Handheld computers: Do they support or constrain nursing students at the point -of -care?

Technology has made a significant impact within the healthcare system over recent years. As technology continues to evolve and becomes a major driving force within the healthcare system, so will the need for preparing technologically competent healthcare professionals. Also within the healthcare system, changes such as a decrease in the length of hospital stay, the aging population, and the multi-disease processes of the aging population, presents a challenge to nursing faculty to adequately prepare tomorrows\u27 nurse. One of the most promising technological devices being used by healthcare professionals is the handheld computer or personal digital assistant (PDA). Although the current literature supports the use of the PDA by practicing nurses and nursing students, little is known how to incorporate these devices to support and develop life-long learners; A mixed-method design directed this study. Biemiller & Meichenbaum\u27s Think-Aloud was conducted at the onset and conclusion of the study. A grounded theory approach was utilized to gather data pertaining to PDAs and nursing students. Upon observing the participant accessing the PDA, a semi-structured interview occurred. The last component of data collection was obtained via a tracking system on a nursing focused PDA software program; The results demonstrate that the PDA supports self-regulated/self-directed learning in nursing students. Biemiller & Meichenbaum\u27s Think-Aloud demonstrated that all participants increased in their ability to be self-directed learners at the conclusion of the study. Furthermore, the results demonstrated that students are accessing the PDA in the clinical site, in the classroom, in studying for test/exams, and when completing assignments. Although the age varied for the participants, the method preferred for learning was from the screen; Pintrich\u27s self-regulated learning model was used as a method of determining the extent and progression of identifying self-regulated learners. Again, the results displayed that the PDA supported the participant in becoming self-regulated learners by providing them with a tool that offers precise, current, accurate, and current time information. With the ease of accessing information any time and from anywhere, nursing students have the potential to control what and how learning occurs

Interactive Multi-Submission Deposit Workflows for Desktop Applications

Online submission and publishing is the norm for academic researchers. With the pressure on these authors to submit their work to conferences, journals and Institutional Repositories, this leads to demands on the author to go through multiple web based interfaces, filling in forms with the same information multiple times before they can submit. At the same time, each of these services in turn will have made policy decisions on what types of format they allow and what templates the content has to conform to. The amount of work expected of the author does not adding up to the potential gain, thus most authors will only submit into the repository or publication where they foresee the most benefit. In this paper we propose a solution to this problem that embeds the workflow for multiple submissions into the desktop application of the author, most commonly Microsoft Word. We also propose extending the work done on the Microsoft Word Author Add-in tool to allow two-way negotiation between each repository and the desktop application

Management of allergic conjunctivitis: an evaluation of the perceived comfort and therapeutic efficacy of olopatadine 0.2% and azelastine 0.05% from two prospective studies

Arthur B Epstein1, Peter T Van Hoven2, Alan Kaufman3, Warner W Carr41North Shore Contact Lens and Vision Consultants, Roslyn Heights, NY, USA; 2Primary Eyecare Group PC, Brentwood, TN, USA; 3Adult Allergy Clinic and the Division of Allergy and Immunology, Our Lady of Mercy Medical Center, Bronx, NY, USA; 4Southern California Research, Mission Viejo, CA, USAPurpose: Results from 2 patient-reported outcome studies of allergic conjunctivitis sufferers who used olopatadine 0.2% and azelastine 0.05% are analyzed.Methods: The PACE (Pataday Allergic Conjunctivitis Evaluation) multi-center, prospective, open-label study examined patient perceptions of olopatadine 0.2% once daily (qd) and previous twice daily (bid) allergic conjunctivitis medications via questionnaire in allergic conjunctivitis sufferers who had previously used bid medication and then initiated olopatadine. A second conjunctival antigen challenge (CAC) study evaluated comfort of 4 allergic conjunctivitis medications. Results: Forty-nine patients from the PACE study (N = 125) with prior azelastine use were examined. Significantly more patients rated themselves “very satisfied” with current olopatadine use compared with past azelastine use on drop comfort (p < 0.0001), speed of relief (p = 0.0004), and overall satisfaction (70% vs 16%, p < 0.0001). Significantly more patients reported olopatadine “very effective” against swelling compared with azelastine (47% vs 8%, p = 0.0404). In the CAC study (N = 36), data from olopatadine (n = 8), azelastine (n = 9) and placebo (N = 36) groups were reported. Olopatadine was rated significantly more comfortable than azelastine upon instillation (p = 0.0223), at 30 seconds (p = 0.0479), and at 1 minute after instillation (p = 0.0240).Conclusion: In the reported studies, olopatadine 0.2% qd was more comfortable than azelastine 0.05% and preferred by patients with allergic conjunctivitis by a ratio of 4:1.Keywords: allergic conjunctivitis, azelastine, ocular allergy, olopatadine, patient perception

