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Results for “Competency framework”

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At least 433 records · Page 24Linked to original sources

PubMed2005

Application of model discriminating experimental design for modeling and development of a fermentative fed-batch L-valine production process.

A model discriminating experimental design approach for fed-batch processes has been developed and applied to the fermentative production of L-valine by a genetically modified Corynebacterium glutamicum strain possessing multiple auxotrophies as an example. Being faced with the typical situation of uncertain model information based on preliminary experiments, model discriminating design was successfully applied to improve discrimination between five competing models. Within the same modeling and experimental design framework, also the planning of an optimized production process with respect to the total volumetric productivity is shown. Simulation results were experimentally affirmed, yielding an increased total volumetric productivity of 6.2 mM L-valine per hour. However, also so far unknown metabolic mechanisms were observed in the optimized process, underlining the importance of process optimization during modeling to avoid problems of extreme extrapolation of model predictions during the final process optimization.

Biotechnology↗

PubMed2002

The cost of not treating bednets.

For centuries, bednets have been used as a physical barrier against biting insects. Recent epidemiological investigations into their protective effects against malaria were quickly overtaken by studies focusing on the benefits of impregnating bednets with insecticide. The operational problems encountered in re-treating bednets with insecticide are often cited as an impediment to wide-scale implementation. The evidence for a protective effect of untreated nets against malaria is presented here alongside an analysis of how well untreated nets would need to work in order to compete with treated nets within a cost-effectiveness framework.

Animals↗

PubMed2005

Neurobiology of the stress response: contribution of the sympathetic nervous system to the neuroimmune axis in traumatic injury.

Acute injury produces an immediate activation of neuroendocrine mechanisms aimed at restoring hemodynamic and metabolic counter-regulatory responses. These counter-regulatory responses are mediated by the systemic and tissue-localized release of neuroendocrine-signaling molecules known to affect immune function. This has led to the recognition of the importance of neuroendocrine-immune modulation during acute injury as well as throughout the recovery period. The period immediately after acute injury is characterized by upregulation of proinflammatory cytokine expression leading to a later period of generalized immunosuppression. The course and progression of the host recovery from traumatic injury and the integrity of its response to a secondary challenge is directly related to the effective control of the immediate proinflammatory responses to the initial insult. Among the neuroendocrine mechanisms involved in restoring homeostasis, the sympathetic nervous system plays a central role in mediating acute counter-regulatory stress responses to injury. In addition to its recognized cardiovascular, hemodynamic, and metabolic effects, the neurotransmitters released by the sympathetic nervous system have been shown to affect immune function through specific adrenergic receptor-mediated pathways. In turn, cells of the immune system and their products have been shown to influence peripheral and central neurotransmission, leading to the conceptualization of a bidirectional neuroimmune communication system. The reflex activation of this bidirectional neuroimmune pathway in response to injury, integrated with the parasympathetic nervous system, and opioid and glucocorticoid pathways responsible for orchestrating the counterregulatory stress response, results in dynamic regulation of host defense mechanisms vital for immune competence and tissue repair. This review provides the biological framework for the integration of our understanding of the neuroendocrine mechanisms involved in mediating the stress response and their role in modulating immune function during and after traumatic injury.

Humans↗

PubMed2002

"Devil's staircases" in bulk-immiscible ultrathin alloy films.

Ground-state phase diagrams of ultrathin epitaxial alloy films are studied within the framework of a discrete lattice-model Hamiltonian incorporating competing elastic and chemical interactions. For bulk-immiscible alloy systems an infinite number of commensurate, long-period stripe-superstructure ground states are obtained as a function of chemical potential. The average periodicity of these stripe superstructures is found to be a nonmonotonic function of alloy composition, in contrast to the predictions of continuum theories for two-dimensional systems with competing interactions.

Journal Article↗

PubMed2006

Whiteness and difference in nursing.

