Royal Canadian Navy

The Department of Health, England, issued new guidance on continence services earlier this year. Sue Thomas examines the guidelines with a view to the future of continence care.

OBJECTIVE: To assess the subjective health status, quality of life, and functional ability of patients whose intensive care stay was prolonged and to compare their quality of life with that of the general population. DESIGN: Inception cohort study. SETTING: Twenty-three-bed multidisciplinary intensive care unit (ICU) in a tertiary care center. PATIENTS: A consecutive sample of 718 patients aged > or = 18 yrs who required intensive care > or = 4 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The Nottingham Health Profile was used to compare the ICU patients with a random sample (n = 2,595) of the general population. The quality of life and functional ability of 368 respondents (78.3% of 470 survivors) were assessed at 6 months after ICU admission. The length of the ICU stay was 13.6+/-11.8 (median, 9; maximum, 81) days. The quality of life and its various dimensions were influenced by the diagnosis for ICU admission and age. Although problems in physical mobility and energy were prevalent among all patient groups, only a small proportion was dependent on others for the management of daily activities. Patients with trauma or respiratory failure experienced the most limitations. The quality of life of elderly patients and patients who had undergone cardiac surgery was comparable with the general population regarding emotional reactions, social isolation, and pain. CONCLUSIONS: The quality of life of survivors after a prolonged intensive care stay is fairly good, although not comparable with that of the general population. The psychosocial aspects of the quality of life are restored more rapidly than physical performance.

The agenda for change initiative to modernise pay and grading in the NHS rolls out nationally from this month. Gary Kirwan discusses what it means for emergency nurses

Experiencing pleasure and displeasure is a fundamental part of life. Hedonics guide behavior, affect decision-making, induce learning, and much more. As the positive and negative valence of feelings, hedonics are core processes that accompany emotion, motivation, and bodily states. Here, the affective neuroscience of pleasure and displeasure that has largely focused on the investigation of reward and pain processing, is reviewed. We describe the neurobiological systems of hedonics and factors that modulate hedonic experiences (e.g., cognition, learning, sensory input). Further, we review maladaptive and adaptive pleasure and displeasure functions in mental disorders and well-being, as well as the experience of aesthetics. As a centerpiece of the Human Affectome Project, language used to express pleasure and displeasure was also analyzed, and showed that most of these analyzed words overlap with expressions of emotions, actions, and bodily states. Our review shows that hedonics are typically investigated as processes that accompany other functions, but the mechanisms of hedonics (as core processes) have not been fully elucidated.

Susan Sutton discusses the RCN’s position on trade union recognition in relation to the independent sector following the launch of Fairness at Work

AIM: The RCN Clinical Leadership Development Programme was set up in 1995 and sought to identify how clinical nurses in recognised leadership positions could improve the quality of patient care. METHOD: The programme was tested on four senior nurses and 24 ward sisters in four acute hospital trusts in England over an 18-month period. The primary research question was whether the intervention improved the clinical leadership skills of participants. A pre-test/post-test design incorporating action research was deployed. RESULTS: On a number of leadership dimensions, ward sisters' and senior nurses' performance had significantly improved. Five key themes emerged from the process data documenting the journey towards more effective clinical leadership: managing self; managing the team; patient-centred care; networking; and becoming more politically aware. There was evidence to show that patient care had also improved as measured by the way nursing care was organised; by patients' accounts of care they received and by documented improvements nurses carried out as a result of direct observation of care. CONCLUSION: From the results of the study, it appears that there is a need for more effective clinical leadership development programmes for nurses to achieve better patient-centred care.

FIRST, a confession: I’ve never read Senge’s book from cover to cover.

Moral Injury (MI) describes the profound distress experienced by military personnel as a result of a violation of personal beliefs. Impacting not only psychological, but spiritual, health, and well-being, MI is associated with spiritual/religious (S/R) suffering and a need to find hope, trust, connection, reconciliation, and wholeness. Addressing spiritual wounds can help military personnel overcome fundamental barriers that may impede them from effectively engaging in or benefitting from traditional trauma therapies and having a more complete recovery. Military Chaplains in the Canadian Armed Forces (CAF) are both embedded with the troops in garrison and theater and work closely with service providers such as the Royal Canadian Medical Services. In their role, they offer front-line support and services to members and their families and facilitate access to care. Specific to the assessment and treatment of MI, Mental Health Chaplains (MHCs) offer S/R expertise and a complimentary clinical skill set to service members and interdisciplinary teams. This perspectives article explores the S/R dimension of MI, discusses the role of MHCs in CAF Mental Health (MH) Clinics, and provides clinical perspectives of a MHC regarding the treatment of MI. Key focuses of MHC interventions include bridging to other mental health services and supports, facilitating S/R coping and grounding, reconciling worldviews, resolving anger at a God-figure (not specific to any S/R perspective) and fostering reconciliation. Based on the literature, Mental Health practitioner's feedback, and clinical experience, MHCs are integral to service provision regarding MI and warrant more widespread inclusion on interdisciplinary teams in CAF MH Clinics.

