Alarm setting for the critically ill patient : A descriptive pilot survey of nurses’ perceptions of current practice in an Australian Regional Critical Care Unit

Aim: The aim of this survey was to assess registered nurse’s perceptions of alarm setting and management in an Australian Regional Critical Care Unit. Background: The setting and management of alarms within the critical care environment is one of the key responsibilities of the nurse in this area. However, with up to 99% of alarms potentially being false-positives it is easy for the nurse to become desensitised or fatigued by incessant alarms; in some cases up to 400 per patient per day. Inadvertently ignoring, silencing or disabling alarms can have deleterious implications for the patient and nurse. Method: A total population sample of 48 nursing staff from a 13 bedded ICU/HDU/CCU within regional Australia were asked to participate. A 10 item open-ended and multiple choice questionnaire was distributed to determine their perceptions and attitudes of alarm setting and management within this clinical area. Results: Two key themes were identified from the open-ended questions: attitudes towards inappropriate alarm settings and annoyance at delayed responses to alarms. A significant number of respondents (93%) agreed that alarm fatigue can result in alarm desensitisation and the disabling of alarms, whilst 81% suggested the key factors are those associated with false-positive alarms and inappropriately set alarms.

Young Men s Sexual Behaviour in Finland and Estonia : Opportunities for prevention of sexually transmitted infections

Background: The incidence of sexually transmitted infections (STIs) in most EU states has gradually increased and the rate of newly diagnosed HIV cases has doubled since 1999. STIs differ in their clinical features, prognosis and transmission dynamics, though they do share a common factor in their mode of transmission −that is, human behaviour. The evolvement of STI epidemiology involves a joint action of biological, epidemiological and societal factors. Of the more immediate factors, besides timely diagnosis and appropriate treatment, STI incidence is influenced by population patterns of sexual risk behaviour, particularly the number of sexual partners and the frequency of unprotected intercourse. Assessment of sexual behaviour, its sociodemographic determinants and time-trends are important in understanding the distribution and dynamic of STI epidemiology. Additionally, in the light of the basic structural determinants, such as increased level of migration, changes in gender dynamics and impacts from globalization, with its increasing alignment of values and beliefs, can reveal future challenges related to STI epidemiology. STI case surveillance together with surveillance on sexual behaviour can guide the identification of preventive strategies, assess their effectiveness and predict emerging trends. The objective of this study was to provide base line data on sexual risk behaviour, self-reported STIs and their patterns by sociodemographic factors as well as associations of sexual risk behaviour with substance use among young men in Finland and Estonia. In Finland national population based data on adult men s sexual behaviour is limited. The findings are discussed in the context of STI epidemiology as well as their possible implications for public health policies and prevention strategies. Materials and Methods: Data from three different cross-sectional population-based surveys conducted in Finland and Estonia, during 1998 2005, were used. Sexual behaviour- and health-related questions were incorporated in two surveys in Finland; the Health 2000, a large scale general health survey, focussed on young adults, and the Military health behavioural survey on military conscripts participating in the mandatory military training. Through research collaboration with Estonia, similar questions to the Finnish surveys were introduced to the second Estonian HIV/AIDS survey, which was targeted at young adults. All surveys applied mail-returned, anonymous, self-administered questionnaires with multiple choice formatted answers. Results: In Finland, differences in sexual behaviour between young men and women were minor. An age-stratified analysis revealed that the sex-related difference observed in the youngest age group (18 19 years) levelled off in the age group 20 24 and almost disappeared among those aged 25 29. Marital status was the most important sociodemographic correlate for sexual behaviour for both sexes, singles reporting higher numbers of lifetime-partners and condom use. This effect was stronger for women than for men. However, of those who had sex with casual partners, 15% were married or co-habiting, with no difference between male and female respondents. According to the Military health behavioural survey, young men s sexual risk behaviour in Finland did not markedly change over a period of time between 1998 and 2005. Approximately 30−40% of young men had had multiple sex partners (more than five) in their lifetime, over 20% reported having had multiple sex partners (at least three) over the past year and 50% did not use a condom in their last sexual intercourse. Some 10% of men reported accumulation of risk factors, i.e. having had both, multiple sex partners and not used a condom in their last intercourse, over the past year of the survey. When differences and similarities were viewed within Finland and Estonia, a clear sociodemographic patterning of sexual risk behaviour and self-reported STIs was found in Finland, but a somewhat less consistent trend in Estonia. Generally, both, alcohol and drug use were strong correlates for sexual risk behaviour and self-reported STIs in Finland and Estonia, having a greater effect on engagement with multiple sex partners rather than unprotected intercourse or self-reported STIs. In Finland alcohol use, relative to drug use, was a stronger predictor of sexual risk behaviour and self-reported STIs, while in Estonia drug use predicted sexual risk behaviour and self-reported STIs stronger than alcohol use. Conclusions: The study results point to the importance for prevention of sexual risk behaviour, particularly strategies that integrate sexual risk with alcohol and drug use risks. The results point to the need to focus further research on sexual behaviour and STIs among young people; on tracking trends among general population as well as applying in-depth research to identify and learn from vulnerable and high-risk population groups for STIs who are exposed to a combination of risk factors.

