Faculty Perceptions of Competencies in the Nursing Profession

In order to respond to the needs of a rapidly changing health care environment, nursing educators must redefine the competencies needed by the beginning registered nurse. The study was designed to assess nursing faculty members\u27 perceptions of competencies used by the beginning registered nurse in practice and their perceptions of the degree to which those same nursing competencies were presented in the nursing curriculum. Faculty members\u27 perceptions were compared also to the results of a previous study which included a survey of beginning nurses to identify their perceptions of such competencies. Nursing faculty members who teach in professional nursing programs in the state of Minnesota were surveyed using an instrument developed by Hyndman (1999). The instrument identified 35 competencies cited in Hyndman\u27s literature review as needed by beginning registered nurses. Faculty members were asked to rate how frequently the faculty member perceived the competency to be used in practice by beginning registered nurses and to rate how frequently the faculty member perceived the competency to be presented in the nursing curriculum. The 35 competencies were categorized into five domains according to the following constructs: intellectual competencies, interpersonal competencies, technical competencies, care management competencies, and community-based competencies. The findings of this study revealed that nursing faculty members and beginning registered nurses are in general agreement on the competencies needed by beginning nurses. Care management was seen as the most important facet of nursing practice by both beginning registered nurses and faculty members. Community-based competencies were perceived to be used the least in practice and presented the least in the nursing curriculum. Economic aspects of health care were perceived by nursing faculty members and beginning nurses to be of a lower importance than other competencies. This may be of concern given the market-driven aspects of the health care environment. Beginning registered nurses reported documentation was the most frequently used competency in practice but perceived the competency was presented less frequently in nursing programs

Innovative system for delivery of low temperature district heating

An innovative low temperature district heating (LTDH) local network is developed in Nottingham, supported by the REMOURBAN project, part of the H2020 Smart City and Community Lighthouse scheme. It was proposed that a branch emanating from the return pipe of the existing district heating system in Nottingham would be created to use low temperature heating for the first time on such scale in the UK. The development is aimed to extract unused heat from existing district heating system and to make it more efficient and profitable. The 94 low-raised flats in four maisonette blocks in Nottingham demo site have been selected to be connected to this new LTDH system. The scheme will provide a primary supply of space heating and hot water at approximately 50°C to 60°C. Innovated solutions have been put forward to overcome certain barriers, such as legionella related risks and peak loads during extreme heating seasons and occasional maintenance

Metabolic profiling predicts response to anti-tumor necrosis factor α therapy in patients with rheumatoid arthritis

<p>Objective: Anti–tumor necrosis factor (anti-TNF) therapies are highly effective in rheumatoid arthritis (RA) and psoriatic arthritis (PsA), but a significant number of patients exhibit only a partial or no therapeutic response. Inflammation alters local and systemic metabolism, and TNF plays a role in this. We undertook this study to determine if the patient's metabolic fingerprint prior to therapy could predict responses to anti-TNF agents.</p> <p>Methods: Urine was collected from 16 RA patients and 20 PsA patients before and during therapy with infliximab or etanercept. Urine metabolic profiles were assessed using nuclear magnetic resonance spectroscopy. Discriminating metabolites were identified, and the relationship between metabolic profiles and clinical outcomes was assessed.</p> <p>Results: Baseline urine metabolic profiles discriminated between RA patients who did or did not have a good response to anti-TNF therapy according to European League Against Rheumatism criteria, with a sensitivity of 88.9% and a specificity of 85.7%, with several metabolites contributing (in particular histamine, glutamine, xanthurenic acid, and ethanolamine). There was a correlation between baseline metabolic profiles and the magnitude of change in the Disease Activity Score in 28 joints from baseline to 12 months in RA patients (P = 0.04). In both RA and PsA, urinary metabolic profiles changed between baseline and 12 weeks of anti-TNF therapy. Within the responders, urinary metabolite changes distinguished between etanercept and infliximab treatment.</p> <p>Conclusion: The clear relationship between urine metabolic profiles of RA patients at baseline and their response to anti-TNF therapy may allow development of novel approaches to the optimization of therapy. Differences in metabolic profiles during treatment with infliximab and etanercept in RA and PsA may reflect distinct mechanisms of action.</p&gt

Tropical Forests Of Oceania. Anthropological Perspectives

The tropical forests of Oceania are an enduring source of concern for indigenous communities, for the migrants who move to them, for the states that encompass them within their borders, for the multilateral institutions and aid agencies, and for the non-governmental organisations that focus on their conservation. Grounded in the perspective of political ecology, contributors to this volume approach forests as socially alive spaces produced by a confluence of local histories and global circulations. In doing so, they collectively explore the multiple ways in which these forests come into view and therefore into being. Exploring the local dynamics within and around these forests provides an insight into regional issues that have global resonance. Intertwined as they are with cosmological beliefs and livelihoods, as sites of biodiversity and Western desire, these forests have been and are still being transformed by the interaction of foreign and local entities. Focusing on case studies from Papua New Guinea, the Solomon Islands and the Gambier Islands, this volume brings new perspectives on how Pacific Islanders continue to creatively engage with the various processes at play in and around their forests

DECOR: Distributed construction of load balanced routing trees for many to one sensor networks

Many sensor networks suffer from the energy hole problem which is a special case of load imbalance caused by the funnelling effect of many sensor nodes transmitting their data to a single, central sink. In order to mitigate the problem, a balanced routing tree is often required and this can be constructed with either a centralised or distributed algorithm. Distributed solutions are typically less effective but are significantly cheaper than centralised solutions in terms of communication overhead and they scale better for the same reason. In this paper we propose a novel distributed algorithm for the construction of a load balanced routing tree. Our proposed solution, Degree Constrained Routing, is unique in that it aims to maximise global balance during construction rather that relying on rebalancing an arbitrary tree or only maximising local balance. The underlying principle is that if all nodes adopt the same number of children as each other while the routing tree grows, then the final tree will be globally balanced. Simulation results show that our algorithm can produce trees with improved balance which results in lifetimes increased by up to 80% compared to the next best distributed algorithm

