Interprofessional collaboration in nursing homes (interprof): A grounded theory study of general practitioner experiences and strategies to perform nursing home visits

Background: Interprofessionalism, considered as collaboration between medical professionals, has gained prominence over recent decades and evidence for its impact has grown. The steadily increasing number of residents in nursing homes will challenge medical care and the interaction across professions, especially nurses and general practitioners (GPS). The nursing home visit, a key element of medical care, has been underrepresented in research. This study explores GP perspectives on interprofessional collaboration with a focus on their visits to nursing homes in order to understand their experiences and expectations. This research represents an aspect of the interprof study, which explores medical care needs as well as the perceived collaboration and communication by nursing home residents, their families, GPS and nurses. This paper focusses on GPS' views, investigating in particular their visits to nursing homes in order to understand their experiences. Methods: Open guideline-interviews covering interprofessional collaboration and the visit process were conducted with 30 GPS in three study centers and analyzed with grounded theory methodology. GPS were recruited via postal request and existing networks of the research partners. Results: Four different types of nursing home visits were found: visits on demand, periodical visits, nursing home rounds and ad-hoc-decision based visits. We identified the core category "productive performance" of home visits in nursing homes which stands for the balance of GPŚ individual efforts and rewards. GPS used different strategies to perform a productive home visit: preparing strategies, on-site strategies and investing strategies. Conclusion: We compiled a theory of GPS home visits in nursing homes in Germany. The findings will be useful for research, and scientific and management purposes to generate a deeper understanding of GP perspectives and thereby improve interprofessional collaboration to ensure a high quality of care.

Generation and Characterisation of a Canine EGFP-HMGA2 Prostate Cancer In Vitro Model

The architectural transcription factor HMGA2 is abundantly expressed during embryonic development. In several malignant neoplasias including prostate cancer, high re-expression of HMGA2 is correlated with malignancy and poor prognosis. The let-7 miRNA family is described to regulate HMGA2 negatively. The balance of let-7 and HMGA2 is discussed to play a major role in tumour aetiology. To further analyse the role of HMGA2 in prostate cancer a stable and highly reproducible in vitro model system is precondition. Herein we established a canine CT1258-EGFP-HMGA2 prostate cancer cell line stably overexpressing HMGA2 linked to EGFP and in addition the reference cell line CT1258-EGFP expressing solely EGFP to exclude EGFP-induced effects. Both recombinant cell lines were characterised by fluorescence microscopy, flow cytometry and immunocytochemistry. The proliferative effect of ectopically overexpressed HMGA2 was determined via BrdU assays. Comparative karyotyping of the derived and the initial CT1258 cell lines was performed to analyse chromosome consistency. The impact of the ectopic HMGA2 expression on its regulator let-7a was analysed by quantitative real-time PCR. Fluorescence microscopy and immunocytochemistry detected successful expression of the EGFP-HMGA2 fusion protein exclusively accumulating in the nucleus. Gene expression analyses confirmed HMGA2 overexpression in CT1258-EGFP-HMGA2 in comparison to CT1258-EGFP and native cells. Significantly higher let-7a expression levels were found in CT1258-EGFP-HMGA2 and CT1258-EGFP. The BrdU assays detected an increased proliferation of CT1258-HMGA2-EGFP cells compared to CT1258-EGFP and native CT1258. The cytogenetic analyses of CT1258-EGFP and CT1258-EGFP-HMGA2 resulted in a comparable hyperdiploid karyotype as described for native CT1258 cells. To further investigate the impact of recombinant overexpressed HMGA2 on CT1258 cells, other selected targets described to underlie HMGA2 regulation were screened in addition. The new fluorescent CT1258-EGFP-HMGA2 cell line is a stable tool enabling in vitro and in vivo analyses of the HMGA2-mediated effects on cells and the development and pathogenesis of prostate cancer.

