Constancy and difference in the dimensions and elements of nursing practice, 1901-1981 : a thesis presented in partial fulfilment of the requirements for the degree of M.A. (Soc. Sci.) at Massey University

Irregular pagination: pgs 124 & 285 missingThis study presents a selective literature review in which the three components of modern nursing (practice, education and research) are identified. Consideration is given to the dimensions and elements of two of the components - nursing education and nursing practice and the relationship between these two components is investigated using the examination system of nursing education as the connective link. From the literature review presented in the first three chapters, the Nursing Education Examination. Practice Model (N.E.E.P.) has been derived for this project which examines the constancy and differences in the six stated dimensions of nursing practice and their associated elements along a time continuum from 1901 to 1981. The model is used to collect and collate the data elicited from the analysis of the five yearly sample of State Final examination papers and the identification of historical trends in the New Zealand Nursing Journal, relating to the six dimensions of nursing practice and their associated elements. This two pronged approach allowed the author to crosscheck the findings from the two data sources. In addition, changes in the composition of nursing practice are studied in one specific area; the nursing care of patients with accidental trauma. The following propositions were derived from the literature review presented in the first section of this study; 1. That the six dimensions of nursing practice (care, cure, protection, teaching, co-ordination and patient advocacy) will remain constant over time and different practice setings; 2. that the elements of each dimension will vary with time and with practice setting. The findings elicited from the analysis of surgical examination papers revealed that the three dimensions of care, cure and co-ordination occur in all the time periods investigated in this study. The same three dimensions of nursing practice are evident in at least 81% of the time periods in which questions relating to accidental trauma in the examination papers are found. Therefore these three dimensions can be said to form the "heart" of nursing practice over the years. Although fluctuations occur in the importance placed upon the dimensions, from 1961 increasing emphasis is found in all the dimensions except the cure dimension where a declining trend is demonstrated. It was found that constancy in all six dimensions of nursing practice is apparent from this time. An examination of the elements of nursing practice shows that although the three dimensions of nursing practice remain constant over the years, findings relating to the elements making up three dimensions indicate both constancy and differences. The five elements of nursing practice which make up the "core" elements of nursing practice are; general nursing care; reference to specific patients; functional status; treatments; and nurse interactions. References to these elements appear in each of the 17 time periods in the general analysis. Their importance in relation to the nursing of patients with accidental trauma is also evident. At the other extreme are the elements of sleep, blood pressure, and T.P.R. which appear in less than 3 of the 17 time periods. Reference to patient preferences/ interests are never found in the data elicited from the examination papers. Examination of accidental trauma findings reveals similar trends to the general results. From 1961 particularly the journal articles substantiate the findings elicited from the examination analysis. A brief discussion of the implications of the constancy and difference in the dimensions of nursing practice and their associated elements for nursing is included

Indigenous vegetation types of Hamilton Ecological District

The following descriptions of indigenous vegetation types and lists of the most characteristic species have been compiled for the major landform units of the Hamilton Ecological District, which lies within the Waikato Ecological Region (McEwen 1987). The boundaries of the Hamilton Ecological District correspond approximately to those of the Hamilton basin, with the addition of parts of hills and foothills at the margins of the basin. The vegetation descriptions and species lists are based on knowledge of the flora of vegetation remnants in the ecological district, historical records (e.g., Gudex 1954), and extrapolation of data from other North Island sites with similar environmental profiles

The clinical effectiveness and cost-effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation

