Living life in residential aged care: A process of continuous adjustment

The aim of this study was to examine whether, and how, residents living in residential aged care homes become involved in their care, and what areas of their care and life they work to influence or negotiate

Abstraction, experience, reduction : time and periodicity in the work of Myron Stout and postwar American art history

This dissertation is the first full-career study of the American painter Myron Stout (1908- 1987). Stout is best known for a series of small black and white abstract paintings he made between 1955 and 1980. He is most often associated with American hard-edge painting of the early 1960s, the movement which set the stage for Minimalism. However, Stout’s work predates hard-edge painting in an important way, namely that he developed it as an extension of Abstract Expressionism. Stout intended the reduced palette, simplified shapes, and absence of gestural marks in his paintings to be effective containers for an expression of lived experience. Stout confounds typical art historical narratives in other ways. He was introduced to modernism in the 20s, but did not begin his life as a painter until the late 1940s. In an era of high production he made very few paintings—about fifteen over twenty-five years. His work “predicts” some of the issues that emerged in Minimalism, but by the mid-1960s Stout appeared very much a 50s artist. Whilst seemingly a die-hard, purist painter, his artistic milieu included artists innovating very different kinds of practices, from Happenings and Pop to realist painting. Finally, from today’s perspective, Stout is a lesser-known artist, but he is and was nonetheless an insider in terms of his education and his artistic contacts. By addressing the practice of a single artist, this dissertation demonstrates that even in the face of newer, more inclusive methodologies, recent histories Abstract Expressionism and Minimalism still have problems with inclusivity, indeed depend to a large degree on narrow views. The approach here is to illuminate moments where Stout’s history collides with conventional period-histories. Using Stout’s chronological age in addition to his interface with the art world, it takes a longer view of his career, addressing early and late parts of his life. Stout's continuity through these periods raises questions about how models of périodisation continue to drive the way art history is written

Developing theory-informed interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework

Background: There is little systematic operational guidance about how best to develop complex interventions to reduce the gap between practice and evidence. This article is one in a series of articles documenting the development and use of the Theoretical Domains Framework (TDF) to advance the science of implementation research. Methods: The intervention was developed considering three main components: theory, evidence, and practical issues. We used a four-step approach, consisting of guiding questions, to direct the choice of the most appropriate components of an implementation intervention: Who needs to do what, differently? Using a theoretical framework, which barriers and enablers need to be addressed? Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? And how can behaviour change be measured and understood? Results: A complex implementation intervention was designed that aimed to improve acute low back pain management in primary care. We used the TDF to identify the barriers and enablers to the uptake of evidence into practice and to guide the choice of intervention components. These components were then combined into a cohesive intervention. The intervention was delivered via two facilitated interactive small group workshops. We also produced a DVD to distribute to all participants in the intervention group. We chose outcome measures in order to assess the mediating mechanisms of behaviour change. Conclusions: We have illustrated a four-step systematic method for developing an intervention designed to change clinical practice based on a theoretical framework. The method of development provides a systematic framework that could be used by others developing complex implementation interventions. While this framework should be iteratively adjusted and refined to suit other contexts and settings, we believe that the four-step process should be maintained as the primary framework to guide researchers through a comprehensive intervention development process

