bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current practice and perception of barriers in the use of Evidence-Based Practice by a nurse in the optimum pain treatment in the elderly - preliminary study
Authors: Mędrzycka-Dąbrowska Wioletta , Gutysz-Wojnicka Aleksandra , Basiński Andrzej , Małecka-Dubiela Anna , Ozga Dorota 
Published: March 2017

Advances in the study of pain and the methods for its relief since the late 1980s have led to a rise in the role of the nurse in pain management and monitoring. The application of Evidence-Based Practice (EBP) related to acute pain is on the increase in the world at large. The purpose of this study is to describe current practices, perceived barriers and perceived facilitators of Polish nurses on using EBP) for assessing and managing acute pain in postoperative older adults on the basis of the Acute Pain Evidence-Based Practice Questionnaire for Gerontological Nursing (APEBPQ). The project involved 1300 nurses working on surgical hospital wards. A mixed method, a descriptive exploratory survey and a qualitative content analysis, were used. Study was conducted using the Acute Pain Evidence-Based Practice Questionnaire for Gerontological Nursing. Range of responses concerned (and was) the assessment of knowledge, needs, skills and deployment context of Evidence-Based Medicine (EBM) (medium range = 3.04-4.06), use of sources of knowledge about pain and its treatment (mean range = 2.80-4.05), the assessment of current practice in assessing and controlling pain in elderly patients (mean range = 2.64-4.24), the assessment of obstacles for the evidence-based practice (medium range = 2.82-3.54), and the assessment of the extent to which people working with nurses are useful in the practice of evidence-based (medium range = 2.96-3.32). Nurses’ awareness of EBP and use of current practices related to pain assessment and management in elderly patients increases with their level of education. One of the major problems hindering the use of EBP is not enough available professional literature in Polish literature for nurses, unfamiliarity with the English language, lack of time, as well as a lack of support from the Head of the Department.
Fear avoidance model – review of selected reports
Authors: Zdun-Ryżewska Agata , Basiński Krzysztof 
Published: March 2017

SUMMARY: Based on the bio-psycho-social approach, fear-avoidance model can be used in situations when somebody avoids movement because of fear of pain. This model can be applied in groups of patients with low back pain and musculoskeletal pain and explains how acute pain becomes chronic. A simple behavioral model of classical and operant conditioning that explains activity avoidance was developed into a more sophisticated, cognitive-behavioral fear-avoidance model, postulating the existence of a vicious circle that causes increasing disability of patients in chronic pain. The variables involved in this mechanism are catastrophizing, fear of activity, avoiding movement, increased distress and fear-avoidance beliefs. This article also presents some further improvements to the model that include pain intensity and motivational theory. A brief overview of tools used in research on fear-avoidance is also presented. It is recommended to take Fear Avoidance Model in to consideration when working with patients with no improvement and the risk of recurrent episodes of pain. Further studies are needed to empirically verify the fear-avoidance model.
La formation interculturelle et inclusive du personnel enseignant : conceptualisation et opérationnalisation de compétences professionnelles
Authors: Larochelle-Audet Julie , Borri-Anadon Corina , Potvin Maryse 
Published: March 2017

