The core role of the nurse practitioner: practice, professionalism and clinical leadership.

AIM: To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. BACKGROUND: Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. METHOD: This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. FINDINGS: The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. CONCLUSION: A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice. RELEVANCE TO CLINICAL PRACTICE: The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

Determining process model precision and generalization with weighted artificial negative events

Process mining encompasses the research area which is concerned with knowledge discovery from event logs. One common process mining task focuses on conformance checking, comparing discovered or designed process models with actual real-life behavior as captured in event logs in order to assess the “goodness” of the process model. This paper introduces a novel conformance checking method to measure how well a process model performs in terms of precision and generalization with respect to the actual executions of a process as recorded in an event log. Our approach differs from related work in the sense that we apply the concept of so-called weighted artificial negative events towards conformance checking, leading to more robust results, especially when dealing with less complete event logs that only contain a subset of all possible process execution behavior. In addition, our technique offers a novel way to estimate a process model’s ability to generalize. Existing literature has focused mainly on the fitness (recall) and precision (appropriateness) of process models, whereas generalization has been much more difficult to estimate. The described algorithms are implemented in a number of ProM plugins, and a Petri net conformance checking tool was developed to inspect process model conformance in a visual manner.

COX-derived prostanoid pathways in gastrointestinal cancer development and progression : novel targets for prevention and intervention

Arachidonic acid metabolism through cyclooxygenase (COX) pathways leads to the generation of biologically active eicosanoids. Eicosanoid expression levels vary during development and progression of gastrointestinal (GI) malignancies. COX-2 is the major COX-isoform responsible for G.I. cancer development/progression. COX-2 expression increases during progression from a normal to cancerous state. Evidence from observational studies has demonstrated that chronic NSAID use reduces the risk of cancer development, while both incidence and risk of death due to G.I. cancers were significantly reduced by daily aspirin intake. A number of randomized controlled trials (APC trial, Prevention of Sporadic Adenomatous Polyps trial, APPROVe trial) have also shown a significant protective effect in patients receiving selective COX-2 inhibitors. However, chronic use of selective COX-2 inhibitors at high doses was associated with increased cardiovascular risk, while NSAIDs have also been associated with increased risk. More recently, downstream effectors of COX-signaling have been investigated in cancer development/progression. PGE 2, which binds to both EP and PPAR receptors, is the major prostanoid implicated in the carcinogenesis of G.I. cancers. The role of TXA 2 in G.I. cancers has also been examined, although further studies are required to uncover its role in carcinogenesis. Other prostanoids investigated include PGD 2 and its metabolite 15d-PGJ2, PGF 1α and PGI 2. Targeting these prostanoids in G.I. cancers has the promise of avoiding cardiovascular toxicity associated with chronic selective COX-2 inhibition, while maintaining anti-tumor reactivity.A progressive sequence from normal to pre-malignant to a malignant state has been identified in G.I. cancers. In this review, we will discuss the role of the COX-derived prostanoids in G.I. cancer development and progression. Targeting these downstream prostanoids for chemoprevention and/or treatment of G.I. cancers will also be discussed. Finally, we will highlight the latest pre-clinical technologies as well as avenues for future investigation in this highly topical research field. © 2011 Elsevier B.V.

Alcohol consumption in young adults : the role of multisensory imagery

Little is known about the subjective experience of alcohol desire and craving in young people. Descriptions of alcohol urges continue to be extensively used in the everyday lexicon of young, non-dependent drinkers. Elaborated Intrusion (EI) Theory contends that imagery is central to craving and desires, and predicts that alcohol-related imagery will be associated with greater frequency and amount of drinking. This study involved 1,535 age stratified 18–25 year olds who completed an alcohol–related survey that included the Imagery scale of the Alcohol Craving Experience (ACE) questionnaire. Imagery items predicted 12-16% of the variance in concurrent alcohol consumption. Higher total Imagery subscale scores were linearly associated with greater drinking frequency and lower self-efficacy for moderate drinking. Interference with alcohol imagery may have promise as a preventive or early intervention target in young people.

