A mixed methods study of the work patterns of full-time nurse practitioners in Canadian nursing homes
The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. The study used a sequential mixed methods design using a national survey followed by case studies. A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care., Martin‐Misener, R., Donald, F., Wickson‐Griffiths, A., Akhtar‐Danesh, N., Ploeg, J., Brazil, K., . . . Taniguchi, A. (2015). A mixed methods study of the work patterns of full‐time nurse practitioners in nursing homes. Journal of Clinical Nursing, 24(9-10), 1327-1337. doi:10.1111/jocn.12741
A multi-dasymetric mapping approach for tourism
The challenge of measuring at municipal level tourism density has been a daunting task for both statisticians and geographers. The reason of this is enforced by the fact that administrative areas, such as municipalities, tend to be large spatial administrative units, sharing a large demographic asymmetry of tourist demand within the municipality. The rationale is that geographic characteristics such as coastal line, climate and vegetation, play a crucial role in tourist offer, leaning towards the conclusion that traditional census at administrative level are simply not enough to interpret the true distribution of tourism data. A more quantifiable method is necessary to assess the distribution of socio-economic data. This is developed by means of a dasymetric approach adding on the advantages of multi-temporal comparison. This paper adopts a dasymetric approach for defining tourism density per land use types using the CORINE Land Cover dataset. A density map for tourism is calculated, creating a modified areal weighting (MAW) approach to assess the distribution of tourism density per administrative municipality. This distribution is then assessed as a bidirectional layer on the land use datasets for two temporal stamps: 2000 and 2006, which leads to (i) a consistent map on a more accurate distribution of tourism in Algarve, (ii) the calculation of tourism density surfaces, and (iii) a multi-locational and temporal assessment through density cross-tabulation. Finally a geovisual interpretation of locational analysis of tourism change in Algarve for the last decade is created. This integrative spatial methodology offers unique characteristics for more accurate decision making at regional level, bringing an integrative methodology to the forefront of linking tourism with the spatio-temporal clusters formed in rapidly changing economic regions.
A multidisciplinary collaborative web site for cardiovascular surgery
* Patients, healthcare providers, and students have differing information needs in regard to surgical procedures.
* Often, separate information sources are designed for each group, resulting in fragmented information.
* Interactive, multidisciplinary, collaborative Web site is being developed to address the needs of all members of the healthcare team.
Cardiovascular surgical (CVS) settings encompass shared physical spaces that are accessible to patients, physicians, nurses, residents, and other members of the healthcare team.1 Dynamic, fluid interactions are constantly occurring among various members of the team at any point in time.1 Within these interactions, each member seeks to meet unique information and communication needs. For example, patients require information and support for learning and application of new self-care behavior skills, residents and students require mentorship to guide practice, and nurses and physicians require up-to-date empirical and theoretical information to revise and evaluate existing care endeavors. Traditionally, separate resources have been designed and administered for each member of the healthcare team; however, a single intervention that addresses the needs of each member of a multidisciplinary team has not been designed or evaluated.2,3 We developed an interactive, multidisciplinary, collaborative Web site as an intervention designed to address the needs of all members of the healthcare team, including patients. The Web site addresses the needs of postoperative patients, cardiovascular medical residents, nursing students, and other trainees, as well as nurses and physicians. In doing so, the site mimics the collective functioning of the existing healthcare teams within a shared physical space. The Web site can be accessed by different members of the healthcare team anywhere there is a wireless connection, and so it does not depend on shared physical space. Furthermore, it allows for interactive discussion through online chat rooms and open forums. As a result of this Web site, we anticipate an increase in the quality of patient care that is delivered within the CVS setting., Fredericks, S. (2015). A multidisciplinary collaborative web site for cardiovascular surgery. Computers Informatics Nursing, 33(7), 273-277. DOI: 10.1097/CIN.0000000000000167.
A new life for Old City Hall
Possible future uses for Toronto’s iconic Old City Hall with case studies from around town and across the globe. In 2015, City of Toronto staff embarked on a study to determine future uses for Old City Hall, a beloved landmark in the heart of Canada’s largest city. This report does not put forth recommendations, but intends to spark creative thinking and inspire a public discussion., Carter-Shamai, S., & Nelischer, C. (2016). A new life for Old City Hall. Toronto: Ryerson University, City Building Institute, Faculty of Community Services.
A note on cash-in-advance constraints in continuous time
This paper demonstrates a robust proof of the continuous-time transformations of Stockman's cash-in-advance constraints. When the constraint applies to consumption and capital purchases, monetary growth lowers steady state consumption and capital. When the constraint applies only to consumption purchases, monetary growth is superneutral., Also available for download from:
A practical servomotor project: combining the Web with simulation tools to solidify concepts in undergraduate control education
Current technology enables the lecturer to use computer tools to enhance the conceptualisation of lecture material. This can be especially useful in an engineering curriculum, as the course material can be rendered less abstract through visual illustration of difficult mathematical concepts. In this paper, we present an example of a multimedia enhanced course in linear control theory, taught by authors at Ryerson Polytechnic University (Toronto, Canada). In our implementation of the course, we combine software simulations of practical systems to illustrate control theory concepts with extensive online course notes to assist with comprehension. Followup analysis shows that the use of the WWW and computer tools to enhance the learning process leads to increased enthusiasm, comprehension, and information retention. A review of the process required to create the technology enabled learning environment shows that initially there is a great deal of work involved. However, we conclude that the effort is justified by allowing a positive qualitative change in the way we educate engineering students, Proceedings of the 1998 American Control Conference. 21-26 Jun 1998: Volume 2: 1309-1313.
