Use of Longitudinal Subdrains in the 3R Program, Final Report, HR-509, 1981

Construction of the interstate highway system began in 1956. This U.S. network of highway consists of more than 41,000 miles with 790 miles in Iowa. There have been many benefits of the controlled access roadway, but probably the most significant is the improved safety for the motorist. In Iowa, we have always endeavored to utilize quality locally available materials in our construction using the most economical or cost effective methods. Obviously when the effort is to build a cost effective system, there will be some portions of the network that will not perform as well as expected. In the design of our interstate, the main consideration for base construction under the pavement was structural capacity. The material was dense graded with the aim of supporting the pavement and distributing the load as it is transferred to the underlying grade. The drainage characteristic of the base was apparently not given adequate consideration. On jointed portland cement concrete (pcc) pavement, the water that is trapped immediately beneath the pavement causes severe problems. The traffic causes rapid movement of the water resulting in the hydraulic pressures or "pumping" (movement and redeposit of base fine material) resulting in faulting between individual slabs. Recognizing the need for maintaining this large national highway network, the Federal Highway Administration has initiated a funding program for resurfacing, restoration and rehabilitation (3R). Many miles of the system are more than 20 years old and in need of major maintenance. This new 3R Program necessitated a complete inventory of the Iowa interstate system to establish priorities and to identify those sections in need of immediate remedial treatments.

Habitat selection in zones of parapatric contact between the common shrew Sorex araneaus and Millet's shrew S. coronatus

(1) The common shrew Sorex araneus and Millet's shrew S. coronatusare sibling species.They are morphologically and genetically very similar but do not hybridize.Their parapatric distribution throughout south-western Europe, with a few narrow zones of distributional overlap, suggests that they are in competitive parapatry. (2) Two of these contact zones were studied; there was evidence of coexistence over periods of 2 years as well as habitat segregation. In both zones, the species segregated on litter thickness and humidity variables. (3) A simple analysis of spatial distribution showed that habitats visible in the field corresponded to the habitats selected by the species. Habitat selection was found throughout the annual life-cycle of the shrews. (4) In one contact zone, a removal experiment was performed to test whether habitat segregation is induced by interspecific interactions. The experiment showed that the species select habitats differentially when both are present and abandon habitat selection when their competitor removed. (5)These results confirm the role of resource partitioning in promoting narrow ranges of distributional overlap between such parapatric species and qualitatively support the prediction of habitat selection theory that, in a two-species system, coexistence may be achieved by differential habitat selection to avoid competition. The results also support the view that the common shrew and Millet's shrew are in competitive parapatry.

Effects of Special Aggregate on Bridge Deck Overlay Frictional Properties, HR-205, 1986

The Iowa DOT has been using the "Iowa Method" thin bonded low-slump dense Portland Cement Concrete (PCC) bridge deck overlay for rehabilitation of delaminated decks since 1963. In time, continued use of studded tires will wear away the transverse grooved texture. The objective of this research was to evaluate the benefit of incorporating a hard durable aggregate into a dense PCC overlay to provide frictional property longevity. The project included three overlays on I-35 near Ankeny. The texture and friction properties of two overlays, one constructed with crushed granite and the other with crushed quartzite coarse aggregate, were compared to an overlay constructed with locally available crushed limestone. There were no construction problems resulting from the use of crushed granite or quartzite. There was no significant frictional property benefit from the crushed granite or crushed quartzite through six years.

Religious coping in schizophrenia patients : spiritual support in medical care and pastoral counselling

Following an introduction focusing on the role of religion in the treatment of psychosis, the first part of this paper describes an initial study in which the role of spirituality and religiosity was assessed in 115 patients with schizophrenia in Geneva (Switzerland) and 126 in Trois-Rivières (Quebec). These themes have been shown to be highly prevalent for these patients, though their clinicians are often unaware of this prevalence. The following part of the paper presents a second study where religious supervision was offered to clinicians in Geneva. Comparison between forty patients who received spiritual assessment and opportunities to work on religious topics with their clinicians was made with thirty patients without religious intervention. In the supervisory sessions, six different types of religious interventions were suggested. Outcomes at three months show that patients of the intervention group maintain their interest for help in religious matters while clinicians' interest in integrating religious topics in discussions with their patients has decreased. The third and main part of the paper is devoted to an analysis of the suggested interventions from the viewpoint of the study of religions. Five aspects of religion are distinguished, and explanations of the reasons some of them are easier to manage for clinicians are proposed. The paper concludes with proposals for the education of clinicians to help them to differentiate different kinds of religious coping and to recognize when it could be helpful to refer the patient to a pastoral counsellor.

