Heart failure nursing in Australia: Challenges, strengths, and opportunities

Australia has a land mass similar to the United States of America, supporting a population of just over 20 million, which is distributed predominantly across the coastal perimeter. The Australian society is rich in cultural diversity fostered by decades of migration. Both these factors present challenges for health care. First, because resources are scare in rural and remote regions, health outcomes are poorer in these regions, especially among indigenous populations. Second, the cultural diversity of Australians is a challenge to providing evidence-based treatment recommendations. In Australia, in parallel with international trends, there is a strong association between socioeconomic status, chronic conditions, and health outcomes

Learning the Rules of the Game: The Nature of Game and Classroom Supports When Using a Concept-Integrated Digital Physics Game in the Middle School Science Classroom

Games in science education is emerging as a popular topic of scholarly inquiry. The National Research Council recently published a report detailing a research agenda for games and science education entitled Learning Science Through Computer Games and Simulations (2011). The report recommends moving beyond typical proof-of-concept studies into more exploratory and theoretically-based work to determine how best to integrate games into K-12 classrooms for learning , as well as how scaffolds from within the game and from outside the game (from peers and teachers) support the learning of applicable science. This study uses a mixed-methods, quasi-experimental design with an 8th grade class at an independent school in southern Connecticut to answer the following questions: 1. What is the nature of the supports for science content learning provided by the game, the peer, and the teacher, when the game is used in a classroom setting? 2. How do the learning gains in the peer support condition compare to the solo play condition, both qualitatively and quantitatively? The concept-integrated physics game SURGE (Scaffolding Understanding through Redesigning Games for Education) was selected for this study, as it was developed with an ear towards specific learning theories and prior work on student understandings of impulse, force, and vectors. Stimulated recall interviews and video observations served as the primary sources and major patterns emerged through the triangulation of data sources and qualitative analysis in the software QSR NVivo 9. The first pattern which emerged indicated that scaffolding from within the game and outside the game requires a pause in game action to be effective, unless that scaffolding is directly useful to the player in the moment of action. The second major pattern indicated that both amount and type of prior gaming experience has somewhat complex effects on both the uses of supports and learning outcomes. In general, a high correlation was found between students who were more successful navigating supports from the game, the teacher, and the peer and higher gain scores from pre- to posttest. However, students with a lot of prior game experience that found the game to be easy without much assistance did not do as well from pre- to posttest as they did not need as much assistance from the game to do well and therefore missed out on important physics connections to impulse, force, and vectors. However, those students with little prior game experience did not find game scaffolds as useful and did not do as well from pre- to posttest without significant teacher and peer support to bolster or supplant the game's intended scaffolding. Implications for educators, educational game designers, and games in science education researchers are presented. It is argued that teachers must find ways to extract those scaffolds from the game which are easy to miss or require failure to activate so that all students, even those who find the game easy, are exposed to the intended learning in the game. Ideally, game designers are encouraged to find new ways to present scaffolds such that players of any ability can benefit from the connections from the game to physics

Nature in the poetry of Saint-Amant

The purpose of this study was to investigate the use of nature in the poetry of Saint-Amant. The study was encouraged by the recently renewed interest of scholars in the work of Saint-Amant as well as by new scholarly studies on the subject of nature in early seventeenth-century French literature. Background chapters provide material supportive of the study itself. The first chapter investigates nature in the work of major poets of the early seventeenth century in order to characterize its general use throughout the period studied. The second documents the critical appraisal of Saint-Amant from the seventeenth through the nineteenth centuries and discusses the important twentieth-century scholarly studies of his life and work. Essentially according to Francoise Gourier's system of classifying Saint-Amant's poetry, selected poems were then studied with attention to the natural elements detected in them in order to characterize the forms and functions of nature throughout his poetry. It was concluded that Saint-Amant's use of nature follows conventional trends as well as shows a considerable originality. It was also shown that this particular facet of Saint-Amant's writing reflects tendencies seen throughout his poetry which characterize him as a poet of the baroque tradition

Monolithic Flexure Pre-Stressed Ultrasonic Horns

A monolithic ultrasonic horn where the horn, backing, and pre-stress structures are combined in a single monolithic piece is disclosed. Pre-stress is applied by external flexure structures. The provision of the external flexures has numerous advantages including the elimination of the need for a pre-stress bolt. The removal of the pre-stress bolt eliminates potential internal electric discharge points in the actuator. In addition, it reduces the chances of mechanical failure in the actuator stacks that result from the free surface in the hole of conventional ring stacks. In addition, the removal of the stress bolt and the corresponding reduction in the overall number of parts reduces the overall complexity of the resulting ultrasonic horn actuator and simplifies the ease of the design, fabrication and integration of the actuator of the present invention into other structures

Monolithic Flexure Pre-Stressed Ultrasonic Horns

High-power ultrasonic actuators are generally assembled with a horn, backing, stress bolt, piezoelectric rings, and electrodes. The manufacturing process is complex, expensive, difficult, and time-consuming. The internal stress bolt needs to be insulated and presents a potential internal discharge point, which can decrease actuator life. Also, the introduction of a center hole for the bolt causes many failures, reducing the throughput of the manufactured actuators. A new design has been developed for producing ultrasonic horn actuators. This design consists of using flexures rather than stress bolts, allowing one to apply pre-load to the piezoelectric material. It also allows one to manufacture them from a single material/plate, rapid prototype them, or make an array in a plate or 3D structure. The actuator is easily assembled, and application of pre-stress greater than 25 MPa was demonstrated. The horn consists of external flexures that eliminate the need for the conventional stress bolt internal to the piezoelectric, and reduces the related complexity. The stress bolts are required in existing horns to provide prestress on piezoelectric stacks when driven at high power levels. In addition, the manufacturing process benefits from the amenability to produce horn structures with internal cavities. The removal of the pre-stress bolt removes a potential internal electric discharge point in the actuator. In addition, it significantly reduces the chances of mechanical failure in the piezoelectric stacks that result from the hole surface in conventional piezoelectric actuators. The novel features of this disclosure are: 1. A design that can be manufactured from a single piece of metal using EDM, precision machining, or rapid prototyping. 2. Increased electromechanical coupling of the horn actuator. 3. Higher energy density. 4. A monolithic structure of a horn that consists of an external flexure or flexures that can be used to pre-stress a solid piezoelectric structure rather than a bolt, which requires a through hole in the piezoelectric material. 5. A flexure system with low stiffness that accommodates mechanical creep with minor reduction in pre-stress

Monolithic Flexure Pre-Stressed Ultrasonic Horns

A monolithic ultrasonic horn where the horn, backing, and pre-stress structures are combined in a single monolithic piece is disclosed. Pre-stress is applied by external flexure structures. The provision of the external flexures has numerous advantages including the elimination of the need for a pre-stress bolt. The removal of the pre-stress bolt eliminates potential internal electric discharge points in the actuator. In addition, it reduces the chances of mechanical failure in the actuator stacks that result from the free surface in the hole of conventional ring stacks. In addition, the removal of the stress bolt and the corresponding reduction in the overall number of parts reduces the overall complexity of the resulting ultrasonic horn actuator and simplifies the ease of the design, fabrication and integration of the actuator of the present invention into other structures