Shocks and Thermal Conduction Fronts in Retracting Reconnected Flux Tubes

We present a model for plasma heating produced by time-dependent, spatially localized reconnection within a flare current sheet separating skewed magnetic fields. The reconnection creates flux tubes of new connectivity which subsequently retract at Alfv\'enic speeds from the reconnection site. Heating occurs in gas-dynamic shocks which develop inside these tubes. Here we present generalized thin flux tube equations for the dynamics of reconnected flux tubes, including pressure-driven parallel dynamics as well as temperature dependent, anisotropic viscosity and thermal conductivity. The evolution of tubes embedded in a uniform, skewed magnetic field, following reconnection in a patch, is studied through numerical solutions of these equations, for solar coronal conditions. Even though viscosity and thermal conductivity are negligible in the quiet solar corona, the strong gas-dynamic shocks generated by compressing plasma inside reconnected flux tubes generate large velocity and temperature gradients along the tube, rendering the diffusive processes dominant. They determine the thickness of the shock that evolves up to a steady-state value, although this condition may not be reached in the short times involved in a flare. For realistic solar coronal parameters, this steady-state shock thickness might be as long as the entire flux tube. For strong shocks at low Prandtl numbers, typical of the solar corona, the gas-dynamic shock consists of an isothermal sub-shock where all the compression and cooling occur, preceded by a thermal front where the temperature increases and most of the heating occurs. We estimate the length of each of these sub-regions and the speed of their propagation.Comment: 39 pages (AASTeX: 29 pages of text, 10 figures), accepted for publication in the Astrophysical Journa

Shifting focus: how registered nurses in residential aged care organise their work: a grounded theory study

Registered nurses in residential aged care work with older people who have complex care needs. Besides providing direct care, these nurses have a wide range of responsibilities which include supervising staff and attending to the smooth running of the care facility. This grounded theory study using dimensional analysis was aimed at answering the question: How do registered nurses organise their work? Indepth interviews were conducted with 10 registered nurses who worked in a range of positions in aged care facilities. Theoretical sampling and constant comparative analysis was used to guide both ongoing data collectiona and data analysis. Categories were examined for their relationships and dimensions to arrive at a substantive grounded theory which I have named 'shifting focus'. Individual and institutional philosophies of care were core elements in the registered nurses' focus of work. There was a relationship between staffing adequacy, individual and institutional philosophies of care, and the focus of registered nurse work. These relationships created conditions where the registered nurse would focus on ensuring the delivery of individualised resident care or focus on getting through the routine of care. The relationship between staffing adequacy, philosophies of care and the registered nurses' focus of work remained consistent when staffing adequacy changed. In instances of decreased staffing adequacy, the participants' focus shifted to either maintaining individualised care or focusing on safety. When the registered nurse aimed to change the philosophy of care, an increase in staffing adequacy enabled some aspects of cultural change to commence. The relationships between residents, family and staff were significant contrasting elements within an individualised philosophy of care, and an institutional philosophy of care. In the former, relationships were valued and developed. In the latter, they were benevolent, functional or conflicted. The significance of this study is that it reveals how registered nurses and management personnel in aged care facilities, can create conditions where the relationships between residents, their families and staff, are valued and developed to result in positive care outcomes. It is recommended that future research be conducted to examine the resources required to maintain an individualised approach to the nursing care of residents in aged care facilities

A novel microfluidic device capable of maintaining functional thyroid carcinoma specimens ex vivo provides a new drug screening platform

© 2019 The Author(s). Background: Though the management of malignancies has improved vastly in recent years, many treatment options lack the desired efficacy and fail to adequately augment patient morbidity and mortality. It is increasingly clear that patient response to therapy is unique to each individual, necessitating personalised, or 'precision' medical care. This demand extends to thyroid cancer; ~ 10% patients fail to respond to radioiodine treatment due to loss of phenotypic differentiation, exposing the patient to unnecessary ionising radiation, as well as delaying treatment with alternative therapies. Methods: Human thyroid tissue (n = 23, malignant and benign) was live-sliced (5 mm diameter × 350-500 μm thickness) then analysed or incorporated into a microfluidic culture device for 96 h (37 °C). Successful maintenance of tissue was verified by histological (H&E), flow cytometric propidium iodide or trypan blue uptake, immunohistochemical (Ki67 detection/ BrdU incorporation) and functional analysis (thyroxine [T4] output) in addition to analysis of culture effluent for the cell death markers lactate dehydrogenase (LDH) and dead-cell protease (DCP). Apoptosis was investigated by Terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL). Differentiation was assessed by evaluation of thyroid transcription factor (TTF1) and sodium iodide symporter (NIS) expression (western blotting). Results: Maintenance of gross tissue architecture was observed. Analysis of dissociated primary thyroid cells using flow cytometry both prior to and post culture demonstrated no significant change in the proportion of viable cells. LDH and DCP release from on-chip thyroid tissue indicated that after an initial raised level of release, signifying cellular damage, detectable levels dropped markedly. A significant increase in apoptosis (p < 0.01) was observed after tissue was perfused with etoposide and JNK inhibitor, but not in control tissue incubated for the same time period. No significant difference in Ki-67 positivity or TTF1/NIS expression was detected between fresh and post-culture thyroid tissue samples, moreover BrdU positive nuclei indicated on-chip cellular proliferation. Cultured thyroid explants were functionally viable as determined by production of T4 throughout the culture period. Conclusions: The described microfluidic platform can maintain the viability of thyroid tissue slices ex vivo for a minimum of four days, providing a platform for the assessment of thyroid tissue radioiodine sensitivity/adjuvant therapies in real time

