IPV nurse education: Scoping things out to see who's doing what?

Introducing best practice approaches to help nursing students identify and respond to patients who are/have been exposed to intimate partner violence (IPV) is instrumental to their professional development. The objectives of this study are to gather preliminary data from the American Association for the Colleges of Nursing (AACN) affiliated schools of nursing to determine 1) if they offer any training of students at the undergraduate or graduate level in identifying and responding to IPV; 2) if so, what are the components of that training, outcomes, and satisfaction with the existing approach; 3) if not, what are the individual and institutional level barriers to offering this training; and 4) if schools are interested in incorporating best practice, IPV training content into their curriculum. DESIGN AND METHODS: A total of 836 AACN affiliated nursing schools across the US were surveyed using a 64-item electronic survey. RESULTS: Of the 95 (11%) schools that completed at least 40% of the survey, approximately 60% offer IPV training once at the undergraduate level and only 30% offered such preparation at the graduate level. We found that most IPV education took place as embedded material within an existing course. Those nursing schools not providing any IPV education identified that they would like to at both levels and the 50% of nursing schools already providing this education said they wanted to provide more. The greatest barriers to offering IPV education were lack of faculty expertise and time constraints, yet about 70% of the participants stated that IPV education should be an essential part of undergraduate and graduate nursing school. CONCLUSION: This study provides useful insights to inform IPV curriculum development by identifying common gaps in IPV education experienced by participating schools and strategies for addressing them.

Don't be scared, be angry: the politics and ethics of Ebola.

The current outbreak of Ebola virus disease in West Africa is the worst so far. The unprecedented extent of mortality and morbidity in this outbreak has followed more from imposition of neoliberal economic policies on the countries affected than from the biological virulence of Ebola virus. The lack of vaccines and medications for Ebola virus disease is evidence that markets cannot reliably supply treatments for epidemic diseases. We attribute the current difficulties in containment chiefly to the erosion or non-development of the health and medical infrastructure needed to respond effectively, as a direct result of market-privileging policies imposed in the interests of wealthy nations. These events and responses hold lessons for public health priorities in Australia.

Writing social determinants into and out of cancer control: an assessment of policy practice.

A large literature concurs that social determinants of health (SDH) are demonstrable, important, and insufficiently attended to in policy and practice. A resulting priority for research should be to determine how the social determinants of health can best be addressed. In this paper we support the more effective transfer of social determinants research into policy by: (1) describing a qualitative analysis of thirty-two cancer control policy documents from six English-speaking OECD countries and two transnational organizations, demonstrating great variability in the treatment of social determinants in these policies; (2) critiquing these various policy practices in relation to their likely impact on social determinants of health; and (3) advancing a tool that policy writers can use to assess the way in which social determinants of health have been addressed in their work. In the sample of policy documents, the distinction between structural and intermediate determinants, population-based and targeted interventions, and their respective relationships to equity were not always clear. The authors identified four approaches to social determinants (acknowledging SDH, auditing SDH, stating aims regarding SDH and setting out actions on SDH), and five ways of writing about the relationship between social determinants and cancer risk. These five discourses implied, respectively: that group membership was intrinsically risky; that not enough was known about SDH; that risk arose from choices made by individuals; that groups were constrained by circumstance; or that structural change was necessary. Socio-cultural factors were generally presented negatively, though New Zealand policies modeled a possible alternative. Based on their empirical work, the authors propose a matrix and a set of questions to guide the development and assessment of health policy.

Influenza virus endoribonuclease.

The influenza virus polymerase complex contains two associated enzymatic activities, an endoribonuclease and a RNA-dependent RNA polymerase activity. Both activities have so far been observed only with the complete polymerase complex consisting of three subunits, PB1, PB2, and PA. This chapter describes a robust and optimized procedure for the purification of active influenza virus polymerase in complex with genomic RNA and the single-stranded RNA-binding protein nucleoprotein from influenza virus particles. It also explains the synthesis of capped RNA molecules as substrates of the influenza virus endonuclease. The enzymatic properties of influenza virus-derived endoribonuclease activity have been characterized with a model RNA substrate of 20-nucleotide length, termed G20 RNA. The rate of RNA cleavage under steady state conditions appears to be limited by product dissociation. Therefore conditions have been optimized to study the chemical step of RNA cleavage under single turnover conditions. The enzyme requires divalent metal ions for activity and can use Mn(II), Co(II), and Fe(II) efficiently at pH 7, Mg(II) with intermediate efficiency, and Ni(II) and Zn(II) with lower efficiency. The reaction progress curves show slow binding of Zn(II) and Ni(II) to the protein, suggesting a conformational change of the active site as a prerequisite for endonuclease activity in the presence of these two metal ions. Low concentrations of the detergent DOC inhibit the activity and also disrupt the trimeric polymerase complex, whereas other detergents do not have a significant effect on the activity.

A sensitive, single-tube assay to measure the enzymatic activities of influenza RNA polymerase and other poly(A) polymerases: application to kinetic and inhibitor analysis.