Biological control of prickly acacia: Current research and future prospects

Prickly acacia, Vachellia nilotica subsp. indica (syn. Acacia nilotica subsp. indica) (Fabaceae), a major weed in the natural grasslands of western Queensland, has been a target of biological control since the 1980s with limited success to date. Surveys in India, based on genetic and climate matching, identified five insects and two rust pathogens as potential agents. Host-specificity tests were conducted for the insects in India and under quarantine conditions in Australia, and for the rust pathogens under quarantine conditions at CABI in the UK. In no-choice tests, the brown leaf-webber, Phycita sp. A, (Lepidoptera: Pyralidae) completed development on 17 non-target plant species. Though the moth showed a clear preference for prickly acacia in oviposition choice trials screening of additional test-plant species was terminated in view of the potential non-target risk. The scale insect Anomalococcus indicus (Hemiptera: Lecanodiaspididae) developed into mature gravid females on 13 out of 58 non-target plant species tested. In the majority of cases very few female scales matured but development was comparable to that on prickly acacia on four of the non-target species. In multiple choice tests, the scale insect showed a significant preference for the target weed over non-target species tested. In a paired-choice trial under field conditions in India, crawler establishment occurred only on prickly acacia and not on the non-target species tested. Further choice trials are to be conducted under natural field conditions in India. A colony of the green leaf-webber Phycita sp. B has been established in quarantine facilities in Australia and host-specificity testing has commenced. The gall-rust Ravenelia acaciae-arabicae and the leaf-rust Ravenelia evansii (Puccineales: Raveneliaceae) both infected and produced viable urediniospores on Vachellia sutherlandii (Fabaceae), a non-target Australian native plant species. Hence, no further testing with the two rust species was pursued. Inoculation trials using the gall mite Aceria liopeltus (Acari: Eriophyidae) from V. nilotica subsp. kraussiana in South Africa resulted in no gall induction on V. nilotica subsp. indica. Future research will focus on the leaf-weevil Dereodus denticollis (Coleoptera: Curculionidae) and the leaf-beetle Pachnephorus sp. (Coleoptera: Chrysomelidae) under quarantine conditions in Australia. Native range surveys for additional potential biological control agents will also be pursued in northern and western Africa.

Organisational Responses to Workplace Harassment: An Exploratory Study

Purpose – The aim of this paper is to explore what kind of measures personnel managers have taken to intervene in workplace harassment and to explore how organisational characteristics and the characteristics of the personnel manager affect the choice of response strategies. Design/methodology/approach – The study was exploratory and used a survey design. A web-based questionnaire was sent to the personnel managers of all Finnish municipalities and data on organisational responses and organisational characteristics were collected. Findings – The study showed that the organisations surveyed relied heavily on reconciliatory measures for responding to workplace harassment and that punitive measures were seldom used. Findings indicated that personnel manager gender, size of municipality, use of “sophisticated” human resource management practices and having provided information and training to increase awareness about harassment all influence the organisational responses chosen. Research limitations/implications – Only the effects of organisational and personnel manager characteristics on organisational responses were analysed. Future studies need to include perpetrator characteristics and harassment severity. Practical implications – The study informs both practitioners and policy makers about the measures that have been taken and that can be taken in order to stop harassment. It also questions the effectiveness of written anti-harassment policies for influencing organisational responses to harassment and draws attention to the role of gendered perceptions of harassment for choice of response strategy. Originality/value – This paper fills a gap in harassment research by reporting on the use of different response strategies and by providing initial insights into factors affecting choice of responses.

