The implementation of a guideline of care for patients with a Sengstaken-Blakemore tube in situ in a general intensive care unit using transitional change theory

The use of the Sengstaken–Blakemore tube as a life-saving treatment for bleeding oesophageal varices is slowly becoming the least preferred method possibly due to the potential complications associated with its placement. Nursing practice pertaining to the care of this patient group appears ad hoc and reliant on local knowledge and experience as opposed to recognised evidence of best practice. Therefore, this paper focuses on the application of Lewin's transitional change theory used to introduce a change in nursing practice with the application of a guideline to enhance the care of patients with a Sengstaken–Blakemore tube in situ within a general intensive care unit. This method identified some of the complexities surrounding the change process including the driving and restraining forces that must be harnessed and minimised in order for the adoption of change to be successful.

The climate change risk management matrix for the grazing industry of northern Australia

The complexity, variability and vastness of the northern Australian rangelands make it difficult to assess the risks associated with climate change. In this paper we present a methodology to help industry and primary producers assess risks associated with climate change and to assess the effectiveness of adaptation options in managing those risks. Our assessment involved three steps. Initially, the impacts and adaptation responses were documented in matrices by ‘experts’ (rangeland and climate scientists). Then, a modified risk management framework was used to develop risk management matrices that identified important impacts, areas of greatest vulnerability (combination of potential impact and adaptive capacity) and priority areas for action at the industry level. The process was easy to implement and useful for arranging and analysing large amounts of information (both complex and interacting). Lastly, regional extension officers (after minimal ‘climate literacy’ training) could build on existing knowledge provided here and implement the risk management process in workshops with rangeland land managers. Their participation is likely to identify relevant and robust adaptive responses that are most likely to be included in regional and property management decisions. The process developed here for the grazing industry could be modified and used in other industries and sectors. By 2030, some areas of northern Australia will experience more droughts and lower summer rainfall. This poses a serious threat to the rangelands. Although the impacts and adaptive responses will vary between ecological and geographic systems, climate change is expected to have noticeable detrimental effects: reduced pasture growth and surface water availability; increased competition from woody vegetation; decreased production per head (beef and wool) and gross margin; and adverse impacts on biodiversity. Further research and development is needed to identify the most vulnerable regions, and to inform policy in time to facilitate transitional change and enable land managers to implement those changes.

Patient group directions : the application and integration of knowledge in advancing nursing practice

Background: The introduction of Patient Group Directions (PGD) has changed significantly the way in which nurses can now administer prescription only medicines as a one-off for patients requiring this level of service. PGD’s are a written authority to administer drugs to patients that are not identified at the time of treatment. Aim: The aim of this project was to develop a PGD for use within an Outreach team to administer colloid boluses to patients presenting with hypovolemia. Method: Using a case exemplar this paper will discuss the development of a PGD using aspects of transitional change theory to highlight the potential barriers that were encountered. Implications for Practice: The implications for this PGD are wide reaching. First it now enables members from the nursing Outreach team to administer colloid fluid boluses to a prescribed patient cohort without the need for prescription. Second, it ensures the deteriorating patient has interventions initiated in a timely and appropriate manner to reduce inadvertent admission to high care areas. Last, it will improve inter-professional team-working and communication so much so that collaborative patient care reduces health costs and identifies earlier those patients requiring substantially greater nursing and medical input. Conclusion: The experience of developing a working PGD for fluid administration has meant that the Outreach team is able to respond to patients in a more effective way. In addition, it is the experience of developing this PGD that has enabled the team to contemplate other PGD’s in the execution of Outreach work.

The role of migration in urban transition : studies of the relationship between migration and modernisation for Brisbane and Stockholm

Wilbur Zelinsky formulated a Hypothesis of Mobility Transition in 1971,in which he tried to relate all aspects of mobility to the Demographic Transition and modernisation. This dissertation applies the theoretical framework, proposed by Zelinsky and extended to encompass a family of transitions, to understand migration patterns of city regions. The two city regions, Brisbane and Stockholm, are selected as case studies, representing important city regions of similar size, but drawn from contrasting historical settings. A comparison of the case studies with the theoretical framework aims to determine how the relative contributions of net migration, the source areas of migrants, and the migration intensity change with modernisation. In addition, the research also aims to identify aspects of modernisation affecting migration. These aspects of migration are analysed with a "historical approach" and a "multivariate approach". An extensive investigation into the city regions' historical background provides the source, from which evidence for a relationship between migration and modernisation is extracted. With this historical approach, similarities and differences in migration patterns are identified. The other research approach analyse multivariate data, from the last two decades, on migration flows and modernisation. Correlations between migration and key aspects of modernisation are tested with multivariate regression, based on an alternative version of a spatial interaction model. The project demonstrates that the changing functions of cities and the structural modernisation are influential on migration. Similar patterns are found, regarding the relative contributions of net migration and natural increase to population growth. The research finds links between these changes in the relative contribution of net migration and demographic modernisation. The findings on variations in urban and rural source areas of migrants to city regions do not contradict the expected pattern, but data limitations prevent definite conclusion to be drawn. The assessment of variations in migration intensity resulted in the expected pattern not being supported. Based on Swedish data, the hypothesised increase in migration intensity is rejected. Interactional migration data also show patterns different from those derived from the theoretical framework. The findings, from both research approaches, suggested that structural modernisation affected migration flows more than demographic modernisation. The findings lead to a formulation of hypothesised patterns for migration to city regions. The study provides an important research contribution by applying the two research approaches to city regions. It also combines the study of internal and international migration to address the research objectives within a framework of transitional change.

