1,837 research outputs found

    Shaping nursing praxis : some registered nurses' perceptions and beliefs of theory practice : a thesis presented in partial fulfilment of the requirements for the degree of Master of Educational Administration at Massey University

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    This thesis investigates the beliefs and perceptions of registered nurses in relation to the theory practice gap. In order to discover these perceptions and beliefs, this qualitative study used critical ethnography, a framework and process in which the paiticipants share in the journey of discovery which sets out to explore, describe and transform these beliefs and perceptions of theory-practice. The theory-practice debate has been highlighted in nursing for some time and is interpreted in many ways. This multiple interpretation causes confusion and has an impact on the development of the discipline of nursing. The participants were six nurse clinicians and six nurse educators from a large metropolitan hospital and a School of Nursing and Midwifery within a tertiary educational institution. Within the critical framework, the research methods used were interviews, observation, paiticipants' personal logs and triangulation between methods and within methods. Data analysis was through content analysis using themes, patterns, and categories arising from the data. The analysis of data indicated that through reciprocal dialogue, the paiticipants' theory-practice perceptions and beliefs had been transformed. This transformation was being premised on an assumption of the existence of a theory-practice gap to an acceptance of the theory-practice relationship as an integrated concept where nursing praxis is shaped by an ongoing development process. Empowering strategies and recommendations for the development of nursing praxis include coaching, clinical supervision, mentoring, case management, ongoing education, research, faculty practice, joint appointments and reciprocal advisory groups. These strategies provide opportunities for nurses to come together, and reflect on practice in that by becoming aware of their beliefs and perceptions, they gain the confidence and knowledge to begin transforming conditions of power and control, thereby promoting change which results in praxis and professional autonomy

    Perspectives of Employed People Experiencing Homelessness of Self and Being Homeless: Challenging Socially Constructed Perceptions and Stereotypes

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    In a study that sought to identify the multiple factors resulting in homelessness from the perspective of 65 individuals in Calgary, Alberta, Canada who were both employed and homeless, we found that participants\u27 perceptions of being homeless emerged as a major theme which impacts their entry to and exit from homelessness. Four sub-themes related to these perceptions were identified: (1) perceptions of self and situation; (2) impact of being homeless on self-reflection; (3) aspects of hope to consider; and (4) perspectives on having a permanent residence. Analytically, these findings help challenge present stereotypes about homelessness and usefully inform social service delivery organizations

    Navigating the Digital Divide

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    The digital divide has now been analyzed for over a decade. Many in the field believe it is time to reflect on where we are today. Has the concept lost all meaning as academics and policy-makers grapple with the issues? Is the digital divide just a more subtle way of discussing poverty and social exclusion or is it a valid new formulation for discussing recent and novel changes occurring in an information society? Much of the content of the following special edition journal is based on papers given at a May 2003 conference on International social welfare policy and practice for vulnerable groups: International perspectives on social justice and technology - held concurrently at the Universities of Calgary and Regina, Canada. The conference involved over 100 participants from North America, South America, and Europe, and over 30 peer reviewed papers delivered in person or in real time via electronic media from such remote sites as Boston, New York, and Amsterdam

    Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability: Prospective Multicenter Protocol-Directed Cohort Study