In Search of Corporate Renewal: How to Benefit from Corporate Venturing?

Despite the rapid change in today's business environment there are relatively few studies about corporate renewal. This study aims for its part at filling that research gap by studying the concepts of strategy, corporate renewal, innovation and corporate venturing. Its purpose is to enhance our understanding of how established companies operating in dynamic and global environment can benefit from their corporate venturing activities. The theoretical part approaches the research problem in corporate and venture levels. Firstly, it focuses on mapping the determinants of strategy and suggests using industry, location, resources, knowledge, structure and culture, market, technology and business model to assess the environment and using these determinants to optimize speed and magnitude of change.Secondly, it concludes that the choice of innovation strategy is dependent on the type and dimensions of innovation and suggests assessing market, technology, business model as well as novelty and complexity related to each of them for choosing an optimal context for developing innovations further. Thirdly, it directsattention on processes through which corporate renewal takes place. On corporate level these processes are identified as strategy formulation, strategy formation and strategy implementation. On the venture level the renewal processes are identified as learning, leveraging and nesting. The theoretical contribution of this study, the framework of strategic corporate venturing, joins corporate and venture level management issues together and concludes that strategy processes and linking processes are the mechanism through which continuous corporate renewaltakes place. The framework of strategic corporate venturing proposed by this study is a new way to illustrate the role of corporate venturing as a purposefullybuilt, different view of a company's business environment. The empirical part extended the framework by enhancing our understanding of the link between corporate renewal and corporate venturing in its real life environment in three Finnish companies: Metso, Nokia and TeliaSonera. Characterizing companies' environmentwith the determinants of strategy identified in this study provided a structured way to analyze their competitive position and renewal challenges that they arefacing. More importantly the case studies confirmed that a link between corporate renewal and corporate venturing exists and found out that the link is not as straight forward as indicated by the theory. Furthermore, the case studies enhanced the framework by indicating a sequence according to which the processes work. Firstly, the induced strategy processes strategy formulation and strategy implementation set the scene for corporate venturing context and management processes and leave strategy formation for the venture. Only after that can strategies formed by ventures come back to the corporate level - and if found viable in the corporate level be formalized through formulation and implementation. With the help of the framework of strategic corporate venturing the link between corporaterenewal and corporate venturing can be found and managed. The suggested response to the continuous need for change is continuous renewal i.e. institutionalizing corporate renewal in the strategy processes of the company. As far as benefiting from venturing is concerned the answer lies in deliberately managing venturing in a context different to the mainstream businesses and establishing efficientlinking processes to exploit the renewal potential of individual ventures.

Development of Special Pumps Repair Process

Tässä diplomityössä käsitellään erikoispumppujen korjausprosessia teollisuuspumppujen korjauksiin erikoistuneessa konepajassa. Työn pääasiallinen tarkoitus on tuotantoprosessin kehittäminen ja tuotantovaiheiden esitteleminen. Tavoitteen taustalla on pyrkimys entisestään parantaa palvelukykyä ja asiakastyytyväisyyttä.Kolme eri keinoa päätavoitteen saavuttamiseksi ovat tuotannon suunnittelun ja ohjauksen kehittäminen, työssä käsiteltyjen pumpputyyppien korjausprosessien läpäisyaikojen lyhentäminen sekä korjausvaiheiden määrittely ja esittely vaihe vaiheelta. Työssä käsiteltyjä erikoispumpputyyppejä ovat imupumput, monijaksopumput sekä pysty/potkuripumput.Tuotannonsuunnittelun ja -ohjauksen kehittämiseksi sekä läpäisyaikojen lyhentämiseksi työssä etsittiin vaihtoehtoisia toimintatapoja. Kolmas tavoite, eli korjausvaiheiden määrittely, toteutettiin esittelemällä korjausprosessin vaiheet käsitellyillä pumpputyypeillä.Tuloksena saatiin keinoja tuotannon suunnittelun ja hallinnan kehittämiseksi. Useimmat keinot koskevat toimintatapojen selkiyttämistä. Myös keinoja läpäisyaikojen lyhentämiseksi löydettiin. Tietyllä imupumpputyypillä ja -koolla läpäisyajan lyheneminen oli 25 % ja osalla monijaksopumpuista jopa 75 %. Tulokset saavutetaan varastoimalla tiettyjä komponentteja, joilla on pitkä valmistus- tai korjausaika. Pysty/potkuripumppujen korjauksen läpäisyaikaa ei saatu lyhennettyä työn rajausten puitteissa Näiden tulosten lisäksi korjausprosessin toimintatavat määriteltiin.

