Patient advocacy: Barriers and facilitators

Background: During the two recent decades, advocacy has been a topic of much debate in the nursing profession. Although advocacy has embraced a crucial role for nurses, its extent is often limited in practice. While a variety of studies have been generated all over the world, barriers and facilitators in the patient advocacy have not been completely identified. This article presents the findings of a study exploring the barriers and facilitators influencing the role of advocacy among Iranian nurses. Method: This study was conducted by grounded theory method. Participants were 24 Iranian registered nurses working in a large university hospital in Tehran, Iran. Semi-structured interviews were used for data collection. All interviews were transcribed verbatim and simultaneously Constant comparative analysis was used according to the Strauss and Corbin method. Results: Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. Nurses in this study identified powerlessness, lack of support, law, code of ethics and motivation, limited communication, physicians leading, risk of advocacy, royalty to peers, and insufficient time to interact with patients and families as barriers to advocacy. As for factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing patients' needs, nurses' responsibility, physician as a colleague, and nurses' knowledge and skills could be influential in adopting the advocacy role. Conclusion: Participants believed that in this context taking an advocacy role is difficult for nurses due to the barriers mentioned. Therefore, they make decisions and act as a patient's advocate in any situation concerning patient needs and status of barriers and facilitators. In most cases, they can not act at an optimal level; instead they accept only what they can do, which we called 'limited advocacy' in this study. It is concluded that advocacy is contextually complex, and is a controversial and risky component of the nursing practice. Further research is needed to determine the possibility of a correlation between identified barriers/ facilitators and the use of advocacy. © 2006Negarandeh et al; licensee BioMed Central Ltd

Antisense PNA accumulates in Escherichia coli and mediates a long post-antibiotic effect

Antisense agents that target growth-essential genes display surprisingly potent bactericidal properties. In particular, peptide nucleic acid (PNA) and phosphorodiamidate morpholino oligomers linked to cationic carrier peptides are effective in time kill assays and as inhibitors of bacterial peritonitis in mice. It is unclear how these relatively large antimicrobials overcome stringent bacterial barriers and mediate killing. Here we determined the transit kinetics of peptide-PNAs and observed an accumulation of cell-associated PNA in Escherichia coli and slow efflux. An inhibitor of drug efflux pumps did not alter peptide-PNA potency, indicating a lack of active efflux from cells. Consistent with cell retention, the post-antibiotic effect (PAE) of the anti-acyl carrier protein (acpP) peptide-PNA was greater than 11 hours. Bacterial cell accumulation and a long PAE are properties of significant interest for antimicrobial development.Peer reviewe

Modelling lubricated revolute joints in multibody mechanical systems

This work deals with the modelling of lubricated revolute joints in multibody mechanical systems. In most machines and mechanisms, the joints are designed to operate with some lubricant fluid. The high pressures generated in the lubricant fluid act to keep the journal and the bearing apart. Moreover, the thin film formed by lubricant reduces friction and wear, provides load capacity and adds damping to dissipate undesirable mechanical vibrations. In the dynamic analysis of journal–bearings, the hydrodynamic forces, which include both squeeze and wedge effects, produced by the lubricant fluid oppose the journal motion. These forces are obtained by integrating the pressure distribution evaluated with the aid of Reynolds’ equation written for the dynamic regime. The hydrodynamic forces are nonlinear functions of journal centre position and velocity relative to the bearing centre. In a simple way, the hydrodynamic forces built up by the lubricant fluid are evaluated from the state of variable of the system and included into the equations of motion of the mechanical system. Results for an elementary slider–crank mechanism, in which a lubricated revolute joint connects the connecting rod and slider, are used to discuss the assumptions and procedures adopted.Fundação para a Ciência e a Tecnologia (FCT

Providing models for socialization of educational spaces relying on the Constructivism Approach and production of space

This research focuses on the expansion of educational spaces compatible with the teacher-centered method that has caused the lack of improvement of these spaces with the student-oriented instruction methods. The hypothesis is that by applying constructivist approaches and theories of social production of space, school environments can be designed to enhance students’ interactions and active participation in learning that ultimately increases their motivation for education. The research is descriptive-analytical in nature and follows a qualitative and interdisciplinary approach as well as uses a developmental method. The educational spaces of three purposefully selected schools are analyzed using various theories. The analysis results in the identification of five types of educational spaces that can support the application of constructivist methods of instruction and promote students' social interactions. The proposed spatial structure includes classroom sets, public spaces, and common areas, aiming to create a spatial convergence and fluidity that prevent spatial disarray. The intention is to move away from teacher-oriented spaces and towards more flexible and open environments that foster social interactions and student engagement. Overall, this research contributes to the understanding of how educational spaces can be adapted to facilitate the student-oriented instruction and promote constructivist learning approaches. The findings offer insights into the design principles that can enhance students' motivation and active participation in the education process

Direct Singular Positions of the Parallel Manipulator Tricept

[[abstract]]In this article, the direct singular positions of the parallel manipulator Tricept are determined. An alternative 3 x 3 Jacobian matrix, simpler than the existing one, is obtained in this study. For a given moving platform's orientation, the determinant of this Jacobian matrix may be expressed as a cubic polynomial in moving platform's equation length. Direct singular positions may thus be obtained by solving cubic polynomial equations. For an arbitrarily chosen moving platform's orientation, there exists at least one moving platform's extension length that causes direct kinematic singularity. It is found that if moving platform's size is larger than a specific value, then within the moving platform's domain there exist two regions, in which direct kinematic singularities can only occur at positions impossible to reach.[[notice]]補正完畢[[booktype]]紙本[[countrycodes]]GB