Compiler-Directed Dynamic Voltage Scaling using Program Phases

Energy consumption has become a major constraint in providing increased functionality for devices with small form factors. Dynamic voltage and frequency scaling has been identified as an effective approach for reducing the energy consumption of embedded systems. Earlier works on dynamic voltage scaling focused mainly on performing voltage scaling when the CPU is waiting for memory subsystem or concentrated chiefly on loop nests and/or subroutine calls having sufficient number of dynamic instructions. This paper concentrates on coarser program regions and for the first time uses program phase behavior for performing dynamic voltage scaling. Program phases are annotated at compile time with mode switch instructions. Further, we relate the Dynamic Voltage Scaling Problem to the Multiple Choice Knapsack Problem, and use well known heuristics to solve it efficiently. Also, we develop a simple integer linear program formulation for this problem. Experimental evaluation on a set of media applications reveal that our heuristic method obtains a 38% reduction in energy consumption on an average, with a performance degradation of 1% and upto 45% reduction in energy with a performance degradation of 5%. Further, the energy consumed by the heuristic solution is within 1% of the optimal solution obtained from the ILP approach.

Dual Binding Site Assisted Chromogenic and Fluorogenic Recognition and Discrimination of Fluoride and Cyanide by a Peripherally Borylated Metalloporphyrin: Overcoming Anion Interference in Organoboron Based Sensors

Peripherally triarylborane decorated porphyrin (2) and its Zn(II) complex (3) have been synthesized. Compound 3 contains of two different Lewis acidic binding sites (Zn(II) and boron center). Unlike all previously known triarylborane based sensors, the optical responses of 3 toward fluoride and cyanide are distinctively different, thus enabling the discrimination of these two interfering anions. Metalloporphyrin 3 shows a multiple channel fluorogenic response toward fluoride and cyanide and also a selective visual colorimetric response toward cyanide. By comparison with model systems and from detailed photophysical studies on 2 and 3, we conclude that the preferential binding of fluoride occurs at the peripheral borane moieties resulting in the cessation of the EET (electronic energy transfer) process from borane to porphyrin core and with negligible negetive cooperative effects. On the other hand, cyanide binding occurs at the Zn(II) core leading to drastic changes in its absorption behavior which can be followed by the naked eye. Such changes are not observed when the boryl substituent is absent (e.g., Zn-TPP and TPP). Compounds 2 and 3 were also found to be capable of extracting fluoride from aqueous medium.

Intermediate Macroeconomics : Self-evaluation exercises

This resource can be particularly helpful to students taking the Intermediate Macroeconomics course, which corresponds to the second year of the current Degree in Economics at the University of the Basque Country UPV/ EHU. The precise content of this resource is a collection of eight chapters of multiple-choice questions. For each question the user is asked to guess which the correct answer is. Finally, the tool will return all the correct answers for the whole test, thereby allowing the user to check the validity of his/her answers. A remarkable feature of the tool is that it has been edited in three versions, for the three languages (Spanish, Basque and English) in which the subject is taught at the UPV/EHU.

Measuring Learning Outcomes in Library Instruction

The author uses clicker technology to incorporate polling and multiple choice question techniques into library instruction classes. Clickers can be used to give a keener understanding of how many students grasp the concepts presented in a specific class session. Typically, a student that aces a definition-type question will fail to answer an application-type question correctly. Immediate, electronic feedback helps to calibrate teaching approaches and gather data about learning outcomes. This presentation will analyze learning outcomes specific to scientific disciplines, and demonstrate the usefulness of clickers to engage and sustain student learning.

Evaluation of a national evidence-based health care course via teleconference in a developing country

Rationale, aims and objectives Continuing health education is essential but challenged. in 2006, the Brazilian Cochrane Center, in collaboration with the Ministry of Health, launched a mass teaching initiative in evidence-based health care (EBH) for public-sector professionals via teleconferencing. This 152-hour, interactive EBH course has enrolled over 4500 professionals. This study aimed to assess the acquisition EBH knowledge and skills, as well as the attitudes and perceptions of a sample of students enrolled in the 2009 course via teleconferencing.Methods This prospective cohort study analyzed three aspects of this 152-hour EBH course that recruited 1040 volunteer participants, all public health sector employees working in 131 different hospitals or health agencies. Pre- and post-course tests using a modified version of the Berlin questionnaire with 20 multiple-choice questions were used to examine knowledge acquisition in a sample of 297 students. Tests were completed upon registration and at course completion. the research projects submitted by 872 participants were evaluated to assess skill acquisition. Answers to an anonymous survey assessed the attitudes and perceptions of 914 participants.Results There was a significant increase in knowledge from baseline to course completion (mean scores 8.2 +/- 3.3 versus 13.7 +/- 3.0, P < 0.001). Over 90% of the research projects were judged to be of adequate quality (appropriate rationale for the study, well-formulated research question and feasible execution); over 95% of the participants were satisfied with the course.Conclusion the Brazilian EBH course via teleconference improved the knowledge and skills of public-sector health professionals and was approved by the vast majority of students.

