New Nurse Residency - An Evidence Based Approach

Nurse educators believe that their graduates are well-prepared for entry level positions in nursing. In the acute healthcare setting, new graduates are placed on virtually every type of nursing unit, including critical care. Employers have developed formal orientations to familiarize new graduate nurses new with the institution and its policies and procedures and to teach the things employers believe new RNs need to know but do not, either because they were never taught the material or they have not retained it. The purposes of this project were to (a) examine the evidence relative to a disconnect between nursing education and nursing practice, (b) design a formal residency program for new graduates based on the evidence, and (c) implement and evaluate the residency program. Based on the evidence, a 16-week new nurse residency was developed in which Residents were each assigned both a Preceptor and Mentor to assist their progress. Weekly educational offerings were targeted at specific competency deficits identified by Residents, Preceptors and Mentors at the beginning of the residency program. Seven out of the original 10 Residents completed the Residency. Pre-residency, the Residents were very confident of their clinical skills and abilities and this was unchanged post-residency. The Preceptors and Mentors were much less confident of the clinical skills and abilities of the Residents pre-residency. Post-residency, the confidence level of the Preceptors and Mentors was improved, but significantly so only for the Mentors. It is imperative that nursing administrators be aware of the discrepancy between the confidence new nurses have in their own skills and the perceptions of the nurses who work side by side with them on a daily basis. Residencies for new graduate nurses are costly. Nursing administrators must make the determination if the benefits outweigh the costs. They may find the results of not having a residency are far more costly

Thermal shock resistance of ceramic matrix composites

The experimental and analytical investigation of the thermal shock phenomena in ceramic matrix composites is detailed. The composite systems examined were oxide-based, consisting of an aluminosilicate matrix with either polycrystalline aluminosilicate or single crystal alumina fiber reinforcement. The program was divided into three technical tasks; baseline mechanical properties, thermal shock modeling, and thermal shock testing. The analytical investigation focused on the development of simple expressions for transient thermal stresses induced during thermal shock. The effect of various material parameters, including thermal conductivity, elastic modulus, and thermal expansion, were examined analytically for their effect on thermal shock performance. Using a simple maximum stress criteria for each constituent, it was observed that fiber fracture would occur only at the most extreme thermal shock conditions and that matrix fracture, splitting parallel to the reinforcing fiber, was to be expected for most practical cases. Thermal shock resistance for the two material systems was determined experimentally by subjecting plates to sudden changes in temperature on one surface while maintaining the opposite surface at a constant temperature. This temperature change was varied in severity (magnitude) and in number of shocks applied to a given sample. The results showed that for the most severe conditions examined that only surface matrix fracture was present with no observable fiber fracture. The impact of this damage on material performance was limited to the matrix dominated properties only. Specifically, compression strength was observed to decrease by as much as 50 percent from the measured baseline

Dead Sea evaporation by eddy covariance measurements vs. aerodynamic, energy budget, Priestley–Taylor, and Penman estimates

The Dead Sea is a terminal lake, located in an arid environment. Evaporation is the key component of the Dead Sea water budget and accounts for the main loss of water. So far, lake evaporation has been determined by indirect methods only and not measured directly. Consequently, the governing factors of evaporation are unknown. For the first time, long-term eddy covariance measurements were performed at the western Dead Sea shore for a period of 1 year by implementing a new concept for onshore lake evaporation measurements. To account for lake evaporation during offshore wind conditions, a robust and reliable multiple regression model was developed using the identified governing factors wind velocity and water vapour pressure deficit. An overall regression coefficient of 0.8 is achieved. The measurements show that the diurnal evaporation cycle is governed by three local wind systems: a lake breeze during daytime, strong downslope winds in the evening, and strong northerly along-valley flows during the night. After sunset, the strong winds cause half-hourly evaporation rates which are up to 100 % higher than during daytime. The median daily evaporation is 4.3 mm d−1 in July and 1.1 mm d−1 in December. The annual evaporation of the water surface at the measurement location was 994±88 mm a−1 from March 2014 until March 2015. Furthermore, the performance of indirect evaporation approaches was tested and compared to the measurements. The aerodynamic approach is applicable for sub-daily and multi-day calculations and attains correlation coefficients between 0.85 and 0.99. For the application of the Bowen ratio energy budget method and the Priestley–Taylor method, measurements of the heat storage term are inevitable on timescales up to 1 month. Otherwise strong seasonal biases occur. The Penman equation was adapted to calculate realistic evaporation, by using an empirically gained linear function for the heat storage term, achieving correlation coefficients between 0.92 and 0.97. In summary, this study introduces a new approach to measure lake evaporation with a station located at the shoreline, which is also transferable to other lakes. It provides the first directly measured Dead Sea evaporation rates as well as applicable methods for evaporation calculation. The first one enables us to further close the Dead Sea water budget, and the latter one enables us to facilitate water management in the region

Establishing a proactive safety and health risk management system in the fire service

