Nurse practitioner and midwife prescribing in Australia

There is an increasing trend worldwide for nurses and other non-medical healthcare professionals to be accorded the right to prescribe drugs. In Australia, nurse practitioners and eligible midwives have gained prescribing privileges in recent years. This RESEARCH ROUNDup examines their prescribing patterns and the evidence about the effectiveness and safety of nurse and midwife prescribing

Sound of Terror: Hearing Ghosts in Victorian Fiction

Sounds of Terror explores the interrelations between discourses of sound and the ghostly in Victorian novels and short stories. Narrative techniques used by Charles, Dickens, George Eliot, Henry James, and Charlotte Mew are historically and culturally situated through their use of or reactions against acoustic technology. Since ghost stories and nvoels with gothic elements rely for the terrifying effects on tropes of liminality, my study consists of an analysis of an important yet largely unacknowledged species of these tropes: auditory metaphors. Many critics have examined the visual metaphors that appear in nineteenth-century fiction, but, until recently, aural representations have remain critically ignored. The aural itself represents the liminal or the numinous since sounds are less identifiable than visuals because of their ephemeral nature. My study shows the the significance of auditory symbols becomes increasingly intensified as the century progresses. Through analyses of Charles Dickens\u27s David Copperfield, George Eliot\u27s Daniel Deronda, and short stories by Henry James ( The Altar of the Dead and In the Cage )and Charlotte Mew ( Passed and A White Night ), I argue that Victorian writers using gothic modes employ metaphors and symbolism as an alternative to frightening visual images--what could be heard or not heard proved terrifying and dreadful

Influences on Participation in Life After Spinal Cord Injury: Qualitative Inquiry Reveals Interaction of Context and Moderators

Background: Greater understanding of the influences on participation in life after spinal cord injury (SCI) can inform rehabilitation theory and practice. Careful qualitative inquiry can reveal subjective meanings associated with the relevant experiences, strategies, and perceptions of those with lived experience of SCI. A search of literature, followed by a thematic synthesis of qualitative studies, was undertaken to bring together these insights in a meaningful way. Methods: The research question guiding the literature review and synthesis was, What do people with SCI perceive to be the influences on their participation in life? Three critical databases were searched for qualitative studies examining influences on participation in life after SCI. Peer-reviewed studies published after 2006, involving adults with SCI living in countries with advanced economies, were included. Data were extracted from 24 articles and subjected to three-level thematic synthesis—the coding of primary data from the studies, the development of descriptive themes based on an organization of those codes, and the generation of analytical themes. Results: The synthesis yielded five analytical themes, supported by 17 descriptive themes. The analytical themes were (1) external contextual influences, (2) personal physical context, (3) personal psychological context, (4) potential moderators of participation outcomes, and (5) temporal dimensions of participating in life after SCI. Interpretation: These themes highlight the complex interactions that shape participation from the perspective of people with SCI. Closer examination of the potential moderators may provide insights into effective rehabilitation interventions. Conclusions: Synthesis of qualitative inquiry provides valuable insights into the perceptions of influences on participation in life from the point of view of people with SCI. The findings of this synthesis are instructive for rehabilitation theory and practice. It can complement what we learn from using the ICF to understand participatio

Implementing Policy, Systems, and Environmental Change Through Community Coalitions and Extension Partnerships to Address Obesity in Rural Louisiana

Community coalitions and agents funded by the Louisiana State University Agricultural Center\u27s Healthy Communities program implemented multilevel obesity prevention interventions in 3 rural parishes (ie, counties) with an obesity prevalence of 40% or higher. The Healthy Communities coalitions appraised local health concerns through needs assessments and community forums. On the basis of local needs and the evidence base, the coalitions identified and implemented policy, systems, and environmental (PSE) strategies and supporting education to promote healthy behavior change among residents, overcoming barriers in the process. Interventions varied by parish but included Complete Streets implementation plans, healthy retail initiatives, play space improvements, downtown beautification projects, and Smarter Lunchrooms

Longitudinal effects of time since injury and age at injury on outcomes of people with spinal cord injury in Queensland, Australia

Study design: Longitudinal cohort study. Objectives: To investigate the longitudinal effects of time since injury and age at injury on outcomes of quality of life, physical function, secondary conditions and participation, in people with traumatic spinal cord injury (SCI). Setting: Community resident people with spinal cord injury in Queensland, Australia. Methods: A baseline sample of 270 people with SCI was recruited. Telephone surveys on measures of quality of life (WHOQOL-Bref), secondary conditions (Secondary Conditions Surveillance Instrument, subset), physical functioning (Functional Independence Measure motor subscale) and participation (Community Integration Measure) were conducted each year between 2004 and 2008, and again in 2018. Random-effect within-between models were used to determine the effect of time since injury and age at injury on each outcome variable. Inverse probability-of-censoring weights were used to correct for selection bias. Results: There was an effect of time since injury on secondary conditions, with a one-year change associated with 9% higher odds of having worse Secondary Conditions Surveillance Instrument scores (odds ratio = 1.09, 95% confidence interval = 1.02, 1.17; p = 0.006). We did not find any evidence of a time since injury effect on quality of life, physical function, or participation. Similarly, we did not find any evidence of an age at injury effect on any outcome variable. Conclusions: Secondary conditions may increase with longer time since injury among people with SCI, suggesting appropriate formal and informal supports are required to minimise the impact of these emerging health problems as individuals age

The Influence of Internal Model Variability in GEOS-5 on Interhemispheric CO2 Exchange

An ensemble of eight atmospheric CO2 simulations was completed employing the National Aeronautics and Space Administration (NASA) Goddard Earth Observation System, Version 5 (GEOS-5) for the years 2000-2001, each with initial meteorological conditions corresponding to different days in January 2000 to examine internal model variability. Globally, the model runs show similar concentrations of CO2 for the two years, but in regions of high CO2 concentrations due to fossil fuel emissions, large differences among different model simulations appear. The phasing and amplitude of the CO2 cycle at Northern Hemisphere locations in all of the ensemble members is similar to that of surface observations. In several southern hemisphere locations, however, some of the GEOS-5 model CO2 cycles are out of phase by as much as four months, and large variations occur between the ensemble members. This result indicates that there is large sensitivity to transport in these regions. The differences vary by latitude-the most extreme differences in the Tropics and the least at the South Pole. Examples of these differences among the ensemble members with regard to CO2 uptake and respiration of the terrestrial biosphere and CO2 emissions due to fossil fuel emissions are shown at Cape Grim, Tasmania. Integration-based flow analysis of the atmospheric circulation in the model runs shows widely varying paths of flow into the Tasmania region among the models including sources from North America, South America, South Africa, South Asia and Indonesia. These results suggest that interhemispheric transport can be strongly influenced by internal model variability

FOOT STRIKE PATTERN trends in sub-elite half marathon runners

The purpose of this study was to examine the changes in foot strike patterns throughout a sub elite half-marathon and examine the relationship between foot strike pattern and race performance. Race participants were filmed at mile 2, 5.5 and 12.5. Video was analysed to determine if participants used a forefoot, mid-foot strike or rear foot strike pattern at each camera. Furthermore participants were broken down in performance groups of 50 based off of time taken to reach each camera. At mile 5.5 and 12.5 significant difference in foot strike pattern (

Predicting suicide following self-harm : A systematic review of risk factors and risk scales

Background People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex. Aims To undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm. Method We conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable. Results Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the meta-analysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38–2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91–3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16–3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70–2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%. Conclusions The four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed