Developing a theory of change model for a learning and innovation network: A qualitative study.

AIM: The aim of this study is to further develop a preliminary framework into a model that can translate mechanisms into output and impact, based on the views of those working in practice and the relations between the mechanisms: a model that can inform practitioners and organizations on what has to be in place to shape a learning and innovating environment in nursing. BACKGROUND: A Learning and Innovation Network (LIN) is a network of healthcare professionals, students and education representatives who come together to be part of a nursing community to integrate education, research and practice to contribute to quality of care. In a previous study a preliminary framework was developed through a concept analysis based on publications. The preliminary framework describes input, throughput and output factors in a linear model that does not explain what the components entail in practice and how the components work together. DESIGN: Focus groups. METHODS: We designed a Theory of Change (ToC) in four phases. This was based on a focus group interview with lecturer practitioners (Phase 1); a first concept ToC based on thematic analysis of the focus group interview (Phase 2); three paired interviews where the ToC was presented to other lecturer practitioners to complement and verify the ToC model (Phase 3); and adjustment of the model based on the feedback of phase 3 (Phase 4). RESULTS: The developed ToC model describes important preconditions that have to be in place to start a LIN: a shared vision, a facilitating support system and a diversity of participants who are open to change. It describes the mechanisms by which a wide range of activities can lead to an improvement of the quality of care through collaboration between practice, education and research by working, learning, performing practice based research and implementing new methods together. CONCLUSION: This study gives a comprehensive overview of the concept of the 'Learning and Innovation Network' (LIN); how the activities in the LIN can lead to impact; and under what conditions. Previously published findings supported elements of the ToC model. The overarching ToC model and the detailed appendix offer a theoretical and practice-based model for practitioners, managers and policy makers.

Tissue characterization of acute lesions during cardiac magnetic resonance-guided ablation of cavo-tricuspid isthmus-dependent atrial flutter: a feasibility study.

AIMS: To characterize acute lesions during cardiac magnetic resonance (CMR)-guided radiofrequency (RF) ablation of cavo-tricuspid isthmus (CTI)-dependent atrial flutter by combining T2-weighted imaging (T2WI), T1 mapping, first-pass perfusion, and late gadolinium enhancement (LGE) imaging. CMR-guided catheter ablation offers a unique opportunity to investigate acute ablation lesions. Until present, studies only used T2WI and LGE CMR to assess acute lesions. METHODS AND RESULTS: Fifteen patients with CTI-dependent atrial flutter scheduled for CMR-guided RF ablation were prospectively enrolled. Directly after achieving bidirectional block of the CTI line, CMR imaging was performed using: T2WI (n = 15), T1 mapping (n = 10), first-pass perfusion (n = 12), and LGE (n = 12) imaging. In case of acute reconnection, additional RF ablation was performed. In all patients, T2WI demonstrated oedema in the ablation region. Right atrial T1 mapping was feasible and could be analysed with a high inter-observer agreement (r = 0.931, ICC 0.921). The increase in T1 values post-ablation was significantly lower in regions showing acute reconnection compared with regions without reconnection [37 ± 90 ms vs. 115 ± 69 ms (P = 0.014), and 3.9 ± 9.0% vs. 11.1 ± 6.8% (P = 0.022)]. Perfusion defects were present in 12/12 patients. The LGE images demonstrated hyper-enhancement with a central area of hypo-enhancement in 12/12 patients. CONCLUSION: Tissue characterization of acute lesions during CMR-guided CTI-dependent atrial flutter ablation demonstrates oedema, perfusion defects, and necrosis with a core of microvascular damage. Right atrial T1 mapping is feasible, and may identify regions of acute reconnection that require additional RF ablation.

Learning and innovation network in nursing: A concept analysis.