Product placement in integrated marketing communications strategy

Perinteisten markkinointiviestintäkanavien menettäessä jatkuvasti tehoaan mediakentän ja kohderyhmien sirpaloituessa yhä pienempiin yksiköihin markkinointiorganisaatiot etsivät vaihtoehtoisia tapoja tavoittaakseen kohdeyleisönsä. Yksi vaihtoehtoinen markkinointiviestintäkeino on tuotesijoittelu (product placement), jossa (merkki)tuotteita sijoitetaan erilaisten viihdetuotantojen, kuten elokuvien, televisio-ohjelmien ja tietokonepelien, tarinan yhteyteen, jotta yhä medialukutaitoisempi kohdeyleisö ei pystyisi välttämään kaupallista viestiä esimerkiksi vaihtamalla televisiokanavaa tai kääntämällä lehden sivua. Koska tuote on sijoitettu kerrottavan tarinan sisään, markkinointiviestin — eli tuotteen havaitsemisen — välttäminen on huomattavasti vaikeampaa kuin perinteisten markkinointiviestintämenetelmien kohdalla. Lisäksi, sijoitellut tuotteet ovat tavallisesti kiinteässä yhteydessä tarinan juonen ja henkilöhahmojen kanssa siten, että tuote saa näistä yhteyksistä positiivista vahvistusta imagolleen. Pro Gradu-tutkielman tarkoituksena oli selvittää tuotesijoittelun käyttökelpoisuutta markkinointiviestinnässä sekä miten kulutushyödykemarkkinoijat voivat hyödyntää menetelmää markkinointiviestintästrategioissaan. Tuotesijoittelun poikkeava luonne markkinointiviestintävälineenä tuotti kysymyksen miten tuotesijoittelua voitaisiin hyödyntää yhteistyössä muiden markkinointiviestintäkeinojen kanssa. Tätä varten tutkimuksessa tuotesijoittelu yhdistettiin integroidun markkinointiviestinnän (IMC) viitekehykseen. IMC-konsepti syntyi markkinointiviestinnässä vastaamaan samaan tarpeeseen kuin tuotesijoittelukin: pirstaloitunut mediakenttä ja yksittäiset kohderyhmät vaativat kehittyneempää ja yhtenäisempää markkinointiviestinnän suunnittelua ja toteutusta. Tutkimuksen johtopäätöksenä tuotesijoittelu todettiin käyttökelpoiseksi markkinointiviestintäkeinoksi mikäli viestinnän tavoitteena on muu kuin tuotteen myyntiin suorasti vaikuttaminen. Tuotesijoittelu on sen sijaan erittäin tehokas tuotetietoisuuden lisäämisessä, erityisesti tunnistamisen kohdalla. Tuotesijoittelu voi myös tuottaa suoran ostotarpeen mutta tällöin viestin vastaanottajalla täytyy olla vallitseva tarve kyseisen tuoteryhmän osalta ennen altistumista ko. markkinointiviestille. Tuotesijoittelu voidaan sisällyttää IMC-suunnitteluprosessiin markkinointiviestintästrategian kiinteänä osana. Integraatio markkinointiviestinnässä siten, että tuotesijoittelua tuettaisiin muilla viestintäkeinoilla yhtenäisen kampanjan kehittämiseksi on kuitenkin paljon ennakoitua harvinaisempaa, johtuen ehkä eniten tuotesijoittelun poikkeuksellisesta luonteesta ja kyseisen viestintämuodon vaikeasta hallittavuudesta markkinoijan taholta. Tutkimus toteutettiin normatiivisena case-tutkimuksena pääasiassa sekundäärisiä tietolähteitä hyödyntäen. Case-tutkimuksia varten kerättiin primääristä tietoa kyselylomakkeella kahdesta tuotesijoittelua käyttävästä kansainvälisestä yhtiöstä, jonka lisäksi myös sekundäärisiä tietolähteitä hyödynnettiin case-osan tiedonkeruussa.