Background: This review examines the clinical effectiveness and cost-effectiveness of hand-held inhalers to deliver medication for the routine management of chronic asthma in children aged between 5 and 15 years. Asthma is a common disease of the airways, with a prevalence of treated asthma in 5–15-year-olds of around 12% and an actual prevalence in the community as high as 23%. Treatment for the condition is predominantly by inhalation of medication. There are three main types of inhaler device, pressurised metered dose, breath actuated, and dry powder, with the option of the attachment of a spacer to the first two devices under some prescribed circumstances. Two recent reviews have examined the clinical and cost-effectiveness evidence on inhaler devices, but one was for children aged under 5 years and the comparison in the second was made between pressurised metered dose inhalers and other types only. Objectives: This review examines the clinical effectiveness and cost-effectiveness of manual pressurised metered dose inhalers, breath-actuated metered dose inhalers, and breath-actuated dry powder inhalers, with and without spacers as appropriate, to deliver medication for the routine management of chronic asthma in children aged between 5 and 15 years. Methods: Two previous HTA reviews have compared the effectiveness of inhaler devices, one focusing on asthma in children aged under 5 years and the other on asthma and chronic obstructive airways disease in all age groups. For the current review, a literature search was carried out to identify all evidence relating to the use of inhalers in older children with chronic asthma. A search of in-vitro studies undertaken for one of the previous reviews was also updated. The data sources used were: 15 electronic bibliographic databases; the reference lists of one of the previous HTA reports and other relevant articles; health services research-related internet resources; and all sponsor submissions. Studies were selected according to strict inclusion and exclusion criteria, and relevant information concerning effectiveness and patient compliance and preference was extracted directly on to an extraction/evidence table. Quality assurance was monitored. Economic evaluation was undertaken by reviewing existing cost-effective evidence. Further economic modelling was carried out, and tables constructed to determine device cost-minimisation and incremental quality-adjusted life-year (QALY) thresholds between devices. Results: Number and quality of studies, and direction of evidence: Fourteen randomised controlled studies were identified relating to the clinical effectiveness of inhaler devices for delivering β2-agonists. A further five were on devices delivering corticosteroids and one concerned the delivery of cromoglicate. Overall, there were no differences in clinical efficacy between inhaler devices, but a pressurised metered dose inhaler with a spacer would appear to be more effective than one without. These findings endorse those of a previous HTA review but extend them to other inhaler devices. Seven randomised controlled trials examined the impact on clinical effectiveness of using a nonchlorofluorocarbon (CFC) propellant in place of a CFC propellant in metered dose inhalers, both pressurised and breath activated, although only one study considered the latter type. No differences were found between inhalers containing either propellant. A further 30 studies of varying quality, from 12 randomised controlled trials to non-controlled studies, were identified that concerned the impact of use by, and preference for, inhaler type, and treatment adherence in children. Differences between the studies, and limitations in comparative data between various inhaler device types, make it difficult to draw any firm conclusions from this evidence. Summary of benefits: No obvious benefits for one inhaler device type over another for use in children aged 5–15 years were identified. Costs and cost per quality-adjusted life-year: Two approaches have been taken: cost-minimisation and QALY threshold. In the QALY threshold approach, additional QALYs that each device must produce compared with a cheaper device to achieve an acceptable cost per QALY were calculated. Using the cheapest and most expensive devices for delivering 200 μg of beclometasone per day, assuming no cost offset for any device, and a threshold of £5000, the largest QALY needed was 0.00807. With such a small QALY increase, no intervention can be categorically rejected as not cost-effective. Conclusions: Generalisability of findings: On the available evidence there are no obvious benefits for one inhaler device over another when used by children aged 5–15 years with chronic asthma. However, the evidence, in the majority of cases, was compiled on children with mild to moderate asthma and restricted to a limited number of drugs. Therefore the findings may not be generalisable to those at the more severe end of the spectrum of the disease or to inhaler devices delivering some of the drugs used in the management of asthma. Need for further research: Many of the previous studies are likely to have been underpowered. Further clinical trials with a robust methodology, sufficient power and qualitative components are needed to demonstrate any differences in clinical resource use and patients’ asthma symptoms. Further studies should also include the behavioural aspects of patients towards their medication and its delivery mechanisms. It is acknowledged that sufficient power may prove impractical owing to the large numbers of patients required

On non-normality and classification of amplification mechanisms in stability and resolvent analysis

We seek to quantify non-normality of the most amplified resolvent modes and predict their features based on the characteristics of the base or mean velocity profile. A 2-by-2 model linear Navier-Stokes (LNS) operator illustrates how non-normality from mean shear distributes perturbation energy in different velocity components of the forcing and response modes. The inverse of their inner product, which is unity for a purely normal mechanism, is proposed as a measure to quantify non-normality. In flows where there is downstream spatial dependence of the base/mean, mean flow advection separates the spatial support of forcing and response modes which impacts the inner product. Success of mean stability analysis depends on the normality of amplification. If the amplification is normal, the resolvent operator written in its dyadic representation reveals that the adjoint and forward stability modes are proportional to the forcing and response resolvent modes. If the amplification is non-normal, then resolvent analysis is required to understand the origin of observed flow structures. Eigenspectra and pseudospectra are used to characterize these phenomena. Two test cases are studied: low Reynolds number cylinder flow and turbulent channel flow. The first deals mainly with normal mechanisms and quantification of non-normality using the inverse inner product of the leading forcing and response modes agrees well with the product of the resolvent norm and distance between the imaginary axis and least stable eigenvalue. In turbulent channel flow, structures result from both normal and non-normal mechanisms. Mean shear is exploited most efficiently by stationary disturbances while bounds on the pseudospectra illustrate how non-normality is responsible for the most amplified disturbances at spatial wavenumbers and temporal frequencies corresponding to well-known turbulent structures

Identifying the transporters of different flavonoids in plants

We recently identified a new component of flavonoid transport pathways in Arabidopsis. The MATE protein FFT (Flower Flavonoid Transporter) is primarily found in guard cells and seedling roots, and mutation of the transporter results in floral and growth phenotypes. The nature of FFT’s substrate requires further exploration but our data suggest that it is a kaempferol diglucoside. Here we discuss potential partner H+-ATPases and possible redundancy among the close homologues within the large Arabidopsis MATE family