STUDY ON THE PHENOMENA OF LASER-EXCITED POPULATION-CHANGE ON RES-ONANTLY TRANSITIONAL LOWER LEVEL AND ITS APPLICATION

Ⅰ. INTRODUCTIONLaser-excited atomic fluorescence spectrometry in hollow cathode discharge(HCD) has been widely used in the research field of laser spectroscopy in recent years. Similar to traditional method, information obtained in the researches was direct line nonresonance fluorescence arising from the resonantly transitional upper level. Attention has not been sufficiently paid to the phenomenon of population change on the resonantly transitional lower level due to laser irradiation of plasma in HCD,...

‘The Judiciary and Political Change in Africa: Developing Transitional Jurisprudence in Nigeria’

At a time of increased evaluations of law, human rights, and the rise of judicial power all over the globe, the work of most African judiciaries and the principles of the jurisprudence they espouse in promoting social justice remain an unlikely focus of comparative legal scholarship. This ought not to be so in view of the considerable activities of the courts on the continent in the dawn of the third wave of democratization. This article explores the work of the Nigerian Supreme Court in the political transition to democracy since 1999. Utilizing insights from the work of Ruti Teitel, it attempts to outline some of the major constitutional and extraconstitutional principles adopted by the Court in mediating intergovernmental contestations in the turbulent transition away from almost three decades of authoritarian military rule. It emerges that the task of fostering social transformation through the “weakest” branch seriously tasks the institutional integrity of the judiciary.

Contradictions : Genre, causal layered analysis and analysis of institutional change

In what follows, I put forward an argument for an analytical method for social science that operates at the level of genre. I argue that generic convergence, generic hybridity, and generic instability provide us with a powerful perspectives on changes in political, cultural, and economic relationships, most specifically at the level of institutions. Such a perspective can help us identify the transitional elements, relationships, and trajectories that define the place of our current system in history, thereby grounding our understanding of possible futures.1 In historically contextualising our present with this method, my concern is to indicate possibilities for the future. Systemic contradictions indicate possibility spaces within which systemic change must and will emerge. We live in a system currently dominated by many fully-expressed contradictions, and so in the presence of many possible futures. The contradictions of the current age are expressed most overtly in the public genres of power politics. Contemporary public policy—indeed politics in general-is an excellent focus for any investigation of possible futures, precisely because of its future-oriented function. It is overtly hortatory; it is designed ‘to get people to do things’ (Muntigl in press: 147). There is no point in trying to get people to do things in the past. Consequently, policy discourse is inherently oriented towards creating some future state of affairs (Graham in press), along with concomitant ways of being, knowing, representing, and acting (Fairclough 2000).

Influencing innovation in SME’s : from designer to transitional engineer

The following paper presents insights found during an ongoing industry engagement with a family-owned manufacturing SME in Australia. The study seeks to unpack cultural, strategic, product opportunities and challenges available to the firm engaging in a design led approach to innovation. Design led innovation finds new market opportunities to innovate through a holistic perspective of both the internal business operations, focusing on the customer experience and external stakeholders. The action research based methodology consisted of 25 semi-structured interviews, a reflective journal and focus group, all of which were analysed thematically. This paper focuses on the resultant themes of the focus group data constituting a discussion around the best strategies to try and integrate design thinking as a fundamental skill across the company. The main thematic results included the participant’s limited views of themselves (in current roles) as being to create ‘buy-in’ to change initiatives, a preference to act as a group to gain traction in the firm, importance of better defining the problem before reaching a design solution and lastly the time required to implement versus the need for change. These findings are valuable in assisting other family owned firms in managing core growth activities with design and innovation initiatives, particularly in the area of new product development.

