59974 research outputs found
Sort by
Estes Health Assessment and Physical Examination
No full textHealth assessment is a process that evaluates the whole person as a physical, psychosocial and functional being, whether they’re young or old, well or ill. This market-leading text presents health assessment, physical examination information and skills for health professionals who complete these types of assessments. Health Assessment and Physical Examination takes students from basic concepts to more advanced health assessment. It uses the ENAP (Examine–Normal–Abnormal–Pathophysiology) approach to allow the student to collect useful information. A case study at the end of each chapter walks them through an assessment example. The text includes advanced topics as well as ‘Urgent findings’, which highlights serious or life-threatening signs and critical assessment findings that need immediate attention. Instructor resources include Instructor's Guide, PowerPoints, Testbank, Case Database and Clinical Skills Videos
Transition support arrangements to support new graduate & novice nurses entry to perioperative nursing: a scoping review
Get PDFBackground and objectives: As novice nurses transition into the workforce, they often experience transition shock as they assimilate into a new role, causing cause significant stress, anxiety and job dissatisfaction. This phenomenon is commonly observed within the perioperative nursing speciality. The development of transition support programs is aimed at assisting novice nurses' transition by providing fundamental knowledge, socialisation, support, and training.
This review aimed to uncover the support programs and their components available to nurses transitioning into the perioperative speciality. The research question that provided guidance for this review was ‘What are the transition support arrangements, and their characteristics, to support new graduate nurses and novice nurses who are transitioning into perioperative nursing?'.
Literature search: Arksey & O'Malley's’ five-step scoping review framework was used. The researchers performed a comprehensive literature search of PubMed, Proquest, CINHAL and SCOPUS with no limit on publication date until April 2023. A blinded screening process was undertaken, and the data extraction was tabulated. Data was presented as a narrative synthesis following thematic analysis.
Results: The initial search identified 537 publications. Screening and duplicate removal led to the exclusion of 512 publications. Of the 25 publications included in this review, two were primary research publications, while the other 23 were discussion papers. Analysis indicated that program approaches and components of programs were frequently described.
Conclusion: The findings highlight the significance of transition programs within the perioperative speciality area. However, the paucity of empirical evidence on the pedagogical underpinnings and evaluation of effectiveness indicates the need for further research. Conducting further research within perioperative transition to practice will enable programs to be designed based on theoretically-sound and evidence-based approaches to support nursing transition to practice within the speciality perioperative environment
Telehealth program for symptomatic COVID-19 patients in Mindanao, Philippines: a whole-of-system, pragmatic interventional study on patient monitoring from isolation facilities to community reintegration
Get PDFThe COVID-19 pandemic is impacting individuals and society's physical and mental health. Despite the lack of any definite and effective therapeutic regimen, public health measures such as quarantine and isolation have been instituted to contain this pandemic. However, these mitigating measures have also raised issues regarding isolated patients' mental and psychological well-being. Several stakeholders were engaged in this approach, including the university, the local health office, the tertiary hospital, and the local communities. This intervention addresses concerns regarding the health status of isolated individuals due to COVID-19 infection, making the program available to anyone who agrees to participate. This was done through telehealth services delivered via phone calls and SMS. The university provided technical support and telehealth manpower through medical students. The local health unit manages the isolation facilities, while the referral hospital offers specialty care for isolated patients through teleconsultation. Finally, the local community is the one that reintegrates discharged patients into their communities. Three hundred forty-four (344) participants were provided seven sessions on telehealth education and tracking of their COVID-19 prescribed practices and mental health. The mean age of the patients was 37 years; half were females, and 15% had comorbidities. Regarding their mental health status, the level of depression dropped from 6% to 1% (p<0.0001), the level of anxiety dropped from 12% to 2% (p<0.0001), and the level of stress dropped from 3% to 0% (p<0.0001) from the first day of admission to 2 weeks after discharge. Moreover, a general trend of statistically significant increase in various practices was noted: wearing face masks, physical distancing, disinfecting frequently held objects, hand hygiene, and self-monitoring for COVID-19 symptoms. Those with progressing symptoms of COVID-19 were referred immediately to the referral hospital. There were also no reports of complications of co-morbidities during their stay in the isolation facilities or social isolation upon community reintegration. The study concludes that telehealth services have the potential to address many challenges in providing continuous healthcare services to isolated patients until they are reintegrated into their community. Furthermore, a whole-of-society approach is necessary to provide holistic care to patients affected by the pandemic
Pharmacist and student evaluation of a preceptor training program in a regional Australian University: a multi-method study
Get PDFBackground: Increased emphasis on workplace-based learning within pharmacy curricula has led to a focus on the quality of preceptors and the provision of preceptor training, with a diverse range of training programs for preceptors being developed across the globe. To ensure that preceptors are trained appropriately and deemed to be competent in their role, it is essential that all training programs are suitably evaluated. This research aimed to evaluate an online preceptor training program at a regional Australian University.