Dans un contexte de mondialisation, les systèmes éducatifs, du primaire à l’université, doivent prendre en compte des réalités de plus en plus complexes qui les interpellent, notamment quant aux compétences que doivent développer les enseignants et les enseignantes. À cet égard, l’importance d’une formation relative à la diversité ethnoculturelle, religieuse et linguistique est régulièrement rappelée, tant sur le plan politique que scientifique. Pourtant, un portrait de cette formation dans les universités québécoises a montré que celle-ci demeure globalement lacunaire (Larochelle-Audet, Borri-Anadon, Mc Andrew et Potvin, 2013). Alors que prévaut depuis 2001 une approche par compétences pour la formation à l’enseignement, un groupe de travail interuniversitaire a entrepris de pallier ce manque en enrichissant le référentiel ministériel de compétences professionnelles du personnel enseignant. Les travaux du groupe, présentés dans l’article, s’appuient sur une analyse critique du référentiel, qui révèle l’absence de considérations concrètes quant à la diversité ethnoculturelle et aux finalités d’une formation interculturelle et inclusive en enseignement. Les membres du groupe ont élaboré deux modalités visant à insérer au référentiel des compétences interculturelles et inclusives : la première propose d’intégrer 21 composantes à même les 12 compétences professionnelles existantes et la seconde privilégie l’ajout d’une nouvelle compétence dite interculturelle et inclusive. Leur opérationnalisation comporte certaines limites et certains risques, qui font ici l’objet d’une discussion.
Leveraging social capital: multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru
Authors: Perez‐Brumer Amaya G. , Reisner Sari L. , McLean Sarah A. , Silva‐Santisteban Alfonso , Huerta Leyla , Mayer Kenneth H. , Sanchez Jorge , Clark Jesse L. , Mimiaga Matthew J. , Lama Javier R. 
Published: March 2017

AbstractIntroduction: In Peru, transgender women (TW) experience unique vulnerabilities for HIV infection due to factors that limit access to, and quality of, HIV prevention, treatment and care services. Yet, despite recent advances in understanding factors associated with HIV vulnerability among TW globally, limited scholarship has examined how Peruvian TW cope with this reality and how existing community‐level resilience strategies are enacted despite pervasive social and economic exclusion facing the community. Addressing this need, our study applies the understanding of social capital as a social determinant of health and examines its relationship to HIV vulnerabilities to TW in Peru.Methods: Using qualitative methodology to provide an in‐depth portrait, we assessed (1) intersections between social marginalization, social capital and HIV vulnerabilities; and (2) community‐level resilience strategies employed by TW to buffer against social marginalization and to link to needed HIV‐related services in Peru. Between January and February 2015, 48 TW participated (mean age = 29, range = 18–44) in this study that included focus group discussions and demographic surveys. Analyses were guided by an immersion crystallization approach and all coding was conducted using Dedoose Version 6.1.18.Results: Themes associated with HIV vulnerability included experiences of multilevel stigma and limited occupational opportunities that placed TW at risk for, and limited their engagement with, existing HIV services. Emergent resiliency‐based strategies included peer‐to‐peer and intergenerational knowledge sharing, supportive clinical services (e.g. group‐based clinic attendance) and emotional support through social cohesion (i.e. feeling part of a community).Conclusion: This study highlights the importance of TW communities as support structures that create and deploy social resiliency‐based strategies aimed at deterring and mitigating the impact of social vulnerabilities to discrimination, marginalization and HIV risk for individual TW in Peru. Public health strategies seeking to provide HIV prevention, treatment and care for this population will benefit from recognizing existing social capital within TW communities and incorporating its strengths within HIV prevention interventions. At the intersection of HIV vulnerabilities and collective agency, dimensions of bridging and bonding social capital emerged as resiliency strategies used by TW to access needed healthcare services in Peru. Fostering TW solidarity and peer support are key components to ensure acceptability and sustainability of HIV prevention and promotion efforts.
Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples
Authors: Ngure Kenneth , Kimemia Grace , Dew Kristin , Njuguna Njambi , Mugo Nelly , Celum Connie , Baeten Jared M , Heffron Renee 
Published: March 2017