Antioxidant compoundsand total antioxidant activity in fruits of acerola from cv. Flor Branca, Florida Sweet and BRS 366

Information on antioxidant properties at different ontological stages may help producers and food technologists to identify which cultivar and/or maturity stage are most adequate for their need, therefore this work aimed to study the changes in the antioxidant metabolism during acerola development. Fruit from cv. Flor Branca, BRS366 and Florida Sweet were harvested at different stages: immature green colored (I), physiologically mature with green color and maximum size (II), breaker (III) and full red ripe (IV). After harvest, fruits were selected, divided into four replications with 500 g each and evaluated regarding their titratable acidity, pH, soluble solids, total soluble sugar, vitamin C, polyphenol, anthocyanin, yellow flavonoid, total antioxidant activity and antioxidant enzyme activity. Anthocyanin and flavonoid were determined through LC-DAD-ESI/MS and all analysis followed a completely randomized factorial 3 x 4 design. Fruits of 'Florida Sweet' presented significantly higher soluble solids (9.46ºBrix). Vitamin C content decreased during ripening, but ripe 'BRS 366' fruits showed the greatest values (1363 mg.100 g-1) and highest TAA with 42.36 µM TEAC.g-1FW. Cyanidin 3-rhamnoside (520.76 mg.100 g-1 DM) and quercetin 3-rhamnoside (33.72 mg.100 g-1 DM) were the most abundant anthocyanin and yellow flavonoids found mainly in 'Flor Branca' fruit of acerola, whose antioxidant enzymes activities were also higher. Ripe 'Florida Sweet' fruit presents a great potential for fresh consumption, meanwhile physiologically mature 'BRS 366' fruit seems the best option for the bioactive compounds processing industry. As 'Flor Branca' fruit of acerola kept the highest activity levels, it could be an indicative of greater potential for postharvest conservation.

Quest for Orthologs Entails Quest for Tree of Life: In Search of the Gene Stream.

Quest for Orthologs (QfO) is a community effort with the goal to improve and benchmark orthology predictions. As quality assessment assumes prior knowledge on species phylogenies, we investigated the congruency between existing species trees by comparing the relationships of 147 QfO reference organisms from six Tree of Life (ToL)/species tree projects: The National Center for Biotechnology Information (NCBI) taxonomy, Opentree of Life, the sequenced species/species ToL, the 16S ribosomal RNA (rRNA) database, and trees published by Ciccarelli et al. (Ciccarelli FD, et al. 2006. Toward automatic reconstruction of a highly resolved tree of life. Science 311:1283-1287) and by Huerta-Cepas et al. (Huerta-Cepas J, Marcet-Houben M, Gabaldon T. 2014. A nested phylogenetic reconstruction approach provides scalable resolution in the eukaryotic Tree Of Life. PeerJ PrePrints 2:223) Our study reveals that each species tree suggests a different phylogeny: 87 of the 146 (60%) possible splits of a dichotomous and rooted tree are congruent, while all other splits are incongruent in at least one of the species trees. Topological differences are observed not only at deep speciation events, but also within younger clades, such as Hominidae, Rodentia, Laurasiatheria, or rosids. The evolutionary relationships of 27 archaea and bacteria are highly inconsistent. By assessing 458,108 gene trees from 65 genomes, we show that consistent species topologies are more often supported by gene phylogenies than contradicting ones. The largest concordant species tree includes 77 of the QfO reference organisms at the most. Results are summarized in the form of a consensus ToL (http://swisstree.vital-it.ch/species_tree) that can serve different benchmarking purposes.

Inter-rater Reliability of Criteria-Based Content Analysis of Children's Statements of Abuse.

The evaluation of children's statements of sexual abuse cases in forensic cases is critically important and must and reliable. Criteria-based content analysis (CBCA) is the main component of the statement validity assessment (SVA), which is the most frequently used approach in this setting. This study investigated the inter-rater reliability (IRR) of CBCA in a forensic context. Three independent raters evaluated the transcripts of 95 statements of sexual abuse. IRR was calculated for each criterion, total score, and overall evaluation. The IRR was variable for the criteria, with several being unsatisfactory. But high IRR was found for the total CBCA scores (Kendall's W = 0.84) and for overall evaluation (Kendall's W = 0.65). Despite some shortcomings, SVA remains a robust method to be used in the comprehensive evaluation of children's statements of sexual abuse in the forensic setting. However, the low IRR of some CBCA criteria could justify some technical improvements.

