The work of nurse practitioners : a national work sampling study

Aim: This paper is a report of a study of variations in the pattern of nurse practitioner work in a range of service fields and geographical locations, across direct patient care, indirect patient care and service-related activities. Background. The nurse practitioner role has been implemented internationally as a service reform model to improve the access and timeliness of health care. There is a substantial body of research into the nurse practitioner role and service outcomes, but scant information on the pattern of nurse practitioner work and how this is influenced by different service models. --------- Methods: We used work sampling methods. Data were collected between July 2008 and January 2009. Observations were recorded from a random sample of 30 nurse practitioners at 10-minute intervals in 2-hour blocks randomly generated to cover two weeks of work time from a sampling frame of six weeks. --------- Results: A total of 12,189 individual observations were conducted with nurse practitioners across Australia. Thirty individual activities were identified as describing nurse practitioner work, and these were distributed across three categories. Direct care accounted for 36.1% of how nurse practitioners spend their time, indirect care accounted for 32.2% and service-related activities made up 31.9%. --------- Conclusion. These findings provide useful baseline data for evaluation of nurse practitioner positions and the service effect of these positions. However, the study also raises questions about the best use of nurse practitioner time and the influences of barriers to and facilitators of this model of service innovation.

A Delphi study to validate an advanced practice nursing tool

Aim This paper is a report of a study conducted to validate an instrument for measuring advanced practice nursing role delineation in an international contemporary health service context using the Delphi technique. Background Although most countries now have clear definitions and competency standards for nurse practitioners, no such clarity exists for many advanced practice nurse roles, leaving healthcare providers uncertain whether their service needs can or should be met by an advanced practice nurse or a nurse practitioner. The validation of a tool depicting advanced practice nursing is essential for the appropriate deployment of advanced practice nurses. This paper is the second in a three-phase study to develop an operational framework for assigning advanced practice nursing roles. Method An expert panel was established to review the activities in the Strong Model of Advanced Practice Role Delineation tool. Using the Delphi technique, data were collected via an on-line survey through a series of iterative rounds in 2008. Feedback and statistical summaries of responses were distributed to the panel until the 75% consensus cut-off was obtained. Results After three rounds and modification of five activities, consensus was obtained for validation of the content of this tool. Conclusion The Strong Model of Advanced Practice Role Delineation tool is valid for depicting the dimensions of practice of the advanced practice role in an international contemporary health service context thereby having the potential to optimize the utilization of the advanced practice nursing workforce.

A framework for improved adolescent and child safety in MMOs

This paper presents an approach to providing better safety for adolescents playing online games. We highlight an emerging paedophile presence in online games and offer a general framework for the design of monitoring and alerting tools. Our method is to monitor and detect relationships forming with a child in online games, and alert if the relationship indicates an offline meeting with the child has been arranged or has the potential to occur. A prototype implementation with demonstrative components of the framework has been created and is introduced. The prototype demonstration and evaluation uses a teen rated online relationship-building environment for its case study, specifically the predominant Massive Multiplayer Online Game (MMO) World of Warcraft.

Effects of transportation accessibility on residential property values: Application of spatial hedonic price model in Seoul, South Korea, metropolitan area

A number of studies have focused on estimating the effects of accessibility on housing values by using the hedonic price model. In the majority of studies, estimation results have revealed that housing values increase as accessibility improves, although the magnitude of estimates has varied across studies. Adequately estimating the relationship between transportation accessibility and housing values is challenging for at least two reasons. First, the monocentric city assumption applied in location theory is no longer valid for many large or growing cities. Second, rather than being randomly distributed in space, housing values are clustered in space—often exhibiting spatial dependence. Recognizing these challenges, a study was undertaken to develop a spatial lag hedonic price model in the Seoul, South Korea, metropolitan region, which includes a measure of local accessibility as well as systemwide accessibility, in addition to other model covariates. Although the accessibility measures can be improved, the modeling results suggest that the spatial interactions of apartment sales prices occur across and within traffic analysis zones, and the sales prices for apartment communities are devalued as accessibility deteriorates. Consistent with findings in other cities, this study revealed that the distance to the central business district is still a significant determinant of sales price.