Architecture of the Landscape and Landscape of the Architecture in Japan. A dialogue between water and earth

It's very difficult in traditional Japanese culture separate the landscape from the architecture. The Japanese architectural culture has its roots in China but soon this culture has developed its own culture and an aesthetic that was the result of a long isolation from the rest of the world. Zen Buddhism and the constant relationship with nature define the main characteristics of Japanese architecture: minimalism and simplicity. The architecture is a perfect balance of harmony, proportion and purity. This paper aims to analyze the cultural roots of the relationship between architecture and landscape in Japan and where the characteristics previously defined are very important for to know the significance of the Japanese architectural thinking.

Review on recent trend of solar photovoltaic technology.

Solar photovoltaic technology is one of the renewable technologies, which has a potential to shape a clean, reliable, scalable and affordable electricity system for the future. This article provides a comprehensive review of solar photovoltaic technology in terms of photovoltaic materials efficiency and globally leading countries. Based on past years review and photovoltaic installations in the year 2014, the major five leading countries identified are China, Japan, USA, Germany and UK. These five countries altogether accounted for 80% of photovoltaic installations in 2014. The article also discusses the driving policies, funding and Research and Development activities: to gauge the reasons behind the success of the leading countries. Finally, this article reviews the photovoltaic cost analysis in terms of the photovoltaic module cost, balance of system cost and project cost with the help of listed 98 globally installed projects.

Towards a gravitational wave observatory designer: sensitivity limits of spaceborne detectors

The most promising concept for low frequency (millihertz to hertz) gravitational wave observatories are laser interferometric detectors in space. It is usually assumed that the noise floor for such a detector is dominated by optical shot noise in the signal readout. For this to be true, a careful balance of mission parameters is crucial to keep all other parasitic disturbances below shot noise. We developed a web application that uses over 30 input parameters and considers many important technical noise sources and noise suppression techniques to derive a realistic position noise budget. It optimizes free parameters automatically and generates a detailed report on all individual noise contributions. Thus one can easily explore the entire parameter space and design a realistic gravitational wave observatory. In this document we describe the different parameters, present all underlying calculations, and compare the final observatory's sensitivity with astrophysical sources of gravitational waves. We use as an example parameters currently assumed to be likely applied to a space mission proposed to be launched in 2034 by the European Space Agency. The web application itself is publicly available on the Internet at http://spacegravity.org/designer. Future versions of the web application will incorporate the frequency dependence of different noise sources and include a more detailed model of the observatory's residual acceleration noise.

Reframing Scottish Football: Strategy and the short-term nature of the football industry.

Despite football being deeply entrenched in Scottish culture it is under-researched from a business perspective. This research develops a conceptual framework that views professional football clubs from a number of different perspectives. It draws on strategic management literature since this views the firm as the intersection between internal competence, customer perception and competition within an industry. A review of previous sports business research highlighted five main themes that were used to create a structure for the analysis: on-field performance, attendance, finance, the playing squad and the manager. These themes were used as frames to view the firms within the industry from a number of different perspectives. Each frame allows a different aspect of the firm to be considered singly in turn and then collectively to develop a deeper understanding of the existing frames in use within the industry. The research is based on a pragmatic philosophy that allows mixed methods to be combined to provide both an objective and subjective view of the industry. The subjective view was drawn from five interviews with senior figures within Scottish professional football. These participants were from a number of different roles and organisations within the industry to provide a balance of experiences. The views were triangulated with a descriptive analysis of secondary data from a number of industry sources to establish patterns within and between these frames. A peer group of six clubs was selected as they competed in the Scottish Premier League in each of the seasons within an eleven-year period (2000-2011). The peer group clubs selected were: Aberdeen, Dundee United, Heart of Midlothian (Hearts), Hibernian, Kilmarnock and Motherwell. By focussing on a small group of clubs with a similar on-field record a broad study across the five frames could be carried out in detail without the findings being influenced by the impact of relegation to a lower division or sustained participation in European football. Within each of the original five frames a number of sub-components were identified and linked to the framework; this expanded the content to reflect the findings of this project. There appeared to be little link between on-field performance and attendance although progress to the later stages of cup competitions allowed clubs to connect with fans who do not regularly attend. The relationship between a club’s income and wage bill should be expanded to include interest repayments since this expenditure can be used to highlight future financial problems caused by increased debt levels. Although all of the interview participants spoke with pride of the players that had progressed from the club’s youth academy to success at the highest level the peer group clubs only produced one player each season that played more than ten matches for the club. Almost half of the players signed from the youth academy left the club without playing for the 1st Team. The importance of the relationship between the manager and club chairman was highlighted, although the speed with which managers were appointed suggests that little consideration was given to this before offering a contract. Once appointed there appeared to be little clarity over the job description and areas of responsibility. Several of the interviewees brought experience from other businesses to football but admitted that short-term decision making and entrenched behaviour made change difficult. The conclusion of the research is that by taking a firm-wide view of the club, longer-term decisions can be taken within football. Player development and supporter relationships were both identified as long-term processes that are impacted by the current short-termism. With greater role clarity for managers and a mixture of short and long-term objectives those involved in the industry are more likely to have opportunities to learn from experience and performance, across the different frames, will improve as a result.

