Primary health care nurses caring for people with diabetes: An integrative review of the literature

The aim of this integrative literature review was to analyse and synthesize findings from primary empirical studies concerning how nurses in primary care, care for people with diabetes (PWD). Diabetes is a recognized health priority in United Kingdom (UK) and New Zealand (NZ). Health policies are directing a shift in diabetes services from secondary to primary care. New Zealand primary health care (PHC) nurses are playing an increasing role in caring for a growing number of people with diabetes (PWD) and as such, need to be positioned effectively to contribute to preventing or minimizing associated long term diabetes complications. This research project has identified contrasted and highlighted similarities or differences in breadth and context in NZ nursing practice with UK practice and established important concepts and subsequent implications for this emerging role in NZ. The findings of this integrated review indicate that PHC nurses have developed extended and in some instances advanced specialised practice in caring for PWD across the breadth of the wellness disease continuum. Contextual factors have had a significant influence on how the role has emerged in both countries. The role is more evident in the UK and findings from the UK literature have implications for this emerging specialised PHC nursing role in NZ, particularly in relation to nurses increased role in medicine management of PWD. Recommendations are that new diabetes policies or programmes of care have structures that promote and support effective relationships and collaboration between all providers of the diabetes team. Education for this role should be provided at a nationally agreed standard where nurses’ competencies are measured. Furthermore appropriately qualified diabetes PHC nurses should have an increased role in medicine management and/or prescribing in NZ primary care similar to UK nurses. Finally, contribution of the emerging role of the diabetes PHC nurse should seriously be considered within the context of ‘Better, Sooner, More Convenient Primary Care’ structures that are designed to address chronic disease management and health inequities within the NZ population

Power without representation? The House of Lords and social policy

In the past the House of Lords has generally, and arguably for good reasons, been ignored in discussions of the making and scrutiny of welfare. However, it has always played some role in this field, particularly in the scrutiny and passage of legislation, and since the removal of hereditary Peers in 1999, some writers have argued that the House has become more assertive. This article examines the attitudes of Peers, including a comparison with the views of Members of Parliament, and draws a number of conclusions about the role of the upper House in relation to social policy

Stratification and Isotope Separation in CP Stars

We investigate the elemental and isotopic stratification in the atmospheres of selected chemically peculiar (CP) stars of the upper main sequence. Reconfiguration of the UVES spectrograph in 2004 has made it possible to examine all three lines of the Ca II infrared triplet. Much of the material analyzed was obtained in 2008. We support the claim of Ryabchikova, Kochukhov & Bagnulo (RKB) that the calcium isotopes have distinct stratification profiles for the stars 10 Aql, HR 1217, and HD 122970, with the heavy isotope concentrated toward the higher layers. Better observations are needed to learn the extent to which Ca-40 dominates in the deepest layers of all or most CP stars that show the presence of Ca-48. There is little evidence for Ca-40 in the spectra of some HgMn stars, and the infrared triplet in the magnetic star HD 101065 is well fit by pure Ca-48. In HR 5623 (HD 133792) and HD 217522 it is likely that the heavy isotope dominates, though models are possible where this is not the case. While elemental stratification is surely needed in many cases, we point out the importance of including adjustments in the assumed Teff and log(g) values, in attempts to model stratification. We recommend emphasis on profiles of the strongest lines, where the influence of stratification is most evident. Isotopic mixtures, involving the 4 stable calcium nuclides with masses between 40 and 48 are plausible, but are not emphasized.Comment: 16 Pages, 20 Figures, 10 Tables. Accepted for publication in Monthly Notices of the RA

Implementing TOPbase/Iron Project: Continuous Absorption from Fe II

We discuss implementation of TOPbase and Iron Project opacities for stellar spectral codes. We use a technique employed by Peach, where a Boltzmann-averaged cross section is calculated for selected temperatures, and the opacity obtained from double interpolation in temperature and wavelength. It is straightforward to include {\it all} levels for which cross sections have been calculated. Boltzmann-averaged cross sections for Fe II show a local maximum between 1700 and 2000[A]. We suggest this feature arises from 3d^5 4snl to 3d^5 4pnl transitions within Fe II. IUE spectra of iron-rich CP stars show local minima in this region. Theoretical calculations of a representative stellar continuum demonstrate that Fe II photoionization contributes significantly to the observed minima.Comment: 6 pages, 5 figures. See http://www.astro.lsa.umich.edu/users/cowley/paper2r for better definition figure