From NCLB to ESSA: Implications for Teacher Preparation and Policy

With the 2001 reauthorization of the Elementary and Secondary Education Act (ESEA), the term highly qualified teacher (HQT) became an important component of teacher licensure, including for special educators. However, when ESEA was reauthorized in 2015 as the Every Student Succeeds Act (ESSA), the highly qualified regulations were removed. The purpose of this study was to look back at the historical record of policy implementation of HQT and compare the record across states to provide implications for teacher preparation and licensure policy in the era of ESSA. This was accomplished through a review of the history of special education teacher licensure and completion of a comprehensive analysis of state licensure requirements under the Individuals with Disabilities Education Improvement Act. Despite a general consistency across three domains (i.e., degree, examination, and licensure) of the highly qualified statute, inconsistencies among states at both the elementary and secondary levels of special educator licensure may yield significant challenges related to the impact of teacher quality on student outcomes. Better understanding of these challenges is important as policymakers will be better able to make decisions regarding what teachers need to know prior to entering the field to meet students’ needs and generate student achievement

Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Context: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice. Case Presentation: A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time. Discussion: The patient’s presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work. Relevance to Clinical or Professional Practice: The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work

Investigation of bias in meta-analyses due to selective inclusion of trial effect estimates:empirical study

OBJECTIVE: To explore whether systematic reviewers selectively include trial effect estimates in meta-analyses when multiple are available, and what impact this may have on meta-analytic effects. DESIGN: Cross-sectional study. DATA SOURCES: We randomly selected systematic reviews of interventions from 2 clinical specialties published between January 2010 and 2012. The first presented meta-analysis of a continuous outcome in each review was selected (index meta-analysis), and all trial effect estimates that were eligible for inclusion in the meta-analysis (eg, from multiple scales or time points) were extracted from trial reports. ANALYSIS: We calculated a statistic (the Potential Bias Index (PBI)) to quantify and test for evidence of selective inclusion. The PBI ranges from 0 to 1; values above or below 0.5 are suggestive of selective inclusion of effect estimates more or less favourable to the intervention, respectively. The impact of any potential selective inclusion was investigated by comparing the index meta-analytic standardised mean difference (SMD) to the median of a randomly constructed distribution of meta-analytic SMDs (representing the meta-analytic SMD expected when there is no selective inclusion). RESULTS: 31 reviews (250 trials) were included. The estimated PBI was 0.57 (95% CI 0.50 to 0.63), suggesting that trial effect estimates that were more favourable to the intervention were included in meta-analyses slightly more often than expected under a process consistent with random selection; however, the 95% CI included the null hypothesis of no selective inclusion. Any potential selective inclusion did not have an important impact on the meta-analytic effects. CONCLUSION: There was no clear evidence that selective inclusion of trial effect estimates occurred in this sample of meta-analyses. Further research on selective inclusion in other clinical specialties is needed. To enable readers to assess the risk of selective inclusion bias, we recommend that systematic reviewers report the methods used to select effect estimates to include in meta-analyses