970 resultados para remote area nursing


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Varying the spatial distribution of applied nitrogen (N) fertilizer to match demand in crops has been shown to increase profits in Australia. Better matching the timing of N inputs to plant requirements has been shown to improve nitrogen use efficiency and crop yields and could reduce nitrous oxide emissions from broad acre grains. Farmers in the wheat production area of south eastern Australia are increasingly splitting N application with the second timing applied at stem elongation (Zadoks 30). Spectral indices have shown the ability to detect crop canopy N status but a robust method using a consistent calibration that functions across seasons has been lacking. One spectral index, the canopy chlorophyll content index (CCCI) designed to detect canopy N using three wavebands along the "red edge" of the spectrum was combined with the canopy nitrogen index (CNI), which was developed to normalize for crop biomass and correct for the N dilution effect of crop canopies. The CCCI-CNI index approach was applied to a 3-year study to develop a single calibration derived from a wheat crop sown in research plots near Horsham, Victoria, Australia. The index was able to predict canopy N (g m-2) from Zadoks 14-37 with an r2 of 0.97 and RMSE of 0.65 g N m-2 when dry weight biomass by area was also considered. We suggest that measures of N estimated from remote methods use N per unit area as the metric and that reference directly to canopy %N is not an appropriate method for estimating plant concentration without first accounting for the N dilution effect. This approach provides a link to crop development rather than creating a purely numerical relationship. The sole biophysical input, biomass, is challenging to quantify robustly via spectral methods. Combining remote sensing with crop modelling could provide a robust method for estimating biomass and therefore a method to estimate canopy N remotely. Future research will explore this and the use of active and passive sensor technologies for use in precision farming for targeted N management.

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Queensland fruit fly, Bactrocera tryoni (Froggatt), is the most serious pest of the native tephritid species in Australia and a significant market access impediment for fruit commodities from any area where this species is endemic. An area-wide management (AWM) program was implemented in the Central Burnett district of Queensland with the aim of improving fruit fly control and enhancing market access opportunities for citrus and other fruits produced in the district. The primary control measures adopted in the AWM system included bait spraying of commercial and non-commercial hosts and the year-round installation of male annihilation technology (MAT) carriers in both orchards and town areas. The MAT carrier used consisted of a dental wick impregnated with 1 ml cue-lure [4-(4-acetoxyphenol)-2-butanone] and 1 ml Malathion 500 EC in a plastic cup. The application of these control measures from 2003 to 2007 resulted in overall suppression of fruit fly populations across the entire district. Male trap catches at the peak activity time were reduced by 95% and overall fruit fly infestation in untreated backyard fruit of town areas reduced from 60.8% to 21.8%. Our results demonstrate remarkable improvement in fruit fly control and economic benefit to the Central Burnett horticulture. Therefore, commercial growers are continuing the AWM program as a long-term, industry funded activity, to provide an additional layer of phytosanitary security for market access of fruit commodities from this district.

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In order to reduce the attrition of accelerated nursing students in bioscience/pharmacology, we introduced an innovation to help these students. Although this innovation was associated with reduced attritions from the units in their first year at university, we now show that there was a reduced graduation rate of the accelerated students who survived pharmacology, compared to the traditional students.

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Loading margin sensitivity (LMS) has been widely used in applications in the realm of voltage stability assessment and control. Typically, LMS is derived based on system equilibrium equations near bifurcation and therefore requires full detailed system model and significant computation effort. Availability of phasor measurement units (PMUs) due to the recent development of wide-area monitoring system (WAMS) provides an alternative computation-friendly approach for calculating LMS. With such motivation, this work proposes measurement-based wide-area loading margin sensitivity (WALMS) in bulk power systems. The proposed sensitivity, with its simplicity, has great potential to be embedded in real-time applications. Moreover, the calculation of the WALMS is not limited to low voltage near bifurcation point. A case study on IEEE 39-bus system verifies the proposed sensitivity. Finally, a voltage control scenario demonstrates the potential application of the WALMS.

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Background/Aim There is a 70% higher age-adjusted incidence of heart failure (HF) amongst Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths than non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community healthcare to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim©) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. Methods This study was conducted in two phases and utilised a mixed methods approach (qualitative and quantitative). Phase 1 of this study used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. A HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. Results - Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this and of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. - Phase 2: Five Aboriginal participants, mean age 61.6 ± 10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0 ± 6.7% to 58.0 ± 9.7%, a 20.8% increase and results of the self-care index indicated that the biggest change was in patient confidence for self-care with a 95% increase in confidence score (46.7 ± 16.0 to 91.1 ± 11.5). Changes in management and maintenance scores varied between9275 patients. Conclusion By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

