Evaluation of the role of the breast care nurse at Toowoomba Base Hospital

[Executive Summary]: The Supporting Rural Women with Breast Cancer Project started in Toowoomba in January 2005 with a Breast Care Nurse in a full time position in July 2005. The aim of the project is to develop and implement a revised multidisciplinary model of care resulting in the reorganisation and enhanced coordination of breast care services provided by Toowoomba Health Service District. A key deliverable under the service agreement with the Australian Government is the implementation of an evaluation plan and the compilation of an evaluation report. A decision on continuation of project initiatives will be informed in part by the results of the evaluation reported herein which was conducted by the Centre for Rural and Remote Area Health (CRRAH) based at the University of Southern Queensland. Structured questionnaires were used for both patient and stakeholder feedback. Fifty-one former breast cancer patients were interviewed by telephone. Twenty questions polled patients’ views on their access to the Breast Care Nurse and the nurse’s role in coordinating care, referral to other health professionals, and in providing information and psychosocial, emotional and practical support. Stakeholders received the questionnaire through the Toowoomba Health Services internal email system and returned completed questionnaires by reply paid mail to CRRAH. The questions were designed to provide views on the support that the Breast Care Nurse had made to a multi disciplinary treatment regimen. Views on the reasons for success or failure of the programme were also elicited. Widespread knowledge of the Breast Care Nurse prior to breast cancer treatment was poor; patients were unaware of the Breast Care Nurse until their first contact with her which was usually at the Surgical Outpatients Clinic held at the BreastScreen Toowoomba Service. More information about the position and role could be made available through GPs. Results from the patients revealed enormous gratitude for the support that they received from the Breast Care Nurse. There was overwhelming agreement that the timing of contact, ease of accessibility, information provided and support offered was extremely valuable in making their treatment and recovery easier. The vast majority of participants would recommend to their friends that they should attend hospitals with a Breast Care Nurse. Similar sentiments about the value of the Breast Care Nurse were received from stakeholders who recognised the benefit of the position not only to patients but also to the multidisciplinary team members in terms of coordination and liaison. However stakeholders did believe that a multidisciplinary team approach had not yet been fully achieved. The importance of maintaining a full time position of Breast Care Nurse was noted by both patients and stakeholders as accessibility of the nurse to patients was a key feature of the success of the programme. The study was in agreement with several other Australian reports all of which have demonstrated the success of dedicated Breast Care Nurses. The recommendation from the evaluation team is that the position of a full time Breast Care Nurse should be maintained. The Breast Care Nurse model is one that could be used successfully to support other medical condition

GROUND BEEF: IMPLICATIONS FOR THE SOUTHEASTERN U.S. BEEF INDUSTRY

Livestock Production/Industries,

The three-dimensional evolution of a plane mixing layer. Part 1: The Kelvin-Helmholtz roll-up

The Kelvin Helmholtz roll up of three dimensional, temporally evolving, plane mixing layers were simulated numerically. All simulations were begun from a few low wavenumber disturbances, usually derived from linear stability theory, in addition to the mean velocity profile. The spanwise disturbance wavelength was taken to be less than or equal to the streamwise wavelength associated with the Kelvin Helmholtz roll up. A standard set of clean structures develop in most of the simulations. The spanwise vorticity rolls up into a corrugated spanwise roller, with vortex stretching creating strong spanwise vorticity in a cup shaped region at the vends of the roller. Predominantly streamwise rib vortices develop in the braid region between the rollers. For sufficiently strong initial three dimensional disturbances, these ribs collapse into compact axisymmetric vortices. The rib vortex lines connect to neighboring ribs and are kinked in the opposite direction of the roller vortex lines. Because of this, these two sets of vortex lines remain distinct. For certain initial conditions, persistent ribs do not develop. In such cases the development of significant three dimensionality is delayed. When the initial three dimensional disturbance energy is about equal to, or less than, the two dimensional fundamental disturbance energy, the evolution of the three dimensional disturbance is nearly linear (with respect to the mean and the two dimensional disturbances), at least until the first Kelvin Helmholtz roll up is completed

Coherent structures in a simulated turbulent mixing layer

A direct numerical simulation of a plane turbulent mixing layer has been performed. The simulation was initialized using two turbulent velocity fields obtained from direct numerical simulation of a turbulent boundary layer at momentum thickness Reynolds number 300 (Spalart, 1988). The mixing layer is allowed to evolve long enough for self-similar linear growth to occur, with the visual thickness Reynolds number reaching 14,000. The simulated flow is examined for evidence of the coherent structures expected in a mixing layer (rollers and rib vortices). Before the onset of self-similar growth, such structures are present with properties similar to the corresponding laminar or transitional structures. In the self-similar growth regime, however, only the rollers are present with no indication of rib vortices and no indication of conventional pairing. This results in a reduction of mixing and layer growth

Smooth bumps, a Borel theorem and partitions of smooth functions on p.c.f. fractals

We provide two methods for constructing smooth bump functions and for smoothly cutting off smooth functions on fractals, one using a probabilistic approach and sub-Gaussian estimates for the heat operator, and the other using the analytic theory for p.c.f. fractals and a fixed point argument. The heat semigroup (probabilistic) method is applicable to a more general class of metric measure spaces with Laplacian, including certain infinitely ramified fractals, however the cut off technique involves some loss in smoothness. From the analytic approach we establish a Borel theorem for p.c.f. fractals, showing that to any prescribed jet at a junction point there is a smooth function with that jet. As a consequence we prove that on p.c.f. fractals smooth functions may be cut off with no loss of smoothness, and thus can be smoothly decomposed subordinate to an open cover. The latter result provides a replacement for classical partition of unity arguments in the p.c.f. fractal setting.Comment: 26 pages. May differ slightly from published (refereed) versio

The value of a breast care nurse in supporting rural and remote cancer patients in Queensland

The role of the Breast Care Nurse in Queensland's Supporting Rural Women with Breast Cancer Project was evaluated by mixed methodology. Through questionnaire and interview patients provided views about the nurse's role under categories of Awareness, Access, Coordination, Information and Psychosocial, Emotional and Practical support. Of the 51 participants 37 resided in rural and remote areas with 18 living between 100 and 500 miles from specialised breast care services. The BCN met with patients at their regular hospital visits and was available by telephone at any time. There was overwhelming agreement among the participants that the timing of contact, ease of accessibility, information provided and support offered were extremely valuable in making their treatment and recovery easier. The vast majority of participants would recommend hospitals with a BCN to their friends. Members of the multidisciplinary care team provided views on Awareness of the BCN, Influence on Care Management, Communication and Patient Outcomes. They recognised the benefits of the BCN to patients and to coordination and liaison of the team. The findings concur with unpublished Australian reports that demonstrate the success of dedicated Breast Care Nurses. The BCN model of care could be used successfully to support other medical conditions

Tax Cuts and Employment Growth in New Jersey: Lessons From a Regional Analysis

The Whitman Administration’s 30 percent reduction in New Jersey’s personal income taxes from 1994-96 is prominently cited as a role model for state fiscal policy. We investigate whether the growth benefits attributed to the Whitman tax cuts are warranted. Panel data methods are applied to annual observations of county-level employment growth from New Jersey and the surrounding economic region. Our analysis does not support the hypothesis that tax cuts stimulated employment growth in New Jersey. While New Jersey did experience substantial employment growth subsequent to the tax cuts, most of this growth was shared by the nearby Economic Areas.Tax cuts, economics growth