We describe a fast and robust new assay format to measure poly(A) polymerase (PAP) activity in a microtiter plate format. The new assay principle uses only natural nucleotide triphosphates and avoids a labour-intensive filtration step. A coupled enzymatic system combining PAP and reverse transcriptase forms the basis of the assay. The PAP generates a poly(A) tail on a RNA substrate and the reverse transcriptase is used to quantify the polyadenylated RNA by extension of a biotinylated oligo-dT primer. We demonstrate the principle of the assay using influenza virus RNA polymerase and yeast PAP as examples. A specific increase in the K(m) value for ATP and the observation of burst kinetics in the polyadenylation dependent, but not in the polyadenylation independent, assay suggest that a rate limiting step of influenza polymerase activity occurs after transcription elongation. Yeast PAP was used to validate the assay as an example of a template independent PAP. The new yeast PAP assay was approximately 100-fold more sensitive than the conventional TCA precipitation assay for yeast PAP, but the kinetic analysis of the PAP reaction gave similar results in both assays. The two enzymes show important differences with respect to inhibition by 3'-deoxy-ATP. Whereas the K(i) value for 3'-deoxy-ATP (105-117 microM) is similar to the K(m) value for ATP (186 microM) in the case of influenza RNA polymerase, the K(i) value for 3'-deoxy-ATP (0.4-0.6 microM) is approximately 100-fold lower than the K(m) value for ATP (50 microM) in the case of yeast PAP.

Taking practice forward in paediatric oncology: the impact of a newly developed education programme for nurses working in shared-care hospitals.

Fundamental to any change or development in health care is the quality of the service received by patients and their families. Practitioner-led initiatives that are designed to improve the quality of care are more likely to succeed if they are underpinned with appropriate educational input. A structured programme in paediatric oncology nursing was developed to meet the needs of nurses working in District General Hospitals. Nurses' perceptions of the consequences of undertaking the programme were explored using a focus group approach. Findings have shown that there have been significant changes to nurses' roles and this in turn has had an impact on the individual and the organization. It was perceived that there are positive outcomes for both the service and quality of care for children with cancer and their families. The shared-care nurses believe that this has been the result of improved knowledge, skill and expertise, better communication between care providers, and the collaborative frameworks which have evolved.

Safety, efficacy, and acceptability of home intravenous therapy administered by parents of pediatric oncology patients.

BACKGROUND: A prospective study of patients receiving intravenous therapy administered at home by parents was conducted over 1 year at a United Kingdom regional pediatric oncology center. PROCEDURE: The study defined the patient groups for whom this approach was used and evaluated the safety and efficacy of home treatment. Parents' evaluation of home therapy was sought to determine the acceptability of the scheme from their perspective. Eight-nine courses of antibiotics, chemotherapy or antiemetics were given, comprising a total of 469 days of home treatment. RESULTS: Few clinical problems were encountered. Parents felt that home treatment helped them to cope (72%); they felt more in control (75%) and learned more about their child's illness and treatment (82%). CONCLUSIONS: Home treatment was perceived as less stressful than hospital treatment (79%), and all reported benefits to family life. There is a need for parents to be taught vigilance in observing for and reporting signs of deterioration.

Parent-held shared care records: bridging the communication gaps.

Specialist centres provide excellent treatment and expert care, but the best interests of children may not be served if they must always attend a hospital far from home. Systems of shared care have been developed to offer care nearer the family home whenever possible. Parent-held shared care records were introduced at a paediatric haematology/oncology centre in response to issues raised by parents and professionals concerning the management of shared care. These were set up to facilitate communication, teamwork and family involvement. Consultation took place within the multidisciplinary team to ensure that the design of the records met the needs of each group. During a multidisciplinary study day the records were introduced to professionals from shared care hospitals. Before formally incorporating these records into regular clinical practice they were piloted with a group of families. The records have become an accepted part of the service provided for family and professional partners in shared care. Formal evaluation of this innovation is currently taking place.

Analysis of resistance to gas flow in nine adult ventilator circuits.

We measured the resistance in nine complete ventilator circuits, partial circuits and 7, 8, and 9 mm ID endotracheal tubes at flow rates of 20 to 120 liters per minute. We found a statistically significant (p less than 0.01) increase in resistive pressure with increases in flow rate, as the diameter of the ETT decreased, and as each component of the ventilator circuit was added to the ETT. There was a curvilinear increase in resistive pressure to increase in flow rate. However, when resistances were computed, the Bennett cascade "circuit" created higher resistance at 20 lpm than at flow rates up to 120 lpm. The Bennett cascade humidifier added the greatest resistive pressure, 3.5 to 8.5 cm H2O, the Engstrom Edith, 0.5 to 6.5 cm H2O, and the Conchapak added the least, 0.0 to 2.5 cm H2O at flow rates of 20 to 120 lpm. After all the components of the ventilator circuit were attached to the ETTs, there was approximately a 97 to 450 percent increase in resistive pressure compared to the resistive pressure created by the ETTs alone.

Sensitivity of the mature lateral geniculate nucleus to components of monocular paralysis.

Immobilization of the globe by tenotomization of the extrinsic muscles of one eye reduces the encounter rate for X-latency cells in the contralateral dorsal lateral geniculate nucleus (LGN) of adult cats. The reduction in the relative encounter rate for X-latency cells after tenotomy was comparable to that previously observed in the adult cat following concurrent paralysis of the extrinsic and intrinsic muscles of one eye by transection of cranial nerves III, IV, and VI. Paralysis of the intrinsic muscles alone by atropinization, on the other hand, had no detectable effect upon this aspect of LGN physiology. It appears, therefore, that monocular paralysis by cranial nerve section has its effects on LGN X-latency cells through its paralysis of the extrinsic eye muscles. Furthermore, the reduction in the relative encounter rate for X-latency cells produced by tenotomy occurred in spite of early, incomplete return of mobility of the globe. Thus, unilaterally diminished mobility of the globe, in contrast to the complete, sustained immobility characteristic of monocular praralysis, appears sufficient to alter this aspect of LGN physiology in adult cats. The general observation that sensory modifications, in the adult cat, are capable of inducing shifts in the relative recording probabilities for X- and Y-latency cells in the LGN has been repeatedly made. Further, recent, independent observations have provided confirmation for the phenomenon of X/Y ratio shifts in the LGN following adult-onset stimulus modification.