Idiom processing in aphasic patients

The aim of the present paper is to provide insight into the issue of idiom comprehension in pa- tients who are in the process of recovery from the syndrome of aphasia. Research in figurative language comprehension has seen a robust development in the recent decades. However, it has not been until quite recently that psycholinguists began to delve into the aspect of metaphorical language comprehension in brain damaged populations. It was observed that even though the ability to produce and understand language is recovered in the majority of patients with head trauma, the impairment of some aspects of comprehension may protract. The understanding of idioms, metaphors, similes and proverbs, due to their specific, non-literal character, has been evi- denced to pose a serious problem to aphasic patients, as they fail to decipher the figurative mean- ing of the utterance, and, instead, tend to process the message literally (Papagno et al. 2004). In the present study, three patients who suffered from aphasic disorder were tested for com- prehension of idioms by means of two multiple choice tasks. The obtained results corroborated the hypothesis that patients who are in the process of recovery from aphasia encounter various pitfalls in the comprehension of idiomatic language. Predominantly, they exhibit an inclination to choose the erroneous, literal paraphrases of the presented idioms over their correct, idiomatic counterparts. The present paper aims at accounting for the reasons underlying such a tendency.

Transitions: From novice participation to expertise, pre-school 'matters' in an Irish pre-school community

This in depth, qualitative, participant observer study tracks children's transition experiences from novice to experienced membership of their pre-school community. It also considers adult roles in mediating this process in the context of the recent introduction of a universal free-pre-school year for children growing up in Ireland. Participation and the space to negotiate a participatory identity is understood in this study as a key element of positive experiences of early years transitions, within pre-school and beyond. The underlying theoretical framework is socio-cultural. This approach shifts from a scientific positivist view of thinking and learning as an individual inside the head process and asserts the historical, social, cultural as well as the situated context of learning and meaning making All participants, including myself as researcher, are recognised, explored and valued as embedded in the cultural context studied. In a sense, this approach tilts the worlds being observed through participation in them and reflects them in new light. The aim is to interpret and reflect the multiple realities constructed in this context rather than seek a truth out there waiting to be found. Special efforts are made to be invited in to and acknowledge children's expertise in the cultural worlds they negotiate with peers and adults in pre-school. The aim is to better understand what children may find motivating, interesting or problematic as they interpret reproduce and transform meaning within their play and learning worlds. My aim is for an honest rendering of the voices of stakeholders in pre-school communities from teachers, parents, and policy makers to children themselves. It makes visible constraints; potentials and possibilities within everyday Irish pre-school practices in the situated context studied as well as the broader societal, legislative and macro policy influences it reflects. Casting light on the taken for granted opens the possibility of adaptation or transformation. Transition itself can act as a tool to meet the changing needs of children on their developmental pathways across the life cycle

PARTAKE survey of public knowledge and perceptions of clinical research in India.

BACKGROUND: A public that is an informed partner in clinical research is important for ethical, methodological, and operational reasons. There are indications that the public is unaware or misinformed, and not sufficiently engaged in clinical research but studies on the topic are lacking. PARTAKE - Public Awareness of Research for Therapeutic Advancements through Knowledge and Empowerment is a program aimed at increasing public awareness and partnership in clinical research. The PARTAKE Survey is a component of the program. OBJECTIVE: To study public knowledge and perceptions of clinical research. METHODS: A 40-item questionnaire combining multiple-choice and open-ended questions was administered to 175 English- or Hindi-speaking individuals in 8 public locations representing various socioeconomic strata in New Delhi, India. RESULTS: Interviewees were 18-84 old (mean: 39.6, SD ± 16.6), 23.6% female, 68.6% employed, 7.3% illiterate, 26.3% had heard of research, 2.9% had participated and 58.9% expressed willingness to participate in clinical research. The following perceptions were reported (% true/% false/% not aware): 'research benefits society' (94.1%/3.5%/2.3%), 'the government protects against unethical clinical research' (56.7%/26.3%/16.9%), 'research hospitals provide better care' (67.2%/8.7%/23.9%), 'confidentiality is adequately protected' (54.1%/12.3%/33.5%), 'participation in research is voluntary' (85.3%/5.8%/8.7%); 'participants treated like 'guinea pigs'' (20.7%/53.2%/26.0%), and 'compensation for participation is adequate' (24.7%/12.9%/62.3%). CONCLUSIONS: Results suggest the Indian public is aware of some key features of clinical research (e.g., purpose, value, voluntary nature of participation), and supports clinical research in general but is unaware of other key features (e.g., compensation, confidentiality, protection of human participants) and exhibits some distrust in the conduct and reporting of clinical trials. Larger, cross-cultural surveys are required to inform educational programs addressing these issues.

