A postal survey to identify and describe nurse led clinics in genitourinary medicine services across England

Background: Nurses in genitourinary medicine (GUM) services are progressively extending their roles to conduct "comprehensive care" nurse led clinics. In such roles the nurse coordinates the first line, comprehensive care of patients presenting with sexual health conditions and issues. Objectives: To identify and describe comprehensive care nurse led clinics in GUM services across England. Methods: A postal questionnaire consisting of 17 closed response questions was sent to 209 GUM services across England. A second questionnaire was sent to non-responders to increase the response rate. Data were single entered and analysed using SPSS. Results: Of the 190 GUM clinic respondents (91% response rate), 44 (23%) reported providing some form of comprehensive care nurse led clinic, 90% of which were initiated since 1995. Key results show staff development featured as the main reason for initiating such services and there was general consistency in the aspects of care undertaken by these nurses. There was evidence of guideline development specific to nurse led care and some patient group direction use for supplying medication. The level of support from medical staff while nurse led clinics were being conducted varied between services. Few services have conducted any audit or research to monitor/evaluate nurse led care. There was little consistency in the clinical experience and educational prerequisites to undertake comprehensive care nurse led clinics. Continuing professional development opportunities also varied between services. Conclusions: The steady growth of comprehensive care nurse led clinics indicates that the skills of GUM nurses are being recognised. Nurses working in advanced practice roles now require courses and study days reflecting these changes in practice. Locally agreed practice guidelines can define nursing practice boundaries and ensure accountability, as will the development of patient group directions to supply medication. Monitoring and evaluation of nurse led clinics also require attention

Reflexivity of the translation-dilation algebras on L^2(R)

The hyperbolic algebra A_h, studied recently by Katavolos and Power, is the weak star closed operator algebra on L^2(R) generated by H^\infty(R), as multiplication operators, and by the dilation operators V_t, t \geq 0, given by V_t f(x) = e^{t/2} f(e^t x). We show that A_h is a reflexive operator algebra and that the four dimensional manifold Lat A_h (with the natural topology) is the reflexive hull of a natural two dimensional subspace.Comment: 10 pages, no figures To appear in the International Journal of Mathematic

Guiding of Rydberg atoms in a high-gradient magnetic guide

We study the guiding of $^{87}$Rb 59D$_{5/2}$ Rydberg atoms in a linear, high-gradient, two-wire magnetic guide. Time delayed microwave ionization and ion detection are used to probe the Rydberg atom motion. We observe guiding of Rydberg atoms over a period of 5 ms following excitation. The decay time of the guided atom signal is about five times that of the initial state. We attribute the lifetime increase to an initial phase of $l$-changing collisions and thermally induced Rydberg-Rydberg transitions. Detailed simulations of Rydberg atom guiding reproduce most experimental observations and offer insight into the internal-state evolution

Building workforce capacity for complex care coordination: a function analysis of workflow activity

Background The care coordination workforce includes a range of clinicians who manage care for patients with multiple chronic conditions both within and outside a hospital, in the community, or in a patient’s home. These patients require a multi-skilled approach to support complex care and social support needs as they are typically high users of health, community, and social services. In Australia, workforce structures have not kept pace with this new and emerging workforce. The aim of the study was to develop, map, and analyse workforce functions of a care coordination team. Methods Workflow modelling informed the development of an activity log that was used to collect workflow data in 2013 from care coordinators located within the care coordination service offered by a Local Health Network in Australia. The activity log comprised a detailed classification of care coordination functions based on two major categories – direct and indirect care. Direct care functions were grouped into eight domains. A descriptive quantitative investigation design was used for data analysis. The data was analysed using univariate descriptive statistics with results presented in tables and a figure. Results Care coordinators spent more time (70.9%) on direct care than indirect care (29.1%). Domains of direct care that occupied the most time relative to the 38 direct care functions were ‘Assessment’ (14.1%), ‘Documentation’ (13.9%), ‘Travel time’ (6.3%), and ‘Accepting/discussing referral’ (5.7%). ‘Administration’ formed a large component of indirect care functions (14.8%), followed by ‘Travel’ (12.4%). Sub-analyses of direct care by domains revealed that a group of designated ‘core care coordination functions’ contributed to 40.6% of direct care functions. Conclusions The modelling of care coordination functions and the descriptions of workflow activity support local development of care coordination capacity and workforce capability through extensive practice redesigns

Self-consistent massive disks in triaxial dark matter halos

Galactic disks in triaxial dark matter halos become deformed by the elliptical potential in the plane of the disk in such a way as to counteract the halo ellipticity. We develop a technique to calculate the equilibrium configuration of such a disk in the combined disk-halo potential, which is based on the method of Jog (2000) but accounts for the radial variation in both the halo potential and the disk ellipticity. This crucial ingredient results in qualitatively different behavior of the disk: the disk circularizes the potential at small radii, even for a reasonably low disk mass. This effect has important implications for proposals to reconcile cuspy halo density profiles with low surface brightness galaxy rotation curves using halo triaxiality. The disk ellipticities in our models are consistent with observational estimates based on two-dimensional velocity fields and isophotal axis ratios.Comment: ApJ, in pres

Program on Earth Observation Data Management Systems (EODMS), appendixes

The needs of state, regional, and local agencies involved in natural resources management in Illinois, Iowa, Minnesota, Missouri, and Wisconsin are investigated to determine the design of satellite remotely sensed derivable information products. It is concluded that an operational Earth Observation Data Management System (EODMS) will be most beneficial if it provides a full range of services - from raw data acquisition to interpretation and dissemination of final information products. Included is a cost and performance analysis of alternative processing centers, and an assessment of the impacts of policy, regulation, and government structure on implementing large scale use of remote sensing technology in this community of users

Study of fuel cells using storable rocket propellants Final report, 28 Jan. 1964 - 29 Jan. 1965

Fuel cells using storable rocket propellants for reactant