Methods: Kirkpatrick’s four level model for assessment of training was used to evaluate this program. A multi method approach included a preceptor post training survey and interviews and a student survey evaluating the preceptor. Preceptor survey data were analysed using descriptive statistics and content analysis, while inductive thematic analysis was used to analyse the interviews. Student evaluations of trained and untrained preceptors were compared to determine whether training had impacted on student-rated preceptor effectiveness.
Results: Twenty-eight preceptor post-training surveys were received, ten preceptor post-training interviews were conducted, and 35 student surveys were completed. The program was rated positively overall, with notable mention by preceptors of the interactive networking session. Following their first post-training student placement, preceptors found that their overall confidence levels had improved, particularly in relation to student management, evaluating students and providing feedback. Student evaluations of preceptors revealed improved ratings of trained versus untrained preceptors, especially as effective communicators.
Conclusions: This study demonstrated that training had a positive impact on preceptor attitudes, behaviour and confidence levels. From the perspective of the student, training was also found to improve preceptor performance. These results highlight the beneficial effects of training for preceptors, to optimize the student placement experience and their preparation for future practice
Ecological Flow Analysis through an Ecohydraulic-Based Catchment Scale Approach
Get PDFEcological flow regime analysis through developing a novel ecohydraulic optimization method is the objective of this study in which three components are linked. Hydrological analysis is the first component in which average monthly flow is assessed in different hydrological conditions by applying a drought index in the selected control points or representative reaches in the river basin. Another component is the ecological model in which field ecological studies are used for selecting the target species, and habitat loss was modelled through the fuzzy method. The outputs of the hydrological analysis and hydraulic habitat simulation were then applied in the structure of the optimization model in which minimizing ecological impacts and water supply loss were defined as the purposes. Different evolutionary algorithms were used in the optimization process. A decision-making system was utilized to finalize ecological flow by selecting the privileged algorithm. According to the outputs, the proposed method can mitigate ecological impacts and water supply losses simultaneously. Either particle swarm optimization or differential evolution algorithm is the best approach for ecological flow in this research work. The outputs of optimization indicated that the reliability of the water supply in dry years is less than 32%, while it is more than 80% in wet years, which means that changing the hydrological condition will increase the portion of ecological flow regime significantly. In other words, the reliability of the water supply can be reduced by more than 50%. Hence, using other water resources such as groundwater is necessary in dry years in the study area
Responses of digestive enzyme profiles in newly-hatched (Zoea I) larvae of the mud crab Scylla serrata to intermittent food availability and food deprivation
No full textActivities (mU larva−1) of enzymes critical to digestion were examined to better understand how newly-hatched (Zoea I) larvae of the mud crab Scylla serrata respond to intermittent food availability and food deprivation. Specifically, this study examined the activities of trypsin-like proteases, nonspecific esterases, and α-amylase across three experiments that simulated scenarios in which larvae hatch and experience rearing conditions where food was either: (1) continuously available or unavailable; (2) initially unavailable, but subsequently available; or (3) initially available, but subsequently unavailable. Results showed that food availability exerts a significant influence on enzyme profiles in newly-hatched larvae, with nutritional history influencing their response to food deprivation. When food was unavailable from hatch, there was no significant change in larval enzyme activities between 6 and 78 h post-hatch. If food became available at any point during this period, however, newly-hatched larvae were capable of rapidly (within 12–24 h) adjusting enzyme activities in response. Furthermore, a short (36 h) period of food availability appears sufficient to permit continuous substrate utilization during subsequent food deprivation of equivalent duration. Such flexibility is an important physiological strategy allowing newly-hatched larvae of S. serrata to adapt and thrive in challenging tropical oceanic environments and provides a basis for optimizing protocols for hatchery production of this species
Influence of deposition temperature and hydrogen on sustainable and transfer-free graphene transparent electrode for organic solar cells
