An Integrative Review Focusing on Accuracy and Reliability of Clinical Thermometers

Technological advances in clinical thermometers have resulted in a variety of minimally invasive devices that give rapid results but may not have the accuracy necessary for use in acutely ill adults. Inaccurate temperatures can result in missed opportunities for the early identification and treatment of infection and sepsis. Following the methodology outlined by Whittemore and Knafl, the purpose of this project was to conduct an integrative review of the research on the accuracy of clinical thermometers used for acutely ill adults. The evidence was categorized using the Hierarchy of Evidence for Interventional Studies, and the quality of the studies was appraised using the indicators described by Hooper and Andrews. Forty-seven studies met the inclusion criteria; the findings on device accuracy were contradictory. Device accuracy was found in 10 (n = 27) studies on the tympanic (TM), 2 (n = 8) on the chemical dot (CH), 7 (n = 19) on the temporal artery (TAT), and 3 (n = 13) on the axillary (AX) thermometers. Two of 2 studies found the no-touch (NT) device clinically inaccurate. Diagnostic accuracy was found in 3 (n = 8) and 0 (n = 5) studies on the TM and TAT, respectively. Only 22 studies had an acceptable quality grade of A or B, limiting the validity of the evidence. The evidence did not support the use of the NT and TAT thermometers or the AX route for acutely ill adults. The CH device should be use with caution, and abnormal temperatures should be validated with a more reliable device. For thermometers in use, appropriate training and technique are essential for the most accurate results. Closing the knowledge-to-practice gap on clinical thermometers can change the culture of nursing practice, improve early sepsis identification, and increase the quality of patient care

Conservation Values of the North Pennines

Recent and future changes in land use policy, economic environment, land ownership and an increasing emphasis on countryside stewardship means land management in the UK countryside is and will continue to change. Land management practices influence landscape, habitat availability and species distributions, which affect societal welfare estimates for the British countryside. This thesis compares elements of socio-economic and ecological value for the North Pennines Area of Outstanding Natural Beauty (AONB), an upland area of acknowledged conservation importance. The area is composed of privately owned estates, and management is centred on red grouse shooting and upland sheep farming. The aim of this thesis is to compare different elements of conservation related value, and investigate how potential future land use/funding scenarios might ultimately influence these values. Stakeholders (landowners, red grouse shooting tenants and farming tenants) have differential motivations, and not all are motivated primarily for profits. Estates are classified into two types: those with commercially driven red grouse shooting, and those without. Profits are shown to vary across estates and be negative for many. The commercially driven estates, along with tenant farmers, are likely to embrace conservation if subsidised by government. Approximately twenty percent of the non-commercial estates essentially pay for conservation management, with two estates in particular paying farmers for conservation management. Others may come into conflict with conservation where it is not reconciled with red grouse shooting. Recent advances in habitat suitability modelling allowed presence only data to be used to predict the distribution of Biodiversity Action Plan (BAP) species. This technique proved useful and reliable even with small sample sizes, and as expected, each BAP species has different requirements. Agri-environment schemes are shown to be beneficial to 7/15 BAP species, although are detrimental to 2/5 vertebrate BAP species, suggesting that with some attention to vertebrates they can be a strong force for conservation. Contingent valuation was the method chosen to estimate the utility provided by the landscape and biodiversity of the North Pennines. When visitors to the area were surveyed, landscape and biodiversity were both found to be important in preference formation, and significant negative valuations were elicited. Visitors were prepared to pay an average of £10.52 per household annually for the preferred outcome, and an average of £4.22 to prevent the least preferred outcome. A mosaic landscape with increases in blanket bog and the associated increases in rare and threatened birds and mammals (the cute and cuddly effect) was highly valued by respondents. A framework for incorporating these multiple elements of value was presented, allowing the impacts of potential policy scenarios to be demonstrated, via stakeholder reactions. As well as demonstrating a lack of holistic policy proposals, this model made it clear that a decline in the extent of red grouse shooting would represent a cost to society. This thesis showed how to combine multiple elements of value to assess the wider impacts of potential future policies and economic conditions in an upland case study area, and makes suggestions for incorporating further values into this framework

Foreign Attorneys in U.S. LL.M. Programs: Who\u27s In, Who\u27s Out, and Who They Are