BACKGROUND: Approximately 4 years ago a new concept of learning in practice called the 'Learning and Innovation Network (LIN)' was introduced in The Netherlands. To develop a definition of the LIN, to identify working elements of the LIN in order to provide a preliminary framework for evaluation, a concept analysis was conducted. METHOD: For the concept analysis, we adopted the method of Walker and Avant. We searched for relevant publications in the EBSCO host portal, grey literature and snowball searches, as well as Google internet searches and dictionary consults. RESULTS: Compared to other forms of workplace learning, the LIN is in the centre of the research, education and practice triangle. The most important attributes of the LIN are social learning, innovation, daily practice, reflection and co-production. Often described antecedents are societal developments, such as increasing complexity of work, and time and space to learn. Frequently identified consequences are an attractive workplace, advancements of expertise of care professionals, innovations that endorse daily practice, improvement of quality of care and the integration of education and practice. CONCLUSIONS: Based on the results of the concept analysis, we describe the LIN as 'a group of care professionals, students and an education representatives who come together in clinical practice and are all part of a learning and innovation community in nursing. They work together on practice-based projects in which they combine best practices, research evidence and client perspectives in order to innovate and improve quality of care and in which an integration of education, research and practice takes place'. We transferred the outcomes of the concept analysis to an input-throughput-output model that can be used as a preliminary framework for future research.

Impact of the Fukushima accident on tritium, radiocarbon and radiocesium levels in seawater of the western North Pacific Ocean: A comparison with pre-Fukushima situation.

Tritium, radiocarbon and radiocesium concentrations in water column samples in coastal waters offshore Fukushima and in the western North Pacific Ocean collected in 2011-2012 during the Ka'imikai-o-Kanaloa (KoK) cruise are compared with other published results. The highest levels in surface seawater were observed for 134Cs and 137Cs in seawater samples collected offshore Fukushima (up to 1.1 Bq L-1), which represent an increase by about three orders of magnitude when compared with the pre-Fukushima concentration. Tritium levels were much lower (up to 0.15 Bq L-1), representing an increase by about a factor of 6. The impact on the radiocarbon distribution was measurable, but the observed levels were only by about 9% above the global fallout background. The 137Cs (and similarly 134Cs) inventory in the water column of the investigated western North Pacific region was (2.7 ± 0.4) PBq, while for 3H it was only (0.3 ± 0.2) PBq. Direct releases of highly contaminated water from the damaged Fukushima NPP, as well as dry and wet depositions of these radionuclides over the western North Pacific considerably changed their distribution patterns in seawater. Presently we can distinguish Fukushima labeled waters from global fallout background thanks to short-lived 134Cs. However, in the long-term perspective when 134Cs will decay, new distribution patterns of 3H, 14C and 137Cs in the Pacific Ocean should be established for future oceanographic and climate change studies in the Pacific Ocean.

Modelling of marine radionuclide dispersion in IAEA MODARIA program: Lessons learnt from the Baltic Sea and Fukushima scenarios.

State-of-the art dispersion models were applied to simulate (137)Cs dispersion from Chernobyl nuclear power plant disaster fallout in the Baltic Sea and from Fukushima Daiichi nuclear plant releases in the Pacific Ocean after the 2011 tsunami. Models were of different nature, from box to full three-dimensional models, and included water/sediment interactions. Agreement between models was very good in the Baltic. In the case of Fukushima, results from models could be considered to be in acceptable agreement only after a model harmonization process consisting of using exactly the same forcing (water circulation and parameters) in all models. It was found that the dynamics of the considered system (magnitude and variability of currents) was essential in obtaining a good agreement between models. The difficulties in developing operative models for decision-making support in these dynamic environments were highlighted. Three stages which should be considered after an emergency, each of them requiring specific modelling approaches, have been defined. They are the emergency, the post-emergency and the long-term phases.

Iodine-129, Iodine-127 and Cesium-137 in seawater from the North Sea and the Baltic Sea.

In this study, new data are presented for the iodine isotopes (127I, 129I and their isotopic ratios) and Cesium (137Cs) in water samples of the North Sea and the Baltic Sea in 2005 and 2009. This study supplements and extends the study of Michel et al. (2012). Iodine isotopes were separated from their matrix by using an anion exchange method and were determined by applying ICP-MS and AMS. 137Cs in seawater was determined after cesium ion exchange procedure enrichment by gamma-spectrometry. The concentrations of 127I in seawater of the North and Baltic Sea are fairly constant in each Sea with averages of (44 ± 2) and (21 ± 1) ng g-1, respectively, depending on the salinity. However, large variations of 129I concentrations in these areas were detected, which decreased along the French, Belgian, Dutch, German, and Danish shores. 129I/127I isotope ratios in the Baltic Sea are about 10 times lower than in the North Sea in 2009. The highest isotopic ratios (2.7 × 10-6) was detected in the English Channel east of the nuclear reprocessing plant at Cap de la Hague. The results confirm the result of our early study that the sources of 129I in the North Sea are primarily the nuclear reprocessing facilities at Sellafield (UK) and La Hague (F), and that in the Baltic Sea the inflow of water from North Sea through the Danish Straits dominates the occurrence of 129I. In 2009, the activity concentration of 137Cs was at least 6 times higher in the Baltic Sea (37 Bq m-3) than in the North Sea (5.9 Bq m-3), due to release of 137Cs from sediments in the Baltic Sea, which were contaminated by the Chernobyl accident and - to a minor degree - the atmospheric explosions of atomic bombs. The results are discussed by comparing the results of our previous work and the current study demonstrating the continuing disequilibrium of 129I/127I atomic ratio in the environmental compartments.