Widespread mistaken identity in tropical plant collections

Specimens of plants and animals preserved in museums are the primary source of verifiable data on the geographical and temporal distribution of organisms. Museum datasets are increasingly being uploaded to aggregated regional and global databases (e.g. the Global Biodiversity Information Facility; GBIF) for use in a wide range of analyses. Thus, digitisation of natural history collections is providing unprecedented information to facilitate the study of the natural world on a global scale. The digitisation of this information utilises information provided on specimen labels, and assumes they are correctly identified. Here we evaluate the accuracy of names associated with 4,500 specimens of African gingers from 40 herbaria in 21 countries. Our data show that at least 58% of the specimens had the wrong name prior to a recent taxonomic study. A similar pattern of wrongly named specimens is also shown for Dipterocarps and Ipomoea (morning glory). We also examine the number of available plant specimens worldwide. Our data demonstrate that, while the world's collections have more than doubled since 1970, more than 50% of tropical specimens, on average, are likely to be incorrectly named. This finding has serious implications for the uncritical use of specimen data from natural history collections

Attitudes towards Oral Health in Patients with Rheumatoid Arthritis: A Qualitative Study Nested within a Randomized Controlled Trial

Introduction: Patients with rheumatoid arthritis (RA) present a higher incidence and severity of periodontitis than the general population. Our study, Outcomes of Periodontal Treatment in Patients with Rheumatoid Arthritis (OPERA), was a randomized waiting-list controlled trial using mixed methods. Patients randomized to the intervention arm received intensive periodontal treatment, and those in the control arm received the same treatment with a 6-mo delay. Aim: The nested qualitative component aimed to explore patients’ experiences and priorities concerning oral health and barriers and facilitators for trial participation. Methods: Using purposive sampling until thematic saturation was reached, we conducted 21 one-to-one semistructured interviews with randomized patients in either of the 2 treatment arms as well as with patients who did not consent for trial participation. Results: The patients described their experiences about RA, oral health, and study participation. Previous experiences with dental care professionals shaped patients’ current perceptions about oral health and the place of oral health on their list of priorities compared with other conditions. Patients also highlighted some of the barriers and facilitators for study participation and for compliance with oral health maintenance. The patients, in the control arm, presented their views regarding the acceptable length of waiting time for the intervention. Conclusion: The associations between periodontal and systemic health are increasingly recognized by the literature. Our study provided an insight into RA patients’ experiences and perceptions about oral health. It also highlighted some of the barriers and facilitators for participating in a periodontal interventional study for this group. We hope that our findings will support the design of larger interventional periodontal studies in patients with RA. The complex challenges faced by the burden of RA and the associated multimorbidities in this patient group might highlight opportunities to improve access to oral health services in this patient population. Knowledge Transfer Statement: This article provided insights into the experiences and perceptions of rheumatoid arthritis patients about their oral health to improve patient participation in a definitive clinical trial

HO:LULF and HO:LULF Laser Materials

A laser host material LULF (LuLiF4) is doped with holmium (Ho) and thulium (Tm) to produce a new laser material that is capable of laser light production in the vicinity of 2 microns. The material provides an advantage in efficiency over conventional Ho lasers because the LULF host material allows for decreased threshold and upconversion over such hosts as YAG and YLF. The addition of Tm allows for pumping by commonly available GaAlAs laser diodes. For use with flashlamp pumping, erbium (Er) may be added as an additional dopant. For further upconversion reduction, the Tm can be eliminated and the Ho can be directly pumped

Differential effect of lactate on synovial fibroblast and macrophage effector functions

Introduction: The synovial membrane is the main site of inflammation in rheumatoid arthritis (RA). Here several subsets of fibroblasts and macrophages, with distinct effector functions, have been recently identified. The RA synovium is hypoxic and acidic, with increased levels of lactate as a result of inflammation. We investigated how lactate regulates fibroblast and macrophage movement, IL-6 secretion and metabolism via specific lactate transporters. Methods: Synovial tissues were taken from patients undergoing joint replacement surgery and fulfilling the 2010 ACR/EULAR RA criteria. Patients with no evidence of degenerative or inflammatory disease were used as control. Expression of the lactate transporters SLC16A1 and SLC16A3 on fibroblasts and macrophages was assessed by immunofluorescence staining and confocal microscopy. To test the effect of lactate in vitro we used RA synovial fibroblasts and monocyte-derived macrophages. Migration was assessed via scratch test assays or using trans-well inserts. Metabolic pathways were analysed by Seahorse analyser. IL-6 secretion was determined by ELISA. Bioinformatic analysis was performed on publicly available single cell and bulk RNA sequencing datasets. Results: We show that: i) SLC16A1 and SLC16A3 which regulate lactate intake and export respectively, are both expressed in RA synovial tissue and are upregulated upon inflammation. SLC16A3 is more highly expressed by macrophages, while SLC16A1 was expressed by both cell types. ii) This expression is maintained in distinct synovial compartments at mRNA and protein level. iii) Lactate, at the concentration found in RA joints (10 mM), has opposite effects on the effector functions of these two cell types. In fibroblasts, lactate promotes cell migration, IL-6 production and increases glycolysis. In contrast macrophages respond to increases in lactate by reducing glycolysis, migration, and IL-6 secretion. Discussion: In this study, we provide the first evidence of distinct functions of fibroblasts and macrophages in presence of high lactate levels, opening new insights in understanding the pathogenesis of RA and offering novel potential therapeutic targets