AbstractIntroduction: For HIV serodiscordant couples in resource‐limited settings, pregnancy is common despite the risk of sexual and/or perinatal HIV transmission. Some safer conception strategies to reduce HIV transmission during pregnancy attempts are available but often not used for reasons including knowledge, accessibility, preference and others. We sought to understand Kenyan health providers’ and HIV serodiscordant couples’ perspectives and experiences with safer conception.Methods: Between August 2015 and March 2016, we conducted key informant interviews (KIIs) with health providers from public and private HIV care and fertility clinics and in‐depth interviews (IDIs) and focus group discussions (FGDs) with HIV serodiscordant couples participating in an open‐label study of integrated pre‐exposure prophylaxis (PrEP) and antiretroviral therapy (ART) for HIV prevention (the Partners Demonstration Project). An inductive analytic approach identified a number of themes related to experiences with and perceptions of safer conception strategies.Results: We conducted 20 KIIs with health providers, and 21 IDIs and 4 FGDs with HIV serodiscordant couples. HIV clinic providers frequently discussed timed condomless sex and antiretroviral medications while providers at private fertility care centres were more comfortable recommending medically assisted reproduction. Couples experienced with ART and PrEP reported that they were comfortable using these strategies to reduce HIV risk when attempting pregnancy. Timed condomless sex in conjunction with ART and PrEP was a preferred strategy, often owing to them being available for free in public and research clinics, as well as most widely known; however, couples often held inaccurate knowledge of how to identify days with peak fertility in the upcoming menstrual cycle.Conclusions: Antiretroviral‐based HIV prevention is acceptable and accessible to meet the growing demand for safer conception services in Kenya, since medically assisted interventions are currently cost prohibitive. Cross‐disciplinary training for health providers would expand confidence in all prevention options and foster the tailoring of counselling to couples’ preferences.
Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting
Authors: Harrison Andrew M. , Thongprayoon Charat , Aakre Christopher A. , Jeng Jack Y. , Dziadzko Mikhail A. , Gajic Ognjen , Pickering Brian W. , Herasevich Vitaly 
Published: March 2017

Background
Electronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored.

Objective
To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system.

Study Design
In one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview.

Results
The alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148) and 51% (N = 156) from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5) and median 2 min (N = 80) from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers.

Conclusion
Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting.
Submesoscale processes promote seasonal restratification in the Subantarctic Ocean
Authors: du Plessis M. , Swart S. , Ansorge I. J. , Mahadevan A. 
Published: March 2017

AbstractTraditionally, the mechanism driving the seasonal restratification of the Southern Ocean mixed layer (ML) is thought to be the onset of springtime warming. Recent developments in numerical modeling and North Atlantic observations have shown that submesoscale ML eddies (MLE) can drive a restratifying flux to shoal the deep winter ML prior to solar heating at high latitudes. The impact of submesoscale processes on the intraseasonal variability of the Subantarctic ML is still relatively unknown. We compare 5 months of glider data in the Subantarctic Zone to simulations of a 1‐D mixing model to show that the magnitude of restratification of the ML cannot be explained by heat, freshwater, and momentum fluxes alone. During early spring, we estimate that periodic increases in the vertical buoyancy flux by MLEs caused small increases in stratification, despite predominantly down‐front winds that promote the destruction of stratification. The timing of seasonal restratification was consistent between 1‐D model estimates and the observations. However, during up‐front winds, the strength of springtime stratification increased over twofold compared to the 1‐D model, with a rapid shoaling of the MLD from >200 m to <100 m within a few days. The ML stratification is further modified under a negative Ekman buoyancy flux during down‐front winds, resulting in the destruction of ML stratification and deepening of the MLD. These results propose the importance of submesoscale buoyancy fluxes enhancing seasonal restratification and mixing of the Subantarctic ML.
WRF nested large‐eddy simulations of deep convection during SEAC4RS
Authors: Heath Nicholas K. , Fuelberg Henry E. , Tanelli Simone , Turk F. Joseph , Lawson R. Paul , Woods Sarah , Freeman Sean 
Published: March 2017

