Multiple Invaded Consolidating Materials

We study a multiple invasion model to simulate corrosion or intrusion processes. Estimated values for the fractal dimension of the invaded region reveal that the critical exponents vary as function of the generation number $G$, i.e., with the number of times the invasion process takes place. The averaged mass $M$ of the invaded region decreases with a power-law as a function of $G$, $M\sim G^{\beta}$, where the exponent $\beta\approx 0.6$. We also find that the fractal dimension of the invaded cluster changes from $d_{1}=1.887\pm0.002$ to $d_{s}=1.217\pm0.005$. This result confirms that the multiple invasion process follows a continuous transition from one universality class (NTIP) to another (optimal path). In addition, we report extensive numerical simulations that indicate that the mass distribution of avalanches $P(S,L)$ has a power-law behavior and we find that the exponent $\tau$ governing the power-law $P(S,L)\sim S^{-\tau}$ changes continuously as a function of the parameter $G$. We propose a scaling law for the mass distribution of avalanches for different number of generations $G$.Comment: 8 pages and 16 figure

EUPRON: nurses’ practice in interprofessional pharmaceutical care in Europe. A cross-sectional survey in 17 countries

Abstract Objectives Safe pharmaceutical care (PC) requires an interprofessional team approach, involving physicians, nurses and pharmacists. Nurses’ roles however, are not always explicit and clear, complicating interprofessional collaboration. The aim of this study is to describe nurses’ practice and interprofessional collaboration in PC, from the viewpoint of nurses, physicians and pharmacists. Design A cross-sectional survey. Setting The study was conducted in 17 European countries, each with their own health systems. Participants Pharmacists, physicians and nurses with an active role in PC were surveyed. Main outcome measures Nurses’ involvement in PC, experiences of interprofessional collaboration and communication and views on nurses’ competences. Results A total of 4888 nurses, 974 physicians and 857 pharmacists from 17 European countries responded. Providing patient education and information (PEI), monitoring medicines adherence (MMA), monitoring adverse/therapeutic effects (ME) and prescribing medicines were considered integral to nursing practice by 78%, 73%, 69% and 15% of nurses, respectively. Most respondents were convinced that quality of PC would be improved by increasing nurses’ involvement in ME (95%), MMA (95%), PEI (91%) and prescribing (53%). Mean scores for the reported quality of collaboration between nurses and physicians, collaboration between nurses and pharmacists and interprofessional communication were respectively <7/10, ≤4/10, <6/10 for all four aspects of PC. Conclusions ME, MMA, PEI and prescribing are part of nurses’ activities, and most healthcare professionals felt their involvement should be extended. Collaboration between nurses and physicians on PC is limited and between nurses and pharmacists even more

Nurse students’ competences in interprofessional pharmaceutical care in Europe: cross-sectional evaluation

Background: Safe pharmaceutical care requires competent nurses with specific knowledge, skills and attitudes. It is unclear whether nursing students are adequately prepared to perform pharmaceutical care in practice. Mapping their pharmaceutical care competences can lead to a better understanding of the extent to which curricula fit expectations of the labour market. Objectives: To assess pharmaceutical care competences of final-year nursing students of different educational levels. Design: A cross-sectional survey design. Settings: In 14 European countries, nursing schools who offer curricula for level 4 to 7 students, were approached. Participants: Through convenience sampling 1741 final-year student nurses of level 4 to 7 were included. Sampling strategies were country-specific. Methods: A web-platform was developed with an assessment of the level in which students mastered pharmaceutical care competences. Knowledge questions, case studies (basic/advanced level), self-reported practical skills and attitudes were evaluated. Results: Mean scores for knowledge questions differed significantly (p<0.001) between level 5 (56/100), level 6 (68/100) and level 7 students (72/100). For basic cases level 5 students reached lower scores (64/100) compared with level 6 (71/100) and level 7 (72/100) students (p=0.002 and p=0.005). For more advanced cases no difference between levels was observed (overall mean 61/100). Most students (63-90%) considered themselves skilled to perform pharmaceutical care and had positive attitudes towards their participation in pharmaceutical care (65-97%). Conclusions: Relatively low knowledge scores were calculated for final-year student nurses. In some domains, lower levels of students might be insufficiently prepared to take up responsibilities in pharmaceutical care. Our assessment can be used as a tool for educators to evaluate how prepared nursing students are for pharmaceutical care. Its further implementation for students of different educational levels will allow benchmarking between the levels, both within and between countries.This work was supported by the Erasmus+ Programme of the European Union [grant number 2018-1-BE02-KA203-046861] and Consensus accountants, an accountancy service in Belgium that financially supported the Belgian authors, without any conflicts of interest