A comparison of marine radionuclide dispersion models for the Baltic Sea in the frame of IAEA MODARIA program.

Four radionuclide dispersion models have been applied to simulate the transport and distribution of (137)Cs fallout from Chernobyl accident in the Baltic Sea. Models correspond to two categories: box models and hydrodynamic models which solve water circulation and then an advection/diffusion equation. In all cases, interactions of dissolved radionuclides with suspended matter and bed sediments are included. Model results have been compared with extensive field data obtained from HELCOM database. Inventories in the water column and seabed, as well as (137)Cs concentrations along 5 years in water and sediments of several sub-basins of the Baltic, have been used for model comparisons. Values predicted by the models for the target magnitudes are very similar and close to experimental values. Results suggest that some processes are not very relevant for radionuclide transport within the Baltic Sea, for instance the roles of the ice cover and, surprisingly, water stratification. Also, results confirm previous findings concerning multi-model applications.

Certified Reference Material IAEA-446 for radionuclides in Baltic Sea seaweed.

A Certified Reference Material (CRM) for radionuclides in seaweed (Fucus vesiculosus) from the Baltic Sea (IAEA-446) is described and the results of the certification process are presented. The (40)K, (137)Cs, (234)U and (239+240)Pu radionuclides were certified for this material, and information values for 12 other radionuclides ((90)Sr, (99)Tc, (210)Pb ((210)Po), (226)Ra, (228)Ra, (228)Th, (230)Th, (232)Th, (235)U, (238)U, (239)Pu and (240)Pu) are presented. The CRM can be used for Quality Assurance/Quality Control of analysis of radionuclides in seaweed and other biota samples, as well as for development and validation of analytical methods, and for training purposes.

Detection of Fukushima Daiichi nuclear power plant accident radioactive traces in Monaco.

Daily air monitoring of radionuclides in the Principality of Monaco (43°73'N, 7°43'E) after the Fukushima Daiichi nuclear power plant accident showed that only Iodine-131 ((131)I) and Caesium isotopes ((134)Cs and (137)Cs) were detected. The peak of (131)I varied and reached its maximum between March 29th and April 5th, meanwhile both peaks of (134)Cs and (137)Cs arrived later and attained a maximum between April 1st and 4th. Their maximum activity concentrations in air were 354, 30, and 37 µBq m(-3) respectively. The (134)Cs to (137)Cs activity ratio was close to 1, which is different from that one observed after the Chernobyl accident (around 0.54). Up to 95% of caesium isotopes were washed out by wet scavenging during 27-28th of March, where the maximum deposition rates of (134)Cs and (137)Cs (13.7 and 19.1 mBq m(-2) day(-1), respectively) were observed. The significant input of (134)Cs and (137)Cs into the Mediterranean seawater column (30 m depth) was detected later, on the 24th of May. Radioisotopes of caesium and iodine were found far above the applied detection limits, but still with no concern for harmful radiation exposure and public health. The contamination gradually decreased in air and activity concentrations returned to background values after one or two months.

Iodine-129 and iodine-127 in European seawaters and in precipitation from Northern Germany.