Kim Manley and Brendan McCormack argue that person-centredness should inform attempts to measure the quality of care

The Audit Commission report on community health nursing services must be taken on board if community provider units are to flourish.

Jane Ball and colleagues report the findings of the recent RCN survey of trolley waits in A&E

In recent years, military radar operators have been concerned that the transmitted radar signals will beacon the presence of the radar to an enemy. If intercepted, the radar signals alert a target to an attack which could prompt evasive measures or countermeasures to be taken by the target including the possibility of a reprisal attack using an antiradiation missile. Furthermore, intercepted signals can divulge operating parameters of the radar to the enemy. In response to this low probability of intercept (LPI) requirement, waveforms have been designed to minimize the probability of intercept by an enemy receiver. These are largely based on the use of low peak powers and spread spectrum waveforms offering large processing gains. The interception of signals is a function of both the transmitted radar waveform and the intercept receiver. The aim of this work is to deduce a metric which may be used to quantify and hence compare how "discrete" many of the commonly used LPI radar waveforms actually are. This study considers the following LPI waveforms: Linear Frequency Modulation (LFM), Sinusoidal Frequency Modulation (Sin FM), PolyPhase Shift Keying (PPSK) techniques including Frank, P1, P2, P3, and P4 codes Costas code Frequency Shift Keying (FSK), and Costas-Barker Hybrid (FSK/PSK). This work represents the first attempt to be published in the open literature to quantify the LPI properties of transmitted radar waveforms. Secure waveform coding strategies to minimize the risk of divulging radar capabilities is known as low probability of exploitation (LPE) and is not considered here.

In this first part of a special issue, the true costs of constipation to the NHS are revealed by a survey carried out by the RCN’s Continence Care Forum. Brenda Poulton and Sue Thomas detail the amount of district nursing time spent on dealing with constipation and show how it could cost the NHS as much as £810,000 each year in nursing time alone

PROBLEM: The assessment of hospital-related stressors experienced by child and adolescent patients on a psychiatric inpatient unit. SUBJECTS: Child and adolescent inpatients (N = 40) admitted to an acute, short-term psychiatric unit. METHODS: A newly developed stressor survey was administered to subjects to identify the most problematic stressors. Correlation analyses were used to assess associations between hospital-related stress and adjustment variables. FINDINGS: Broad domains and specific items of the most problematic hospital-related stressors were revealed. Also, higher levels of hospital-related stress were consistently associated with poorer hospital-based adjustment. CONCLUSIONS: Implications for treatment include identifying hospital-related stressors for individual patients and providing interventions to enhance coping.

THIS BOOK is intended, more than anything else, to raise questions and stimulate thought. It is not a quick, easy read, and provides no neat frameworks or slogans on how to be a great leader. As author Simon Western comments in the last chapter: 'There is no final word on leadership, no "golden bullet".'

Phosphorylation by the cyclin-dependent kinase 1 (Cdk1) adjacent to nuclear localization signals (NLSs) is an important mechanism of regulation of nucleocytoplasmic transport. However, no systematic survey has yet been performed in human cells to analyze this regulatory process, and the corresponding cell-cycle dynamics have not yet been investigated. Here, we focused on the human proteome and found that numerous proteins, previously not identified in this context, are associated with Cdk1-dependent phosphorylation sites adjacent to their NLSs. Interestingly, these proteins are involved in key regulatory events of DNA repair, epigenetics, or RNA editing and splicing. This finding indicates that cell-cycle dependent events of genome editing and gene expression profiling may be controlled by nucleocytoplasmic trafficking. For in-depth investigations, we selected a number of these proteins and analyzed how point mutations, expected to modify the phosphorylation ability of the NLS segments, perturb nucleocytoplasmic localization. In each case, we found that mutations mimicking hyper-phosphorylation abolish nuclear import processes. To understand the mechanism underlying these phenomena, we performed a video microscopy-based kinetic analysis to obtain information on cell-cycle dynamics on a model protein, dUTPase. We show that the NLS-adjacent phosphorylation by Cdk1 of human dUTPase, an enzyme essential for genomic integrity, results in dynamic cell cycle-dependent distribution of the protein. Non-phosphorylatable mutants have drastically altered protein re-import characteristics into the nucleus during the G1 phase. Our results suggest a dynamic Cdk1-driven mechanism of regulation of the nuclear proteome composition during the cell cycle.