A study on wear evaluation of railway wheels based on multibody dynamics and wear computation

The wear evolution of railway wheels is a very important issue in railway engineering. In the past, the reprofiling intervals of railway vehicle steel wheels have been scheduled according to designers' experience. Today, more reliable and accurate tools in predicting wheel wear evolution and wheelset lifetime can be used in order to achieve economical and safety benefits. In this work, a computational tool that is able to predict the evolution of the wheel profiles for a given railway system, as a function of the distance run, is presented. The strategy adopted consists of using a commercial multibody software to study the railway dynamic problem and a purpose-built code for managing its pre- and post-processing data in order to compute the wear. The tool is applied here to realistic operation scenarios in order to assess the effect of some service conditions on the wheel wear progression

Mobile network performance from user devices: A longitudinal, multidimensional analysis

Abstract. In the cellular environment, operators, researchers and end users have poor visibility into network performance for devices. Improving visibility is challenging because this performance depends factors that include carrier, access technology, signal strength, geographic location and time. Addressing this requires longitudinal, continuous and large-scale measurements from a diverse set of mobile devices and networks. This paper takes a first look at cellular network performance from this perspective, using 17 months of data collected from devices located throughout the world. We show that (i) there is significant variance in key performance metrics both within and across carriers; (ii) this variance is at best only partially explained by regional and time-of-day patterns; (iii) the stability of network performance varies substantially among carriers. Further, we use the dataset to diagnose the causes behind observed performance problems and identify additional measurements that will improve our ability to reason about mobile network behavior

CFD investigation of a complete floating offshore wind turbine

This chapter presents numerical computations for floating offshore wind turbines for a machine of 10-MW rated power. The rotors were computed using the Helicopter Multi-Block flow solver of the University of Glasgow that solves the Navier-Stokes equations in integral form using the arbitrary Lagrangian-Eulerian formulation for time-dependent domains with moving boundaries. Hydrodynamic loads on the support platform were computed using the Smoothed Particle Hydrodynamics method. This method is mesh-free, and represents the fluid by a set of discrete particles. The motion of the floating offshore wind turbine is computed using a Multi-Body Dynamic Model of rigid bodies and frictionless joints. Mooring cables are modelled as a set of springs and dampers. All solvers were validated separately before coupling, and the loosely coupled algorithm used is described in detail alongside the obtained results

On the constraints violation in forward dynamics of multibody systems

It is known that the dynamic equations of motion for constrained mechanical multibody systems are frequently formulated using the Newton-Euler’s approach, which is augmented with the acceleration constraint equations. This formulation results in the establishment of a mixed set of partial differential and algebraic equations, which are solved in order to predict the dynamic behavior of general multibody systems. The classical resolution of the equations of motion is highly prone to constraints violation because the position and velocity constraint equations are not fulfilled. In this work, a general and comprehensive methodology to eliminate the constraints violation at the position and velocity levels is offered. The basic idea of the described approach is to add corrective terms to the position and velocity vectors with the intent to satisfy the corresponding kinematic constraint equations. These corrective terms are evaluated as function of the Moore-Penrose generalized inverse of the Jacobian matrix and of the kinematic constraint equations. The described methodology is embedded in the standard method to solve the equations of motion based on the technique of Lagrange multipliers. Finally, the effectiveness of the described methodology is demonstrated through the dynamic modeling and simulation of different planar and spatial multibody systems. The outcomes in terms of constraints violation at the position and velocity levels, conservation of the total energy and computational efficiency are analyzed and compared with those obtained with the standard Lagrange multipliers method, the Baumgarte stabilization method, the augmented Lagrangian formulation, the index-1 augmented Lagrangian and the coordinate partitioning method.The first author expresses his gratitude to the Portuguese Foundation for Science and Technology through the PhD grant (PD/BD/114154/2016). This work has been supported by the Portuguese Foundation for Science and Technology with the reference project UID/EEA/04436/2013, by FEDER funds through the COMPETE 2020 – Programa Operacional Competitividade e Internacionalização (POCI) with the reference project POCI-01-0145-FEDER-006941.info:eu-repo/semantics/publishedVersio

Patient advocacy: barriers and facilitators

BACKGROUND: During the two recent decades, advocacy has been a topic of much debate in the nursing profession. Although advocacy has embraced a crucial role for nurses, its extent is often limited in practice. While a variety of studies have been generated all over the world, barriers and facilitators in the patient advocacy have not been completely identified. This article presents the findings of a study exploring the barriers and facilitators influencing the role of advocacy among Iranian nurses. METHOD: This study was conducted by grounded theory method. Participants were 24 Iranian registered nurses working in a large university hospital in Tehran, Iran. Semi-structured interviews were used for data collection. All interviews were transcribed verbatim and simultaneously Constant comparative analysis was used according to the Strauss and Corbin method. RESULTS: Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. Nurses in this study identified powerlessness, lack of support, law, code of ethics and motivation, limited communication, physicians leading, risk of advocacy, royalty to peers, and insufficient time to interact with patients and families as barriers to advocacy. As for factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing patients' needs, nurses' responsibility, physician as a colleague, and nurses' knowledge and skills could be influential in adopting the advocacy role. CONCLUSION: Participants believed that in this context taking an advocacy role is difficult for nurses due to the barriers mentioned. Therefore, they make decisions and act as a patient's advocate in any situation concerning patient needs and status of barriers and facilitators. In most cases, they can not act at an optimal level; instead they accept only what they can do, which we called 'limited advocacy' in this study. It is concluded that advocacy is contextually complex, and is a controversial and risky component of the nursing practice. Further research is needed to determine the possibility of a correlation between identified barriers/ facilitators and the use of advocacy