Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers

The development of professional practice standards for Australian general practice nurses

Aims The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Background Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Design Concurrent mixed methods design. Methods Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Findings Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. Conclusion The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses\u27 practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance

An exploration of the experiences of Australian Grey Nomads travelling with chronic conditions

Internationally, the population is ageing and people are living well, longer. In Australia, extended travelling has gained popularity among older Grey Nomads due to time and opportunity post retirement. However, there is limited research available focusing on older Australians\u27 health while travelling. This paper reports the qualitative phase of a larger mixed-method project that explores the experience of Australian Grey Nomads travelling with chronic conditions. Eight Grey Nomads participated in telephone interviews. Data were analysed using inductive thematic analysis. Two themes emerged, namely: continuity of care while travelling and experts on the road. Participants described encountering a fragmented health system, with challenges regarding finding health services; a lack of shared medical records; and difficulties accessing regular medications. Despite these challenges, participants demonstrated health preparedness, an ability to accommodate health on the road, and were all travelling for their health. This study highlights key systems issues that challenge health care while travelling, and identifies opportunities for both usual practices and rural health services to enhance the care provided to this group

The Met Office weather game: investigating how different methods for presenting probabilistic weather forecasts influence decision-making

To inform the way probabilistic forecasts would be displayed on their website, the UK Met Office ran an online game as a mass participation experiment to highlight the best methods of communicating uncertainty in rainfall and temperature forecasts, and to widen public engagement in uncertainty in weather forecasting. The game used a hypothetical “ice-cream seller” scenario and a randomized structure to test decision-making ability using different methods of representing uncertainty and to enable participants to experience being “lucky” or “unlucky” when the most likely forecast scenario did not occur. Data were collected on participant age, gender, educational attainment, and previous experience of environmental modelling. The large number of participants (n > 8000) that played the game has led to the collation of a unique large dataset with which to compare the impact on the decision-making ability of different weather forecast presentation ormats. This analysis demonstrates that within the game the provision of information regarding forecast uncertainty greatly improved decision-making ability and did not cause confusion in situations where providing the uncertainty added no further information

Interferon-γ-induced Regulation of Peroxisome Proliferator-activated Receptor γ and STATs in Adipocytes

Interferon-γ (IFN-γ) is known primarily for its roles in immunological responses but also has been shown to affect fat metabolism and adipocyte gene expression. To further investigate the effects of IFN-γ on fat cells, we examined the effects of this cytokine on the expression of adipocyte transcription factors in 3T3-L1 adipocytes. Although IFN-γ regulated the expression of several adipocyte transcription factors, IFN-γ treatment resulted in a rapid reduction of both peroxisome proliferator-activated receptor (PPAR) protein and mRNA. A 48-h exposure to IFN-γ also resulted in a decrease of both CCAAT/enhancer-binding α and sterol regulatory element binding protein (SREBP-1) expression. The short half-life of both the PPARγ mRNA and protein likely contributed to the rapid decline of both cytosolic and nuclear PPARγ in the presence of IFN-γ. Our studies clearly demonstrated that the IFN-γ-induced loss of PPARγ protein is partially inhibited in the presence of two distinct proteasome inhibitors. Moreover, IFN-γ also inhibited the transcription of PPARγ, which was accompanied by a decrease in PPARγ mRNA accumulation. In addition, exposure to IFN-γ resulted in a substantial increase in STAT I expression and a small increase in STAT 3 expression. IFN-γ treatment of 3T3-L1 adipocytes (48-96 h) resulted in a substantial inhibition of insulin-sensitive glucose uptake. These data clearly demonstrate that IFN-γ treatment results in the development of insulin resistance, which is accompanied by the regulation of various adipocyte transcription factors, in particular the synthesis and degradation of PPARγ

Interpreting the seasonal cycles of atmospheric oxygen and carbon dioxide concentrations at American Samoa Observatory

We present seven years of atmospheric O2/N2 ratio and CO2 concentration data measured from flask samples collected at American Samoa. These data are unusual, exhibiting higher short-term variability, and seasonal cycles not in phase with other sampling stations. The unique nature of atmospheric data from Samoa has been noted previously from measurements of CO2, methyl chloroform, and ozone. With our O2 data, we observe greater magnitude in the short-term variability, but, in contrast, no clear seasonal pattern to this variability. This we attribute to significant regional sources and sinks existing for O2 in both hemispheres, and a dependence on both the latitudinal and altitudinal origins of air masses. We also hypothesize that some samples exhibit a component of "older" air, demonstrating recirculation of air within the tropics. Our findings could be used to help constrain atmospheric transport models which are not well characterized in tropical regions

Socio-political dimensions of CCS deployment through the lens of social network analysis

AbstractThe Socio-Political Evaluation of Energy Deployment (SPEED) framework was proposed to improve understanding of energy technology deployment. It was intended to help energy policy-makers develop and implement more effective strategies to accelerate the deployment of emerging energy technologies. The theoretical underpinnings lie in the fields of sustainability science, political science, and risk perception. Part of the objectives of the SPEED framework are to identify the dominant socio-political influences on energy technology decisions and examine how policy can facilitate a societal response to climate change by contributing insights to stakeholders. The focus is at the state level because it is at the state level that emergent energy technologies are sited, permitted, and built. The purpose of this study was to examine the structure of communication about carbon capture and storage (CCS) technology from the perspective of individuals actively involved in decisions that affect deployment and diffusion. We use density of function-system networks to examine differences between states and categories stakeholders. The information is used to inform the discussion of the current structure of communication and how it might present either barriers or opportunities for CCS innovation. Five function systems are used, each divided into benefits (positive) or risks (negative) associated with CCS: Economic benefit (ECP), economic risk (ECN), environmental benefit (ENP), environmental risk (ENN), health and safety benefit (HLP), health and safety risk (HLN), political benefit (POP), political risk (PON), technical benefit (TEP), and technical risk (TEN). An additional category of CCS statements that could not be definitively assigned to one of these categories was included as an ‘other’ category (OTP and OTN). Networks were constructed for all stakeholders, each state, and each stakeholder type based on ties of shared intensity of communication about the particular frame. From these networks, density measurements were calculated and reported. In the case studies presented here, technical risk dominates communication about CCS at the state level. The economic, technical, and political system functions appear to present the greatest barrier due to largely negative communication. This study focuses on how the development of shared meaning creates ties between individuals in a CCS policy network

Determining the Efficacy of Interventions to Reduce Intimate Partner Violence (IPV) Perpetration by Men who Use Substances: a Systematic Review and Meta-analysis

A summary of key features from a systematic review protocol registered in PROSPERO International prospective register of systematic reviews

Forming Limits of Weld Metal in Aluminum Alloys and Advanced High-Strength Steels

This work characterizes the mechanical properties of DP600 laser welded TWBs (1 mm-1.5 mm) near and in the weld, as well as their limits of formability. The approach uses simple uniaxial experiments to measure the variability in the forming limits of the weld region, and uses a theoretical forming limit diagram calculation to establish a probabilistic distribution of weld region imperfection using an M-K method approac