Iterative Assessment Process Research Articles

Becoming a matter of veterinary concern.

Horses in Great Britain are living into increasingly older age and are often regarded as friends or family members by their owner. The horse is reliant on their owner to meet their needs and this paper discusses how horse owners frame an issue that becomes a matter of veterinary concern within the context of the older horse. Qualitative methods were used to explore the experiences of owners and veterinarians. Data were collected and analysed using a grounded theory approach during the period 2019-2022. Analysis identified that owners undertook an ongoing and iterative process of assessment, monitoring and decision making in relation to the animal and any changes they observed. Matters that became a veterinary concern required the owner to formulate the issue as something that fell within the knowledge domain of the veterinarian. Veterinarians had a medicalised view of older horse health and their perspectives on socially acceptable care were shaped by their understanding of species-specific needs, and whether owners were providing appropriately for those needs. The formulation of a matter of veterinary concern was itself shaped by an owner's experiential knowledge of both veterinary matters and their horse. The extent to which owners felt like they and their individual horse mattered during interactions with veterinarians affected whether they adopted veterinary advice and the nature of future veterinary employment. Findings demonstrate how matters of health, disease, and the role of professionalised forms of medical knowledge, are not static but constantly changing and interacting over time. An issue that became a matter of veterinary concern was contextual, and rooted in individual relationships. The significance of veterinarian-owner interactions in shaping future consumption of veterinary health care may be underestimated.

Assessing for Occult Suicidality at Triage: Experiences of Emergency Nurses

IntroductionScreening for suicidality is a critical nursing function at the initial ED encounter. Suicide is the tenth leading cause of death in the United States, and a substantial percentage of people who die by suicide present for health care in the year before their deaths. The emergency department provides health care professionals with a critical opportunity to identify patients at risk for suicide and intervene appropriately. MethodsQualitative exploratory study using focus-group data. FindingsEffective and accurate suicidality assessment occurs not by asking a single question but also with the assessment of patient behaviors and presentation (appearance, hygiene, etc). When emergency nurses suspected occult suicidality, additional actions (finding private space, keeping patients safe, and passing on information), took priority. DiscussionThe Joint Commission recommends using clinical judgment tools for the final determination of safety for a patient at suspected risk of suicide, as research findings suggest that a screening tool can identify persons at risk for suicide more reliably than a clinician’s personal judgment. Our participants report that when they assessed suicide risk at triage, it was usually by asking a single question such as “Do you have thoughts or plans to harm yourself?” and they expressed concern about the effectiveness of doing so. Participants described their efforts to improve suicide screening across the duration of the patient’s ED stay through an iterative process of assessment that included further probing and eliciting, evaluating, and reacting to the patient’s response.Unlabelled Box

Radionuclides Transport Phenomena in Vadose Zone

Radioactive waste management is fundamental to safeguard population and environment by radiological risks. Environmental assessment of a site, where nuclear activities are located, allows to understand the hydro geological system and the radionuclides transport in groundwater and subsoil. The use of dedicated software allows the investigation of transport phenomena and to predict accidental scenarios dynamic; this allows to understand the evolution of the accidental contamination, but at the mean time the potentiality of the software itself can be verified. The aim of this paper is to perform a numerical analysis by means of HYDRUS 1D code, so as to evaluate radionuclides transport dynamics in a nuclear site in Piedmont region (Italy). In particular, the behaviour in vadose zone has been investigated. An iterative assessment process has been performed for risk assessment of radioactive contamination. The analysis therein developed considers the following aspects: i) hydro geological site characterization; ii) individuation of the main factors influencing water flow and radionuclides transport phenomena; iii) software potential for radionuclides leakage simulation purposes

Enhancing end-of-life care with dignity: characterizing hospice nursing in Romania

The purpose of this research was to characterize the nursing actions practiced by Romanian nurses affiliated with Hospices of Hope that promote dignified dying and explore needs to promote a more dignified death. A survey method used the International Classification for Nursing Practice dignified dying survey. A convenience sample of 43 hospice nurses responded. Descriptive statistics, t-tests and content analysis were used to analyze the data. Characteristics that promoted dignified dying included the use of a formal, iterative process of assessment, interventions that supported pain and symptom management, and spiritual comfort at the end of life. Participants described family-centered hospice care that integrated Christian orthodox tradition that transformed patients as death approached. Dignity for terminally ill Romanian will be enhanced as the nurses implement these interventions. Awareness of cultural and spiritual differences concerning end of life will facilitate dialogue among nurse scientists.

The place of social impacts in the iterative assessment process: a case study of a highway project in the US State of Georgia

Social impact assessments (SIAs) were conducted in accordance with the National Environmental Policy Act (NEPA) process along the US 441 corridor in Clinch and Atkinson Counties, Georgia. The SIA approach consisted of both quantitative and participatory (public involvement) components. Successes in using this approach included: aligning the roadway with access and optimal benefits for the adjacent communities; support for the project despite the change it will bring to the region; improved relationships with the community, which previously had little trust in government; and, most important of all, education of the design engineers about community impacts.

Application of Biochemical Systems Theory to Metabolism in Human Red Blood Cells: SIGNAL PROPAGATION AND ACCURACY OF REPRESENTATION

Human erythrocytes are among the simplest of cells. Many of their enzymes have been characterized kinetically using steady-state methods in vitro, and several investigators have assembled this kinetic information into mathematical models of the integrated system. However, despite its relative simplicity, the integrated behavior of erythrocyte metabolism is still complex and not well understood. Errors will inevitably be encountered in any such model because of this complexity; thus, the construction of an integrative model must be considered an iterative process of assessment and refinement. In a previous study, we selected a recent model of erythrocyte metabolism as our starting point and took it through three stages of model assessment and refinement using systematic strategies provided by biochemical systems theory. At each stage deficiencies were diagnosed, putative remedies were identified, and modifications consistent with existing experimental evidence were incorporated into the working model. In this paper we address two issues: the propagation of biochemical signals within the metabolic network, and the accuracy of kinetic representation. The analysis of signal propagation reveals the importance of glutathione peroxidase, transaldolase, and the concentration of total glutathione in determining systemic behavior. It also reveals a highly amplified diversion of flux between the pathways of pentose phosphate and nucleotide metabolism. In determining the range of accurate representation based on alternative kinetic formalisms we discovered large discrepancies. These were identified with the behavior of the model represented within the Michaelis-Menten formalism. This model fails to exhibit a nominal steady state when the activity of glutathione peroxidase is decreased by as little as 9%. Our current understanding, as embodied in this working model, is in need of further refinement, and the results presented in this paper suggest areas of the model where such effort might profitably be concentrated.

Anticipated Effects of Climate Change on Freshwater Fishes and Their Habitat

Abstract We sketch an iterative assessment process for the effects of climate change on freshwater fisheries that uses water temperature, water quantity, and water quality variables to link the atmosphere to fishery resources. Iterative interaction among atmospheric, ecological, and fisheries scientists clarifies the information needs of each discipline and progressively improves the assessments of effects. The process incorporates information at different scales, i.e., organism/laboratory, species/habitat, and population/ecosystem. We illustrate the operation of the iterative assessment process with recent work done on the water temperature linkage, and sketch some linkages through water quantity and water quality variables. A Wild Salmonid Watch (WSW) could provide a framework for monitoring climate change and its effects on salmonid stocks on a hemispheric scale. We discuss the initial steps required to mobilize a WSW for climate change and its role as climate change develops in the decades ahead.