Children with disorders of sex development: A qualitative study of early parental experience

<p>Abstract</p> <p>Background</p> <p>Clinical research on psychological aspects of disorders of sex development (DSD) has focused on psychosexual differentiation with relatively little attention directed toward parents' experiences of early clinical management and their influence on patient and family psychosocial adaptation.</p> <p>Objectives</p> <p>To characterize parental experiences in the early clinical care of children born with DSD.</p> <p>Study Design</p> <p>Content analysis of interviews with parents (n = 41) of 28 children, newborn to 6 years, with DSD.</p> <p>Results</p> <p>Four major domains emerged as salient to parents: (1) the gender assignment process, (2) decisions regarding genital surgery, (3) disclosing information about their child's DSD, and (4) interacting with healthcare providers. Findings suggested discordance between scientific and parental understandings of the determinants of "sex" and "gender." Parents' expectations regarding the benefits of genital surgery appear largely met; however, parents still had concerns about their child's future physical, social and sexual development. Two areas experienced by many parents as particularly stressful were: (1) uncertainties regarding diagnosis and optimal management, and (2) conflicts between maintaining privacy versus disclosing the condition to access social support.</p> <p>Conclusions</p> <p>Parents' experiences and gaps in understanding can be used to inform the clinical care of patients with DSD and their families. Improving communication between parents and providers (and between parents and their support providers) throughout the early clinical management process may be important in decreasing stress and improving outcomes for families of children with DSD.</p

A Flagellar A-Kinase Anchoring Protein with Two Amphipathic Helices Forms a Structural Scaffold in the Radial Spoke Complex

A-kinase anchoring proteins (AKAPs) contain an amphipathic helix (AH) that binds the dimerization and docking (D/D) domain, RIIa, in cAMP-dependent protein kinase A (PKA). Many AKAPs were discovered solely based on the AH–RIIa interaction in vitro. An RIIa or a similar Dpy-30 domain is also present in numerous diverged molecules that are implicated in critical processes as diverse as flagellar beating, membrane trafficking, histone methylation, and stem cell differentiation, yet these molecules remain poorly characterized. Here we demonstrate that an AKAP, RSP3, forms a dimeric structural scaffold in the flagellar radial spoke complex, anchoring through two distinct AHs, the RIIa and Dpy-30 domains, in four non-PKA spoke proteins involved in the assembly and modulation of the complex. Interestingly, one AH can bind both RIIa and Dpy-30 domains in vitro. Thus, AHs and D/D domains constitute a versatile yet potentially promiscuous system for localizing various effector mechanisms. These results greatly expand the current concept about anchoring mechanisms and AKAPs

Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults

Objective: Evidence for effective management of shoulder impingement is limited. The present study aimed to quantify the clinical, neurophysiological, and biomechanical effects of a scapular motor control retraining for young individuals with shoulder impingement signs.Method: Sixteen adults with shoulder impingement signs (mean age 22 ? 1.6 years) underwent the intervention and 16 healthy participants (24.8 ? 3.1years) provided reference data. Shoulder function and pain were assessed using the Shoulder Pain and Disability Index (SPADI) and other questionnaires. Electromyography (EMG) and 3 dimensional motion analysis was used to record muscle activation and kinematic data during arm elevation to 90? and lowering in 3 planes. Patients were assessed pre and post a 10-week motor control based intervention, utilizing scapular orientation retraining.Results: Pre-intervention, patients reported pain and reduced function compared to the healthy participants (SPADI in patients 20 ? 9.2; healthy 0 ? 0). Post intervention, the SPADI scores reduced significantly (P &lt; .001) by a mean of 10 points (?4). EMG showed delayed onset and early termination of serratus anterior and lower trapezius muscle activity pre-intervention, which improved significantly post-intervention (P &lt; .05). Pre intervention, patients exhibited on average 4.6-7.4? less posterior tilt, which was significantly lower in 2 arm elevation planes (P &lt; .05) than healthy participants. Postintervention, upward rotation and posterior tilt increased significantly (P &lt;.05) during 2 arm movements, approaching the healthy values.Conclusion: A 10-week motor control intervention for shoulder impingement increased function and reduced pain. Recovery mechanisms were indicated by changes in muscle recruitment andscapular kinematics. The efficacy of the intervention requires further examined in a randomizedcontrol trial