Soil quality assessment through a multi-approach analysis in soils of abandoned terraced land in NE Spain

The abandonment of agricultural land in mountainous areas has been an outstanding problem along the last century and has captured the attention of scientists, technicians and administrations, for the dramatic consequences sometimes occurred due to soil instability, steep slopes, rainfall regimes and wildfires. Hidromorfological and pedological alterations causing exceptional floods and accelerated erosion processes has therefore been studied, identifying the cause in the loss of landscape heterogeneity. Through the disappearance of agricultural works and drainage maintenance, slope stability has resulted severely affected. The mechanization of agriculture has caused the displacement of vines, olives and corks trees cultivation in terraced areas along the Mediterranean catchment towards more economically suitable areas. On the one hand, land use and management changes have implicated sociological changes as well, transforming areas inhabited by agricultural communities into deserted areas where the colonization of disorganized spontaneous vegetation has buried a valuable rural patrimony. On the other hand, lacking of planning and management of the abandoned areas has produced badlands and infertile soils due to wildfire and high erosion rates strongly degrading the whole ecosystems. In other cases, after land abandonment a process of soil regeneration has been recorded. Investigations have been conducted in a part of NE Spain where extended areas of terraced soils previously cultivated have been abandoned in the last century. The selected environments were semi-abandoned vineyards, semi-abandoned olive groves, abandoned stands of cork trees, abandoned stands of pine trees, scrubland of Cistaceaea, scrubland of Ericaceaea, and pasture. The research work was focused on the study of most relevant physical, chemical and biological soil properties, as well as runoff and erosion under soils with different plant cover to establish the abandonment effect on soil quality, due to the peculiarity and vulnerability of these soils with a much reduced depth. The period of observation was carried out from autumn 2009 to autumn 2010. The sediment concentration of soil erosion under vines was recorded as 34.52 g/l while under pasture it was 4.66 g/l. In addition, the soil under vines showed the least amount of organic matter, which was 12 times lower than all other soil environments. The carbon dioxide (CO2) and total glomalin (TG) ratio to soil organic carbon (SOC) in this soil was 0.11 and 0.31 respectively. However, the soil under pasture contained a higher amount of organic matter and showed that the CO2 and TG ratio to SOC was 0.02 and 0.11 respectively indicating that the soil under pasture better preserves the soil carbon pool. A similar trend was found in the intermediate soils in the sequence of land use change and abandonment. Soil structural stability increased in the two soil fractions investigated (0.25-2.00 mm, 2.0-5.6 mm) especially in those soils that did not undergo periodical perturbations like wildfires. Soil quality indexes were obtained by using relevant physical and chemical soil parameters. Factor analysis carried out to study the relationship between all soil parameters allowed to related variables and environments and identify those areas that better contribute to soil quality towards others that may need more attention to avoid further degradation processes

Long term trends in prevalence of neural tube defects in Europe: population based study.

STUDY QUESTION: What are the long term trends in the total (live births, fetal deaths, and terminations of pregnancy for fetal anomaly) and live birth prevalence of neural tube defects (NTD) in Europe, where many countries have issued recommendations for folic acid supplementation but a policy for mandatory folic acid fortification of food does not exist? METHODS: This was a population based, observational study using data on 11 353 cases of NTD not associated with chromosomal anomalies, including 4162 cases of anencephaly and 5776 cases of spina bifida from 28 EUROCAT (European Surveillance of Congenital Anomalies) registries covering approximately 12.5 million births in 19 countries between 1991 and 2011. The main outcome measures were total and live birth prevalence of NTD, as well as anencephaly and spina bifida, with time trends analysed using random effects Poisson regression models to account for heterogeneities across registries and splines to model non-linear time trends. SUMMARY ANSWER AND LIMITATIONS: Overall, the pooled total prevalence of NTD during the study period was 9.1 per 10 000 births. Prevalence of NTD fluctuated slightly but without an obvious downward trend, with the final estimate of the pooled total prevalence of NTD in 2011 similar to that in 1991. Estimates from Poisson models that took registry heterogeneities into account showed an annual increase of 4% (prevalence ratio 1.04, 95% confidence interval 1.01 to 1.07) in 1995-99 and a decrease of 3% per year in 1999-2003 (0.97, 0.95 to 0.99), with stable rates thereafter. The trend patterns for anencephaly and spina bifida were similar, but neither anomaly decreased substantially over time. The live birth prevalence of NTD generally decreased, especially for anencephaly. Registration problems or other data artefacts cannot be excluded as a partial explanation of the observed trends (or lack thereof) in the prevalence of NTD. WHAT THIS STUDY ADDS: In the absence of mandatory fortification, the prevalence of NTD has not decreased in Europe despite longstanding recommendations aimed at promoting peri-conceptional folic acid supplementation and existence of voluntary folic acid fortification. FUNDING, COMPETING INTERESTS, DATA SHARING: The study was funded by the European Public Health Commission, EUROCAT Joint Action 2011-2013. HD and ML received support from the European Commission DG Sanco during the conduct of this study. No additional data available.

