Professional closure : the case of the professional development of nursing in Rotorua 1840-1934 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University

The argument that the development and progress of nursing in Rotorua were influenced by the forces of professional closure, and that nursing practice throughout New Zealand reflected this during the period 1840-1934, is the focus of this thesis. Rotorua provides a unique backdrop against which to examine the professional development of nursing as it encountered and exerted the forces of professional closure. For centuries the Maori had utilized the curative powers of the thermal district, incorporating this ancient knowledge into their lifestyle and culture. As Europeans gained access to the region, they recognised and exploited the therapeutic properties of the mineral rich springs, mud pools and thermal waters. Health and tourism became inextricably intertwined at Rotorua, as the government developed the spa resort with aspirations of achieving international acclaim As the boundaries between various medical and health services became more distinct, claims to professional exclusivity emerged. Each health occupational group adopted rules of closure as they attempted to secure a position of privilege in the expanding health care system. Nursing's rules of closure effectively marginalised and excluded the untrained nurse while elevating the status of the trained nurse. As the new century unfolded, institutionalised medical care expanded in Rotorua with the development of scientific knowledge and new technologies. In the spa setting of the Sanatorium Hospital and Baths, nursing complemented medicine. The difference between the trained and the untrained nurse became increasingly apparent. However, legislation aimed at improving standards of health and welfare effectively subordinated nursing to medicine in Rotorua's intensely patriarchal, hierarchical hospital structure. The value of the trained nurse, highlighted during World War I, was reinforced during the national emergency created by the 1918 influenza pandemic. The New Zealand Army utilised the spa treatment for sick and wounded soldiers, then as it withdrew its services from the hospitals, Rotorua's school of nursing for a short time (1923-1932), prepared nurses to replace the military nurses. The school closed, unable to maintain the required standards as nursing strengthened its rules of closure and tightened control over its own professional practice. For more than ninety years the status of nursing in Rotorua parallelled the status of nursing in New Zealand generally. During this period the emerging profession attempted to shed its image of domestic servitude to claim an elite and exclusive position within the developing health care system. However, unable to achieve the vital element of professional self-determination, nursing failed to significantly raise its status above that of a vocation, prior to 1934

Hybrid sample size calculations for cluster randomised trials using assurance

Sample size determination for cluster randomised trials (CRTs) is challenging as it requires robust estimation of the intra-cluster correlation coefficient (ICC). Typically, the sample size is chosen to provide a certain level of power to reject the null hypothesis in a hypothesis test. This relies on the minimal clinically important difference (MCID) and estimates for the standard deviation, ICC and possibly the coefficient of variation of the cluster size. Varying these parameters can have a strong effect on the sample size. In particular, it is sensitive to small differences in the ICC. A relevant ICC estimate is often not available, or the available estimate is imprecise. If the ICC used is far from the unknown true value, this can lead to trials which are substantially over- or under-powered. We propose a hybrid approach using Bayesian assurance to find the sample size for a CRT with a frequentist analysis. Assurance is an alternative to power which incorporates uncertainty on parameters through a prior distribution. We suggest specifying prior distributions for the standard deviation, ICC and coefficient of variation of the cluster size, while still utilising the MCID. We illustrate the approach through the design of a CRT in post-stroke incontinence. We show assurance can be used to find a sample size based on an elicited prior distribution for the ICC, when a power calculation discards all information in the prior except a single point estimate. Results show that this approach can avoid misspecifying sample sizes when prior medians for the ICC are very similar but prior distributions exhibit quite different behaviour. Assurance provides an understanding of the probability of success of a trial given an MCID and can be used to produce sample sizes which are robust to parameter uncertainty. This is especially useful when there is difficulty obtaining reliable parameter estimates.Comment: 21 pages, 4 figures and 2 table

Mainstreaming EC in Africa: The EC facilitative re-granting program—Final narrative report

Since 2006, ECafrique has been working to build the capacity of African nongovernmental organizations to design, implement, and evaluate successful emergency contraception (EC) mainstreaming projects. Through a process of “facilitative regranting,” ECafrique annually awarded nine grants ranging from $25,000 to$30,000 to organizations from across Anglophone and Francophone Africa. The program’s objectives were to increase access to EC across Africa by supporting projects intended to introduce, scale up, or mainstream the method, and build the capacity of African NGOs to design, implement, and evaluate successful EC mainstreaming projects. Each grantee participated in an international proposal development workshop and received individualized technical support throughout the life of their project. The nine projects supported under this program took place in Burkina Faso, Cameroon, Cote d’Ivoire, Ghana, Kenya, Nigeria, Senegal, and Uganda (two). This final narrative report details the accomplishments of each grantee, and highlights lessons learned regarding this approach to grant making

Sexual and transovarian transmission of Crimean-Congo haemorrhagic fever virus in Hyalomma truncatum ticks

A partir d'une expérience en laboratoire, il apparaît que les tiques du genre #Hyalomma$ sont un vecteur essentiel du virus CCHF en Afrique. Leur rôle de vecteur efficace est la résultante de leur aptitude à s'infecter, répliquer et transmettre le virus CCHF. La transmission sexuelle suivie d'une transmission transovarienne pourrait participer au maintien du virus dans la nature, en augmentant le taux d'infection du vecteu

Parent perceptions of a child physical activity initiative in a rural community.

