A comparison of fragmenting lead-based and lead-free bullets for aerial shooting of wild pigs.

In response to the health threats posed by toxic lead to humans, scavenging wildlife and the environment, there is currently a focus on transitioning from lead-based to lead-free bullets for shooting of wild animals. We compared efficiency metrics and terminal ballistic performance for lead-based and lead-free (non-lead) bullets for aerial shooting of wild pigs (Sus scrofa) in eastern Australia. Ballistic testing revealed that lead-based and lead-free bullets achieved similar performance in precision and muzzle kinetic energy (E0) levels (3337.2 J and 3345.7 J, respectively). An aerial shooting trial was conducted with wild pigs shot with one type of lead-based and one type of lead-free bullets under identical conditions. Observations were made from 859 shooting events (n = 430 and 429 respectively), with a sub-set of pigs examined via gross post-mortem (n = 100 and 108 respectively), and a further sub-set examined via radiography (n = 94 and 101 respectively). The mean number of bullets fired per pig killed did not differ greatly between lead-based and lead-free bullets respectively (4.09 vs 3.91), nor did the mean number of bullet wound tracts in each animal via post-mortem inspection (3.29 vs 2.98). However, radiography revealed a higher average number of fragments per animal (median >300 vs median = 55) and a broader distribution of fragments with lead-based bullets. Our results suggest that lead-based and lead-free bullets are similarly effective for aerial shooting of wild pigs, but that the bullet types behave differently, with lead-based bullets displaying a higher degree of fragmentation. These results suggest that aerial shooting may be a particularly important contributor to scavenging wildlife being exposed to lead and that investigation of lead-free bullets for this use should continue.

The applicability of community of inquiry framework to online nursing education: A cross-sectional study.

The Community of Inquiry (CoI) framework has the potential to contribute to online education by addressing the nexus of pedagogy, technology, and learners' needs. However, there has been limited investigation of the application of CoI to Australian online tertiary education, with the awareness of CoI amongst Australian nurse educators being unknown. This paper reports on a project which used an online survey to investigate the level of awareness of the CoI framework and its applicability to the design of online and blended courses in Australian higher education nursing schools. Most respondents ranked the core concepts of the CoI framework as applicable for nursing education, but only 20% of the participants were familiar with the CoI framework before they participated in the survey. While nearly 90% of the participants viewed instructional design and a theoretical framework as essential for building an online course, 70% of respondents indicated that they did not use an explicit theoretical framework to guide the design or the evaluation of their nursing teaching and learning. These results provide the impetus for further investigation of factors influencing the development of online nurse education including the specific consideration of CoI frameworks.

CaseWorld™: Interactive, media rich, multidisciplinary case based learning.

Nurse educators are challenged to keep up with highly specialised clinical practice, emerging research evidence, regulation requirements and rapidly changing information technology while teaching very large numbers of diverse students in a resource constrained environment. This complex setting provides the context for the CaseWorld project, which aims to simulate those aspects of clinical practice that can be represented by e-learning. This paper describes the development, implementation and evaluation of CaseWorld, a simulated learning environment that supports case based learning. CaseWorld provides nursing students with the opportunity to view unfolding authentic cases presented in a rich multimedia context. The first round of comprehensive summative evaluation of CaseWorld is discussed in the context of earlier formative evaluation, reference group input and strategies for integration of CaseWorld with subject content. This discussion highlights the unique approach taken in this project that involved simultaneous prototype development and large scale implementation, thereby necessitating strong emphasis on staff development, uptake and engagement. The lessons learned provide an interesting basis for further discussion of broad content sharing across disciplines and universities, and the contribution that local innovations can make to global education advancement.

CaseWorld: Authentic Case-Based Learning Simulating Healthcare Practice.