Shape and chemically anisotropic colloidal particles: A theoretical study of their structure, phase behavior, and slow dynamics

A detailed non-equilibrium state diagram of shape-anisotropic particle fluids is constructed. The effects of particle shape are explored using Naive Mode Coupling Theory (NMCT), and a single particle Non-linear Langevin Equation (NLE) theory. The dynamical behavior of non-ergodic fluids are discussed. We employ a rotationally frozen approach to NMCT in order to determine a transition to center of mass (translational) localization. Both ideal and kinetic glass transitions are found to be highly shape dependent, and uniformly increase with particle dimensionality. The glass transition volume fraction of quasi 1- and 2- dimensional particles fall monotonically with the number of sites (aspect ratio), while 3-dimensional particles display a non-monotonic dependence of glassy vitrification on the number of sites. Introducing interparticle attractions results in a far more complex state diagram. The ideal non-ergodic boundary shows a glass-fluid-gel re-entrance previously predicted for spherical particle fluids. The non-ergodic region of the state diagram presents qualitatively different dynamics in different regimes. They are qualified by the different behaviors of the NLE dynamic free energy. The caging dominated, repulsive glass regime is characterized by long localization lengths and barrier locations, dictated by repulsive hard core interactions, while the bonding dominated gel region has short localization lengths (commensurate with the attraction range), and barrier locations. There exists a small region of the state diagram which is qualified by both glassy and gel localization lengths in the dynamic free energy. A much larger (high volume fraction, and high attraction strength) region of phase space is characterized by short gel-like localization lengths, and long barrier locations. The region is called the attractive glass and represents a 2-step relaxation process whereby a particle first breaks attractive physical bonds, and then escapes its topological cage. The dynamic fragility of fluids are highly particle shape dependent. It increases with particle dimensionality and falls with aspect ratio for quasi 1- and 2- dimentional particles. An ultralocal limit analysis of the NLE theory predicts universalities in the behavior of relaxation times, and elastic moduli. The equlibrium phase diagram of chemically anisotropic Janus spheres and Janus rods are calculated employing a mean field Random Phase Approximation. The calculations for Janus rods are corroborated by the full liquid state Reference Interaction Site Model theory. The Janus particles consist of attractive and repulsive regions. Both rods and spheres display rich phase behavior. The phase diagrams of these systems display fluid, macrophase separated, attraction driven microphase separated, repulsion driven microphase separated and crystalline regimes. Macrophase separation is predicted in highly attractive low volume fraction systems. Attraction driven microphase separation is charaterized by long length scale divergences, where the ordering length scale determines the microphase ordered structures. The ordering length scale of repulsion driven microphase separation is determined by the repulsive range. At the high volume fractions, particles forgo the enthalpic considerations of attractions and repulsions to satisfy hard core constraints and maximize vibrational entropy. This results in site length scale ordering in rods, and the sphere length scale ordering in Janus spheres, i.e., crystallization. A change in the Janus balance of both rods and spheres results in quantitative changes in spinodal temperatures and the position of phase boundaries. However, a change in the block sequence of Janus rods causes qualitative changes in the type of microphase ordered state, and induces prominent features (such as the Lifshitz point) in the phase diagrams of these systems. A detailed study of the number of nearest neighbors in Janus rod systems reflect a deep connection between this local measure of structure, and the structure factor which represents the most global measure of order.