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Phenotypic variation in heartwood and essential-oil characters of Santalum austrocaledonicum was assessed across eleven populations on seven islands of Vanuatu Trees differed significantly in their percentage heartwood cross-sectional area and this varied independently of stem diameter The concentrations of the four major essential-oil constituents (alpha-santalol, beta-santalol. (Z)-beta-curcumen-12-ol, and cis-nuciferol) of alcohol-extracted heartwood exhibited at least tenfold and continuous tree-to-tree variation Commercially important components alpha- and beta-santalol found in individual trees ranged from 0 8-47% and 0-24 1%, respectively, across all populations, and significant (P < 0 05) differences for each were found between Individual populations. The Erromango population was unique in that the mean concentrations of its monocyclic ((Z)-beta-curcumen-12-ol and cis-nuciferol) sesquiterpenes exceeded those of Its bi- and tricyclic (alpha- and beta-santalol) sesquiterpenes Heartwood colour varied between trees and spanned 65 colour categories, but no identifiable relationships were found between heartwood colour and alpha- and beta-santalol, although a weak relationship was evident between colour saturation and total oil concentration These results indicate that the heartwood colour is not a reliable predictive trait for oil quality The results of this study highlight the knowledge gaps in fundamental understanding of heartwood biology in Santalum genus The intraspecific variation in heartwood cross-sectional area. oil concentration. and oil quality traits is of considerable importance to the domestication of sandalwood and present opportunities for the development of highly superior S austrocaledonicum cultivars that conform to the industry's International Standards used for S album.

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Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses (RNs) at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care RNs following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care RNs consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

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Objectives To review models of care for older adults with cancer, with a focus on the role of the oncology nurse in geriatric oncology care. International exemplars of geriatric oncology nursing care are discussed. Data source Published peer reviewed literature, web-based resources, professional society materials, and the authors' experience. Conclusion Nursing care for older patients with cancer is complex and requires integrating knowledge from multiple disciplines that blends the sciences of geriatrics, oncology, and nursing. and which recognizes the dimensions of quality of life. Implications for Nursing Practice: Oncology nurses can benefit from learning key skills of comprehensive geriatric screening and assessment to improve the care they provide for older adults with cancer.

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This report summarises work conducted by the QDPI, in partnership with the South Burdekin Water Board (SBWB) and the Burdekin Shire Council (BSC) between 2001 and 2003. The broad aim of the research was to assess the potential of native fish as biocontrol agents for noxious weeds, as part of an integrated program for managing water quality in the Burdekin Irrigation Area. A series of trials were conducted at, or using water derived from, the Sandy Creek Diversion near Groper Creek (lower Burdekin delta). Trials demonstrated that aquatic weeds play a positive role in trapping transient nutrients, until such time that weed growth becomes self-shading and weed dieback occurs, which releases stored nutrients and adversely affects water quality. Transient nutrient levels (av. TN<0.5mg/L; av. TP<0.1mg/L) found in the irrigation channel during the course of this research were substantially lower than expected, especially considering the intensive agriculture and sewage effluent discharge upstream from the study site. This confirms the need to consider the control of weeds rather than complete weed extermination when formulating management plans. However, even when low nutrient levels are available, there is competitive exploitation of habitat variables in the irrigation area leading to succession and eventual domination by certain weed species. During these trials, we have seen filamentous algae, phytoplankton, hyacinth and curled pondweed each hold competitive advantage at certain points. However without intervention, floating weeds, especially hyacinth, ultimately predominate in the Burdekin delta due to their fast propagation rate and their ability to out-shade submerged plants. We have highlighted the complexity of interactions in these highly disturbed ecosystems in that even if the more prevalent noxious weeds are contained, other weed species will exploit the vacant niche. This complexity places stringent requirements on the type of native fish that can be used as biocontrol agents. Of the seven fish species identified with herbivorous trophic niches, most target plankton or algae and do not have the physical capacity to directly eat the larger macrophytes of the delta. We do find however that following mechanical weed harvesting, inoculative releases of fish can slow the rate of hyacinth recolonisation. This occurs by mechanisms in addition to direct weed consumption, such as disturbing growth surfaces by grazing on attached biofilms. Predation by birds and water rats presents another impediment to the efficacy of large-scale releases of fish. However, alternative uses of fish in water quality management in the Burdekin irrigation area are discussed.

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In this paper, two new dual-path based area efficient loop filtercircuits are proposed for Charge Pump Phase Locked Loop (CPPLL). The proposed circuits were designed in 0.25 CSM analog process with 1.8V supply. The proposed circuits achievedup to 85% savings in capacitor area. Simulations showed goodmatch of the new circuits with the conventional circuit. Theproposed circuits are particularly useful in applications thatdemand low die area.

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The presence of an inert immiscible organic phase in gas�liquid dispersions in stirred vessels influences the interfacial area in a more complex fashion than hitherto reported. As the organic phase fraction is increased, the interfacial area expressed on the basis of a unit volume of dispersion or aqueous phase, first increases, passes through a maximum and then decreases. This trend is observed irrespective of whether the area is determined by chemical means or by physical method. It is found that for low values of inert phase fraction, the average bubble size decreases whereas the gas holdup increases, resulting in increased interfacial area. The lower average bubble size is found to be due to partial prevention of coalescence as the bubbles size generated in the impeller region actually increases with the organic phase fraction. The actual values of interfacial areas depend on the nature of the organic phase. It is also found that the organic phase provides a parallel path for mass transfer to occur, when the solubility of gas in it is high.