Cultivation

The interest in potentially economically valuable plants (for food, timber, dyes, fabric, and drugs) was part of the concerted effort given by colonial governments towards providing botanic gardens in new colonies. While convicts and guards laboured in Brisbane Town from 1825 until 1849, botanists such as Alan Cunningham were discovering the delights of native plants in their numerous excursions. Their observations and collections of seeds were sent south (to the local botanic gardens at Melbourne and Sydney) and onward to the Royal Botanic Gardens in Britain (at Kew and Edinburgh). This set the local pattern for future exchanges among the global British Imperial botanic garden network...

Effects of pupil center shift on ocular aberrations

Purpose: To investigate effects of pupil shifts, occurring with changes in luminance and accommodation stimuli, on refraction components and higher-order aberrations. Method: Participants were young and older groups (n=20, 22±2 years, age range 18–25 years; n=19, 49±4 years, 45–58 years). Aberrations/refractions at 4 mm and 3 mm diameters were compared between centered and decentered pupils for low (background 0.01cd/m², 0D), and high (6100cd/m², 4D or 6D) stimuli. Decentration was the difference between pupil centers for low and high stimuli. Clinical important changes with decentration were: M ±0.50D or ±0.25D, J180 and J45 ±0.25D or ±0.125D, HORMS ±0.05m, C(3, 1) ±0.05m, C(4, 0) ±0.05m. Results: Because of small pupil shifts in most participants (mean 0.26mm), there were few important changes in most refraction components and higher-order aberration terms. However, M changed by >0.25 D for a third of participants with 4mm pupils. When determining refractions from 2nd-6th order aberration coefficients, the more stringent criteria gave 76/ 534 (14%) possible important changes. Some participants had large pupil shifts with considerable aberration changes. Comparisons at the high stimulus were possible for only 11 participants because of small pupils. When refractions were determined from 2nd order aberration coefficients only, there were only 35 (7%) important changes for the more stringent criteria. Conclusion: Usually pupil shifts with changes in stimulus conditions have little influence on aberrations, but they can with high shifts. The number of aberrations orders that are considered as contributing to refraction influences the proportion of cases that might be considered clinically important.

Importance of knowledge management processes in a project-based organization : a case study of research enterprise

Knowledge Management (KM) is vital factor to successfully undertake projects. The temporary nature of projects necessitates employing useful KM practices for tackling issues such as knowledge leakiness and rework. The Project Management Office (PMO) is a unit within organizations to facilitate and oversee organizational projects. Project Management Maturity Models (PMMM) shows the development of PMOs from immature to mature levels. The existing PMMMs have focused on discussing Project Management (PM) practices, however, the management of project knowledge is yet to be addressed, at various levels of maturity. This research project was undertaken to investigate the mentioned gap for addressing KM practices at the existing PMMMs. Due to the exploratory and inductive nature of this research, qualitative methods were chosen as the research methodology. In total, three cases selected from different industries: research; mining and government organizations, to provide broad categories for research and research questions were examined using the developed framework. This paper presents the partial findings of undertaken investigation of the research organisation with the lowest level of maturity. The result shows that knowledge creation and capturing are the most important processes, while knowledge transferring and reusing are not as important as the other two processes. In addition, it was revealed that provision of “knowledge about client” and “project management knowledge” are the most important types of knowledge that are required at this level of maturity. In conclusion, the outcomes of this paper shall provide powerful guidance to PMOs at lowest level of maturity from KM point of view.