Compliance, peritoneal dialysis and chronic kidney disease : lessons from the literature

Poor patient compliance with peritoneal dialysis (PD) has significant adverse effects on morbidity and mortality rates in individuals with chronic kidney disease (CKD). It also adds to the resource burdens of healthcare services and providers. This paper explores the notion of PD compliance in patients with CKD with reference to the relevant published literature. The analysis of the literature reveals that ‘PD compliance’ is a complex and challenging construct for both patients and health professionals. There is no universal definition of compliance that is widely adopted in practice and research, and therefore a lack of consensus on how to determine ‘compliant’ patient outcomes. There are also multiple and interconnected determinants of PD compliance that are context-bound, which healthcare professionals must be aware of, and which makes producing consensus of measuring PD compliance difficult. The complexity of the interventions required to produce even a modest improvement in PD compliance, which are described in this paper, are significant. Compliance with PD and other treatments for CKD is a multidimensional, context-bound concept, that to date has tended to efface the role and needs of the renal patient. We conclude the paper with the implications for contemporary practice.

Case management educational intervention with public health nurses : cluster randomized controlled trial

Aim: This paper is a report of a study conducted to determine the effectiveness of a community case management collaborative education intervention in terms of satisfaction, learning and performance among public health nurses. Background: Previous evaluation studies of case management continuing professional education often failed to demonstrate effectiveness across a range of outcomes and had methodological weaknesses such as small convenience samples and lack of control groups. Method: A cluster randomised controlled trial was conducted between September 2005 and February 2006. Ten health centre clusters (5 control, 5 intervention) recruited 163 public health nurses in Taiwan to the trial. After pre-tests for baseline measurements, public health nurses in intervention centres received an educational intervention of four half-day workshops. Post-tests for both groups were conducted after the intervention. Two-way repeated measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes. Results: A total of 161 participants completed the pre- and post-intervention measurements. This was almost a 99% response rate. Results revealed that 97% of those in the experimental group were satisfied with the programme. There were statistically significant differences between the two groups in knowledge (p = 0.001), confidence in case management skills (p = 0.001), preparedness for case manager role activities (p = 0.001), self-reported frequency in using skills (p = 0.001), and role activities (p = 0.004). Conclusion: Collaboration between academic and clinical nurses is an effective strategy to prepare nurses for rapidly-changing roles.

Navigating technological contexts and experience design in music education

For some time we have jokingly referred to our network jamming research with jam2jam as ‘Switched on Orff’ (Brown, Sorensen and Dillon 2002; Dillon 2003; Dillon 2006; Dillon 2006; Brown and Dillon 2007). The connection with electronic music and Wendy Carlos’ classic work ‘Switched on Bach’ was obvious; we were using electronic music in schools and with children. The deeper connection with Orff however was about recognising that electronic music and instruments could have cultural values and knowledge embedded in their design and practice in same way as what has come to be known as the Orff method (Orff and Keetman 1958-66). However whilst the Orff method focuses upon Western art music perceptual framework electronic instruments have the potential to have more fluid musical environments and even to move to interdisciplinary study by including visual media. Whilst the Orff method focused on making sense of Western art music through experience electronic environments potentially can make sense of the world of multi media that pervades our lives.

The use of economic evaluation in CAM : an introductory framework

Background For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities. In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Methods Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Conclusions Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM.