This paper uses a semiotic, performative theory of language and post-colonial theory to argue that nursing's representations of 'multiculturalism' need to be grounded in a theory of whiteness, an historicized understanding of how ethnic/cultural differences come to be represented in the ways they are and informed by Foucault's notions of power/knowledge. Using nursing education and 'cultural compentency' as examples, the paper draws on a range of literatures to suggest more critical and politically productive ways of approaching difference from within nursing's largely white interpretive framework.

Authoritarianism↗

PubMed2004

Demystifying disability: a review of the International Classification of Functioning, Disability and Health.

The paper describes and evaluates the theoretical underpinnings of the International Classification of Functioning, Disability and Health (ICF), and develops the proposition that its conceptual framework provides a coherent, if uneven, guide through the competing conceptions of disability. To date, however, there has been little evaluation of the theoretical efficacy of the ICF. In seeking to redress this, the paper develops the argument that the ICF fails to specify, in any detail, the content of some of its main claims about the nature of impairment and disability. This has the potential to limit its capacity to educate and influence users about the relational nature of disability. The paper develops the contention that three parts of the ICF require further conceptual clarification and development: (a) (re)defining the nature of impairment; (b) specifying the content of biopsychosocial theory; and (c) clarifying the meaning and implications of universalisation as a principle for guiding the development of disability policies.

Persons with Disabilities↗

PubMedDate not supplied

The need for specialist nurses to work with older people.

This article is based on a comprehensive literature review undertaken by the Royal College of Nursing gerontological nursing programme on the development of specialist gerontological nursing practice (Schofield et al, 1998). The scope of the original review covered the development of specialist nursing, frameworks for practice, accreditation and regulation, role components and competencies, methods of evaluating the specialist role and fields of practice. The literature review's purpose was to inform work on the development of a specialist gerontological nursing BSc (Hons) degree by distance learning. This article focuses on the key findings of the literature review, setting out the potential for the introduction of specialist gerontological nurses in the UK.

Aged↗

PubMed2006

Analysis of neighborhood dynamics of forest ecosystems using likelihood methods and modeling.

Advances in computing power in the past 20 years have led to a proliferation of spatially explicit, individual-based models of population and ecosystem dynamics. In forest ecosystems, the individual-based models encapsulate an emerging theory of "neighborhood" dynamics, in which fine-scale spatial interactions regulate the demography of component tree species. The spatial distribution of component species, in turn, regulates spatial variation in a whole host of community and ecosystem properties, with subsequent feedbacks on component species. The development of these models has been facilitated by development of new methods of analysis of field data, in which critical demographic rates and ecosystem processes are analyzed in terms of the spatial distributions of neighboring trees and physical environmental factors. The analyses are based on likelihood methods and information theory, and they allow a tight linkage between the models and explicit parameterization of the models from field data. Maximum likelihood methods have a long history of use for point and interval estimation in statistics. In contrast, likelihood principles have only more gradually emerged in ecology as the foundation for an alternative to traditional hypothesis testing. The alternative framework stresses the process of identifying and selecting among competing models, or in the simplest case, among competing point estimates of a parameter of a model. There are four general steps involved in a likelihood analysis: (1) model specification, (2) parameter estimation using maximum likelihood methods, (3) model comparison, and (4) model evaluation. Our goal in this paper is to review recent developments in the use of likelihood methods and modeling for the analysis of neighborhood processes in forest ecosystems. We will focus on a single class of processes, seed dispersal and seedling dispersion, because recent papers provide compelling evidence of the potential power of the approach, and illustrate some of the statistical challenges in applying the methods.

Computer Simulation↗

PubMedDate not supplied

Comparison of two methods for teaching advanced arrhythmias to nurses.