Decisions and actions of distracted drivers at the onset of yellow light

Driving on an approach to a signalized intersection while distracted is relatively risky, as potential vehicular conflicts and resulting angle collisions tend to be relatively more severe compared to other locations. Given the prevalence and importance of this particular scenario, the objective of this study was to examine the decisions and actions of distracted drivers during the onset of yellow lights. Driving simulator data were obtained from a sample of 69 drivers under baseline and handheld cell phone conditions at the University of Iowa – National Advanced Driving Simulator. Explanatory variables included age, gender, cell phone use, distance to stop-line, and speed. Although there is extensive research on drivers’ responses to yellow traffic signals, the examinations have been conducted from a traditional regression-based approach, which do not necessary provide the underlying relations and patterns among the sampled data. In this paper, we exploit the benefits of both classical statistical inference and data mining techniques to identify the a priori relationships among main effects, non-linearities, and interaction effects. Results suggest that the probability of yellow light running increases with the increase in driving speed at the onset of yellow. Both young (18–25 years) and middle-aged (30–45 years) drivers reveal reduced propensity for yellow light running whilst distracted across the entire speed range, exhibiting possible risk compensation during this critical driving situation. The propensity for yellow light running for both distracted male and female older (50–60 years) drivers is significantly higher. Driver experience captured by age interacts with distraction, resulting in their combined effect having slower physiological response and being distracted particularly risky.

The nature of non-equilibrium solidification of undercooled Agsingle bondCu alloys in contact with primary copper dendrites

Liquids of silver-copper alloys with near eutectic compositions embedded in a copper matrix were undercooled. The structural and microstructural investigations of these alloys solidified from undercooled temperature indicated the absence of both the eutectic reaction and diffusionless transformation below the equal free energy curve (T0). Instead the liquid maintained local equilibrium with the copper dendrites continuously until it intersected the extended solidus of the silver rich solid solution.

Literaturnaja skazka A.M. Remizova (1900-1920-e gody)

Literary tale of A.M. Remizov (1900’s – 1920’s) The thesis is devoted to a detailed historical-literary description of a tale as a genre tradition in the creative work of Alexei Mikhailovich Remizov (1877-1957), one of the major Russian prose writers of the 20’s century. This very approach allows to specify the place and functional meaning of this genre in literary practice of the writer and to appeal to one of the key problems of the 20-21 century literature history – a specific of modernistic literature composition principle and a role of montage techniques in its formation. Remizov was working on tales during his whole life, though the most productive years of folklore studies fell to 1900’s – 1910’s. During this period he intensively studied folklore materials, narrated several hundreds of folk tales and in 1900’s – 1920’s published eight tale collections which played a significant role in the formation of stylistic and compositional principles of his prose of the 1910’s – 1920’s, especially montage techniques, which in its turn influenced the development of the narrative forms in the Russian post-revolutionary literature. At the same time a tale has specified not only poetics but also problematics of Remizov’s creative work, as when choosing folklore sources the writer always alluded to modern themes and relevant intellectual trends. The current research work, based on various archive materials and a wide spectrum of modern historical-literary data, complies four chapters with a consistent description of creation history, publication and critics’ reviews of Remizov’s tale collections and single tales contributing to his creative evolution characteristic. Furthermore, the work refers to composition and subject of the particular collections. On the whole it enables to follow up genre dynamics. The first chapter of the work is devoted to Posolon’ (Sunwise), the earliest tale collection of Remizov. The main feature of the collection is that its composition is oriented on the agrarian calendar and the subject – on the system of mythological views reflected in the Russian folklore. This very collection to a large extent corresponds to the writer’s views on the myth represented in Pis’mo v redaktsiyu (Letter to the Editor). The history of this manifesto appearing is analyzed in the second chapter. The incident which caused its forthcoming contributed to ‘legitimization’ of Remizov’s narrations as a relevant genre of modern literature and to upgrading the writer in professional hierarchy. The third chapter analyzes Remizov’s collections of 1900’s – early 1920’s, a result of Remizov’s scrupulous work with a specific tale material. He is acting here as a tale repertory researcher and in some cases as a collector as well. The means of such collections’ topical organization is not the myth but the hero of the tale. According to this principle single pieces are grouped into cycles, which then form complicated montage constructs. Texts themselves can be viewed as a sort of hyper-quotations, as they in fact entirely coincide with their original sources. Besides, collections usually have their own ideal patterns. In the fourth chapter a connection of Remizov’s creative work with folk fun culture and a tradition of the folklore noel story is being demonstrated on Zavetnyie skazy (Secret Tales) material. A consistent collections’ history creation analysis convinces us that the tale was a sort of laboratory in which main writer’s prose methods were being worked out.