Characterization of particle number concentrations and PM2.5 in a school : influence of outdoor air pollution on indoor air

Background, Aim and Scope The impact of air pollution on school children’s health is currently one of the key foci of international and national agencies. Of particular concern are ultrafine particles which are emitted in large quantities, contain large concentrations of toxins and are deposited deeply in the respiratory tract. Materials and methods In this study, an intensive sampling campaign of indoor and outdoor airborne particulate matter was carried out in a primary school in February 2006 to investigate indoor and outdoor particle number (PN) and mass concentrations (PM2.5), and particle size distribution, and to evaluate the influence of outdoor air pollution on the indoor air. Results For outdoor PN and PM2.5, early morning and late afternoon peaks were observed on weekdays, which are consistent with traffic rush hours, indicating the predominant effect of vehicular emissions. However, the temporal variations of outdoor PM2.5 and PN concentrations occasionally showed extremely high peaks, mainly due to human activities such as cigarette smoking and the operation of mower near the sampling site. The indoor PM2.5 level was mainly affected by the outdoor PM2.5 (r = 0.68, p<0.01), whereas the indoor PN concentration had some association with outdoor PN values (r = 0.66, p<0.01) even though the indoor PN concentration was occasionally influenced by indoor sources, such as cooking, cleaning and floor polishing activities. Correlation analysis indicated that the outdoor PM2.5 was inversely correlated with the indoor to outdoor PM2.5 ratio (I/O ratio) (r = -0.49, p<0.01), while the indoor PN had a weak correlation with the I/O ratio for PN (r = 0.34, p<0.01). Discussion and Conclusions The results showed that occupancy did not cause any major changes to the modal structure of particle number and size distribution, even though the I/O ratio was different for different size classes. The I/O curves had a maximum value for particles with diameters of 100 – 400 nm under both occupied and unoccupied scenarios, whereas no significant difference in I/O ratio for PM2.5 was observed between occupied and unoccupied conditions. Inspection of the size-resolved I/O ratios in the preschool centre and the classroom suggested that the I/O ratio in the preschool centre was the highest for accumulation mode particles at 600 nm after school hours, whereas the average I/O ratios of both nucleation mode and accumulation mode particles in the classroom were much lower than those of Aitken mode particles. Recommendations and Perspectives The findings obtained in this study are useful for epidemiological studies to estimate the total personal exposure of children, and to develop appropriate control strategies for minimizing the adverse health effects on school children.

A snapshot of Australian nurse practitioners’ extended practice activities

Introduction The Australian Nurse Practitioner Project (AUSPRAC) was initiated to examine the introduction of nurse practitioners into the Australian health service environment. The nurse practitioner concept was introduced to Australia over two decades ago and has been evolving since. Today, however, the scope of practice, role and educational preparation of nurse practitioners is well defined (Gardner et al, 2006). Amendments to specific pre-existing legislation at a State level have permitted nurse practitioners to perform additional activities including some once in the domain of the medical profession. In the Australian Capital Territory, for example 13 diverse Acts and Regulations required amendments and three new Acts were established (ACT Health, 2006). Nurse practitioners are now legally authorized to diagnose, treat, refer and prescribe medications in all Australian states and territories. These extended practices differentiate nurse practitioners from other advanced practice roles in nursing (Gardner, Chang & Duffield, 2007). There are, however, obstacles for nurse practitioners wishing to use these extended practices. Restrictive access to Medicare funding via the Medicare Benefit Scheme (MBS) and the Pharmaceutical Benefit Scheme (PBS) limit the scope of nurse practitioner service in the private health sector and community settings. A recent survey of Australian nurse practitioners (n=202) found that two-thirds of respondents (66%) stated that lack of legislative support limited their practice. Specifically, 78% stated that lack of a Medicare provider number was ‘extremely limiting’ to their practice and 71% stated that no access to the PBS was ‘extremely limiting’ to their practice (Gardner et al, in press). Changes to Commonwealth legislation is needed to enable nurse practitioners to prescribe medication so that patients have access to PBS subsidies where they exist; currently patients with scripts which originated from nurse practitioners must pay in full for these prescriptions filled outside public hospitals. This report presents findings from a sub-study of Phase Two of AUSPRAC. Phase Two was designed to enable investigation of the process and activities of nurse practitioner service. Process measurements of nurse practitioner services are valuable to healthcare organisations and service providers (Middleton, 2007). Processes of practice can be evaluated through clinical audit, however as Middleton cautions, no direct relationship between these processes and patient outcomes can be assumed.