In order to obtain a comprehensive survey on the consequences of the marine (129)I discharges from the European reprocessing plants La Hague and Sellafield, the distribution of (129)I and (127)I in surface waters of the North Sea, the English Channel, the Irish Sea, and the Northeast Atlantic was studied using accelerator mass spectrometry for (129)I and ICP-MS for (127)I. Samples of seawater were taken in the German Bight in May, September, and November 2005 and in the entire North Sea and the English Channel in August 2005. Further samples were obtained from the Irish Sea in June and August 2006 and from Arctic waters between Spitsbergen and Southern Norway in September 2005. (129)I is a conservative tracer in seawater. The concentrations of (127)I are relatively constant with exceptions of coastal areas with high biological activity and of areas influenced by influx from rivers and the Baltic Sea. The variability of the (129)I/(127)I isotopic ratios is exclusively determined by admixture of (129)I released from the reprocessing facilities Sellafield and La Hague to the seawater. The (129)I/(127)I ratios were between 4 × 10(-9)and 3 × 10(-6): at least 3 orders of magnitude higher than the natural equilibrium isotopic ratio 1.5 × 10(-12). (129)I/(127)I ratios of a few times 10(-10) were only found in seawater from the Indian Ocean and from the Pacific at Hawaii. Comparison of the results obtained for seawater with those of a measurement of airborne iodine species and with iodine isotopes in precipitation in Northern Germany demonstrates the transfer of (129)I and (127)I from the sea into the atmosphere and the dominating role of the marine discharges for the atmospheric fallout of (129)I in Western Europe. The results are discussed with the goal to estimate the relevance of the marine discharges for the contamination of the continental areas.

The primary care physician and Alzheimer's disease: an international position paper.

This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.

A new Certified Reference Material for radionuclides in Irish sea sediment (IAEA-385).

A new Certified Reference Material (CRM) for radionuclides in sediment (IAEA-385) is described and the results of the certification process are presented. Eleven radionuclides ((40)K, (137)Cs, (226)Ra, (228)Ra, (230)Th, (232)Th, (234)U, (238)U, (238)Pu, (239+240)Pu and (241)Am) have been certified and information mass activities with 95% confidence intervals are given for seven other radionuclides ((90)Sr, (210)Pb((210)Po), (235)U, (239)Pu, (240)Pu and (241)Pu). Results for less frequently reported radionuclides ((60)Co, (99)Tc, (134)Cs, (155)Eu, (224)Ra and (239)Np) and information on some activity and mass ratios are also reported. The CRM can be used for quality assurance/quality control of the analysis of radionuclides in sediment samples, for the development and validation of analytical methods and for training purposes.

Sensitizing capacity and residual allergenicity of hydrolyzed cow's milk formulae: results from a murine model.

BACKGROUND: Cow's milk allergy is the most common cause of clinically relevant adverse reactions to food in infants and children. Partially and extensively hydrolyzed formulae are used for the therapy and prevention of cow's milk allergy. However, the immunogenic potency of hydrolyzed cow's milk formulae to induce and/or enhance the allergic phenotype in vivo is still under debate. The aim of this study was to assess the sensitizing capacity and residual allergenicity of various partially and extensively hydrolyzed cow's milk formulae in a murine model of cow's milk allergy. METHODS: BALB/c mice were immunized with either a cow's milk formula or various partially and extensively hydrolyzed formulae. Immediate cutaneous hypersensitivity reactions and allergen-specific antibody production were assessed. RESULTS: Although immunization with cow's milk resulted in 12/13 cases in a positive skin test response to intradermal injection of cow's milk formulae, only 1 mouse showed a positive skin test to one of the partially hydrolyzed formulae, and none showed positive reactions to other partially hydrolyzed formulae, any of the extensively hydrolyzed formulae, phosphate-buffered saline or the amino acid formula. However, 6 of 8 mice showed positive skin tests when immunized with partially hydrolyzed formulae and with one of the extensively hydrolyzed formulae. CONCLUSIONS: The residual allergenic potential is markedly reduced in many hydrolyzed formulae, but most of the formulae investigated could induce an allergic immune response in BALB/c mice. Our murine model seems to be suitable to investigate the sensitizing capacity of hydrolyzed formulae and to differentiate even between extensively hydrolyzed formulae.

Anthropogenic radioactivity in the Arctic Ocean--review of the results from the joint German project.