An experimental study to compare the effectiveness of assisted self-directed learning (ASD) and traditional lecture methods (TLM) in acquiring competency for electrocardiogram interpretation was conducted within a conceptual framework of developmental and adult learning theory (Erickson, Tomlin & Swain, 1983; Knowles, 1980). After two teaching units were designed and an EKG posttest was constructed (r = .75) from actual patient records, registered nurse volunteers (N = 19) were randomly assigned to groups for simultaneous instruction. Because of the small sample size, statistical procedures were used to determine the effectiveness of randomization and to justify statistical procedures. EKG post-test scores for the experimental group (ASD, M = 81) and the control group (TLM, M = 71) were significantly different (one-tailed t = 1.79; p = .045); however, participants' prior knowledge of basic arrhythmias was not independent of method (ANCOVA, F[1, 16] = 21.373, p = .0003, covariate; F[1.16] = 2.312, p = .1479, main effects). EKG post-test scores were not related to critical care experience, cardiac monitoring experience, education level, or course satisfaction. While both methods are effective, ASD had higher mean scores and is more cost- and time-efficient.

Arrhythmias, Cardiac↗

PubMed1988

The chronically mentally ill: a practice approach.

A conceptual framework for social work practice with chronically mentally ill clients is presented. This framework utilizes the ecological perspective, life model, and competence-oriented perspective for comprehensive assessment of problem situations with this client group.

Chronic Disease↗

PubMed1989

Health-care decision making. Part I: Legal and ethical principles.

The growing elderly population and the acquired immunodeficiency syndrome (AIDS) epidemic have focused attention on ethical and legal issues surrounding health-care decision making. It is becoming increasingly critical to involve patients in the decisions that affect their care. Legal frameworks are evolving to protect the rights of both "competent" and "incompetent" patients. By writing instructions in advance, patients can increase their control and autonomy over health-care decisions. Physician assistants can facilitate the process by incorporating a patient value history into the chart and explaining legally recognized documents. Living wills generally apply in the context of terminal illness or irreversible coma; however, definitions of terminal conditions, imminent death, or life-sustaining procedures can be problematic. A number of states recognize the health-care durable power of attorney, which establishes a surrogate decision maker to act with specific instructions and limitations should the patient become incompetent or incapacitated.

Decision Making↗

PubMed2005

A concept analysis of partnership with clients.

The aim of this first paper of two about partnership working with clients is to define and clarify partnership as it is practised within health visiting, by identifying the central notions of partnership working in practice. The aim of the second paper will be to describe an evaluation of a training course in partnership working for health visitors. Partnership is a word in common usage within the health professions but its meaning is ill-defined. A literature search was undertaken to identify ways in which previous authors have used the concept within nursing, counselling and health visiting. Rodgers' approach to concept analysis was undertaken to seek clarity for the concept. This revealed the ways in which various authors have used the word, an analysis of its defining attributes, surrogate terms, antecedents, consequences and a concluding definition. The results showed that partnership with clients in health visiting can be defined as a respectful, negotiated way of working together that enables choice, participation and equity, within an honest, trusting relationship that is based in empathy, support and reciprocity. It is best established within a model of health visiting that recognises partnership as a central tenet. It requires a high level of interpersonal qualities and communication skills in staff who are, themselves, supported through a system of clinical supervision that operates within the same partnership framework.

Clinical Competence↗

PubMed1987

Nursing home reimbursement: implications for cost containment, access, and quality.

The individual states have many options in designing Medicaid reimbursement systems for nursing homes. Each option has a differential effect on incentives--and outcomes--for containing costs, providing quality care, and maintaining access to care. The mix and consequences of specific choices are analyzed in a framework that disaggregates costs into three components. Tradeoffs among competing elements will be inevitable, but reimbursement policy can maximize both efficiency and equity.

Cost Control↗

PubMedDate not supplied

Australian perioperative nursing at Royal Adelaide Hospital.

1. The acronym PRODUCTS has been established to integrate into practice beliefs about perioperative nursing at Royal Adelaide Hospital in Australia. 2. The nursing practice model used focuses on the essential components, interdependence, and crossover components of clinical practice, management, and education aspects of nursing. 3. An emphasis has been placed on valuing the expertise within the clinical team, and providing all nurses with a framework to further develop their nursing care and clinical competence.

Australia↗

PubMed2002

Factors in contraceptive method choice in Bangladesh: goals, competence, evaluation and access.