Historiebruk kring Nådendal : och den kommemorativa anatomin av klostrets minnesplats

This thesis examines the ruins of the medieval Bridgettine (Birgittan) monastery of Naantali (Vallis Gratiae, f. 1443) in Finland and the transformation of the site into a national heritage and a memory landscape. It was archaeologically surveyed in the 19th century by Professor Sven Gabriel Elmgren (1817 1897). His work was followed by Dr. Reinhold Hausen (1850 1942), who excavated the site in the 1870s. During this time the memories of Saint Bridget (Birgitta) in Sweden were also invented as heritage. Hausen published his results in 1922 thus forming the connection with the next generation of actors involved with the Naantali site: the magnate Amos Anderson (1878 1961), the teacher Julius Finnberg (1877 1955) and the archaeologist Juhani Rinne (1872 1950). They erected commemorative monuments etc. on the Naantali site, thus creating a memory landscape there. For them, the site represented the good homeland in connection with a western-oriented view of the history of Finland. The network of actors was connected to the Swedish researchers and so-called Birgitta Friends, such as state antiquarian Sigurd Curman (1879 1966), but also to the members of the Societas Sanctae Birgittae and the Society for the Embellishment of Pirita, among others. Historical jubilees as manifestations of the use of history were also arranged in Naantali in 1943, 1993 and 2003. It seems as if Naantali is needed in Finnish history from time to time after a period of crisis, i.e. after the Crimean War in the 1850s, the civil war of 1918, during World War II and also after the economic crisis of the early 1990s. In 2003, there was a stronger focus on the international Saint Bridget Jubilee in Sweden and all over Europe. Methodologically, the thesis belongs to the history of ideas, but also to research on the use of history, invented traditions and lieux de mémoire. The material for the work consists of public articles and scholarly texts in books or newspapers and letters produced by the actors and kept in archives in Finland, Sweden and Estonia, in addition to pictures and erected commemorative monuments in situ in the Western Finnish region. Keywords: Nådendal, Naantali monastery, Bridgettines, St. Bridget, use of history, lieux de mémoire, invented traditions, commemorative anatomy, memory landscape, Saint Bridget jubilees , S. G. Elmgren, R. Hausen, A. Anderson, J. Finnberg, J. Rinne, S. Curman, High Church Movement, Pirita, Vadstena.

Papin pojasta suurteollisuusmieheksi : Alfred Kihlman ja nousevan keskiluokan sosiaaliset verkostot 1800-luvun Suomessa