Defensive realism and the Concert of Europe

Why do great powers expand? Offensive realist John Mearsheimer claims that states wage an eternal struggle for power, and that those strong enough to seek regional hegemony nearly always do. Mearsheimer's evidence, however, displays a selection bias. Examining four crises between 1814 and 1840, I show that the balance of power restrained Russia, Prussia and France. Yet all three also exercised self-restraint; Russia, in particular, passed up chances to bid for hegemony in 1815 and to topple Ottoman Turkey in 1829. Defensive realism gives a better account of the Concert of Europe, because it combines structural realism with non-realist theories of state preferences.

Accelerating retreat and high-elevation thinning of glaciers in central Spitsbergen

Svalbard is a heavily glacier-covered archipelago in the Arctic. Dickson Land (DL), in the central part of the largest island, Spitsbergen, is relatively arid, and as a result, glaciers there are relatively small and restricted mostly to valleys and cirques. This study presents a comprehensive analysis of glacier changes in DL based on inventories compiled from topographic maps and digital elevation models for the Little Ice Age maximum (LIA), the 1960s, 1990 and 2009/11. Total glacier area decreased by ~38 % since the LIA maximum, and front retreat has increased over the study period. Recently, most of the local glaciers have been consistently thinning in all elevation bands, in contrast to larger Svalbard ice masses which remain closer to balance. The mean 1990–2009/11 geodetic mass balance of glaciers in DL is among the most negative from the Svalbard regional means known from the literature.

Deformation mechanisms in second-phase affected microstructures and their energy balance

Based on the relationship Zener parameter (Z=second-phase size/second-phase volume fraction) vs. calcite grain size (dg), second-phase controlled aggregates and microstructures that are weakly affected by second-phases are discriminated. The latter are characterized by large but constant grain sizes, high calcite grain boundary fractions and crystallographic preferred orientations (CPO), while calcite grain size and calcite grain boundary fraction decrease continuously and CPO weakens with decreasing Z in second-phase controlled microstructures. These observations suggest that second-phase controlled microstructures predominantly deform via granular flow because pinning of calcite grain boundaries reduces the efficiency of dynamic recrystallization favoring mass transfer processes and grain boundary sliding. In contrast, the balance of grain size reduction and growth by dynamic recrystallization maintains a steady state grain size in microstructures that are only weakly affected by second-phases promoting a predominance of dislocation creep. With increasing temperature, the relationship between Z and dg persists but the calcite grain size increases continuously. Based on microstructures, the energy of each modifying process is calculated and its relative contribution is compared with energies of the competing processes (surface energy, dragging energy, dynamic recrystallization energy). The steady state microstructures result from a temperature-dependent energy minimization procedure of the system.

The negation of the other in the novel Sula by Toni Morrison [recurso electr?nico]

This analysis corresponds to an analytical and interpretative essay on the negation of the other in the novel Sula (1973) by Toni Morrison, one of the most important African American writers. In Sula, the author explores the concepts of good and evil as she provides characteristics of the African American culture and black identity. The characters? main struggle is their quest for achieving an authentic identity within this sexist and racist society that constricts their lives and dreams with moral standards. This essay attempts to demonstrate through this novel how human beings find self-destruction by attempting to destroy others, those who have different views of life and the world. The analysis focuses on the most important aspects of life proposed in this book: self-awareness, identity, friendship, traveling, the community, and heritage, which condition one?s vision towards the other and nurture, at the same time, one?s whole identity. As a major conclusion, there is no success for a society that judges and isolates the individuals who want to become authentic and attempt to break the constrictions of moral prejudices. For each member of the community is essential in the balance of it.