Health educators in Australia are challenged by the need to provide clinically relevant education to large numbers of students across a wide range of specialties. This situation is compounded by changed student demographics, new technologies in both the workplace and university, and decreased access to clinical placement opportunities for students. This article describes an innovative response addressing nurse education priorities and implemented in the School of Nursing at Flinders University South Australia, involving the development of CaseWorld, a prototype virtual case-based learning environment. CaseWorld implementation was unique because large-scale innovation occurred as part of routine curriculum development. This was challenging as there was limited opportunity for prototype evaluation before student use, thus necessitating a flexible implementation process. The outcome was the development of scripted unfolding cases that provide students with low-fidelity simulation enhanced by multimedia. Students engage with cases based on real patient experiences, which are modified to protect confidentiality. These authentic cases provide the basis for the development of critical-thinking and decision-making skills as students problem solve issues and identify priorities for nursing care, explain the pathophysiology, and respond to simulated patient complaints. CaseWorld was modified in response to evaluation data from surveys and focus groups, and the revised version is discussed in terms of its implementation in nursing and planned use across multiple health sciences disciplines.

E-learning for Critical Thinking: Using Nominal Focus Group Method to Inform Software Content and Design.

BACKGROUND: Undergraduate nursing students are often confused by multiple understandings of critical thinking. In response to this situation, the Critiique for critical thinking (CCT) project was implemented to provide consistent structured guidance about critical thinking. OBJECTIVES: This paper introduces Critiique software, describes initial validation of the content of this critical thinking tool and explores wider applications of the Critiique software. MATERIALS AND METHODS: Critiique is flexible, authorable software that guides students step-by-step through critical appraisal of research papers. The spelling of Critiique was deliberate, so as to acquire a unique web domain name and associated logo. The CCT project involved implementation of a modified nominal focus group process with academic staff working together to establish common understandings of critical thinking. Previous work established a consensus about critical thinking in nursing and provided a starting point for the focus groups. The study was conducted at an Australian university campus with the focus group guided by open ended questions. RESULTS: Focus group data established categories of content that academic staff identified as important for teaching critical thinking. This emerging focus group data was then used to inform modification of Critiique software so that students had access to consistent and structured guidance in relation to critical thinking and critical appraisal. CONCLUSIONS: The project succeeded in using focus group data from academics to inform software development while at the same time retaining the benefits of broader philosophical dimensions of critical thinking.

Exploring experienced nurses' attitudes, views and expectations of new graduate nurses: a critical review.

OBJECTIVES: This critical review evaluates the existing primary research literature to identify experienced registered nurses' attitudes, views and expectations of graduate nurses which may create a barrier for optimal graduate nurse performance. DESIGN/DATA SOURCES: Relevant primary studies were identified by searching online databases using a wide variety of appropriate keyword combinations. Online databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO and Google Scholar were comprehensively searched for relevant research. The selected studies were subjected to a rigorous critical appraisal to evaluate the studies and to determine if the findings were applicable to practice. REVIEW METHODS: A manual method of thematic analysis was conducted to highlight explicit and implicit themes from the reviewed studies. Themes were grouped and continually reduced until only essential themes remain. Themes and subthemes emerged which were then compared and contrasted to analyse results. The four major themes identified include nursing skills, inadequate preparation during academic program, attitudes and ward culture and concerns with confidence. Subthemes were identified within these categories. RESULTS: Findings indicate experienced registered nurses discussed themes including 'nursing skills', 'inadequate preparation during academic program', 'attitudes and ward culture' and 'concerns with confidence'. Concerns were raised including the value of traditional training versus tertiary education programs, coping with unprofessional behaviour and inadequate preparation for practice. DISCUSSION AND IMPLICATIONS FOR PRACTICE: Further research is required to fully address management of the theory-practice gap, as well as the attitudes of experienced registered nurses educated in traditional programs versus those in tertiary education programs. Nurse managers should be aware of the possible occurrence of unprofessional behaviour, and increased workplace training regarding lateral violence would assist in raising awareness regarding negative and unacceptable behaviour.

A survey of Malaysian Critical Intensive Care Unit nurses' awareness of patients' transition experiences (PE) and transitional care practice (TCP).

BACKGROUND: Preparation of critically ill patients throughout their transition experiences in Critical Intensive Care Units (CICU) and following discharge can impact upon their recovery. However, there is little research addressing critical care nurses' awareness of patients' transition experiences. AIM: This study aimed to examine CICU nurses' awareness of patients' transition experiences and transitional care practice in Malaysia. METHOD: A descriptive questionnaire was used to survey Registered Nurses in seven CICUs in four hospitals in Malaysia. Data were analysed using descriptive statistics and correlation analysis. RESULTS: The survey had a response rate of 65.2% (178 of 273 eligible nurses). The respondents' mean age was 29.6 years. Most of the respondents were from public hospitals and the majority had one to five years' experience working as Registered Nurses, and in CICU. Public teaching hospital nurses had greater awareness of patients' transition experience (PE) (p<0.05), and of transitional care practice (TCP) (p<0.05) than public hospital nurses. Nurses with >10 years Critical Intensive Care Unit experience (p<0.05) had greater awareness of both PE and TCP (p<0.05). Attending a course of any kind did not affect nurses' awareness in both PE and TCP (p>0.05). There was a positive correlation between nurses' awareness of patients' transition experience and its impact, and their awareness of transitional care practice performance (rs=0.42, p<0.05). CONCLUSION: CICU nurses need targeted transition education to enable them to anticipate patients' transitional experiences and to provide appropriate transitional care, particularly for public hospital nurses. Nursing schools need to integrate more content about critically ill patients' transition experiences into the curriculum, to ensure graduate nurses will be able to anticipate the patient's experience and provide appropriate transitional care.

Patients' transition in the intensive care units: concept analysis.

BACKGROUND: Adequate preparation of critically ill patients throughout their transition experience within and following discharge from the Intensive Care Unit is an important element of the nursing care process during critical illness. However, little is known about nurses' perspectives of, and engagement in, caring for critically ill patients during their transition experiences. AIM: This paper aims to review the literature about the concept of transition within the context of critically ill patients in the Intensive Care Unit, focusing on Intensive Care Unit nurses. REVIEW METHOD: CINAHL, MEDLINE, OVID, Science Direct, SAGE eReference and SAGE Journal Online data bases were searched for relevant literature published since 1970. RESULTS: The critically ill patients' transitions in Intensive Care Units are generally described as a period of transfer or change of situation, or the experience of inner change or role during and after the illness. The critically ill patients' transition experience per se is not directly described, nor is nurses' understanding of it. CONCLUSION: Nurses' understanding of critically ill patients' transition may significantly impact the patients' care in the Intensive Care Unit. Thus, research is needed that focuses more on evaluating nurses' understanding of patients' transition and its consequences.

Gastrointestinal helminths of pipistrelle bats (Pipistrellus pipistrellus/Pipistrellus pygmaeus) (Chiroptera: Vespertilionidae) of England.

Although bats are one of the most successful and diverse of mammalian orders, studies that focus upon bat endoparasites are limited. To further knowledge of bat parasitology, pipistrelle bats (Pipistrellus pipistrellus and P. pygmaeus) were acquired from across the Greater Manchester and Lancashire region of England and examined for gastrointestinal helminths using morphological and molecular analyses. Sixty-eight of 90 adult/juvenile bats (76% prevalence) were infected with at least 1 species of helminth and mean helminth abundance was 48·2 (+/-7·0). All helminths were digenean trematodes and the following species were identified in 51 P. pipistrellus specimens (prevalence in parentheses): Lecithodendrium linstowi (80·4%), L. spathulatum (19·6%), Prosthodendrium sp. (35·3%), Plagiorchis koreanus (29·4%) and Pycnoporus heteroporus (9·8%). Statistical analyses, incorporating multifactorial models, showed that male bats exhibited a significantly more aggregated helminth distribution and lower abundance than females. Positive associations were observed between L. linstowi and L. spathulatum, Prosthodendrium sp. and P. heteroporus and between L. spathulatum and P. koreanus. A revised phylogeny of bat-associated Lecithodendriidae, incorporating novel L. spathulatum and Prosthodendrium sp. 28S rRNA sequences, separated the controversial clade formed by L. linstowi and P. hurkovaae. Further studies are likely to assist the understanding of bat-parasite/pathogen relationships, helminth infracommunity structures and phylogenetics.

Paired peer review of university classroom teaching in a school of nursing and midwifery.

BACKGROUND: Peer review of university classroom teaching can increase the quality of teaching but is not universally practiced in Australian universities. AIM: To report an evaluation of paired peer-review process using both paper and web based teaching evaluation tools. METHODS: Twenty university teachers in one metropolitan Australian School of Nursing and Midwifery were randomly paired and then randomly assigned to a paper based or web-based peer review tool. Each teacher reviewed each other's classroom teaching as part of a peer review program. The participants then completed an 18 question survey evaluating the peer review tool and paired evaluation process. Responses were analyzed using frequencies and percentages. RESULTS: Regardless of the tool used, participants found this process of peer review positive (75%), collegial (78%), supportive (61%) and non-threatening (71%). Participants reported that the peer review will improve their own classroom delivery (61%), teaching evaluation (61%) and planning (53%). The web-based tool was found to be easier to use and allowed more space than the paper-based tool. CONCLUSION: Implementation of a web-based paired peer review system can be a positive method of peer review of university classroom teaching. Pairing of teachers to review each other's classroom teaching is a promising strategy and has the potential to improve teaching in teaching universities.

Integrating natural and social science perspectives on plant disease risk, management and policy formulation.

Plant diseases threaten both food security and the botanical diversity of natural ecosystems. Substantial research effort is focused on pathogen detection and control, with detailed risk management available for many plant diseases. Risk can be assessed using analytical techniques that account for disease pressure both spatially and temporally. We suggest that such technical assessments of disease risk may not provide an adequate guide to the strategies undertaken by growers and government to manage plant disease. Instead, risk-management strategies need to account more fully for intuitive and normative responses that act to balance conflicting interests between stakeholder organizations concerned with plant diseases within the managed and natural environments. Modes of effective engagement between policy makers and stakeholders are explored in the paper, together with an assessment of such engagement in two case studies of contemporary non-indigenous diseases in one food and in one non-food sector. Finally, a model is proposed for greater integration of stakeholders in policy decisions.

Patients' quality of life: a comparison of patient and nurse perceptions.

Quality of Life (QoL) is a subjective perception a person has of their position in life. Tailoring care to a patient's unique needs requires nurses and patients to have a similar understanding of a patients' QoL. This study aimed to identify: (a) the level of agreement between patients and nurses about cancer patients' QoL; and (b) variables that may affect the level of agreement between them. Cancer patients (n=117) and nurses (n=49) from a public hospital were invited separately to complete the World Health Organisation Quality of Life Brief (WHOQoL-BREF) questionnaire. This assesses QoL in physical, psychological, social relationship and environmental domains, or dimensions. Intraclass correlation coefficients (ICC) revealed a moderate agreement between nurses' and patients' scores in the physical QoL domain but lower agreement on other domains. A paired t-test identified patients' QoL domain scores were significantly higher than that of nurses in social relationship and environmental domains. Multivariate analysis using standard multiple regression analysis demonstrated that agreement between patients and nurses was higher: (a) in the physical QoL domain with nurses who have greater clinical experience with cancer patients; (b) in the social relationship QoL domain when patients are treated in outpatient departments. These results imply that differences exist between patients' and nurses' perceptions about cancer patients' QoL and nurses tend to underestimate patients' QoL in social relationship and environmental domains. Higher clinical experience with cancer patients may contribute toward a better understanding by nurses of cancer patients' QoL.

Multicenter evaluation of a new ultrasound-guided biopsy device: Improved ergonomics, sampling and rebiopsy rates.

The purpose of this study was to evaluate performance, ergonomics, and immediate rebiopsy rate of a new vacuum-assisted biopsy (VAB) device for ultrasound-guided breast biopsies. Between December 2002 and April 2003, 113 patients meeting study criteria were biopsied at four centers using the new 9 gauge VAB device. The device has a radiofrequency-tipped probe, 360 degrees vacuum, a circumferential cutter, and a coaxial cannula for multiple sampling. Patient and procedural data included breast composition, lesion characteristics, number of samples, procedure time, and complications. Quality of samples, lesion access, and ergonomic features were assessed qualitatively and compared with prior experience with other biopsy devices. Immediate rebiopsy rate included high-risk lesions requiring surgical excision (obligate rebiopsy) and lesions requiring rebiopsy due to discordance or insufficient samples yielding nondiagnostic material. Data were analyzed using the Wilcoxon signed-rank test. One hundred thirteen patients aged 20-83 years (mean 52) were successfully biopsied with dense/fibrous breast tissue in 60% and dense/fibrous lesions in 49%. Lesions measured 6-63 mm (mean 17); 97% were masses. Five circumferential specimens (range 2-19) were obtained in 6 minutes (range 2-20). Operators rated safety and comfort comparable with existing devices and rated sample quality, breast/lesion penetration, and positioning ease/accuracy superior (p < 0.01). Diagnoses included 37 cancers, 70 benign, and six high-risk lesions with one upgrade from atypical ductal hyperplasia to ductal carcinoma in situ at surgery. Excluding obligate excision in high-risk diagnoses, the immediate rebiopsy rate was 2%. No complications required intervention. The new VAB device provides diagnostic samples and reduces sampling error defined by immediate rebiopsy rate. Compared with other devices, it is more ergonomic to target and position for sampling, particularly in dense breast tissue or lesions.

What makes for sustainable Healthy Cities initiatives? - a review of the evidence from Noarlunga, Australia after 18 years

This paper examines the factors that have enabled the Healthy Cities Noarlunga (HCN) initiative to be sustainable over 18 years (1987-2005). Sustainability related to the ability of the initiative to continue to operate continuously in a manner that indicated its existence was accorded value by the community and local service providers. The analysis is based on a narrative review of 29 documents related to HCN, including a number of evaluations. Nine factors emerged as important to ensuring sustainability: strong social health vision; inspirational leadership, a model that can adapt to local conditions; ability to juggle competing demands; strongly supported community involvement that represents genuine engagement; recognition by a broad range of players that Healthy Cities is a relatively neutral space in which to achieve goals; effective and sustainable links with a local university; an outward focus open to international links and outside perspectives; and, most crucial, the initiative makes the transition from a project to an approach and a way of working. These sustainability factors are likely to be relevant to a range of complex, community-based initiatives. (AU)

What makes for sustainable Healthy Cities initiatives?--A review of the evidence from Noarlunga, Australia after 18 years.

This paper examines the factors that have enabled the Healthy Cities Noarlunga (HCN) initiative to be sustainable over 18 years (1987-2005). Sustainability related to the ability of the initiative to continue to operate continuously in a manner that indicated its existence was accorded value by the community and local service providers. The analysis is based on a narrative review of 29 documents related to HCN, including a number of evaluations. Nine factors emerged as important to ensuring sustainability: strong social health vision; inspirational leadership; a model that can adapt to local conditions; ability to juggle competing demands; strongly supported community involvement that represents genuine engagement; recognition by a broad range of players that Healthy Cities is a relatively neutral space in which to achieve goals; effective and sustainable links with a local university; an outward focus open to international links and outside perspectives; and, most crucial, the initiative makes the transition from a project to an approach and a way of working. These sustainability factors are likely to be relevant to a range of complex, community-based initiatives.

Breast biopsy: multicenter study of radiofrequency introducer with US-guided handheld system--initial experience.