A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for posttraumatic stress disorder
Background: Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little
research has been conducted to identify effective post-training support strategies.
Methods: The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and
transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings.
Discussion: Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation.
Trial registration: ClinicalTrials.gov: NCT01861769, Wiltsey Stirman, S., Shields, N., Deloriea, J., Landy, M. S. H., Belus, J. M., Maslej, M. M., & Monson, C. M. (2013). A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for posttraumatic stress disorder. Implementation Science : IS, 8, 82.
A realist review of brief interventions for alcohol misuse delivered in emergency departments
Background: Brief interventions (BIs) involve screening for alcohol misuse and providing feedback to patients
about their use, with the aim of reducing alcohol consumption and related consequences. BIs have been implemented
in various healthcare settings, including emergency departments (ED), where they have been found to contribute
mixed results in their ability to address alcohol misuse among adults. Mechanisms through which BIs work and
contextual factors impacting BI effectiveness are not clear. The purpose of this review was to understand how, for
whom, and under what circumstances BIs work for adults misusing alcohol and who have been admitted to an
ED. A realist review was chosen to answer these questions as realist reviews create context-mechanism-outcome
configurations, leading to the development of comprehensive and detailed theories; in this case explaining how
and for whom BIs work.
Methods: Databases including PsycINFO, Healthstar, CINAHL, Medline, and Nursing and Allied Health were
searched for articles published until December 2013. The search strategy focused on studies examining BIs that
targeted alcohol misuse among adults admitted into the ED. The search identified 145 relevant abstracts, of
which 36 were included in the review. The literature was synthesized qualitatively (immersion/crystallization).
Results: Four mechanisms were found within reviewed studies, including engagement in/retention of BI materials,
resolving ambivalence, increased awareness/insight into consequences of drinking, and increased self-efficacy/empowerment to use skills for change. The following contexts were found to impact mechanisms: emotional state, injury attributed to alcohol use, severity of alcohol use, and baseline stage of change.
Conclusions: This realist review provides advances in theories regarding which mechanisms to target during a BI and
which contexts create the most favorable conditions for these mechanisms to occur, ultimately leading to optimal BI
outcomes. These results can inform future clinical decision-making when delivering BIs in ED settings. Future research should conduct quantitative examination to confirm these findings.
Systematic review registration: PROSPERO CRD42013006549, Davey, C. J., Landy, M. S. H., Pecora, A., Quintero, D., & McShane, K. E. (2015). A realist review of brief interventions for alcohol misuse delivered in emergency departments. Systematic Reviews, 4(1), 45.
A realistic review of family-based interventions for children of substance abusing parents.
Millions of children across North America and Europe live in families with alcohol or drug abusing parents. These children are at risk for a number of negative social, emotional and developmental outcomes, including an increased likelihood of developing a substance use disorder later in life. Family-based intervention programs for children with substance abusing parents can yield positive outcomes. This study is a realist review of evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents (COSAPs). The primary objectives were to uncover patterns of contextual factors and mechanisms that generate program outcomes, and advance program theory in this field.
Realist review methodology was chosen as the most appropriate method of systematic review because it is a theory-driven approach that seeks to explore mechanisms underlying program effectiveness (or lack thereof). A systematic and comprehensive search of academic and grey literature uncovered 32 documents spanning 7 different intervention programs. Data was extracted from the included documents using abstraction templates designed to code for contexts, mechanisms and outcomes of each program. Two candidate program theories of family addiction were used to guide data analysis: the family disease model and the family prevention model. Data analysis was undertaken by a research team using an iterative process of comparison and checking with original documents to determine patterns within the data.
Programs originating in both the family disease model and the family prevention model were uncovered, along with hybrid programs that successfully included components from each candidate program theory. Four demi-regularities were found to account for the effectiveness of programs included in this review: (1) opportunities for positive parent-child interactions, (2) supportive peer-to-peer relationships, (3) the power of knowledge, and (4) engaging hard to reach families using strategies that are responsive to socio-economic needs and matching services to client lived experience.
