A grounded theory of interprofessional learning and paramedic care.

Interprofessional learning (IPL) is a dynamic process. It incorporates adult learning principles and requires active participation. Contemporary paramedic care typically involves collaboration with other health-care professionals. However, little is known about how paramedics work and construct meaning within this interprofessional milieu. Rural areas, where professional collaboration is well illustrated, provide an opportune setting from which to conduct the examination of IPL and paramedic care. Twenty-six participants took part in this investigation. Participants were paramedics and other professionals involved in collaboration in rural locations across the state of Tasmania, Australia. Rural Tasmania provided a diverse range of paramedic practice for investigation, including traditional (pre-hospital) care, extended care, volunteer services, and hospital-based practices. A grounded theory approach was adopted, and semi-structured interviews used to collect critical incidents in which participants described effective and less effective episodes of collaboration. Memos were kept during the research process. Analysis of data followed a process of initial and then focused coding from which the main concepts could be determined. From 75 episodes of collaboration, three main concepts emerged to create a theory of IPL and paramedic care. Relationships included reciprocity and respect, as well as professional acknowledgment. Cooperation recognized professionals as interdependent practitioners adopting open communication. Operational barriers identified contextual features under which professionals work, with constituent categories of protecting turf, and workplace culture. The findings provide new insight into IPL and paramedic care. Hierarchy, professional dominance, and gender disparity emerged as barriers to IPL. Knowledge and skills were shared between professions and this influenced how individuals interacted within interprofessional teams. A successful collaboration produced a clinical environment where patient care was informed by contributions from all team members.

Probing the role of excited states in ionization of acetylene.

Ionization of acetylene by linearly-polarized, vacuum ultraviolet (VUV) laser pulses is modelled using time-dependent density functional theory. Several laser wavelengths are considered including one that produces direct ionization to the first excited cationic state while another excites the molecules to a Rydberg series incorporating an autoionizing state. We show that for the wavelengths and intensities considered, ionization is greatest whenever the molecule is aligned along the laser polarization direction. By considering high harmonic generation we show that populating excited states can lead to a large enhancement in the harmonic yield. Lastly, angularly-resolved photoelectron spectra are calculated which show how the energy profile of the emitted electrons significantly changes in the presence of these excited states.

Interprofessional learning and rural paramedic care.

INTRODUCTION: The traditional view of paramedic practice is one of provision of emergency care and transport within community or industrial settings. With greater integration of emergency services with the overall health system, this role is changing. Paramedics, especially in rural areas, are now working more closely with other professions in new and extended roles that incorporate non-emergency community-based care, preventative medicine and social care. Workforce shortages, health service budget cuts, population size and the changing demographic profile of many rural and remote communities highlight the need for effective interaction between the health professions to respond to the health needs of these communities. The rural environment therefore provides an opportune setting in which to explore the evolving role of paramedics and their interaction with other healthcare professionals in ways that can improve health outcomes for patients and the community. This article presents a critical review of the literature in this area and identifies gaps in which further research is required to further interprofessional learning (IPL) for paramedics. METHODS: Search databases included MEDLINE, SCOPUS, CINAHL and the University of Tasmania (UTAS) electronic library. Specific journal searches included the Journal of Emergency Pre-Hospital Care (JEPHC) and the Journal of Interprofessional Care. Search terms for this literature review consisted of a combination of prefixes 'inter' and 'multi' with adjectives 'professional', 'disciplinary' and 'shared' and the nouns 'education', 'learning' and 'training'. These search terms were then used in combination with each of the terms 'rural' and 'remote' then with 'paramedic/s' and 'pre-hospital' in order to source reports of interprofessional activities in these areas. Each of these was also combined with the search term 'collaboration'. On completion of the initial search process, the reference lists of relevant articles were examined for reports of professional interactions and rural paramedic care. RESULTS: Three major concepts emerged from 24 articles: interprofessional education (IPE), multidisciplinary teamwork, and interprofessional learning. Six articles focused on IPE; nine concerned multidisciplinary teamwork and nine IPL. Examination of the reference lists of these articles revealed a further eight articles with the theme of IPL incorporating paramedics. Predominantly, IPL was associated with new roles for rural paramedics where collaborative practice incorporated community-based care rather than being focused on emergency treatment and transport to hospital. Only two articles reported on a measurable patient care outcome related to IPL. The majority of articles described programs or interventions without having directly examined the interactions and relationships between professions. CONCLUSIONS: Rural paramedics are involved with other healthcare professionals, often in new or expanded roles. Published journal articles that report on this interaction are largely descriptive in nature and few describe the dynamics of this interaction or the conditions under which interprofessional activity could yield potential benefit to health service delivery or patient outcomes. As an overarching construct, IPL may be used to frame further investigation of this interaction and may help shape the emerging role of paramedics in rural settings where population size and other factors limit the availability of health professionals.

Resonantly Enhanced Multiphoton Ionization Spectrum of the Neutral Green Fluorescent Protein Chromophore.

The photophysics of the green fluorescent protein is governed by the electronic structure of the chromophore at the heart of its ß-barrel protein structure. We present the first two-color, resonance-enhanced, multiphoton ionization spectrum of the isolated neutral chromophore in vacuo with supporting electronic structure calculations. We find the absorption maximum to be 3.65 ± 0.05 eV (340 ± 5 nm), which is blue-shifted by 0.5 eV (55 nm) from the absorption maximum of the protein in its neutral form. Our results show that interactions between the chromophore and the protein have a significant influence on the electronic structure of the neutral chromophore during photoabsorption and provide a benchmark for the rational design of novel chromophores as fluorescent markers or photomanipulators.