A study of macro-, meso- and micro-barriers and enablers affecting extended scopes of practice: The case of rural nurse practitioners in Australia

© 2019 The Author(s). Background: Shortages of skills needed to deliver optimal health care in rural and remote locations raises questions about using extended scopes of practice or advanced practice models in a range of health professions. The nurse practitioner (NP) model was introduced to address health service gaps; however, its sustainability has been questioned, while other extended scope of practice roles have not progressed in Australia. This study aimed to explore the experiences and perceptions of NPs and their colleagues about barriers to and enablers of extended scope of practice and consider the relevance of the findings to other health professions. Methods: Semi-structured, in-depth interviews were conducted with primary, nurse practitioner informants, who were also invited to nominate up to two colleagues, as secondary informants. Data analysis was guided by a multi-level, socio-institutional lens of macro-, meso- and micro-perspectives. Results: Fifteen primary informants and five colleagues were interviewed from various rural and remote locations. There was a fairly even distribution of informants across primary, aged, chronic and emergency or critical care roles. Key barriers and enablers at each level of analysis were identified. At the macro-level were legal, regulatory, and economic barriers and enablers, as well as job availability. The meso-level concerned local health service and community factors, such as attitudes and support from managers and patients. The micro-level relates to day-to-day practice. Role clarity was of considerable importance, along with embedded professional hierarchies and traditional role expectations influencing interactions with individual colleagues. Given a lack of understanding of NP scope of practice, NPs often had to expend effort promoting and advocating for their roles. Conclusions: For communities to benefit from extended scope of practice models of health service delivery, energy needs to be directed towards addressing legislative and regulatory barriers. To be successful, extended scope of practice roles must be promoted with managers and decision-makers, who may have limited understanding of the clinical importance. Support is also important from other members of the interprofessional health care team

On the possibility of measuring relativistic gravitational effects with a LAGEOS-LAGEOS II-OPTIS-mission

In this paper we wish to preliminary investigate if it would be possible to use the orbital data from the proposed OPTIS mission together with those from the existing geodetic passive SLR LAGEOS and LAGEOS II satellites in order to perform precise measurements of some general relativistic gravitoelectromagnetic effects, with particular emphasis on the Lense-Thirring effect.Comment: Abridged version. 16 pages, no figures, 1 table. First results from the GGM01C Earth gravity model. GRACE data include

The influence of temperature and seawater carbonate saturation state on 13C–18O bond ordering in bivalve mollusks

© The Author(s), 2013. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Biogeosciences 10 (2013): 4591-4606, doi:10.5194/bg-10-4591-2013.The shells of marine mollusks are widely used archives of past climate and ocean chemistry. Whilst the measurement of mollusk δ18O to develop records of past climate change is a commonly used approach, it has proven challenging to develop reliable independent paleothermometers that can be used to deconvolve the contributions of temperature and fluid composition on molluscan oxygen isotope compositions. Here we investigate the temperature dependence of 13C–18O bond abundance, denoted by the measured parameter Δ47, in shell carbonates of bivalve mollusks and assess its potential to be a useful paleothermometer. We report measurements on cultured specimens spanning a range in water temperatures of 5 to 25 °C, and field collected specimens spanning a range of −1 to 29 °C. In addition we investigate the potential influence of carbonate saturation state on bivalve stable isotope compositions by making measurements on both calcitic and aragonitic specimens that have been cultured in seawater that is either supersaturated or undersaturated with respect to aragonite. We find a robust relationship between Δ47 and growth temperature. We also find that the slope of a linear regression through all the Δ47 data for bivalves plotted against seawater temperature is significantly shallower than previously published inorganic and biogenic carbonate calibration studies produced in our laboratory and go on to discuss the possible sources of this difference. We find that changing seawater saturation state does not have significant effect on the Δ47 of bivalve shell carbonate in two taxa that we examined, and we do not observe significant differences between Δ47-temperature relationships between calcitic and aragonitic taxa.This work was funded by National Science Foundation grants ARC-1215551 to R. A. Eagle and A. K. Tripati, EAR-1024929 to R. A. Eagle and J. M. Eiler, and EAR-0949191 to A. K. Tripati. A. K. Tripati is also supported by the Hellman Fellowship program. Culture of bivalves in Kiel, Germany, was funded by the German Science Foundation (DFG Ei272/21-1, to Anton Eisenhauer) and the European Science Foundation (ESF) Collaborative Research Project CASIOPEIA (04 ECLIM FP08). Determination of bivalve mineralogy by J. B. Ries was funded by National Science Foundation grant OCE-1031995