Tutkimuksen tavoitteena on hahmottaa 1800-luvulla tapahtunutta keskiluokan sosiaalista nousua pohjalaissyntyisen papin, opettajan, liikemiehen ja valtiopäiväedustajan Alfred Kihlmanin (1825-1904) elämänvaiheiden kautta. Kyseessä ei ole perinteinen elämäkerta, vaan työn pyrkimyksenä on mikrotason tarkan analyysin kautta päästä käsiksi laajempiin yhteiskunnallisiin muutosprosesseihin. Erityisen kiinnostuksen kohteena ovat erilaiset sosiaaliset verkostot sekä niiden merkitys Kihlmanin kaltaisen keskiluokkaisen yksilön sosiaaliselle nousulle. Tutkimus jakautuu kahteen pääosaan, joista ensimmäinen käsittelee heränneiden pappien verkostoja 1840-luvulla ja 1850-luvun alussa ja jälkimmäinen liikemiesverkostoja 1850-luvun jälkipuolelta 1870-luvun alkuun. Pääasiallisena lähdeaineistona on Alfred Kihlmanin laaja kirjeenvaihto. Alfred Kihlman liittyi kouluvuosinaan 1840-luvun alussa nuorison piirissä nopeasti levinneeseen herännäisyyteen. Nuoret heränneet papit muodostivat tiiviin sosiaalisen verkoston, joka perustui jaetulle uskonnolliselle ideologialle sekä pappisperheiden välisille avioliittositeille. Lisäksi verkostoa pidettiin yllä yhteisillä kokoontumisilla, vierailuilla, kirjeenvaihdolla sekä palvelusten vaihtamisella. Verkoston välityksellä saatiin tehokkaasti mm. informaatiota sekä rahalainoja. Herännäisyys nousi nuoren keskiluokkaisen papiston omaa yhteiskunnallista voimattomuuttaan kohtaan tuntemasta tyytymättömyydestä. Kun sivistyneistön mahdollisuudet menestyä perinteisillä foorumeilla olivat autonomian alkupuolella heikot, nuoret heränneet kielsivät uskonnollisessa ideologiassaan arvon maalliselta menestykseltä ja rakensivat oman verkostonsa, jonka sisällä he saattoivat toteuttaa pätemisentarvettaan. Yhteiskunnallisen tilanteen muututtua verkosto muuttui 1850-luvun alussa hyödystä rasitteeksi, minkä seurauksena heränneiden pappien rivit hajaantuivat. Irtauduttuaan herännäisyydestä Alfred Kihlman siirtyi opettajan uralle. Heränneeltä vaimoltaan perimänsä varallisuuden sekä nuoruus- ja herännäisvuosinaan solmimiensa ystävyyssuhteiden ansiosta hän ajatui 1850-luvun kuluessa yhä enemmän myös liike-elämään. Hänen merkittävimmäksi toimintakentäkseen muodostuivat Suomen Yhdyspankki sekä Tampereen Pellava- ja Rautateollisuus, jonka johtajana hän toimi vuodesta 1866 lähtien. 1860-luvulla liikemiesverkostot perustuivat suurelta osin sukulaisuuteen, mutta yhä enenevässä määrin myös ystävyys-, kollega- ja liikekumppanuussuhteisiin. Kun pankkilaitos oli vielä hyvin kehittymätön, verkostot olivat etenkin pääomien hankinnassa avainasemassa. Tiiviit lainaverkostot olivat huonojen suhdanteiden aikana toisaalta myös vaaraksi, sillä yksi suuri konkurssi saattoi vetää mukanaan joukoittain liikemiehiä. Verkostojen kautta voitiin välittää ja saada myös suosituksia sekä sisäpiiritietoa, jota ei ollut saatavissa muista lähteistä. Yhteiskunnan muuttuminen ja henkilösuhteet mahdollistivat Alfred Kihlmanin sosiaalisen nousun. Teollistuminen ja liike-elämän vapautuminen tarjosivat uusia mahdollisuuksia keskiluokan yritteliäille yksilöille. Ylempien yhteiskuntaluokkien välisten säätyjen välisten raja-aitojen tasaantuminen tekivät 1850-luvun puolivälissä mahdolliseksi myös papin osallistumisen liike-elämään. Avainsanat: sosiaaliset verkostot - Suomi - 1800-luku - herännäisyys - kirkkohistoria - taloushistoria

Odour emissions from anaerobic piggery ponds. 1. Results of a three season, 14-month survey

Odour emission rates were measured for seven different anaerobic ponds treating piggery wastes at six to nine discrete locations across the surface of each pond on each sampling occasion over a 14-month period. Emission rate values varied between ponds, between seasons for the same pond and even for the same pond on different days of a sampling week. Average seasonal emission rates ranged from 7.9 to 46.5 OU/m2 s, while average emission rates ranged from 16.0 to 29.0 OU/m2 s. Factors potentially responsible for the variability in emission rates were investigated, including air and pond liquor temperatures, time of day of sample collection, season and the impact of a prolonged drought.

Studio portrait of Josef Molling with unidentified man; Heidelberg, Germany.

right: Joseph Molling sitting; left: unknown man standing