Nurse Influence in Policy Development: A Model Using Storytelling

This project will explore how nurses\u27 stories of social injustice can be used to influence legislative action on health policy. Nursing history has proved the profession\u27s roots in political activism and social justice, Role models and trailblazers like Lillian Wald solidified the nursing intervention of political involvement, but somewhere along the way it has lost its value. Using Newman\u27s Health as Expanding Consciousness theory as a guide, nurses can use stories to illustrate the patterns of disruption in the current healthcare system and then lead policy into reform

Evolution of antigen binding receptors

This review addresses issues related to the evolution of the complex multigene families of antigen binding receptors that function in adaptive immunity. Advances in molecular genetic technology now permit the study of immunoglobulin (Ig) and T cell receptor (TCR) genes in many species that are not commonly studied yet represent critical branch points in vertebrate phylogeny. Both Ig and TCR genes have been defined in most of the major lineages of jawed vertebrates, including the cartilaginous fishes, which represent the most phylogenetically divergent jawed vertebrate group relative to the mammals. Ig genes in cartilaginous fish are encoded by multiple individual loci that each contain rearranging segmental elements and constant regions. In some loci, segmental elements are joined in the germline, i.e. they do not undergo genetic rearrangement. Other major differences in Ig gene organization and the mechanisms of somatic diversification have occurred throughout vertebrate evolution. However, relating these changes to adaptive immune function in lower vertebrates is challenging. TCR genes exhibit greater sequence diversity in individual segmental elements than is found in Ig genes but have undergone fewer changes in gene organization, isotype diversity, and mechanisms of diversification. As of yet, homologous forms of antigen binding receptors have not been identified in jawless vertebrates; however, acquisition of large amounts of structural data for the antigen binding receptors that are found in a variety of jawed vertebrates has defined shared characteristics that provide unique insight into the distant origins of the rearranging gene systems and their relationships to both adaptive and innate recognition processes

The scope of practice of physiotherapists who work in intensive care in South Africa: a questionnaire-based survey

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Masters of Science in Physiotherapy. Johannesburg, 2015Patients admitted to the intensive care unit (ICU) require continuous monitoring and care from all staff working in ICU; this includes doctors, nursing staff, physiotherapists, dieticians and various other medical staff. Conventionally ICU was predominantly staffed by physicians and nursing personnel, with other members of health care having a minor part to play in the patient’s care whilst in ICU. Depending on the country, type of unit, amount of staff and level of training, the physiotherapist may screen the patients to assess if they require physiotherapy and if so, what intervention will be required; on the other hand, in some units the physiotherapist may rely on referral from the doctors and administer the treatment requested by the doctor for the particular patient. In 2000, Norrenberg and Vincent conducted a study to establish the profile of physiotherapists working in ICU in Europe. Van Aswegen and Potterton (2005) adjusted the questionnaire compiled by Norrenberg and Vincent (2000) to be more suitable for the South African setting. A pilot study using this questionnaire was done to determine the scope of practice of physiotherapists in ICU in South Africa. The content of the modified questionnaire used by Van Aswegen and Potterton (2005) was not validated prior to its implementation and a sample of convenience was used. Results reported from that survey were therefore only preliminary and no additional surveys had been performed to date. Objectives: The aim of this study was to establish the current scope of practice of physiotherapists in ICU in South Africa. To determine if physiotherapists’ scope of practice in ICU in South Africa has changed since the report published by Van Aswegen and Potterton (2005). To compare South African physiotherapists’ scope of practice in ICU with that reported on an international level. Methodology: A pre-existing questionnaire used by Van Aswegen and Potterton (2005) was content validated for this study. After consensus was reached on the final version of this questionnaire, it was uploaded onto SurveyMonkey. Physiotherapists that worked in ICU in the government sector, hospitals belonging to the Life, MediClinic and NetCare groups or that were members of the Cardiopulmonary Physiotherapy Rehabilitation Group of the South African Society of Physiotherapy were invited to participate in this study. Results: A total of 319 questionnaires were sent out and 108 responses were received. The combined response rate for this survey was 33.9%. An assessment technique that was performed ‘very often’ by respondents was an ICU chart assessment (n=90, 83.3%), auscultation (n=94, 81, 8%) and strength of cough effort (n=81, 75%). Assessment techniques that were ‘almost never’ or ‘never’ used included assessment of lung compliance (n=75; 69.4%), calculation for the presence of hypoxemia (n=74; 68.5%) and patient readiness for weaning (n=63; 58.3%). Treatment techniques performed by respondents ‘very often’ included manual chest clearance techniques (n=101, 93.5%), mobilising a patient in bed (n=91, 84.3%), positioning a patient in bed (n=91, 84.3%), airway suctioning (n=89, 82.4%), mobilising a patient out of bed (n=84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle strengthening exercises (n=79, 73.1%). Treatment techniques that were ‘never’ or ‘almost never’ used included the flutter device (n=77, 71.3%), implementation and supervision of non-invasive ventilatory support (n=77, 71.3%) and adjustment of mechanical ventilation settings for respiratory muscle training (n=76, 70.4%). Physiotherapists working in the private sector made up 60.2% (n=65) of the respondents. An afterhours physiotherapy service was provided to ICU patients by 78 (72.2%) of the respondents during the week. One hundred and five (97.2%) of the respondents provided a physiotherapy service for ICU patients over the weekend. When comparing the results of the current study to the studies by Norrenberg and Vincent (2000) and Van Aswegen and Potterton (2005), there was a significant difference (p < 0.05) in the usage of IPPB/NIPPV, weaning patients from MV, adjustment of MV settings and IS between the studies. Results from the current study showed a significant difference (p < 0.05) in the involvement of respondents in suctioning, extubation and adjustment of MV settings compared to that reported by Norrenberg and Vincent (2000). Conclusion: Physiotherapists in this study performed a multisystem assessment of their patient’s which is important since physiotherapists are first line practitioners in South Africa. Physiotherapists play an important role in treating and preventing respiratory and musculoskeletal complications that occur in ICU. The results from this study showed that physiotherapists in South Africa are treating their patient’s according to evidenced based practice but due to the high nonresponse bias these results should be interpreted with caution. The results from this study can be used to develop preliminary clinical practice guidelines for physiotherapists working in ICU in South Africa