Heat transfer enhancement is an important subject in heat exchangers research. An understanding of different shapes and designs of tubes and pipes means of improving heat extraction will have a direct effect on a new design for a heat exchanger. The present paper involved various investigations of thermal efficiency in flat tubes and regular pipes. The results revealed that a flat tube with an aspect ratio of 0.15 (Width/Height) exhibited enhanced heat extraction when compared to a circular pipe for the same cross section. The insertion of a porous material in the flat tube further improved the heat extraction, as seen by examining the thermal efficiency, known to be the ratio of the local Nusselt number to the fanning friction coefficient. Furthermore, the presence of a nanofluid in the flat tube flow led to an improvement in heat extraction depending on the concentration of the nanoparticle. A 5% enhancement was noticeable for a Reynolds number of 1000 with 1%vol Al2O3/water nanofluid for a flat tube. The enhancement increased to 12% in the presence of 2%vol Al2O3/water nanofluid. This enhancement was independent of the Reynolds number.

This article explores the tension between the population genetics and sociobiological approaches to the study of evolution. Whereas population geneticists, like Stanford's Marc Feldman, insist that the genetic complexities of organisms cannot be overlooked, sociobiologists (many of whom now prefer to call themselves "behavioral ecologists") rely on optimization models that are based on the simplest possible genetics.These optimization approaches have their roots in the classical result known as the fundamental theorem of natural selection, formulated by R. A. Fisher in 1930. From the start there was great uncertainty over the proper interpretation of Fisher's theorem, which became confused with Sewall Wright's immensely influential adaptive landscape concept. In the 1960s, a new generation of mathematical biologists proved that Fisher's theorem did not hold when fitness depended on more than one locus. Similar reasoning was used to attack W. D. Hamilton's inclusive fitness theory. A new theory, known as the theory of long-term evolution, attempts to reconcile the rigorous population genetics approach with the long-standing sociobiological view that natural selection acts to increase the fitness of organisms.

Propeller cavitation is a significant contributor to vessel underwater radiated noise (URN). It is often assumed to be the major contributor for large vessels at higher speeds, but very little work is available in the literature on the role of cavitation on small boat propellers. In this work, data from two trials are presented to show how cavitation develops on small boats and how this contributes to the overall sound levels. Camera footage is combined with hydrophone measurements to determine the cavitation inception speed and this shows that tip vortex cavitation can appear at 5 knots. The emergence of cavitation is accompanied by a sharp rise in the URN levels. Cavitation due to gas bubbles being pulled close to the propeller blades is observed at speeds as low as 4 knots, leading to either bubble collapse close to the blades or the tip vortex cavitating downstream of the propeller. Wavelet analysis is used to investigate the makeup of the high frequency noise, providing insights into the types of cavitation that are present and how they scale with speed. This shows that high frequency noise from cloud cavitation increases far more substantially with speed than for tip vortex cavitation. • Camera footage shows the cavitation pattern on an outboard propeller. • The cavitation inception speed on all three boats is no more than 6 knots. • Tip vortex cavitation predominates on both outboard-powered vessels. • High frequency noise scales weakly with speed when tip vortex cavitation predominates. • High frequency noise scales strongly with speed when cloud cavitation predominates.

The Psychodiagnostic Chart (PDC) operationalizes the Psychodynamic Diagnostic Manual (PDM) Adult section. The authors collected 104 PDC cases from 15 psychologists who are experts with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). They found very good construct validity when the PDC was compared to MMPI-2, the Karolinska Psychodynamic Profile (KAPP), and the Operationalized Psychodynamic Diagnosis (OPD) Psychic Structure/Mental Functioning Scales. They found very good reliability for the 73 cases with a 2-week test-retest of the PDC. Additionally, 61 psychologists were recruited from listservs and asked to use the PDC on a recent client; 84% rated Level of Personality Organization as "helpful-very helpful" in understanding their patients. There was also similar support for the Personality Patterns or Disorders and Mental Functioning dimensions. In comparison, only 31% rated the ICD or DSM symptoms as "helpful-very helpful" in understanding their patients. The PDC may be used for diagnoses, treatment formulations, progress reports, and outcome assessment, as well as for empirical research on the PDM.