Análisis de los incentivos tributarios en la industria textil aplicado a la empresa exportadora de sombreros de paja toquilla Serrano Hat Export Cía. Ltda.

La actual crisis económica mundial y específicamente la del Ecuador, ha ocasionado que el actual gobierno busque la manera de incentivar la producción nacional, para dinamizar la economía. A más de los incentivos a la producción existen otros incentivos tanto económicos y tributarios, como de asesoría y capacitación, que buscan ayudar a las empresas exportadoras a mejorar su competitividad en el mercado internacional, atrayendo divisas al país para a la postre mejorar la Balanza de Pagos. En el presente trabajo de investigación, se realizó un estudio descriptivo, cuantitativo, deductivo, de análisis y de síntesis, con el objetivo de determinar si al realizar una correcta planificación tributaria, se podría evidenciar el posible beneficio de aprovechar determinados incentivos y su factibilidad de aplicación en el sector de exportaciones de sombreros de paja toquilla, específicamente en la empresa Serrano Hat Export Cía. Ltda. Como resultado, se pudo evidenciar que, existen incentivos tributarios a la producción y a la exportación de sombreros de paja toquilla, que en la empresa Serrano Hat Export Cía. Ltda. no son aprovechados, ya sea por desconocimiento, falta de interés o condiciones necesarias para su aplicación. Al igual que Serrano Hat, existen otras empresas de su sector, que podrían beneficiarse tanto económica como financieramente de este tipo de incentivos, siempre y cuando sean aplicados correctamente.

Effects of different intensity of early leaf removal on vegetative and productive activity and grape quality (cv. Nero d'Avola, Vitis vinifera)

Mestrado Vinifera Euromaster - Instituto Superior de Agronomia - UL

Removal of paracetamol on biomass-derived activated carbon: Modeling the fixed bed breakthrough curves using batch adsorption experiments

The remediation of paracetamol (PA), an emerging contaminant frequently found in wastewater treatment plants, has been studied in the low concentration range (0.3–10 mg L−1) using as adsorbent a biomass-derived activated carbon. PA uptake of up to 100 mg g−1 over the activated carbon has been obtained, with the adsorption isotherms being fairly explained by the Langmuir model. The application of Reichemberg and the Vermeulen equations to the batch kinetics experiments allowed estimating homogeneous and heterogeneous diffusion coefficients, reflecting the dependence of diffusion with the surface coverage of PA. A series of rapid small-scale column tests were carried out to determine the breakthrough curves under different operational conditions (temperature, PA concentration, flow rate, bed length). The suitability of the proposed adsorbent for the remediation of PA in fixed-bed adsorption was proven by the high PA adsorption capacity along with the fast adsorption and the reduced height of the mass transfer zone of the columns. We have demonstrated that, thanks to the use of the heterogeneous diffusion coefficient, the proposed mathematical approach for the numerical solution to the mass balance of the column provides a reliable description of the breakthrough profiles and the design parameters, being much more accurate than models based in the classical linear driving force.

Cold Season Physiology of Arctic Plants

The cold season in the Arctic extends over eight to nine months during which ecosystem gas exchange and water balance of arctic plants have been largely unexplored. The overall objective of this thesis was to examine two critical gaps in our knowledge about tundra cold season processes – ecosystem respiration at very low temperatures and water uptake during the winter-spring transition. I determined the temperature response of ecosystem respiration of tundra monoliths down to temperatures as low as can be expected under snow-covered conditions (-15 °C). Temperature responses fit the Arrhenius function well with Q10 values over the range of -15 to 15 °C varying from 6.1 to 4.8. I used deuterium-enriched water (2H2O) as a tracer to evaluate water uptake of evergreen plants at snowmelt when soils are largely frozen. The results revealed that evergreen plants take up water under snow cover, possibly via roots but undoubtedly by foliar uptake.