AbstractLarge‐eddy simulations (LES) and observations are often combined to increase our understanding and improve the simulation of deep convection. This study evaluates a nested LES method that uses the Weather Research and Forecasting (WRF) model and, specifically, tests whether the nested LES approach is useful for studying deep convection during a real‐world case. The method was applied on 2 September 2013, a day of continental convection that occurred during the Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC4RS) campaign. Mesoscale WRF output (1.35 km grid length) was used to drive a nested LES with 450 m grid spacing, which then drove a 150 m domain. Results reveal that the 450 m nested LES reasonably simulates observed reflectivity distributions and aircraft‐observed in‐cloud vertical velocities during the study period. However, when examining convective updrafts, reducing the grid spacing to 150 m worsened results. We find that the simulated updrafts in the 150 m run become too diluted by entrainment, thereby generating updrafts that are weaker than observed. Lastly, the 450 m simulation is combined with observations to study the processes forcing strong midlevel cloud/updraft edge downdrafts that were observed on 2 September. Results suggest that these strong downdrafts are forced by evaporative cooling due to mixing and by perturbation pressure forces acting to restore mass continuity around neighboring updrafts. We conclude that the WRF nested LES approach, with further development and evaluation, could potentially provide an effective method for studying deep convection in real‐world cases.
Beyond debuttressing: Mechanics of paraglacial rock slope damage during repeat glacial cycles
Authors: Grämiger Lorenz M. , Moore Jeffrey R. , Gischig Valentin S. , Ivy‐Ochs Susan , Loew Simon 
Published: March 2017

AbstractCycles of glaciation impose mechanical stresses on underlying bedrock as glaciers advance, erode, and retreat. Fracture initiation and propagation constitute rock mass damage and act as preparatory factors for slope failures; however, the mechanics of paraglacial rock slope damage remain poorly characterized. Using conceptual numerical models closely based on the Aletsch Glacier region of Switzerland, we explore how in situ stress changes associated with fluctuating ice thickness can drive progressive rock mass failure preparing future slope instabilities. Our simulations reveal that glacial cycles as purely mechanical loading and unloading phenomena produce relatively limited new damage. However, ice fluctuations can increase the criticality of fractures in adjacent slopes, which may in turn increase the efficacy of fatigue processes. Bedrock erosion during glaciation promotes significant new damage during first deglaciation. An already weakened rock slope is more susceptible to damage from glacier loading and unloading and may fail completely. We find that damage kinematics are controlled by discontinuity geometry and the relative position of the glacier; ice advance and retreat both generate damage. We correlate model results with mapped landslides around the Great Aletsch Glacier. Our result that most damage occurs during first deglaciation agrees with the relative age of the majority of identified landslides. The kinematics and dimensions of a slope failure produced in our models are also in good agreement with characteristics of instabilities observed in the field. Our results extend simplified assumptions of glacial debuttressing, demonstrating in detail how cycles of ice loading, erosion, and unloading drive paraglacial rock slope damage.
Impact of multiconstellation satellite signal reception on performance of satellite‐based navigation under adverse ionospheric conditions
Authors: Paul Ashik , Paul Krishnendu Sekhar , Das Aditi 
Published: March 2017

AbstractApplication of multiconstellation satellites to address the issue of satellite signal outages during periods of equatorial ionospheric scintillations could prove to be an effective tool for maintaining the performance of satellite‐based communication and navigation without compromise in accuracy and integrity. A receiver capable of tracking GPS, Global Navigation Satellite System (GLONASS), and Galileo satellites is operational at the Institute of Radio Physics and Electronics, University of Calcutta, Calcutta, India, located near the northern crest of the equatorial ionization anomaly in the Indian longitude sector. The present paper shows increased availability of satellites combining GPS, GLONASS, and Galileo constellations from Calcutta compared to GPS‐only scenario and estimates intense scintillation‐free (S4 < 0.6) satellite vehicle look angles at different hours of the postsunset period 19:00–01:00 LT during March 2014. A representative case of 1 March 2014 is highlighted in the paper and overall statistics for March 2014 presented to indicate quantitative advantages in terms of scintillation‐free satellite vehicle look angles that may be utilized for planning communication and navigation channel spatial distribution under adverse ionospheric conditions. The number of satellites tracked and receiver position deviations has been found to show a good correspondence with the occurrence of intense scintillations and poor user receiver‐satellite link geometry. The ground projection of the 350 km subionospheric points corresponding to multiconstellation shows extended spatial coverage during periods of scintillations (0.2 < S4 < 0.6) compared to GPS.
A joint active/passive physical model of sea surface microwave signatures
Authors: Plant William J. , Irisov Vladimir 
Published: March 2017