This review yielded new findings that had not otherwise been explored in COSAP program research and are discussed in order to help expand program theory. Implications for practice and evaluation are further discussed., Usher, A. M., McShane, K. E., & Dwyer, C. (2015). A realist review of family-based interventions for children of substance abusing parents. Systemic Reviews, 4, 177. doi:10.1186/s13643-015-0158-4
A regional spatial-retrofitting approach to geovisualise regional urban growth: An application to the Golden Horseshoe in Canada
Understanding urban change in particular for larger regions has been a great demur in both regional planning and geography. One of the main challenges has been linked to the potential of modelling urban change. The absence of spatial data and size of areas of study limit the traditional urban monitoring approaches, which also do not take into account visualization techniques that share information with the community. This is the case of the Golden Horseshoe in southern Ontario in Canada, one of the fastest growing regions in North America. An unprecedented change on the urban environment has been witnessed, leading to an increased importance of awareness for future planning in the region. With a population greater than 8 million, the Golden Horseshoe is steadily showing symptoms of becoming a mega-urban region, joining surrounding cities into a single and diversified urban landscape. However, little effort has been done to understand these changes, nor to share information with policy makers, stakeholders and investors. These players are in need of the most diverse information on urban land use, which is seldom available from a single source. The spatio-temporal effect of the growth of this urban region could very well be the birth of yet another North American megacity. Therefore, from a spatial perspective there is demand for joint collaboration and adoption of a regional science perspective including land use and spatio-temporal configurations. This calls forth a novel technique that allows for assessment of urban and regional change, and supports decision-making without having the usual concerns of locational data availability. It is this sense, that we present a spatial-retrofitting model, with the objective of (i) retrofitting spatial land use based on current land use and land cover, and assessing proportional change in the past, leading to four spatial timestamps of the Golden Horseshoe’s land use, while (ii) integrating this in a multi-user open source web environment to facilitate synergies for decision-making. This combined approach is referred to as a regional-spatial-retrofitting approach (RSRA), where the conclusions permit accurate assessment of land use in past time frames based on Landsat imagery. The RSRA also allows for a collective vision of regional urban growth supporting local governance through a decision-making process adhering to Volunteered Geographic Information Systems. Urban land use change can be refined by means of contribution from end-users through a web environment, leading to a constant understanding and monitoring of urban land use and urban land use change.
A review of mathematical models of influenza A infections within a host or cell culture: lessons learned and challenges ahead
Most mathematical models used to study the dynamics of influenza A have thus far focused on the between-host population level, with the aim to inform public health decisions regarding issues such as drug and social distancing intervention strategies, antiviral stockpiling or vaccine distribution. Here, we investigate mathematical modeling of influenza infection spread at a different scale; namely that occurring within an individual host or a cell culture. We review the models that have been developed in the last decades and discuss their contributions to our understanding of the dynamics of influenza infections. We review kinetic parameters (e.g., viral clearance rate, lifespan of infected cells) and values obtained through fitting mathematical models, and contrast them with values obtained directly from experiments. We explore the symbiotic role of mathematical models and experimental assays in improving our quantitative understanding of influenza infection dynamics. We also discuss the challenges in developing better, more comprehensive models for the course of influenza infections within a host or cell culture. Finally, we explain the contributions of such modeling efforts to important public health issues, and suggest future modeling studies that can help to address additional questions relevant to public health., Beauchemin, C. A. A., & Handel, A. (2011). A review of mathematical models of influenza A infections within a host or cell culture: Lessons learned and challenges ahead. BMC Public Health, 11 Suppl 1(Suppl 1), S7-S7. doi:10.1186/1471-2458-11-S1-S7
A simplified cervix model in response to induction balloon in pre-labour
Background: Induction of labour is poorly understood even though it is performed in
20% of births in the United States. One method of induction, the balloon dilator
applied with traction to the interior os of the cervix, engages a softening process,
permitting dilation and effacement to proceed until the beginning of active labour.
The purpose of this work is to develop a simple model capable of reproducing the
dilation and effacement effect in the presence of a balloon.
Methods: The cervix, anchored by the uterus and the endopelvic fascia was modelled
in pre-labour. The spring-loaded, double sliding-joint, double pin-joint mechanism
model was developed with a Modelica-compatible system, MapleSoft MapleSim 6.1,
with a stiff Rosenbrock solver and 1E-4 absolute and relative tolerances. Total
simulation time for pre-labour was seven hours and simulations ended at 4.50 cm
dilation diameter and 2.25 cm effacement.
Results: Three spring configurations were tested: one pin joint, one sliding joint and
combined pin-joint-sliding-joint. Feedback, based on dilation speed modulated the
spring values, permitting controlled dilation. Dilation diameter speed was maintained
at 0.692 cm · hr−1 over the majority of the simulation time. In the sliding-joint-only
mode the maximum spring constant value was 23800 N · m−1. In pin-joint-only the
maximum spring constant value was 0.41 N·m· rad−1.With a sliding-joint-pin-joint pair
the maximum spring constants are 2000 N · m−1 and 0.41 N · m · rad−1, respectively.
Conclusions: The model, a simplified one-quarter version of the cervix, is capable of
maintaining near-constant dilation rates, similar to published clinical observations for
pre-labour. Lowest spring constant values are achieved when two springs are used, but
nearly identical tracking of dilation speed can be achieved with only a pin joint spring.
Initial and final values for effacement and dilation also match published clinical
observations. These results provide a framework for development of electro-mechanical
phantoms for induction training, as well as dilator testing and development., Smith, J. A. (2013). A simplified cervix model in response to induction balloon in pre-labour. Theoretical Biology & Medical Modelling, 10(1), 58-58. doi:10.1186/1742-4682-10-58