In this study, we have extended Bulatao's conceptual framework for selecting the determinants of method choice. Attempts have been made to capture Bulatao's dimensions directly rather than through proxies. The results of logistic regression analysis using the 1996-97 BDHS indicate that as the number of living children increases, women prefer non-terminal efficient methods such as the pill and injectable/IUD/implant and depend less on inefficient methods such as condom and permanent methods such as sterilization. With an increase in marital duration and age, women increasingly prefer sterilization as compared with other modern methods. The results may indicate a strong preference for male children among those in the sample, as women increasingly use permanent methods to prevent pregnancy as the number of living male children increases. Condom use increases with education of both women and their husbands, compared with other modern methods, indicating that more educated couples possibly have the greater understanding necessary to use the method. The better educated are significantly less likely to use sterilization. The two indicators of contraceptive evaluation, side effect and convenience of current modern method, are very important considerations in selecting the pill, injectable/IUD/implant, and condom over other modern methods. On the basis of convenience, women are most likely to use the pill over other modern methods, while they are least likely to use sterilization. Condom is the most preferred method on the basis of side effect. On the other hand, sterilization is the least preferred of other modern methods for the same reason. Sterilization is significantly less common among the Muslims, which is likely due to religious reasons, while condom use is significantly less common among non-Muslims. The two indicators of contraceptive access, accessibility/availability of current modern method and cost of current modern method, are very important considerations in pill use, while sterilization is less preferred over other modern methods on the basis of both accessibility/availability and cost. The programmatic factor visit of family planning workers/FWAs significantly increases the likelihood of using the pill compared to other modern methods.

Adolescent↗

PubMedDate not supplied

Perspectives of cultural competence in health care.

AIM: The aim of this study was to explore the views of one group of healthcare professionals on the importance of cultural awareness in healthcare practice. METHOD: A qualitative approach was used. Ten nurses of varying age from two counties in Scotland who worked across a range of clinical practice areas were interviewed. The interviews were largely unstructured but included an opening question and prompts for the interviewer FINDINGS: A lack of knowledge and understanding was demonstrated by the participants in relation to the diverse cultural groups who constitute the population of this country, and a gap in nurse education and training provision across a range of healthcare areas. CONCLUSION: Nursing curricula need to include more knowledge and learning about cultural awareness, and nurses need more practical experience of caring for patients from different cultures. The findings assisted in the development of a framework for nurse education that embraces the concept of cultural competency.

Adult↗

PubMed1976

A method for defining competency in Pediatrics.

In 1972 the American Board of Pediatrics (ABP) initiated studies leading to a report which identifies the important components of competency needed in the practice of pediatrics. The development of the report involved a group process engaging ABP board members and examiners. The outcome has been (a) the delineation of a process for establishing definitions of competency in a medical discipline; (b) the development of a framework for specifying the abilities needed to perform the tasks required of pediatricians; (c) an elaboration of samples of pediatric subjects to which these abilities and tasks are relevant; and (d) the development of a basis for choice of methods to use for purposes of certification.

Certification↗

PubMed1993

From competent novice to competent expert: a discussion of competence in the light of the post registration and practice project (PREPP).

The nursing profession in the UK, is today faced with major changes in the light of the Post Registration and Practice Project (PREPP) (UKCC 1990). This paper raises questions about how the maintenance of professional competence as detailed in PREPP can be assured. Through a discussion of professional porfolios and continuing education, the subjectivity of guaranteeing a practitioner's competence at tri-annual re-registration is raised. With reference to Benner's (1984) work, the paper suggests that there may be some similarities on the 'novice to expert' continuum that relate directly to the UKCC's proposals. However, the inherent deficiencies with such a mandatory approach to professional development are discussed and questions posed about the extent of nurses' continuing education needs being met. In view of the controversy that still surrounds who will finance the changes, and what format the portfolios will adopt, practitioners are at risk of conforming to the changes but being denied the opportunity of ensuring that they possess the necessary skills and framework, that are essential in ensuring the maintenance of clinical competence. The paper suggests that a concerted effort will be required by both educators and service personnel to ensure that the PREPP proposals are successful.

Certification↗