Advanced practice nursing role development: factor analysis of a modified role delineation tool

Aim his study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third paper from a multi-phase Australian study aimed at assigning advanced practice roles. Methods A postal survey was conducted of a random sample of state government employed Registered nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach’s alpha coefficient determined reliability of the overall scale and identified factors. Results There were 658 responses (42% response rate). The five factors found with loadings of ≥.400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach’s alpha coefficient was .94 overall and for the factors ranged from 0.83 to 0.95. Conclusion Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment

Cough: are children really different to adults?

Worldwide paediatricians advocate that children should be managed differently from adults. In this article, similarities and differences between children and adults related to cough are presented. Physiologically, the cough pathway is closely linked to the control of breathing (the central respiratory pattern generator). As respiratory control and associated reflexes undergo a maturation process, it is expected that the cough would likewise undergo developmental stages as well. Clinically, the 'big three' causes of chronic cough in adults (asthma, post-nasal drip and gastroesophageal reflux) are far less common causes of chronic cough in children. This has been repeatedly shown by different groups in both clinical and epidemiological studies. Therapeutically, some medications used empirically for cough in adults have little role in paediatrics. For example, anti-histamines (in particular H(1 )antagonists) recommended as a front-line empirical treatment of chronic cough in adults have no effect in paediatric cough. Instead it is associated with adverse reactions and toxicity. Similarly, codeine and its derivatives used widely for cough in adults are not efficacious in children and are contraindicated in young children. Corticosteroids, the other front-line empirical therapy recommended for adults, are also minimally (if at all) efficacious for treating non-specific cough in children. In summary, current data support that management guidelines for paediatric cough should be different to those in adults as the aetiological factors and treatment in children significantly differ to those in adults

Managing pertussis in adults

Pertussis or whooping cough is typically characterised by paroxysms of coughing with a whooping sound during inhalation. It is thought to be under-diagnosed generally. Whooping cough is caused by Bordetella pertussis and is highly contagious. Although childhood immunisation has been effective in preventing the disease, outbreaks in Australia have been associated with waning immunity in older children and adolescents. The peak incidence of infection now occurs in people aged 15 or older. When given early in the illness, antibiotics can decrease the infectious period, but have no effect on the duration or severity of disease. Symptomatic treatment of cough has shown no clear benefit. Antibiotic prophylaxis of contacts is recommended for certain high-risk groups, but there is limited evidence of its effectiveness. Although infants remain the most at risk for severe, life-threatening disease, it is adolescent and adult booster immunisation which remains critical for prevention programs

Argan e Giacomo Serpotta

Il testo, frutto dell\u2019intervento tenuto alla giornata di studi su Giulio Carlo Argan, docente di Storia dell\u2019Arte all\u2019universit\ue0 di Palermo tra il 1955 e il 1959, prende in esame un suo breve ma fondamentale contributo sullo scultore-stuccatore palermitano Giacomo Serpotta (1656-1752) scritto nel 1957. L\u2019analisi critica del testo, interpretando la densit\ue0 dei concetti espressi dal critico e storico dell\u2019arte, mette in evidenza gli aspetti salienti della critica arganiana sull\u2019argomento. Si rileva come Argan voli subito molto alto ed tracci delle interpretazioni ancora estremamente valide, come anche alcune letture complesse e di certo avvincenti, che pongono in ulteriore luce l\u2019arte del maestro palermitano come un artista del pieno barocco e per nulla provinciale

QoS-Aware Middleware for Web Services Composition

The paradigmatic shift from a Web of manual interactions to a Web of programmatic interactions driven by Web services is creating unprecedented opportunities for the formation of online Business-to-Business (B2B) collaborations. In particular, the creation of value-added services by composition of existing ones is gaining a significant momentum. Since many available Web services provide overlapping or identical functionality, albeit with different Quality of Service (QoS), a choice needs to be made to determine which services are to participate in a given composite service. This paper presents a middleware platform which addresses the issue of selecting Web services for the purpose of their composition in a way that maximizes user satisfaction expressed as utility functions over QoS attributes, while satisfying the constraints set by the user and by the structure of the composite service. Two selection approaches are described and compared: one based on local (task-level) selection of services and the other based on global allocation of tasks to services using integer programming