Experimental Study on the Thermal Argon Plasma Generation and Jet Length Change Characteristics at Atmospheric Pressure

The generation, jet length and flow-regime change characteristics of argon plasma issuing into ambient air have been experimentally examined. Different torch structures have been used in the tests. Laminar plasma jets can be generated within a rather wide range of working-gas flow rates, and an unsteady transitional flow state exists between the laminar and turbulent flow regimes. The high-temperature region length of the laminar plasma jet can be over an order longer than that of the turbulent plasma jet and increases with increasing argon flow rate or arc current, while the jet length of the turbulent plasma is less influenced by the generating parameters. The flow field of the plasma jet has very high radial gradients of plasma parameters, and a Reynolds number alone calculated in the ordinary manner may not adequately serve as a criterion for transition. The laminar plasma jet can have a higher velocity than that of an unsteady or turbulent jet. The long laminar plasma jet has good stiffness to withstand the impact of laterally injected cold gas and particulate matter. It could be used as a rather ideal object for fundamental studies and be applied to novel materials processing due to its attractive stable and adjustable properties.

Estimates of body sizes at maturation and at sex change, and the spawning seasonality and sex ratio of the endemic Hawaiian grouper (Hyporthodus quernus, F. Epinephelidae)

A case study of the reproductive biology of the endemic Hawaiian grouper or hapu’upu’u (Hyporthodus quernus) is presented as a model for comprehensive future studies of economically important epinephelid groupers. Specimens were collected throughout multiple years (1978–81, 1992–93, and 2005–08) from most reefs and banks of the Northwestern Hawaiian Islands. The absence of small males, presence of atretic oocytes and brown bodies in testes of mature males, and both developed ovarian and testicular tissues in the gonads of five transitional fish provided evidence of protogynous hermaphroditism. No small mature males were collected, indicating that Hawaiian grouper are monandrous (all males are sex-changed females). Complementary microscopic criteria also were used to assign reproductive stage and estimate median body sizes (L50) at female sexual maturity and at adult sex change from female to male. The L50 at maturation and at sex change was 580 ±8 (95% confidence interval [CI]) mm total length (TL) and 895 ±20 mm TL, respectively. The adult sex ratio was strongly female biased (6:1). Spawning seasonality was described by using gonadosomatic indices. Females began ripening in the fall and remained ripe through April. A February–June main spawning period that followed peak ripening was deduced from the proportion of females whose ovaries contained hydrated oocytes, postovulatory follicles, or both. Testes weights were not affected by season; average testes weight was only about 0.2% of body weight—an order of magnitude smaller than that for ovaries that peaked at 1–3% of body weight. The species’ reproductive life history is discussed in relation to its management.

Testate amoebae as indicators of hydroseral change: an 8,500 year record from Mer Bleue Bog, eastern Ontario, Canada.

Testate amoebae have been used widely as a proxy of hydrological change in ombrotrophic peatlands, although their response to abiotic controls in other types of mire and fenland palaeo-environments is less well understood. This paper examines the response of testate amoebae to hydroseral and other environmental changes at Mer Bleue Bog, Ontario, Canada, a large ombrotrophic peatland, which evolved from a brackish-water embayment in the early Holocene. Sediments, plant macrofossils and diatoms examined from a 5.99 m core collected from the dome of the bog record six stages of development: i) a quiet, brackish-water riverine phase (prior to ca. 8500 cal BP); ii) a shallow lake (ca. 8500–8200 cal BP); iii) fen (8200–7600 cal BP); iv) transitional mire (7600–6900 cal BP); v) pioneer raised mire (6900–4450 cal BP); and vi) ombrotrophic bog (4450 cal BP-present).

Testate amoebae, notably small (<25 µm diameter) specimens of Centropyxis aculeata type, first appear in low abundances in sediments ascribed to the lacustrine phase. Diatoms from the same horizons record a shallowing in water depth, a decline in salinity and the development of emergent macrophytic vegetation, which may have provided favourable conditions for testate amoeba colonization. The testate amoeba communities of the inferred fen phase are more diverse and include centropyxids, cyclopyxids, Arcellidae and Hyalospheniidae, although the assemblages show some differences to those recently reported in modern European fen environments. The Fen–Bog Transition (FBT) is also dominated by C. aculeata type. The change in testate amoeba communities around this key transition is apparent in the results of Detrended Correspondence Analysis (DCA), and appears to reflect a latent nutrient gradient and a secondary moisture gradient. DCA analyses of plant macrofossil remains around the FBT show a similar trend, although the sensitivity of the two proxies to the inferred environmental changes differs. Comparisons with other regional mid-Holocene peatland records confirm the important influence of reduced effective precipitation on the testate amoeba communities during the initiation and development of Sphagnum-dominated, raised bog communities.