The paper presents the results of the joint project carried out in Germany in order to assess the consequences in the marine environment from the dumping of nuclear wastes in the Kara and Barents Seas. The project consisted of experimental work on measurements of radionuclides in samples from the Arctic marine environment and numerical modelling of the potential pathways and dispersion of contaminants in the Arctic Ocean. Water and sediment samples were collected for determination of radionuclide such as 137Cs, 90Sr, 239 + 240Pu, 238Pu, and 241Am and various organic micropollutants. In addition, a few water and numerous surface sediment samples collected in the Kara Sea and from the Kola peninsula were taken by Russian colleagues and analysed for artificial radionuclide by the BSH laboratory. The role of transport by sea ice from the Kara Sea into the Arctic Ocean was assessed by a small subgroup at GEOMAR. This transport process might be considered as a rapid contribution due to entrainment of contaminated sediments into sea ice, following export from the Kara Sea into the transpolar ice drift and subsequent release in the Atlantic Ocean in the area of the East Greenland Current. Numerical modelling of dispersion of pollutants from the Kara and Barents Seas was carried out both on a local scale for the Barents and Kara Seas and for long range dispersion into the Arctic and Atlantic Oceans. Three-dimensional baroclinic circulation models were applied to trace the transport of pollutants. Experimental results were used to validate the model results such as the discharges from the nuclear reprocessing plant at Sellafield and subsequent contamination of the North Sea up the Arctic Seas.

[Daytime admission and day care for the elderly. Current provisions in development]. / Dagopvang en dagverzorging voor ouderen. Nieuwe voorzieningen in ontwikkeling

The last five years day centres for the elderly have been developed on a large scale in the The Netherlands. In this article a number of characteristics of forty day centres is described. By means of a content analysis these characteristics were derived from written reports. There is a considerable variety in the denominations of the schemes, the accommodation that is used, the number of days per week during which the centres are open, the responsible organizations, admission procedures and costs per day. The objectives of the day care schemes are directed towards the visitors, their caregivers and towards the functioning of services as such. Usually visitors come to the day centre once or twice a week. The large majority is 70 years or older, often experiencing psychosocial problems. Besides social-recreational activities, in general an activating and/or therapeutical package of care is offered, in a number of cases together with personal care. Frequently both professional workers and volunteers carry out the work, with or without external support. There are indications of the existence of three types of schemes, varying in professionalism and care that is offered. In the discussion some relevant topics for future research are outlined.

Chernobyl nuclide record from a North Sea sediment trap.

Nuclides liberated by explosion and subsequent fire at Chernobyl No. 4 reactor on 26 April 1986, travelled to Western Europe with lower tropospheric air masses. They reached the northern Alps and Paris on 30 April, southern Great Britain on 2 May, the southern North Sea on 3 May, and the northern North Sea on 3 May and again on 8 May. Levels of deposited activity varied by a factor of 30 or more over distances less than 100 km because of variability of rainfall. A sediment trap deployed 222-m-deep in the North Sea off Bergen recorded the onset and magnitude of the deposition of Chernobyl nuclides. The trap collected 13 samples between 24 April and 21 September 1986. The flux of nuclides adsorbed to particles sinking from surface waters to sediments started less than ten days after contaminated air reached the site. Maximum specific activity occurred on 16-27 May for 137Cs, 134Cs, 106Ru and 103Ru, and on 8-20 June for 144Ce, 95Nb and 95Zr. The highest activity was found for 103Ru. The highest total specific activity of these nuclides in depositing sediments reached 670,000 Bq kg-1, and the highest total activity flux for one day amounted to 50 Bq m-2.

[The report "Care of the Aged": an ambiguous future scenario]. / De nota 'Zorg voor ouderen': een tweeslachtig toekomstscenario.

The Dutch governmental report 'Care of the elderly' is evaluated in the light of the findings of the study 'The elderly and their health in the Netherlands, 1984-2000'. The latter delineates three scenario's, by which in the near future the need of provisions may develop. The reference-scenario assumes a stable, relative demand for provisions, the growth-scenario an increasing and the shrinkage-scenario a decreasing demand. For economical and ideological reasons the Dutch government adheres to the shrinkage-scenario. Nevertheless, the same government also expresses severe doubts concerning the underlying assumptions. The proposed measures appear not to be consistent with the shrinkage-scenario. It is concluded that 'Care of the elderly' demonstrates ambiguity in its view on the future need of provisions by the elderly. This ambiguity appears to be largely determined by restricted financial and regulating means.