Constraints on the origin and evolution of Iani Chaos, Mars

[1] The origin mechanisms and geologic evolution of chaotic terrain on Mars are poorly constrained. Iani Chaos, located at the head Ares Vallis, is among the most geomorphologically complex of the chaotic terrains. Its morphology is defined by (1) multiple, 1 to 2 km deep basins, (2) flat‐topped, fractured plateaus that are remnants of highland terrain, (3) knobby, fractured remnants of highland terrain, (4) plateaus with a knobby surface morphology, (5) interchaos grooved terrain, (6) interior layered deposits (ILDs), and (7) mantling material. Topography, the observed geomorphology, and measured fracture patterns suggest that the interchaos basins formed as a result of subsurface volume loss and collapse of the crust, likely owing to effusion of groundwater to the surface. Regional patterns in fracture orientation indicate that the basins developed along linear zones of preexisting weakness in the highland crust. Multiple overlapping basins and fracture systems point to multiple stages of collapse at Iani Chaos. Furthermore, the total estimated volume loss from the basins (104 km3) is insufficient to explain erosion of 104–105 km3 of material from Ares Vallis by a single flood. Comparisons with the chronology of Ares Vallis indicate multiple water effusion events from Iani Chaos that span the Hesperian, with termination of activity in the early Amazonian. Recharge of groundwater through preexisting fracture systems may explain this long‐lived, but likely episodic, fluvial activity. Late‐stage, early to middle Amazonian aqueous processes may have deposited the ILDs. However, the topography data indicate that the ILDs did not form within lacustrine environments

Hypotheses for the Origin of the Hypanis Fan-Shaped Deposit at the Edge of the Chryse Escarpment, Mars: Is it a Delta?

We investigated the origin of the fan-shaped deposit at the end of Hypanis Valles that has previously been proposed as an ExoMars, Mars 2020, and human mission candidate landing site, and found evidence that the landform is an ancient delta. Previous work suggests that the deposit originated from a time of fluvial activity both distinct from and prior to catastrophic outflow, and crater counting placed the deposit’s age at  ≥ 3.6 Ga. We found over 30 thin sedimentary strata in the proposed delta wall, and from our slope analysis conclude that the fluvial sequence is consistent with a lowering/retreating shoreline. We measured nearly horizontal bedding dip angles ranging from 0° to 2° over long stretches of cliff and bench exposures seen in HiRISE images and HiRISE stereo DTMs. From THEMIS night IR images we determined that the fan-shaped deposit has a low thermal inertia (150-240 Jm-2 K-1 s-1/2) and the surrounding darker-toned units correspond to thermal inertia values as high as 270-390 Jm-2 K-1 s-1/2. We interpret these findings to indicate that the fan-shaped deposit consists mostly of silt-sized and possibly finer grains, and that the extremely low grade and large lateral extent of these beds implies that the depositional environment was calm and relatively long-lived. We interpret the geomorphology and composition as incompatible with an alluvial fan or mudflow hypothesis. From our stratigraphic mapping we interpret the order of events which shaped the region. After the Chryse impact, sediment filled the basin, a confined lake or sea formed allowing a large delta to be deposited near its shoreline, the water level receded to the north, darker sedimentary/volcanic units covered the region and capped the light-toned deposit as hydro-volcanic eruptions shaped the interior of Lederberg crater, freeze/thaw cycles and desiccation induced local fracturing, and finally wrinkle ridges associated with rounded cones warped the landscape following trends in degraded crater rims and existing tectonic features. The ancient deltaic deposit we observe today was largely untouched by subsequent catastrophic outflows, and its surface has been only moderately reshaped by over 3 billion years of aeolian erosion

Classical novae from the POINT-AGAPE microlensing survey of M31 -- I. The nova catalogue

The POINT-AGAPE survey is an optical search for gravitational microlensing events towards the Andromeda Galaxy (M31). As well as microlensing, the survey is sensitive to many different classes of variable stars and transients. Here we describe the automated detection and selection pipeline used to identify M31 classical novae (CNe) and we present the resulting catalogue of 20 CN candidates observed over three seasons. CNe are observed both in the bulge region as well as over a wide area of the M31 disk. Nine of the CNe are caught during the final rise phase and all are well sampled in at least two colours. The excellent light-curve coverage has allowed us to detect and classify CNe over a wide range of speed class, from very fast to very slow. Among the light-curves is a moderately fast CN exhibiting entry into a deep transition minimum, followed by its final decline. We have also observed in detail a very slow CN which faded by only 0.01 mag day$^{-1}$ over a 150 day period. We detect other interesting variable objects, including one of the longest period and most luminous Mira variables. The CN catalogue constitutes a uniquely well-sampled and objectively-selected data set with which to study the statistical properties of classical novae in M31, such as the global nova rate, the reliability of novae as standard-candle distance indicators and the dependence of the nova population on stellar environment. The findings of this statistical study will be reported in a follow-up paper.Comment: 21 pages, 13 figures, re-submitted for publication in MNRAS, typos corrected, references updated, figures 5-9 made cleare