Stress, coping and personal strengths and difficulties in internationally adopted children in spain

This study analyses the types of coping strategies used by internationally adopted children, and explores the relation between these strategies and personal strengths and difficulties. The Kidcope checklist (Spirito, Stark, & Williams, 1998) and the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) were administered to a sample of 35 Spanish adoptees (25.7% boys and 74.3% girls, aged 8-12 years) and their parents. Self-reported problems were categorised and their relation with coping strategies and psychological adjustment was explored. Results indicated that adopted children report problems of interpersonal nature. The content of the problems mainly refers to relationships and health, illness, or accidents. Parents reported that children were generally well-adjusted and they had no problems outside the normal range. International adoptees used mainly control-oriented coping strategies. Escape-oriented coping was linked to parents' ratings of total difficulties, with self-criticism accounting for the highest percentage of the variance.

Bias in dissemination of clinical research findings: structured OPEN framework of what, who and why, based on literature review and expert consensus.

OBJECTIVE: The aim of this study is to review highly cited articles that focus on non-publication of studies, and to develop a consistent and comprehensive approach to defining (non-) dissemination of research findings. SETTING: We performed a scoping review of definitions of the term 'publication bias' in highly cited publications. PARTICIPANTS: Ideas and experiences of a core group of authors were collected in a draft document, which was complemented by the findings from our literature search. INTERVENTIONS: The draft document including findings from the literature search was circulated to an international group of experts and revised until no additional ideas emerged and consensus was reached. PRIMARY OUTCOMES: We propose a new approach to the comprehensive conceptualisation of (non-) dissemination of research. SECONDARY OUTCOMES: Our 'What, Who and Why?' approach includes issues that need to be considered when disseminating research findings (What?), the different players who should assume responsibility during the various stages of conducting a clinical trial and disseminating clinical trial documents (Who?), and motivations that might lead the various players to disseminate findings selectively, thereby introducing bias in the dissemination process (Why?). CONCLUSIONS: Our comprehensive framework of (non-) dissemination of research findings, based on the results of a scoping literature search and expert consensus will facilitate the development of future policies and guidelines regarding the multifaceted issue of selective publication, historically referred to as 'publication bias'.

Nursing Advocacy: A concept clarification in context of procedural pain care

The purpose of this study was to clarify the concept of advocacy in context of procedural pain care and to investigate the implementation of advocacy in that context. First, the concept of advocacy was described on the basis of a literature review (n = 89 empirical studies from 1990 to 2003). Then, the concept was described in the context of procedural pain care on the basis of interview data (n = 22 patients, 21 nurses) in a medical and surgical context. In the second phase, an instrument exploring the content of advocacy and the implementation of advocacy in context of procedural pain care was developed and validated. Then, the content of advocacy and implementation of it was explored in a sample of otolaryngeal patients (n = 405) and nurses (n = 118) in 12 hospitals. In the third phase, an update literature review (n = 35 empirical studies from 2003 to 2007) was conducted, and all data from phases one and two were reviewed in order to refine the elements the concept of advocacy, and the relationships between these elements. As a result of this study, advocacy in context of procedural pain care was defined as consisting of the dual aspects of patient advocacy and professional advocacy, and called nursing advocacy. It was divided into dimensions and subdimensions in which patient and nurse empowerment seems to play a vital role. All the data obtained lend support to this definition of nursing advocacy. Patients and nurses felt that nearly all of the activities that they considered as advocacy were implemented.