In recent decades, there has been a remarkable growth in the number of foreign attorneys enrolled at U.S. law schools and particularly in LL.M. programs. To learn more about these students and how they fare, we conducted research in two law schools, one in the Midwest and the second on the East Coast. We examine the admissions process for foreign attorneys from the perspectives and experiences of both the administrators who make admissions decisions and the students who seek admission. We consider the layered international, national, state, and local laws that complicate the selection process, as well as the standards set by the schools themselves. To understand who gets in and who does not, we interviewed nine administrators who admit and support the international students during their studies. We observed how accounting practices and techniques of audit culture color administrative decision-making, but also the conditions under which discretion comes into play. We collected quantitative data about the students at the two schools and analyzed their personal statements using the anthropological and linguistic concept of genre, a stylized narrative, that revealed students\u27 life histories, education, work experiences, motives for attending the programs, and future goals. The narratives, and our interviews with fifty students who attended the programs, demonstrate that internationalizationh as changed the terms for inclusion in U.S. law schools. The structures of privilege play by different rules at the international level. They include a wider politics of interstate relations, the vicissitudes of international and national law, the operation of audit cultures, a certain proficiency in English as the lingua franca of international law, and the ability to muster economic and other symbolic resources, even under great hardship. As sites of globalization, law schools are creating new legal experts who will reinvent the future meaning of being a lawyer and doing a lawyer\u27s work

Designing a 3D serious game about career pathways in the games industry

The aim of this paper is to give a detailed overview of the development of a 3D serious game that informs game students about career pathways in the games industry. The paper provides a scoping review on the key principles related to serious game design. These core design issues are reiterated in relation to how the development of the game has adhered to them. The paper illustrates the game’s audit trail in terms of implementation providing a development blueprint for other educators to follow when developing an educational game. The learning outcomes of the game are also accentuated and how the implementation of the game has catered for them. An important aspect of the paper is to highlight how the underlying aspects of game design can accommodate intrinsic content and motivation whilst accommodating the various pedagogical frameworks embedded in the gameplay. The characterising goals of the game have adopted a linear and cyclical approach that allows the player to progress through the gameplay completing formative and summative assessment challenges. The serious game was developed using the Unity game engine adopting a hub and spoke design. A key challenge when designing the game was how to ensure that the game remained endogenous when designing the game’s levels. The design considerations presented in this paper provide a solid implementational framework about how to implement principles of learning and assessment associated with employability skill sets with a specific focus to the games industry

Stress resilience, sleep and physical activity in older manual workers.

This thesis investigated the relationships between stress resilience, sleep and physical activity (PA) in older manual workers (OMW). The first study aimed to explore latent profiles of individuals at risk of ill health and being based on presenteeism, stress resilience and PA. Profiles of OMW differed on work-related affect and health perceptions, and high levels of PA were associated with lower levels of presenteeism. As such, implementing interventions that focus on high levels of PA may be efficient in the reduction of presenteeism in some groups of OMW and potentially in improving stress resilience. The aim of study two in this thesis was to explore the relationship between perceived psychological resilience and work-related factors (presenteeism and work engagement) and the physiological response to acute psychological stress in a group of OMW. The results indicated that psychological resilience was not associated with work-related factors. In contrast, cardiovascular reactivity was significantly related to work-related factors such that workers with high levels of presenteeism and low work engagement had high heart rate reactivity to stress. Thus, exaggerated cardiac reactivity in workers with high presenteeism may provide a pathway to cardiovascular disease (CVD). Study three examined the association of PA levels, BMI and undiagnosed obstructive sleep apnoea (OSA), which is common in OMW. Preliminary results indicated that undiagnosed OSA was associated with low levels of PA, although BMI was a stronger indicator, implying that PA may be a modifiable risk factor in OSA development. The aim of the fourth and final study of this thesis was to investigate the ability of a 12-week PA intervention to reduce moderate OSA independent of BMI in a group of older workers. The results indicated that the PA intervention was effective in the reduction of OSA independent of BMI and weight-loss and therefore, supports previous research that increasing PA may provide a means of managing OSA and improving cardiovascular health. In summary, increasing levels of PA, decreasing stress and promoting sufficient quality and duration of sleep may well be the pathway to promoting good health and wellbeing in older workers, which will enable them to continue a long and efficient working life

Undiagnosed Obstructive Sleep Apnea and Physical Activity in Older Manual Workers

First paragraph: Sleep is essential for life and integral to health and well-being (Roehrs, 2000). However, during the aging process, sleep patterns become disrupted, which leads to sleep deprivation (Stanley, 2005). Inadequate sleep has adverse effects on the body, including the production of higher cortisol (stress hormone) levels, which causes wear and tear physiologically, and further contributes to wakefulness (Stanley, 2005)