Solid deuterium surface degradation at ultracold neutron sources

Solid deuterium (sD_2) is used as an efficient converter to produce ultracold neutrons (UCN). It is known that the sD_2 must be sufficiently cold, of high purity and mostly in its ortho-state in order to guarantee long lifetimes of UCN in the solid from which they are extracted into vacuum. Also the UCN transparency of the bulk sD_2 material must be high because crystal inhomogeneities limit the mean free path for elastic scattering and reduce the extraction efficiency. Observations at the UCN sources at Paul Scherrer Institute and at Los Alamos National Laboratory consistently show a decrease of the UCN yield with time of operation after initial preparation or later treatment (`conditioning') of the sD_2. We show that, in addition to the quality of the bulk sD_2, the quality of its surface is essential. Our observations and simulations support the view that the surface is deteriorating due to a build-up of D_2 frost-layers under pulsed operation which leads to strong albedo reflections of UCN and subsequent loss. We report results of UCN yield measurements, temperature and pressure behavior of deuterium during source operation and conditioning, and UCN transport simulations. This, together with optical observations of sD_2 frost formation on initially transparent sD_2 in offline studies with pulsed heat input at the North Carolina State University UCN source results in a consistent description of the UCN yield decrease.Comment: 15 pages, 22 figures, accepted by EPJ-

Evolution of the polarization of the optical afterglow of the gamma-ray burst GRB 030329

We report 31 polarimetric observations of the afterglow of GRB 030329 with high signal-to-noise and high sampling frequency. We establish the polarization light curve, detect sustained polarization at the percent level, and find significant variability of polarization degree and angle. The data imply that the afterglow magnetic field has small coherence length and is mostly random, probably generated by turbulence.Comment: Nature 426 (13. Nov. 2003), 2 figure

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness.

OBJECTIVE: The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior. METHOD: Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement prize draw procedure contingent on EtG-negative samples (/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods. RESULTS: Contingency management participants were 3.1 times (95% CI=2.2-4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional alcohol abstinence compared with controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, compared with controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up. CONCLUSIONS: This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness

AC losses in Bi,Pb(2223) multifilamentary wires with square cross-section

We have fabricated prototype Bi,Pb(2223)/Ag superconduting multifilamentary wires with a square cross-section. The AC losses of these wires were measured, compared with those of tapes and also compared with the theory. Wires show largely reduced AC magnetic field losses at 47 Hz, compared to those of tapes in a perpendicular magnetic field. The effects of the twist pitch and of the use of the high resisitive barriers were also investigated. The results show that the use of a twist pitch of about 10 mm is sufficient for decoupling the filaments, and that the use of very short twist pitches does not further reduce the absolute value of the AC losses. The losses in the wires are still higher than those of tapes in a parallel magnetic field, but the results show that the square or round configurations are interesting for applications where a perpendicular component of the magnetic field cannot be avoided, or for applications in rotating magnetic fields.Comment: 8 pages, 11 figures, submitted to Physica

Study of coupling loss on bi-columnar BSCCO/Ag tapes by a.c. susceptibility measurements

Coupling losses were studied in composite tapes containing superconducting material in the form of two separate stacks of densely packed filaments embedded in a metallic matrix of Ag or Ag alloy. This kind of sample geometry is quite favorable for studying the coupling currents and in particular the role of superconducting bridges between filaments. By using a.c. susceptibility technique, the electromagnetic losses as function of a.c. magnetic field amplitude and frequency were measured at the temperature T = 77 K for two tapes with different matrix composition. The length of samples was varied by subsequent cutting in order to investigate its influence on the dynamics of magnetic flux penetration. The geometrical factor $\chi_0$ which takes into account the demagnetizing effects was established from a.c. susceptibility data at low amplitudes. Losses vs frequency dependencies have been found to agree nicely with the theoretical model developed for round multifilamentary wires. Applying this model, the effective resistivity of the matrix was determined for each tape, by using only measured quantities. For the tape with pure silver matrix its value was found to be larger than what predicted by the theory for given metal resistivity and filamentary architecture. On the contrary, in the sample with a Ag/Mg alloy matrix, an effective resistivity much lower than expected was determined. We explain these discrepancies by taking into account the properties of the electrical contact of the interface between the superconducting filaments and the normal matrix. In the case of soft matrix of pure Ag, this is of poor quality, while the properties of alloy matrix seem to provoke an extensive creation of intergrowths which can be actually observed in this kind of samples.Comment: 20 pages 11 figure, submitted to Superconductor Science and Technolog