Marine Volcaniclastic Record of Early Arc Evolution in the Eastern Ritter Range Pendant, Central Sierra Nevada, California

Marine volcaniclastic rocks in the Sierra Nevada preserve a critical record of silicic magmatism in the early Sierra Nevada volcanic arc, and this magmatic record provides precise minimum age constraints on subduction inception and tectonic evolution of the early Mesozoic Cordilleran convergent margin at this latitude. New zircon Pb/U ages from the Ritter Range pendant and regional correlations indicate arc inception no later than mid‐Triassic time between 37 and 38°N. The regional first‐order felsic magma eruption rate as recorded by marine volcanic arc rocks was episodic, with distinct pulses of ignimbrite emplacement at ca. 221 to 216 Ma and 174 to 167 Ma. Ignimbrites range from dacite to rhyolite in bulk composition, and are petrographically similar to modern arc‐type, monotonous intermediate dacite or phenocryst‐poor, low‐silica rhyolite. Zircon trace element geochemistry indicates that Jurassic silicic melts were consistently Ti‐ and light rare earth‐enriched and U‐depleted in comparison to Triassic melts of the juvenile arc, suggesting Jurassic silicic melts were hotter, drier, and derived from distinct lithospheric sources not tapped in the juvenile stage of arc construction. Pulses of ignimbrite deposition were coeval with granodioritic to granitic components of the underlying early Mesozoic Sierra Nevada batholith, suggesting explosive silicic volcanism and batholith construction were closely coupled at one‐ to two‐million‐year time scales

Exhumation of the Inyo Mountains, California: Implications for the Timing of Extension along the Western Boundary of the Basin and Range Province and Distribution of Dextral Fault Slip Rates across the Eastern California Shear Zone

New geologic mapping, tectonic geomorphologic, 10Be terrestrial cosmogenic nuclide, and (U-Th)/He zircon and apatite thermochronometric data provide the first numerical constraints on late Cretaceous to late Quaternary exhumation of the Inyo Mountains and vertical slip and horizontal extension rates across the eastern Inyo fault zone, California. The east-dipping eastern Inyo fault zone bounds the eastern flank of the Inyo Mountains, a prominent geomorphic feature within the western Basin and Range Province and eastern California shear zone. (U-Th)/He zircon and apatite thermochronometry yield age patterns across the range that are interpreted as indicating: (1) two episodes of moderate to rapid exhumation associated with Laramide deformation during the late Cretaceous/early Tertiary; (2) development of a slowly eroding surface during a prolonged period from early Eocene to middle Miocene; (3) rapid cooling, exhumation, and initiation of normal slip along the eastern Inyo fault zone, accommodated by westward tilting of the Inyo Mountains block, at 15.6 Ma; and (4) rapid cooling, exhumation, and renewed normal slip along the eastern Inyo fault zone at 2.8 Ma. Fault slip continues today as indicated by fault scarps that cut late Pleistocene alluvial fan surfaces. The second episode of normal slip at 2.8 Ma also signals onset of dextral slip along the Hunter Mountain fault, yielding a Pliocene dextral slip rate of 3.3 ± 1.0 mm/a, where a is years. Summing this dextral slip rate with estimated dextral slip rates along the Owens Valley, Death Valley, and Stateline faults yields a net geologic dextral slip rate across the eastern California shear zone of 9.3 + 2.2/–1.4 to 9.8 + 1.4/–1.0 mm/a