The mantle isotopic printer: Basic mantle plume geochemistry for seismologists and geodynamicists

High-temperature geochemistry combined with igneous petrology is an essential tool to infer the conditions of magma generation and evolution in the Earth's interior. During the past thirty years, a large number of geochemical models of the Earth, essentially inferred from the isotopic composition of basaltic rocks, have been proposed. These geochemical models have paid little attention to basic physics concepts, broadband seismology, or geological evidence, with the effect of producing results that are constrained more by assumptions than by data or first principles. This may not be evident to seismologists and geodynamicists. A common view in igneous petrology, seismology, and mantle modeling is that isotope geochemistry (e.g., the Rb-Sr, Sm-Nd, U-Th-Pb, U-Th-He, Re-Os, Lu-Hf, and other less commonly used systems) has the power to identify physical regions in the mantle, their depths, their rheological behavior, and the thermal conditions of magma generation. We demonstrate the fallacy of this approach and the model-dependent conclusions that emerge from unconstrained or poorly constrained geochemical models that do not consider physics, seismology (other than teleseismic travel-time tomography and particularly compelling colored mantle cross sections), and geology. Our view may be compared with computer printers. These can reproduce the entire range of colors using a limited number of basic colors (black, magenta, yellow, and cyan). Similarly, the isotopic composition of oceanic basalts and nearly all their primitive continental counterparts can be expressed in terms of a few mantle end members. The four most important (actually “most extreme”, because some are extraordinarily rare) mantle end members identified by isotope geochemists are DMM or DUM (depleted MORB [mid-ocean-ridge basalt] mantle or depleted upper mantle), HIMU (high mu, where mu = μ = ^(238)U/^(204)Pb), EMI, and EMII (enriched mantle type I and type II). Other mantle end members, or components, have been proposed in the geochemical literature (e.g., PHeM, FOZO, LVC, PreMa, EMIII, CMR, LOMU, and C), but these can be considered to be less extreme components or mixtures in the geochemical mantle zoo. Assuming the existence of these extreme "colors" in the mantle isotopic printer, the only matter for debate is their location in the Earth's interior. At least three of them need long-term insulation from convection-driven homogenization or mixing processes. In other words, where these extreme isotopic end members are located needs to be defined. In our view, no geochemical, geological, geophysical, or physical arguments require the derivation of any magma from deep mantle sources. Arguments to the contrary are assumption based. The HIMU, EMI, and EMII end members can be entirely located in the shallow non-convecting volume of the mantle, while the fourth, which is by far the more abundant volumetrically (DMM or DUM), can reside in the transition zone. This view is inverted compared with current canonical geochemical views of the Earth's mantle, where the shallowest portions are assumed to be DMM like (ambient mantle) and the EMI-EMII-HIMU end members are assumed to be isolated, located in the deep mantle, and associated with thermal anomalies. We argue that the ancient, depleted signatures of DMM imply long-term isolation from recycling and crustal contamination while the enriched components are not free of contamination by shallow materials and can therefore be shallow

HEB in the Spotlight: Transcriptional Regulation of T-Cell Specification, Commitment, and Developmental Plasticity

The development of T cells from multipotent progenitors in the thymus occurs by cascades of interactions between signaling molecules and transcription factors, resulting in the loss of alternative lineage potential and the acquisition of the T-cell functional identity. These processes require Notch signaling and the activity of GATA3, TCF1, Bcl11b, and the E-proteins HEB and E2A. We have shown that HEB factors are required to inhibit the thymic NK cell fate and that HEBAlt allows the passage of T-cell precursors from the DN to DP stage but is insufficient for suppression of the NK cell lineage choice. HEB factors are also required to enforce the death of cells that have not rearranged their TCR genes. The synergistic interactions between Notch1, HEBAlt, HEBCan, GATA3, and TCF1 are presented in a gene network model, and the influence of thymic stromal architecture on lineage choice in the thymus is discussed

Educational Color Mixer

Background: The production of intermediate colors using a combination of primary colors is an important phenomenon for children to learn about. It is also desirable for children to be exposed to robotics/mechatronics at an early age. One machine could address both of these goals. Product: A device with three colored liquids or paints (red, yellow and blue) and a way to select a color from the color wheel. The device automatically dispenses the correct amounts of each colored liquid or paint into one container to produce the desired color. The electromechanical components should be easy to see, but shielded enough to maintain safety

"Spin-Disentangled" Exact Diagonalization of Repulsive Hubbard Systems: Superconducting Pair Propagation

By a novel exact diagonalization technique we show that bound pairs propagate between repulsive Hubbard clusters in a superconducting fashion. The size of the matrices that must be handled depends on the number of fermion configurations {\em per spin}, which is of the order of the square root of the overall size of the Hilbert space. We use CuO$_{4}$ units connected by weak O-O links to model interplanar coupling and c-axis superconductivity in Cuprates. The numerical evidence on Cu$_{2}$O$_{8}$ and Cu$_{3}$O$_{12}$ prompts a new analytic scheme describing the propagation of bound pairs and also the superconducting flux quantization in a 3-d geometry.Comment: 5 pages, 3 figure