prevent aggregation and promote disaggregation of preformed aggregates of MBP. When a complex of the denatured protein and SecB was preformed, SecB could completely prevent aggregation and promote folding of MBP and preMBP even in crowded solution. Thus, in addition to maintaining substrates in an unfolded, export-competent conformation, SecB also suppresses the aggregation of its substrates in the crowded intracellular environment. SecB is also able to promote passive disaggregation of macroscopic aggregates of MBP in the absence of an energy source such as ATP or additional cofactors. These experiments also demonstrate that signal peptide can reatly influence protein stability and aggregation propensity.

Use of optical density as a measure of Claviceps africana conidial suspension concentration

Sorghum ergot, caused by Claviceps africana, has remained a major disease problem in Australia since it was first recorded in 1996, and is the focus of a range of biological and integrated management research. Artificial inoculation using conidial suspensions is an important tool in this research. Ergot infection is greatly influenced by environmental factors, so it is important to reduce controllable sources of variation such as inoculum concentration. The use of optical density was tested as a method of quantifying conidial suspensions of C. africana, as an alternative to haemocytometer counts. This method was found to be accurate and time efficient, with possible applications in other disease systems.

Critical criminological understandings of adult pornography and woman abuse: New progressive directions in research and theory

There is a small, but growing, social scientific literature on the racist and violent nature of contemporary adult pornography. However, considerably more empirical and theoretical work needs to be done to advance a critical criminological understanding of how such hurtful sexual media contribute to various forms of woman abuse in intimate relationships. The main objective of this article is to briefly review the relevant literature and to suggest a few new progressive empirical and theoretical directions.