BACKGROUND: Formalized risk management (RM) is an internationally accepted process for reducing hazards in the workplace, with defined steps including hazard scoping, risk assessment, and implementation of controls, all within an iterative process. While required for all industry in the European Union and widely used elsewhere, the United States maintains a compliance-based regulatory structure, rather than one based on systematic, risk-based methodologies. Firefighting is a hazardous profession, with high injury, illness, and fatality rates compared with other occupations, and implementation of RM programs has the potential to greatly improve firefighter safety and health; however, no descriptions of RM implementation are in the peer-reviewed literature for the North American fire service. METHODS: In this paper we describe the steps used to design and implement the RM process in a moderately-sized fire department, with particular focus on prioritizing and managing injury hazards during patient transport, fireground, and physical exercise procedures. Hazard scoping and formalized risk assessments are described, in addition to the identification of participatory-led injury control strategies. Process evaluation methods were conducted to primarily assess the feasibility of voluntarily instituting the RM approach within the fire service setting. RESULTS: The RM process was well accepted by the fire department and led to development of 45 hazard specific-interventions. Qualitative data documenting the implementation of the RM process revealed that participants emphasized the: value of the RM process, especially the participatory bottom-up approach; usefulness of the RM process for breaking down tasks to identify potential risks; and potential of RM for reducing firefighter injury. CONCLUSIONS: As implemented, this risk-based approach used to identify and manage occupational hazards and risks was successful and is deemed feasible for U.S. (and other) fire services. While several barriers and challenges do exist in the implementation of any intervention such as this, recommendations for adopting the process are provided. Additional work will be performed to determine the effectiveness of select controls strategies that were implemented; however participants throughout the organizational structure perceived the RM process to be of high utility while researchers also found the process improved the awareness and engagement in actively enhancing worker safety and health.This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at [email protected]

emerging perspectives for flood risk assessment and management

Flood estimation and flood management have traditionally been the domain of hydrologists, water resources engineers and statisticians, and disciplinary approaches abound. Dominant views have been shaped; one example is the catchment perspective: floods are formed and influenced by the interaction of local, catchment-specific characteristics, such as meteorology, topography and geology. These traditional views have been beneficial, but they have a narrow framing. In this paper we contrast traditional views with broader perspectives that are emerging from an improved understanding of the climatic context of floods. We come to the following conclusions: (1) extending the traditional system boundaries (local catchment, recent decades, hydrological/hydraulic processes) opens up exciting possibilities for better understanding and improved tools for flood risk assessment and management. (2) Statistical approaches in flood estimation need to be complemented by the search for the causal mechanisms and dominant processes in the atmosphere, catchment and river system that leave their fingerprints on flood characteristics. (3) Natural climate variability leads to time-varying flood characteristics, and this variation may be partially quantifiable and predictable, with the perspective of dynamic, climate-informed flood risk management. (4) Efforts are needed to fully account for factors that contribute to changes in all three risk components (hazard, exposure, vulnerability) and to better understand the interactions between society and floods. (5) Given the global scale and societal importance, we call for the organization of an international multidisciplinary collaboration and data-sharing initiative to further understand the links between climate and flooding and to advance flood research

Floods and climate: emerging perspectives for flood risk assessment and management

Flood estimation and flood management have traditionally been the domain of hydrologists, water resources engineers and statisticians, and disciplinary approaches abound. Dominant views have been shaped; one example is the catchment perspective: floods are formed and influenced by the interaction of local, catchment-specific characteristics, such as meteorology, topography and geology. These traditional views have been beneficial, but they have a narrow framing. In this paper we contrast traditional views with broader perspectives that are emerging from an improved understanding of the climatic context of floods. We come to the following conclusions: (1) extending the traditional system boundaries (local catchment, recent decades, hydrological/hydraulic processes) opens up exciting possibilities for better understanding and improved tools for flood risk assessment and management. (2) Statistical approaches in flood estimation need to be complemented by the search for the causal mechanisms and dominant processes in the atmosphere, catchment and river system that leave their fingerprints on flood characteristics. (3) Natural climate variability leads to time-varying flood characteristics, and this variation may be partially quantifiable and predictable, with the perspective of dynamic, climate-informed flood risk management. (4) Efforts are needed to fully account for factors that contribute to changes in all three risk components (hazard, exposure, vulnerability) and to better understand the interactions between society and floods. (5) Given the global scale and societal importance, we call for the organization of an international multidisciplinary collaboration and data-sharing initiative to further understand the links between climate and flooding and to advance flood research

A new kaonic helium measurement in gas by SIDDHARTINO at the DAFNE collider*

The SIDDHARTINO experiment at the DA{\Phi}NE Collider of INFN-LNF, the pilot run for the SIDDHARTA-2 experiment which aims to perform the measurement of kaonic deuterium transitions to the fundamental level, has successfully been concluded. The paper reports the main results of this run, including the optimization of various components of the apparatus, among which the degrader needed to maximize the fraction of kaons stopped inside the target, through measurements of kaonic helium transitions to the 2p level. The obtained shift and width values are {\epsilon}_2p = E_exp-E_e.m = 0.2 {\pm} 2.5(stat) {\pm} 2(syst) eV and {\Gamma}_2p = 8 {\pm} 10 eV (stat), respectively. This new measurement of the shift, in particular, represents the most precise one for a gaseous target and is expected to contribute to a better understanding of the kaon-nuclei interaction at low energy

Abortamento de estruturas reprodutivas de plantas de canola em função da desfolha.

As folhas exercem papel fundamental nas plantas, pois através delas é possível que a energia solar seja convertida em energia química por meio do processo de fotossíntese. Os fotoassimilados resultantes deste processo são utilizados para manutenção da planta e também para formação de novas estruturas, dentre elas, as estruturas reprodutivas. Para cultura da canola, trabalhos tem mostrado que além das folhas e dos ramos, as síliquas também contribuem na produção de fotoassimilados durante sua fase reprodutiva, em que as síliquas mais desenvolvidas servem como fonte e as síliquas em início de desenvolvimento apresentam-se como drenos. Portanto, o objetivo do trabalho foi avaliar a importância das folhas a partir do início da floração e o efeito da desfolha total das plantas no abortamento de estruturas reprodutivas de canola