Things learned in early adulthood are remembered best.

Evidence is reviewed that for older adults the period from 10 to 30 years of age produces recall of the most autobiographical memories, the most vivid memories, and the most important memories. It is the period from which peoples' favorite films, music, and books come and the period from which they judge the most important world events to have originated. Factual, semantic, general-knowledge, multiple-choice questions about the Academy Awards, the World Series, and current events from this period were answered more accurately by two different groups of 30 older adults tested 10 years apart. A cognitive theory based on the importance of transitions and several noncognitive theories are considered as explanations of this pervasive phenomenon.

Combined Effects Of Body Size Food Concentration And Season On Physiology Of Mytilus-Edulis

Multivariate experiments are used to study the effects of body size, food concentration, and season on the oxygen consumption, ammonia excretion, food assimilation efficiency and filtration rate of Mytilus edulis adults. Food concentrations and season affect both the intercept and the slope of the allometric equation describing oxygen uptake as a function of body size. Multiple regression and response surface techniques are used to describe and illustrate the complex relationship between metabolic rate, ration, season and the body size of M. edulis. Filtration rate has a relatively low weight exponent Q> = 038) and the intercept for the allometric equation is not significantly affected by food concentration, season or acclimation temperatures between 5 and 20 °C. Food assimilation efficiency declines exponentially with increasing food concentration and is dependent on body size at high food levels. The rate of ammonia excretion shows a similar seasonal cycle to that of oxygen consumption. They are both minimal in the autumn/winter and reach a maximum in the spring /summer.

Tigecycline challenge triggers sRNA production in Salmonella enterica serovar Typhimurium

Background: Bacteria employ complex transcriptional networks involving multiple genes in response to stress, which is not limited to gene and protein networks but now includes small RNAs (sRNAs). These regulatory RNA molecules are increasingly shown to be able to initiate regulatory cascades and modulate the expression of multiple genes that are involved in or required for survival under environmental challenge. Despite mounting evidence for the importance of sRNAs in stress response, their role upon antibiotic exposure remains unknown. In this study, we sought to determine firstly, whether differential expression of sRNAs occurs upon antibiotic exposure and secondly, whether these sRNAs could be attributed to microbial tolerance to antibiotics.

Results: A small scale sRNA cloning strategy of Salmonella enterica serovar Typhimurium SL1344 challenged with half the minimal inhibitory concentration of tigecycline identified four sRNAs (sYJ5, sYJ20, sYJ75 and sYJ118) which were reproducibly upregulated in the presence of either tigecycline or tetracycline. The coding sequences of the four sRNAs were found to be conserved across a number of species. Genome analysis found that sYJ5 and sYJ118 mapped between the 16S and 23S rRNA encoding genes. sYJ20 (also known as SroA) is encoded upstream of the tbpAyabKyabJ operon and is classed as a riboswitch, whilst its role in antibiotic stress-response appears independent of its riboswitch function. sYJ75 is encoded between genes that are involved in enterobactin transport and metabolism. Additionally we find that the genetic deletion of sYJ20 rendered a reduced viability phenotype in the presence of tigecycline, which was recovered when complemented. The upregulation of some of these sRNAs were also observed when S. Typhimurium was challenged by ampicillin (sYJ5, 75 and 118); or when Klebsiella pneumoniae was challenged by tigecycline (sYJ20 and 118).

Conclusions: Small RNAs are overexpressed as a result of antibiotic exposure in S. Typhimurium where the same molecules are upregulated in a related species or after exposure to different antibiotics. sYJ20, a riboswitch, appears to possess a trans-regulatory sRNA role in antibiotic tolerance. These findings imply that the sRNA mediated response is a component of the bacterial response to antibiotic challenge.