Optimisation of a class of transportation problems using genetic algorithms

This paper presents a Genetic Algorithms (GA) approach to search the optimized path for a class of transportation problems. The formulation of the problems for suitable application of GA will be discussed. Exchanging genetic information in the sense of neighborhoods will be introduced for generation reproduction. The performance of the GA will be evaluated by computer simulation. The proposed algorithm use simple coding with population size 1 converged in reasonable optimality within several minutes.

Celebrity entrepreneurship and celebrity endorsement : similarities, differences and the effect of deeper engagement

Increasingly, celebrities appear not only as endorsers for products but are apparently engaged in entrepreneurial roles as initiators, owners and perhaps even managers in the ventures that market the products they promote. Despite being extensively referred to in popular media, scholars have been slow to recognise the importance of this new phenomenon. This thesis argues theoretically and shows empirically that celebrity entrepreneurs are more effective communicators than typical celebrity endorsers because of their increased engagement with ventures. I theorise that greater engagement increases the celebrity‘s emotional involvement as perceived by consumers. This is an endorser quality thus far neglected in the marketing communications literature. In turn, emotional involvement, much like the empirically established dimensions trustworthiness, expertise and attractiveness, should affect traditional outcome variables such as attitude towards the advertisement and brand. On the downside, increases in celebrity engagement may lead to relatively stronger and worsening changes in attitudes towards the brand if and when negative information about the celebrity is revealed. A series of eight experiments was conducted on 781 Swedish and Baltic students and 151 Swedish retirees. Though there were nuanced differences and additional complexities in each experiment, participants‘ reactions to advertisements containing a celebrity portrayed as a typical endorser or entrepreneur were recorded. The overall results of these experiments suggest that emotional involvement can be successfully operationalised as distinct from variables previously known to influence communication effectiveness. In addition, emotional involvement has positive effects on attitudes toward the advertisement and brand that are as strong as the predictors traditionally applied in the marketing communications literature. Moreover, the celebrity entrepreneur condition in the experimental manipulation consistently led to an increase in emotional involvement and to a lesser extent trustworthiness, but not expertise and attractiveness. Finally, negative celebrity information led to a change in participants‘ attitudes towards the brand which were more strongly negative for celebrity entrepreneurs than celebrity endorsers. In addition, the effect of negative celebrity information on a company‘s brand is worse when they support the celebrity rather than fire them. However, this effect did not appear to interact with the celebrity‘s purported engagement.

4-Carbamoylpiperidinium acetate monohydrate

In the structure of the title compound, C6H13N2O+ C2H3O2- . H2O, the amide H atoms of the cations form centrosymetric cyclic hydrogen-bonding associations incorporating two water molecules [graph set R^2^~4~(8)], which are conjoint with cyclic water-bridged amide-amide associations [R^4^~4~(12)] and larger R4/4(20) associations involving the water molecule and the acetate anions, which bridge through the piperidinium H donors, giving an overall three-dimensional framework structure.

4-Carbamoylpiperidinium phenylacetate hemihydrate

In the structure of the title compound, C6H13N2O+ C8H7O2- . 0.5H2O, the asymmetric unit comprises two isonipecotamide cations, two phenylacetate anions and a water molecule of solvation. The hydrogen-bonding environments for both sets of ion pairs are essentially identical with the piperidinium and amide 'ends' of each cation involved in lateral heteromolecular hydrogen-bonded cyclic N---H...O associations [graph set R2/2(11)] which incorporate a single carboxyl O-atom acceptor. These cyclic motifs enclose larger R5/5(21) cyclic systems forming sheet substructures which lie parallel to (101) and are linked across b by the single water molecule via water O---H...O(carboxyl) associations to give a two-dimensional duplex-sheet structure