Get PDFThe transfer-free graphene transparent conducting electrode (TCE) is a promising alternative to indium tin oxide (ITO) for organic solar cells (OSCs). In the present work, a comprehensive investigation on how deposition temperature and H2 flow rates affect the growth, structural, optical, and electrical properties of graphene produced by RF plasma enhanced chemical vapor deposition using sustainable sources was conducted. Invertedgeometry OSCs with P3HT: PCBM photoactive layer were fabricated on transfer-free graphene TCEs developed under different conditions. Moreover, the coupling of silver nanowires (AgNWs) with different graphene
films was studied for hybrid graphene-AgNWs TCEs for OSCs. Devices based on graphene TCEs prepared at low or zero H2 flow have shown better performances than those at high flow of H2. Similarly, graphene TCEs prepared at high temperature (>700 ◦C, on quartz) led to a deteriorated device performance due to the highly increased growth of vertically oriented graphene nanosheets, which dramatically reduced film transmittance and increased surface roughness. The present work provides solid understanding of the growth mechanism of RFPECVD graphene on glass from a sustainable carbon source. More importantly, the sustainable, ecofriendly, cost- and time-effective production of scalable transfer-free graphene TCEs for OSCs is optimized which paves the way towards ITO-free optoelectronics
Assessing changes in global fire regimes
Get PDFBackground: The global human footprint has fundamentally altered wildfire regimes, creating serious consequences for human health, biodiversity, and climate. However, it remains difficult to project how long-term interactions among land use, management, and climate change will affect fire behavior, representing a key knowledge gap for sustainable management. We used expert assessment to combine opinions about past and future fire regimes from 99 wildfire researchers. We asked for quantitative and qualitative assessments of the frequency, type, and implications of fire regime change from the beginning of the Holocene through the year 2300.
Results: Respondents indicated some direct human influence on wildfire since at least ~ 12,000 years BP, though natural climate variability remained the dominant driver of fire regime change until around 5,000 years BP, for most study regions. Responses suggested a ten-fold increase in the frequency of fire regime change during the last 250 years compared with the rest of the Holocene, corresponding first with the intensification and extensification of land use and later with anthropogenic climate change. Looking to the future, fire regimes were predicted to intensify, with increases in frequency, severity, and size in all biomes except grassland ecosystems. Fire regimes showed different climate sensitivities across biomes, but the likelihood of fire regime change increased with higher warming scenarios for all biomes. Biodiversity, carbon storage, and other ecosystem services were predicted to decrease for most biomes under higher emission scenarios. We present recommendations for adaptation and mitigation under emerging fire regimes, while recognizing that management options are constrained under higher emission scenarios.
Conclusion: The influence of humans on wildfire regimes has increased over the last two centuries. The perspective gained from past fires should be considered in land and fire management strategies, but novel fire behavior is likely given the unprecedented human disruption of plant communities, climate, and other factors. Future fire regimes are likely to degrade key ecosystem services, unless climate change is aggressively mitigated. Expert assessment complements empirical data and modeling, providing a broader perspective of fire science to inform decision making and future research priorities
Next-Generation Vaccines for Tropical Infectious Diseases
Get PDFTropical infectious diseases inflict an unacceptable burden of disease on humans living in developing countries. While anti-pathogenic drugs have been widely used, they carry a constant threat of selecting for resistance. Vaccines offer a promising means by which to enhance the global control of tropical infectious diseases, but these have been difficult to develop, mostly due to the complex nature of the pathogen lifecycles. Here, we present recently developed vaccine candidates for five tropical infectious diseases in the form of a catalogue, that have either entered clinical trials or have been licenced for use. We deliberate on recently licensed dengue vaccines; provide evidence why combination vaccination could have a synergistic impact on schistosomiasis; critically appraise the value of typhoid conjugate vaccines; and discuss the potential of vaccines in the efforts to eliminate vivax malaria and hookworms
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
Get PDFBackground:
Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period.
Methods:
22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.
Findings:
Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.
Interpretation:
Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic