Advanced practice nursing role development: factor analysis of a modified role delineation tool

Aim his study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third paper from a multi-phase Australian study aimed at assigning advanced practice roles. Methods A postal survey was conducted of a random sample of state government employed Registered nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach’s alpha coefficient determined reliability of the overall scale and identified factors. Results There were 658 responses (42% response rate). The five factors found with loadings of ≥.400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach’s alpha coefficient was .94 overall and for the factors ranged from 0.83 to 0.95. Conclusion Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment

Managing pertussis in adults

Pertussis or whooping cough is typically characterised by paroxysms of coughing with a whooping sound during inhalation. It is thought to be under-diagnosed generally. Whooping cough is caused by Bordetella pertussis and is highly contagious. Although childhood immunisation has been effective in preventing the disease, outbreaks in Australia have been associated with waning immunity in older children and adolescents. The peak incidence of infection now occurs in people aged 15 or older. When given early in the illness, antibiotics can decrease the infectious period, but have no effect on the duration or severity of disease. Symptomatic treatment of cough has shown no clear benefit. Antibiotic prophylaxis of contacts is recommended for certain high-risk groups, but there is limited evidence of its effectiveness. Although infants remain the most at risk for severe, life-threatening disease, it is adolescent and adult booster immunisation which remains critical for prevention programs

QoS-Aware Middleware for Web Services Composition

The paradigmatic shift from a Web of manual interactions to a Web of programmatic interactions driven by Web services is creating unprecedented opportunities for the formation of online Business-to-Business (B2B) collaborations. In particular, the creation of value-added services by composition of existing ones is gaining a significant momentum. Since many available Web services provide overlapping or identical functionality, albeit with different Quality of Service (QoS), a choice needs to be made to determine which services are to participate in a given composite service. This paper presents a middleware platform which addresses the issue of selecting Web services for the purpose of their composition in a way that maximizes user satisfaction expressed as utility functions over QoS attributes, while satisfying the constraints set by the user and by the structure of the composite service. Two selection approaches are described and compared: one based on local (task-level) selection of services and the other based on global allocation of tasks to services using integer programming

Argan e Giacomo Serpotta

Il testo, frutto dell\u2019intervento tenuto alla giornata di studi su Giulio Carlo Argan, docente di Storia dell\u2019Arte all\u2019universit\ue0 di Palermo tra il 1955 e il 1959, prende in esame un suo breve ma fondamentale contributo sullo scultore-stuccatore palermitano Giacomo Serpotta (1656-1752) scritto nel 1957. L\u2019analisi critica del testo, interpretando la densit\ue0 dei concetti espressi dal critico e storico dell\u2019arte, mette in evidenza gli aspetti salienti della critica arganiana sull\u2019argomento. Si rileva come Argan voli subito molto alto ed tracci delle interpretazioni ancora estremamente valide, come anche alcune letture complesse e di certo avvincenti, che pongono in ulteriore luce l\u2019arte del maestro palermitano come un artista del pieno barocco e per nulla provinciale

Safety and efficacy of vismodegib in patients aged ≥65 years with advanced basal cell carcinoma.

Because many patients with unresectable basal cell carcinoma (BCC) are aged ≥65 years, this study explores the efficacy and safety of vismodegib in these patients with locally advanced (la) or metastatic (m) basal cell carcinoma (BCC) in the ERIVANCE BCC trial and the expanded access study (EAS).We compared patients aged ≥65 years to patients aged <65 years taking vismodegib 150 mg/day, using descriptive statistics for response and safety. Patients aged ≥65 years (laBCC/mBCC) were enrolled in ERIVANCE BCC (33/14) and EAS (27/26). Investigator-assessed best overall response rate in patients ≥65 and <65 years was 46.7%/35.7% and 72.7%/52.6% (laBCC/mBCC), respectively, in ERIVANCE BCC and 45.8%/33.3% and 46.9%/28.6%, respectively, in EAS. These differences were not clinically meaningful. Safety was similar in both groups, although those aged ≥65 years had a higher percentage of grade 3-5 adverse events than those aged <65 years. Vismodegib demonstrated similar clinical activity and adverse events regardless of age

Long-term effects of pneumonia in young children

Each year an estimated 120 million episodes of pneumonia occur in children younger than 5 years of age, resulting in one million deaths globally. Within this age group the lungs are still developing by increasing alveoli numbers and airway dimensions. Pneumonia during this critical developmental period may therefore adversely affect the lung’s structure and function, with increased risk of subsequent chronic lung disease. However, there are few longitudinal studies of pneumonia in otherwise healthy children that extend into adulthood to help address this important question. Birth cohort, longitudinal, case-control and retrospective studies have reported restrictive and obstructive lung function deficits, asthma, bronchiectasis, and chronic obstructive pulmonary disease. In particular, severe hospitalised pneumonia had the greatest risk for long-term sequelae. Most studies, however, were limited by incomplete follow-up, some reliance upon parental recall, risk of diagnostic misclassification, and potential confounders such as nutrition, social deprivation, and pre-existing small airways or lungs. More long-term studies measuring lung function shortly after birth are needed to help disentangle the complex relationships between pneumonia and later chronic lung disease, while also addressing host responses, types of infection, and potential confounding variables. Meanwhile, parents of young children with pneumonia need to be advised about the importance of symptom resolution, post-pneumonia. In addition, paying attention to factors associated with optimising lung growth such as good nutrition, minimising exposure to air pollution, avoiding cigarette smoke, and decreasing the risk of preventable infections through good hygiene and having their children fully vaccinated should be emphasised. Finally, in the developing world and for disadvantaged communities in developed countries, public health policies leading to good quality housing and heating, hygiene, education, and improving socio-economic status are also essential