AbstractActive and passive microwave signatures of the ocean can only depend on the ocean wave spectrum if bound and breaking waves are neglected. However, history has not been kind to attempts to explain both radiometer brightness temperatures (Tb) and normalized radar cross sections (σo) of the sea using the same ocean wave spectrum without bound and breaking waves. In this paper, we show that if bound and breaking waves are included in physical models of radiometer and scatterometer microwave signatures of the ocean, a single wave spectrum can explain both Tb and σo to reasonable accuracy. Bound waves are the roughness produced by gently breaking, or crumpling, waves that travel near the speed of the parent wave. Bound wave modeling is based on earlier work by Plant (1997) but using additional information about the slope probability distributions of the bound waves' parents. Breaking wave and foam modeling both build on the function Λ(cb) introduced by Phillips (1985), which describes the average length of breaking wavefronts on the ocean per unit area as a function of breaker velocity, cb. We model Λ(cb) as documented in Irisov and Plant (2016) where we show that the wave spectrum completely determines Λ(cb). We thus show here that the result of including bound and breaking waves in radiometer and scatterometer models of oceanic signatures is a much closer fit to data over a wide range of microwave frequencies and incidence angles using a single wave spectrum.
Overshoot‐free nonholonomic source seeking in 3‐D
Authors: Lin Jinbiao , Song Shiji , You Keyou , Krstic Miroslav 
Published: March 2017

SummaryThis paper studies the problem of steering a nonholonomic vehicle with a constant forward velocity to localize a source in 3‐D. Of two existing 3‐D source‐seeking strategies, one causes overshoots of the vehicle around the source while the other shows slow convergence rate in approaching the source. We propose a composite of these 2 control strategies to achieve a balanced performance by taking advantage of both strategies. Moreover, we prove local exponential stability for a static spherical signal map using averaging and describe the influence of the parameters using root locus method. Simulation results further validate the effectiveness and advantages of the combined strategy.
Adaptive finite‐time control for high‐order nonlinear systems with mismatched disturbances
Authors: Yang Hongjiu , Wang Yingjie , Yang Yana 
Published: March 2017

SummaryIn this paper, adaptive finite‐time control is addressed for a class of high‐order nonlinear systems with mismatched disturbances. An adaptive finite‐time controller is designed in which variable gains are adjusted to ensure finite‐time stabilization for the closed‐loop system. Chattering is reduced by a designed adaptive sliding mode observer which is also used to deal with the mismatched disturbances in finite time. The proposed adaptive finite‐time control method avoids calculating derivative repeatedly of traditional backstepping methods and reduces computational burden effectively. Three numerical examples are given to illustrate the effectiveness of the proposed method.
Diastereoselective Synthesis of Functionalized Angularly‐Fused Tetracycles via an Organocatalytic Quadruple Reaction Sequence
Authors: Chang Fu‐Jie , Gurubrahamam Ramani , Chen Kwunmin 
Published: March 2017

AbstractAn efficient diastereoselective strategy to access complex structural tetracycles was described through an organocascade quadruple reaction sequence between (E)‐2‐(3‐arylallylidene)‐1H‐indene‐1,3(2H)‐diones and β‐keto esters. The reaction proceeded through remote 1,6‐addition followed by sequential 1,4‐addition and aldol/aldol reactions to generate angularly‐fused carbocyclic motifs with favourable to excellent yields (up to 94%) and diastereoselectivities (up to >20:1 dr). An enantioselective organocascade approach was attempted to yield densely functionalized tetracycles containing seven chiral centres including a quaternary centre.magnified image