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    BACKGROUND: Studies examining the association between hyperoxia exposure after resuscitation from cardiac arrest and clinical outcomes have reported conflicting results. Our objective was to test the hypothesis that early postresuscitation hyperoxia is associated with poor neurological outcome. METHODS: This was a multicenter prospective cohort study. We included adult patients with cardiac arrest who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation. We excluded patients with cardiac arrest caused by trauma or sepsis. Per protocol, partial pressure of arterial oxygen (Pao2) was measured at 1 and 6 hours after return of spontaneous circulation. Hyperoxia was defined as a Pao2 >300 mm Hg during the initial 6 hours after return of spontaneous circulation. The primary outcome was poor neurological function at hospital discharge, defined as a modified Rankin Scale score >3. Multivariable generalized linear regression with a log link was used to test the association between Pao2 and poor neurological outcome. To assess whether there was an association between other supranormal Pao2 levels and poor neurological outcome, we used other Pao2 cut points to define hyperoxia (ie, 100, 150, 200, 250, 350, 400 mm Hg). RESULTS: Of the 280 patients included, 105 (38%) had exposure to hyperoxia. Poor neurological function at hospital discharge occurred in 70% of patients in the entire cohort and in 77% versus 65% among patients with versus without exposure to hyperoxia respectively (absolute risk difference, 12%; 95% confidence interval, 1-23). Hyperoxia was independently associated with poor neurological function (relative risk, 1.23; 95% confidence interval, 1.11-1.35). On multivariable analysis, a 1-hour-longer duration of hyperoxia exposure was associated with a 3% increase in risk of poor neurological outcome (relative risk, 1.03; 95% confidence interval, 1.02-1.05). We found that the association with poor neurological outcome began at ≥300 mm Hg. CONCLUSIONS: Early hyperoxia exposure after resuscitation from cardiac arrest was independently associated with poor neurological function at hospital discharge

    Wintering Steer Calves at the Spur Station.

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    12 p

    Automatic Inference of Upper Bounds for Recurrence Relations in Cost Analysis

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    The classical approach to automatic cost analysis consists of two phases. Given a program and some measure of cost, we first produce recurrence relations (RRs) which capture the cost of our program in terms of the size of its input data. Second, we convert such RRs into closed form (i.e., without recurrences). Whereas the first phase has received considerable attention, with a number of cost analyses available for a variety of programming languages, the second phase has received comparatively little attention. In this paper we first study the features of RRs generated by automatic cost analysis and discuss why existing computer algebra systems are not appropriate for automatically obtaining closed form solutions nor upper bounds of them. Then we present, to our knowledge, the first practical framework for the fully automatic generation of reasonably accurate upper bounds of RRs originating from cost analysis of a wide range of programs. It is based on the inference of ranking functions and loop invariants and on partial evaluation

    Zooming In on the Progenitors of Superluminous Supernovae With the HST

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    We present Hubble Space Telescope (HST) rest-frame ultraviolet imaging of the host galaxies of 16 hydrogen-poor superluminous supernovae (SLSNe), including 11 events from the Pan-STARRS Medium Deep Survey. Taking advantage of the superb angular resolution of HST, we characterize the galaxies' morphological properties, sizes and star formation rate (SFR) densities. We determine the supernova (SN) locations within the host galaxies through precise astrometric matching, and measure physical and host-normalized offsets, as well as the SN positions within the cumulative distribution of UV light pixel brightness. We find that the host galaxies of H-poor SLSNe are irregular, compact dwarf galaxies, with a median half-light radius of just 0.9 kpc. The UV-derived SFR densities are high ( ~ 0.1 M_sun/yr/kpc^2), suggesting that SLSNe form in overdense environments. Their locations trace the UV light of their host galaxies, with a distribution intermediate between that of long-duration gamma-ray bursts (LGRBs) (which are strongly clustered on the brightest regions of their hosts) and a uniform distribution (characteristic of normal core-collapse SNe), though cannot be statistically distinguished from either with the current sample size. Taken together, this strengthens the picture that SLSN progenitors require different conditions than those of ordinary core-collapse SNe to form, and that they explode in broadly similar galaxies as do LGRBs. If the tendency for SLSNe to be less clustered on the brightest regions than are LGRBs is confirmed by a larger sample, this would indicate a different, potentially lower-mass progenitor for SLSNe than LRGBs.Comment: ApJ in press; matches published version. Minor changes following referee's comments; conclusions unchange

    Rifampicin and clarithromycin (extended release) versus rifampicin and streptomycin for limited Buruli ulcer lesions: a randomised, open-label, non-inferiority phase 3 trial.