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Prescribing for older patients is challenging. The prevalence of diseases increases with advancing age and causes extensive drug use. Impairments in cognitive, sensory, social and physical functioning, multimorbidity and comorbidities, as well as age-related changes in pharmacokinetics and pharmacodynamics all add to the complexity of prescribing. This study is a cross-sectional assessment of all long-term residents aged ≥ 65 years in all nursing homes in Helsinki, Finland. The residents’ health status was assessed and data on their demographic factors, health and medications were collected from their medical records in February 2003. This study assesses some essential issues in prescribing for older people: psychotropic drugs (Paper I), laxatives (Paper II), vitamin D and calcium supplements (Paper III), potentially inappropriate drugs for older adults (PIDs) and drug-drug interactions (DDIs)(Paper IV), as well as prescribing in public and private nursing homes. A resident was classified as a medication user if his or her medication record indicated a regular sequence for its dosage. Others were classified as non-users. Mini Nutritional Assessment (MNA) was used to assess residents’ nutritional status, Beers 2003 criteria to assess the use of PIDs, and the Swedish, Finnish, INteraction X-referencing database (SFINX) to evaluate their exposure to DDIs. Of all nursing home residents in Helsinki, 82% (n=1987) participated in studies I, II, and IV and 87% (n=2114) participated in the study III. The residents’ mean age was 84 years, 81% were female, and 70% were diagnosed with dementia. The mean number of drugs was 7.9 per resident; 40% of the residents used ≥ 9 drugs per day, and were thus exposed to polypharmacy. Eighty percent of the residents received psychotropics; 43% received antipsychotics, and 45% used antidepressants. Anxiolytics were prescribed to 26%, and hypnotics to 28% of the residents. Of those residents diagnosed with dementia, 11% received antidementia drugs. Fifty five percent of the residents used laxatives regularly. In multivariate analysis, those factors associated with regular laxative use were advanced age, immobility, poor nutritional status, chewing problems, Parkinson’s disease, and a high number of drugs. Eating snacks between meals was associated with lower risk for laxative use. Of all participants, 33% received vitamin D supplementation, 28% received calcium supplementation, and 20% received both vitamin D and calcium. The dosage of vitamin D was rather low: 21% received vitamin D 400 IU (10 µg) or more, and only 4% received 800 IU (20 µg) or more. In multivariate analysis, residents who received vitamin D supplementation enjoyed better nutritional status, ate snacks between meals, suffered no constipation, and received regular weight monitoring. Those residents receiving PIDs (34% of all residents) more often used psychotropic medication and were more often exposed to polypharmacy than residents receiving no PIDs. Residents receiving PIDs were less often diagnosed with dementia than were residents receiving no PIDs. The three most prevalent PIDs were short-acting benzodiazepine in greater dosages than recommended, hydroxyzine, and nitrofurantoin. These three drugs accounted for nearly 77% of all PID use. Of all residents, less than 5% were susceptible to a clinically significant DDI. The most common DDIs were related to the use of potassium-sparing diuretics, carbamazepine, and codeine. Residents exposed to potential DDIs were younger, had more often suffered a previous stroke, more often used psychotropics, and were more often exposed to PIDs and polypharmacy than were residents not exposed to DDIs. Residents in private nursing homes were less often exposed to polypharmacy than were residents in public nursing homes. Long-term residents in nursing homes in Helsinki use, on average, nearly eight drugs daily. The use of psychotropic drugs in our study was notably more common than in international studies. The prevalence of laxatives equaled other prior international studies. Regardless of the known benefit and recommendation of vitamin D supplementation for elderly residing mostly indoors, the proportion of nursing home residents receiving vitamin D and calcium was surprisingly low. The use of PIDs was common among nursing home residents. PIDs increased the likelihood of DDIs. However, DDIs did not seem a major concern among the nursing home population. Monitoring PIDs and potential drug interactions could improve the quality of prescribing.

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The highly complex disorder of chronic wounds is a significant problem. Information is often lacking, dynamically changing, or contradictory and thus acts to impede the progression of research and its translation into clinical care. Transdisciplinary collaboration may play an important role in chronic wound research, permitting key stakeholders with a single, central goal to take a unified approach towards addressing the problem. While transdisciplinary collaboration is not a new concept, its implementation within chronic wound research is relatively new. This is because the research area is still largely dominated by single-discipline researchers or by multiple disciplines working in isolation. Transdisciplinary research is a transcending approach, requiring a greater level of understanding between disciplines and may represent the next leap forward in wound care research. This approach necessitates a deeper understanding by all team members of the co-disciplines involved; where key stakeholders are better equipped to respond to dynamic changes and problems that arise in chronic wound research. In this paper, we illustrate what a transdisciplinary approach in wound care research may entail, with the ultimate goal of such an undertaking to improve understanding of the complexities of wound care, which could lead to potential benefits in wound management.

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Regional implementation of Integrated Pest Management (IPM) in Bundaberg production horticulture providing a unified approach to pest and disease control on an area-wide basis. This is aimed at reducing chemical dependency, increasing sustainability, profitability and enhancing biodiversity through detailed investigations, technology application, coordination, monitoring, communication and education.