A case study of asthma care in school age children using nurse-coordinated multidisciplinary collaborative practices

Aim: To describe the role of school nursing in leading and coordinating a multidisciplinary networked system of support for children with asthma, and to analyze the strengths and challenges of undertaking and supporting multiagency interprofessional practice. Background: The growth of networked and interprofessional collaborations arises from the recognition that a number of the most pressing public health problems cannot be addressed by single-discipline or -agency interventions. This paper identifies the potential of school nursing to provide the vision and multiagency leadership required to coordinate multidisciplinary collaboration. Method: A mixed-method single-case study design using Yin’s approach, including focus groups, interviews, and analysis of policy documents and public health reports. Results: A model that explains the integrated population approach to managing school-age asthma is described; the role of the lead school nurse coordinator was seen as critical to the development and sustainability of the model. Conclusion: School nurses can provide strategic multidisciplinary leadership to address pressing public health issues. Health service managers and commissioners need to understand how to support clinicians working across multiagency boundaries and to identify how to develop leadership skills for collaborative interprofessional practice so that the capacity for nursing and other health care professionals to address public health issues does not rely on individual motivation. In England, this will be of particular importance to the commissioning of public health services by local authorities from 2015

The Role of Cold Flows in the Assembly of Galaxy Disks

We use high resolution cosmological hydrodynamical simulations to demonstrate that cold flow gas accretion, particularly along filaments, modifies the standard picture of gas accretion and cooling onto galaxy disks. In the standard picture, all gas is initially heated to the virial temperature of the galaxy as it enters the virial radius. Low mass galaxies are instead dominated by accretion of gas that stays well below the virial temperature, and even when a hot halo is able to develop in more massive galaxies there exist dense filaments that penetrate inside of the virial radius and deliver cold gas to the central galaxy. For galaxies up to ~L*, this cold accretion gas is responsible for the star formation in the disk at all times to the present. Even for galaxies at higher masses, cold flows dominate the growth of the disk at early times. Within this modified picture, galaxies are able to accrete a large mass of cold gas, with lower initial gas temperatures leading to shorter cooling times to reach the disk. Although star formation in the disk is mitigated by supernovae feedback, the short cooling times allow for the growth of stellar disks at higher redshifts than predicted by the standard model.Comment: accepted to Ap

Nine percent nickel steel heavy forging weld repair study

The feasibility of making weld repairs on heavy section 9% nickel steel forgings such as those being manufactured for the National Transonic Facility fan disk and fan drive shaft components was evaluated. Results indicate that 9% nickel steel in heavy forgings has very good weldability characteristics for the particular weld rod and weld procedures used. A comparison of data for known similar work is included

Magnetic order in the quasi-one-dimensional spin 1/2 chain, copper pyrazine dinitrate

We present the first evidence of magnetic order in the quasi-one-dimensional spin 1/2 molecular chain compound, copper pyrazine dinitrate Cu(C4H4N2)(NO3)2}. Zero field muon-spin relaxation measurements made at dilution refrigerator temperatures show oscillations in the measured asymmetry, characteristic of a quasistatic magnetic field at the muon sites. Our measurements provide convincing evidence for long range magnetic order below a temperature T_N=107(1) mK. This leads to an estimate of the interchain coupling constant of |J'|/k_B=0.046 K and to a ratio |J'/J| = 4.4 x 10^-3.Comment: 4 pages, 3 figures. Submitted to Physical Review Letter

Charge transfer complexes and radical cation salts of chiral methylated organosulfur donors

The single crystal X-ray structure of the all-axial conformer of the (R,R,R,R) enantiomer of the chiral donor tetramethyl-BEDT-TTF (TM-BEDT-TTF) was described and compared to the all-equatorial conformer. (S,S,S,S)-Tetramethyl-BEDT-TTF formed crystalline 1 : 1 complexes with TCNQ and TCNQ-F4, as well as a THF solvate of the TCNQ complex. Donors bis((2S,4S)-pentane-2,4-dithio)tetrathiafulvalene and (ethylenedithio)((2S,4S)-pentane-2,4-dithio)tetrathiafulvalene, which contain seven-membered rings bearing chirally oriented methyl groups, only formed complexes with TCNQ-F4. The TCNQ-F4 complexes contain planar organosulfur systems, in contrast to the TCNQ complexes in which there is minimal charge transfer. A variety of crystal packing modes were observed. Electrocrystallization experiments with both enantiomers and the racemic form of tetramethyl-BEDT-TTF afforded mixed valence radical cation salts with the AsF6 and SbF6 anions formulated as (TM-BEDT-TTF)2XF6 (X = As, Sb). Electrical conductivity was only found in one charge transfer complex, while the radical cation salts are all semiconducting

PEComa of the Upper Extremity: A Unique Case and Description of an Initial Response to Neoadjuvant Chemotherapy

Purpose. Tumors of the perivascular epithelial cell tumor (PEComa), first described in 1992, represent a rare soft tissue neoplasm of varying malignant potential. Cases of PEComa have been previously described in a few somatic and visceral sites, most notably in the gastrointestinal tract, genitourinary tract, and one extremity case in the thigh. To date, most malignant cases of PEComa have been resistant to chemotherapy, and as such, an appropriate therapy is not known. Case report. Here we describe the first case of PEComa of the upper extremity. Open biopsy revealed a high-grade malignant lesion, and the patient subsequently underwent both neoadjuvant therapy with doxorubicin, ifosfamide and mensa, and radiation therapy prior to wide surgical resection. After six cycles of chemotherapy, the tumor underwent an 80% reduction in size. Subsequent neoadjuvant radiation therapy of 5000 cGy did not further reduce the size of the tumor. Following limb sparing radical resection, pathology showed 20% necrosis within a high-grade malignant lesion. Twenty one months after beginning treatment, the patient shows no sign of local recurrence, but metastatic disease was confirmed after resection of a lung nodule. Conclusion. Given the favorable albeit partial response seen in this patient, the course of therapy outlined here may represent a good starting point for neoadjuvant treatment in a tumor with a historically bleak prognosis. In addition, the diagnosis of PEComa must now be entertained in the differential diagnosis of upper extremity soft tissue sarcoma

Feedback control of thermal lensing in a high optical power cavity

This paper reports automatic compensation of strong thermal lensing in a suspended 80 m optical cavity with sapphire test mass mirrors. Variation of the transmitted beam spot size is used to obtain an error signal to control the heating power applied to the cylindrical surface of an intracavity compensation plate. The negative thermal lens created in the compensation plate compensates the positive thermal lens in the sapphire test mass, which was caused by the absorption of the high intracavity optical power. The results show that feedback control is feasible to compensate the strong thermal lensing expected to occur in advanced laser interferometric gravitational wave detectors. Compensation allows the cavity resonance to be maintained at the fundamental mode, but the long thermal time constant for thermal lensing control in fused silica could cause difficulties with the control of parametric instabilities.This research was supported by the Australian Research Council and the Department of Education, Science and Training and by the U.S. National Science Foundation, through LIGO participation in the HOPF