PURPOSE: To evaluate the utility of a radiofrequency (RF) introducer in placement and use of a handheld breast biopsy system during ultrasonography (US)-guided breast biopsy. MATERIALS AND METHODS: In three institutions from September 2000 through June 2001, 99 patients were scheduled for US-guided breast biopsy with the handheld system. Patients were randomly assigned to undergo biopsy with the handheld system alone (control group, 50 patients) or with the RF introducer and the handheld system (treatment group, 49 patients). Investigators compared the ability of the radiologist and pathologist to obtain a histologic diagnosis, ease of tissue penetration, procedure time, and pain. Patients assessed their pain level after the procedure and at 1, 7, and 30 days after biopsy. RESULTS: The RF introducer provided easier penetration (treatment group mean score, 1.6; control group, 2.4), particularly in patients with dense breasts (treatment group, 1.0; control group, 2.9) on the basis of a five-point scale (1 = very easy, 5 = extremely difficult). A histologic diagnosis was obtained in all cases, and no RF-induced artifact was reported. Average biopsy procedure time for treatment and control groups was not significantly different. Average patient pain levels were comparable between groups for each evaluation interval. Clinical complications in four treatment patients and three control patients were minor and resolved spontaneously. CONCLUSION: The RF introducer may serve as a useful adjunct to the handheld biopsy system by facilitating penetration of breast tissue without causing any deleterious effects for the patient or the biopsy specimen.

Design and synthesis of trans-3-(2-(4-((3-(3-(5-methyl-1,2,4-oxadiazolyl))- phenyl)carboxamido)cyclohexyl)ethyl)-7-methylsulfonyl-2,3,4,5-tetrahydro-1H-3-benzazepine (SB-414796): a potent and selective dopamine D3 receptor antagonist.

At their clinical doses, current antipsychotic agents share the property of both dopamine D(2) and D(3) receptor blockade. However, a major disadvantage of many current medications are the observed extrapyramidal side-effects (EPS), postulated to arise from D(2) receptor antagonism. Consequently, a selective dopamine D(3) receptor antagonist could offer an attractive antipsychotic therapy, devoid of the unwanted EPS. Using SAR information gained in two previously reported series of potent and selective D(3) receptor antagonists, as exemplified by the 2,3,4,5-tetrahydro-1H-3-benzazepine 10 and the 2,3-dihydro-1H-isoindoline 11, a range of 7-sulfonyloxy- and 7-sulfonylbenzazepines has been prepared. Compounds of this type combined a high level of D(3) affinity and selectivity vs D(2) with an excellent pharmacokinetic profile in the rat. Subsequent optimization of this series to improve selectivity over a range of receptors and reduce cytochrome P450 inhibitory potential gave trans-3-(2-(4-((3-(3-(5-methyl-1,2,4-oxidiazolyl))phenyl)carboxamido)cyclohexyl)ethyl)-7-methylsulfonyl-2,3,4,5-tetrahydro-1H-3-benzazepine (58, SB-414796). This compound is a potent and selective dopamine D(3) receptor antagonist with high oral bioavailability and is CNS penetrant in the rat. Subsequent evaluation in the rat has shown that 58 preferentially reduces firing of dopaminergic cells in the ventral tegmental area (A10) compared to the substantia nigra (A9), an observation consistent with a prediction for atypical antipsychotic efficacy. In a separate study, 58 has been shown to block expression of the conditioned place preference (CPP) response to cocaine in male rats, suggesting that it may also have a role in the treatment of cue-induced relapse in drug-free cocaine addicts.

Atypical ductal hyperplasia of the breast diagnosed by 11-gauge directional vacuum-assisted biopsy.

BACKGROUND: Small nonpalpable mammographic abnormalities are frequently diagnosed by percutaneous stereotactically guided core needle biopsy. The reliability of the histologic diagnosis of atypical ductal hyperplasia (ADH) made from tissue obtained by 11-gauge directional, vacuum-assisted biopsy of these nonpalpable breast lesions is unknown. METHODS: The records of 31 patients who were found to have ADH by 11-gauge directional vacuum-assisted biopsy were reviewed. All of these patients subsequently underwent surgical excision with needle localization biopsy of the ADH and they are the subjects of this retrospective study. RESULTS: Eleven of the 31 patients with ADH on 11-gauge directional vacuum-assisted biopsy were upgraded to ductal carcinoma in situ or infiltrating carcinoma by the excisional biopsy. This was a 35% underestimation of malignancy in our patients. CONCLUSIONS: When the histologic diagnosis of ADH is made from tissue harvested by an 11-gauge directional vacuum assisted biopsy, surgical excision of the entire abnormality is recommended to avoid underdiagnosis of breast cancer.