This study assessed the extent to which a community-based intervention developed for children impacted parent perceptions and behaviors toward physical activity in a rural community. Focus groups and individual interviews were conducted with parents of children who participated in physical activity programs. Analysis revealed an increased community awareness surrounding physical activity following program implementation. Parents and children encouraged each other to be physically active. Ecological barriers and enabling factors to adult physical activity were identified these findings indicate a bidirectional influence between parent and child physical activity and the need for community facilities where families can be active together

Relativistic neutron star merger simulations with non-zero temperature equations of state I. Variation of binary parameters and equation of state

An extended set of binary neutron star (NS) merger simulations is performed with an approximative conformally flat treatment of general relativity to systematically investigate the influence of the nuclear equation of state (EoS), the neutron star masses, and the NS spin states prior to merging. We employ the two non-zero temperature EoSs of Shen et al. (1998a,b) and Lattimer & Swesty (1991). In addition, we use the cold EoS of Akmal et al. (1998) with a simple ideal-gas-like extension according to Shibata & Taniguchi (2006), and an ideal-gas EoS with parameters fitted to the supernuclear part of the Shen-EoS. We estimate the mass sitting in a dilute high-angular momentum ``torus'' around the future black hole (BH). The dynamics and outcome of the models is found to depend strongly on the EoS and on the binary parameters. Larger torus masses are found for asymmetric systems (up to ~0.3 M_sun for a mass ratio of 0.55), for large initial NSs, and for a NS spin state which corresponds to a larger total angular momentum. We find that the postmerger remnant collapses either immediately or after a short time when employing the soft EoS of Lattimer& Swesty, whereas no sign of post-merging collapse is found within tens of dynamical timescales for all other EoSs used. The typical temperatures in the torus are found to be about 3-10 MeV depending on the strength of the shear motion at the collision interface between the NSs and thus depending on the initial NS spins. About 10^{-3}-10^{-2} M_sun of NS matter become gravitationally unbound during or right after the merging process. This matter consists of a hot/high-entropy component from the collision interface and (only in case of asymmetric systems) of a cool/low-entropy component from the spiral arm tips. (abridged)Comment: 20 pages, 15 figures, accepted for publication in A&A, included changes based on referee comment

Mold and Endotoxin Levels in the Aftermath of Hurricane Katrina: A Pilot Project of Homes in New Orleans Undergoing Renovation

BACKGROUND: After Hurricane Katrina, many New Orleans homes remained flooded for weeks, promoting heavy microbial growth. OBJECTIVES: A small demonstration project was conducted November 2005–January 2006 aiming to recommend safe remediation techniques and safe levels of worker protection, and to characterize airborne mold and endotoxin throughout cleanup. METHODS: Three houses with floodwater lines between 0.3 and 2 m underwent intervention, including disposal of damaged furnishings and drywall, cleaning surfaces, drying remaining structure, and treatment with a biostatic agent. We measured indoor and outdoor bioaerosols before, during, and after intervention. Samples were analyzed for fungi [culture, spore analysis, polymerase chain reaction (PCR)] and endotoxin. In one house, real-time particle counts were also assessed, and respirator-efficiency testing was performed to establish workplace protection factors (WPF). RESULTS: At baseline, culturable mold ranged from 22,000 to 515,000 colony-forming units/m(3), spore counts ranged from 82,000 to 630,000 spores/m(3), and endotoxin ranged from 17 to 139 endotoxin units/m(3). Culture, spore analysis, and PCR indicated that Penicillium, Aspergillus, and Paecilomyces predominated. After intervention, levels of mold and endotoxin were generally lower (sometimes, orders of magnitude). The average WPF against fungal spores for elastomeric respirators was higher than for the N-95 respirators. CONCLUSIONS: During baseline and intervention, mold and endotoxin levels were similar to those found in agricultural environments. We strongly recommend that those entering, cleaning, and repairing flood-damaged homes wear respirators at least as protective as elastomeric respirators. Recommendations based on this demonstration will benefit those involved in the current cleanup activities and will inform efforts to respond to future disasters