Revisión de la literatura integradora acerca de intervenciones de la enfermería volcadas hacia el incremento del autocuidado entre pacientes con insuficiencia cardiaca

Objective: to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients.Methods: PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients).Results: this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints.Conclusions: these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.Objetivo:analisar e sintetizar o conchecimento relacionado aos componentes críticos das intervençoes que têm, sido propostas e implementadas por enfermeiros(as) com objetivo de optimizar o auto-cuidado de pacientes portadores de insuficiência cardíaca.Método:PubMed e CINAHL foram as bases de dados electrônicas utilizadas para investigar artigos revisados por pares (peer review), apresentando as descrições das intervenções dirigidas ao paciente ou ao paciente e sua familia, visando melhorar o auto-cuidado. Foram incluídos 42 estudos na amostra final (n=4799 pacientes).Resultados:esta revisão apontou variedade e complexidade das intervenções de enfermagem. Como o auto-cuidado envolve diferentes comportamentos, as intervenções visaram em média 3,6 comportamentos. As Atividades de educação e aconselhamento foram combinadas ou não com estratégias cognitivo-comportamentais, mas somente a metade dos estudos utilizaram suporte teórico para guiar as intervenções. A avaliação e o manejo clínico foram frequentemente associados às intervenções de auto-cuidado, as quais variam em número de sessões (1 a 30), duração do seguimento (2 semanas a 12 meses) e desfechos.Conclusão:estes resultados podem ser úteis para guiar os enfermeiros no que se refere à futuros estudos sobre intervenções de auto-cuidado, de maneira a propor a comparação de diferentes modalidades de intervenção, uso de suporte teórico e estabelecimento de desfechos para melhor avaliar sua eficácia.Objetivo:analizar y sintetizar el conocimiento relacionado a componentes críticos de intervenciones que han sido propuestas e implementadas por enfermeros(as) con el objetivo de optimizar el autocuidado entre pacientes con insuficiencia cardiaca.Método:PUBMED y CINAHL han sido las bases de datos electrónicas usadas para investigar artículos revisados por pares (peer review), presentando descripciones de intervenciones destinadas a perfeccionar el autocuidado dirigido al paciente o al paciente y a su familia. Se incluyeron 42 estudios en la muestra final (n=4799 pacientes).Resultados:esta revisión apuntó a una variedad y complejidad de intervenciones de enfermería. Como el autocuidado abarca varios comportamientos, las intervenciones tuvieron como blanco, en media, 3,6 comportamientos. Actividades de educación/consejería fueron combinadas o no con estrategias cognitivo-comportamentales, pero tan solo cerca de la mitad de los estudios tenían aporte teórico para guiar intervenciones. La gestión y la evaluación clínica fueron frecuentemente asociadas a intervenciones de autocuidado, las cuales oscilaron en número de sesiones (1 a 30), duración del seguimiento (2 semanas a 12 meses) y objetivos.Conclusiones:estos resultados pueden ser útiles para informar a las enfermeras acerca de nuevas investigaciones en intervenciones de autocuidado, de modo a proponer la comparación de distintas modalidades de intervención, el uso de un aporte teórico y el establecimiento de objetivos para evaluar su eficacia

The NUPHAC-EU Framework for Nurses' Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe.

Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses' responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses' level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86-97%), patient education (85-96%), medication safety (83-95%), monitoring adherence (82-97%), care coordination (82-95%), and drug monitoring (78-96%). The most prevalent level of responsibility was 'with shared responsibility'. Prescription management tasks were considered to be nurses' responsibility by 48-81% of the professionals. All contextual factors were indicated as being relevant for nurses' role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks

Medication calculation skills of graduating nursing students within European context.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAim: The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors. Background: Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students. Design: As part of a broader research project, this study applies a multinational cross-sectional survey design with three populations: graduating nursing students, nurse managers and patients. Methods: The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross-sectional studies was applied. Results: Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested. Conclusions: Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed. Relevance to clinical practice: Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research. Keywords: drug dosage calculations; graduating nursing students; medication calculation skills; nurse managers; patients.Academy of Finland European Commissio