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    BACKGROUND: Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS: We did an open-label, non-inferiority, randomised (1:1 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter. The trial was open label, and neither the investigators who took measurements of the lesions nor the attending doctors were masked to treatment assignment. The primary clinical endpoint was lesion healing (ie, full epithelialisation or stable scar) without recurrence at 52 weeks after start of antimicrobial therapy. The primary endpoint and safety were assessed in the intention-to-treat population. A sample size of 332 participants was calculated to detect inferiority of RC8 by a margin of 12%. This study was registered with ClinicalTrials.gov, NCT01659437. FINDINGS: Between Jan 1, 2013, and Dec 31, 2017, participants were recruited to the trial. We stopped recruitment after 310 participants. Median age of participants was 14 years (IQR 10-29) and 153 (52%) were female. 297 patients had PCR-confirmed Buruli ulcer; 151 (51%) were assigned to RS8 treatment, and 146 (49%) received oral RC8 treatment. In the RS8 group, lesions healed in 144 (95%, 95% CI 91 to 98) of 151 patients, whereas lesions healed in 140 (96%, 91 to 99) of 146 patients in the RC8 group. The difference in proportion, -0·5% (-5·2 to 4·2), was not significantly greater than zero (p=0·59), showing that RC8 treatment is non-inferior to RS8 treatment for lesion healing at 52 weeks. Treatment-related adverse events were recorded in 20 (13%) patients receiving RS8 and in nine (7%) patients receiving RC8. Most adverse events were grade 1-2, but one (1%) patient receiving RS8 developed serious ototoxicity and ended treatment after 6 weeks. No patients needed surgical resection. Four patients (two in each study group) had skin grafts. INTERPRETATION: Fully oral RC8 regimen was non-inferior to RS8 for treatment of early, limited Buruli ulcer and was associated with fewer adverse events. Therefore, we propose that fully oral RC8 should be the preferred therapy for early, limited lesions of Buruli ulcer. FUNDING: WHO with additional support from MAP International, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac

    Clinical, radiologic, pathologic, and molecular characteristics of long-term survivors of diffuse intrinsic pontine glioma (DIPG): a collaborative report from the International and European Society for Pediatric Oncology DIPG registries

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    Purpose Diffuse intrinsic pontine glioma (DIPG) is a brainstem malignancy with a median survival of < 1 year. The International and European Society for Pediatric Oncology DIPG Registries collaborated to compare clinical, radiologic, and histomolecular characteristics between short-term survivors (STSs) and long-term survivors (LTSs). Materials and Methods Data abstracted from registry databases included patients from North America, Australia, Germany, Austria, Switzerland, the Netherlands, Italy, France, the United Kingdom, and Croatia. Results Among 1,130 pediatric and young adults with radiographically confirmed DIPG, 122 (11%) were excluded. Of the 1,008 remaining patients, 101 (10%) were LTSs (survival ≥ 2 years). Median survival time was 11 months (interquartile range, 7.5 to 16 months), and 1-, 2-, 3-, 4-, and 5-year survival rates were 42.3% (95% CI, 38.1% to 44.1%), 9.6% (95% CI, 7.8% to 11.3%), 4.3% (95% CI, 3.2% to 5.8%), 3.2% (95% CI, 2.4% to 4.6%), and 2.2% (95% CI, 1.4% to 3.4%), respectively. LTSs, compared with STSs, more commonly presented at age < 3 or > 10 years (11% v 3% and 33% v 23%, respectively; P < .001) and with longer symptom duration ( P < .001). STSs, compared with LTSs, more commonly presented with cranial nerve palsy (83% v 73%, respectively; P = .008), ring enhancement (38% v 23%, respectively; P = .007), necrosis (42% v 26%, respectively; P = .009), and extrapontine extension (92% v 86%, respectively; P = .04). LTSs more commonly received systemic therapy at diagnosis (88% v 75% for STSs; P = .005). Biopsies and autopsies were performed in 299 patients (30%) and 77 patients (10%), respectively; 181 tumors (48%) were molecularly characterized. LTSs were more likely to harbor a HIST1H3B mutation (odds ratio, 1.28; 95% CI, 1.1 to 1.5; P = .002). Conclusion We report clinical, radiologic, and molecular factors that correlate with survival in children and young adults with DIPG, which are important for risk stratification in future clinical trials
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