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A venous leg ulcer is a chronic leg wound caused by poor venous blood circulation in the lower limbs. It is a recurring condition causing pain, malodour, reduced mobility, and depression. Randomised controlled trials evaluating treatments for venous leg ulcers provide important evidence to inform clinical decision-making. However, for findings to be useful, outcomes need to be clinically meaningful, consistently reported across trials, and fully reported. Research has identified the large number of outcomes reported in venous leg ulcer trials, impacting both synthesis of results, and clinical decision-making. To address this, a core outcome set will be developed. A core outcome set is an agreed standardised set of outcomes which should be, as a minimum, measured and reported in all trials which evaluate treatment effectiveness for a given indication. A core outcome set has the potential to reduce research waste, improve the utility of RCTs, reduce reporting bias, facilitate treatment comparisons across different sources of evidence and expedite the production of systematic reviews, meta-analyses and evidence-based clinical guidelines. The aim of this project is to develop a core outcome set for research evaluating the effectiveness of interventions for treating venous leg ulceration. Through a scoping review of the literature on venous leg ulceration, we will firstly identify a list of candidate outcome domains (broad categories in relation to what is being measured) from randomised controlled trials and qualitative research, and outcomes (specific methods in relation to what is being measured). In two further stages, we will use the resulting lists of outcome domains and outcomes to design two online surveys. A range of stakeholders will be invited to participate in the surveys and they will be asked to indicate which outcome domains and outcomes are most important and should be considered as core in future research reports. • A core outcome set is an agreed standardised set of outcomes which should be, as a minimum, measured and reported in all trials which evaluate treatment effectiveness for a given indication. • A core outcome set has the potential to reduce research waste and reporting bias, and improve the utility of RCTs. • It can facilitate treatment comparisons across different sources of evidence. • It also has the potential to expedite the production of systematic reviews, meta-analyses and evidence-based guidelines. • This paper presents a protocol for the development of a core outcome set for venous leg ulceration research evaluations. [ABSTRACT FROM AUTHOR]

This article focuses on the ways that threatened heritage sites are caught up in complex deliberations of UNESCO's World Heritage Committee around inscription to the List of World Heritage in Danger. Through quantitative and qualitative analyses of Committee decision-making from 1979–2018, we observe geopolitical inequity and bureaucratic inefficacy characterizing the implementation of the List in Danger that prevent the realization of its envisioned purpose as a collaborative tool for garnering international investment in preservation. We argue that this situation stems from the development of diplomatic practices used by powerful States Parties to ensure their sites are only ever "considered" rather than "inscribed" on the List in Danger. The proliferation of "consideration" for the List in Danger effectively erases situations of danger rather than resolving threats in any real sense, subjecting endangered sites on the World Heritage List to further peril. [ABSTRACT FROM AUTHOR]

Patients', family members' and healthcare practitioners' experiences of Stevens-Johnson syndrome and toxic epidermal necrolysis: a qualitative descriptive study using emotional touchpoints Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are devastating conditions resulting from a severe immune-mediated mucocutaneous reaction which normally occurs as a result of medication.1 In the acute phase, the patient presents with a febrile illness, followed by skin and mucous membrane necrosis and detachment.2 The patient can quickly become critically ill and is treated as a medical emergency. There may be long-lasting psychological effects on patients and their significant others.3 However, there is a dearth of research on the experiences of patients with SJS/TEN, those close to them and healthcare practitioners (HCPs) providing care. [Extracted from the article]

Summary Background The Objective Structured Clinical Examination (OSCE) is an established tool in the repertoire of clinical assessment methods in nurse education. The use of OSCEs facilitates the assessment of psychomotor skills as well as knowledge and attitudes. Identified benefits of OSCE assessment include development of students' confidence in their clinical skills and preparation for clinical practice. However, a number of challenges exist with the traditional paper methodology, including documentation errors and inadequate student feedback. Objectives To explore electronic OSCE delivery and evaluate the benefits of using an electronic OSCE management system. To explore assessors' perceptions of and attitudes to the computer based package. Design This study was conducted using electronic software in the management of a four station OSCE assessment with a cohort of first year undergraduate nursing students delivered over two consecutive years (n = 203) in one higher education institution in Ireland. A quantitative descriptive survey methodology was used to obtain the views of the assessors on the process and outcome of using the software. Methods OSCE documentation was converted to electronic format. Assessors were trained in the use of the OSCE management software package and laptops were procured to facilitate electronic management of the OSCE assessment. Following the OSCE assessment, assessors were invited to evaluate the experience. Results Electronic software facilitated the storage and analysis of overall group and individual results thereby offering considerable time savings. Submission of electronic forms was allowed only when fully completed thus removing the potential for missing data. The feedback facility allowed the student to receive timely evaluation on their performance and to benchmark their performance against the class. Conclusions Assessors' satisfaction with the software was high. Analysis of assessment results can highlight issues around internal consistency being moderate and examiners variability. Regression analysis increases fairness of result calculations. [ABSTRACT FROM AUTHOR]

The flow induced acoustics in an inline tube bank (P/d = 3) subject to cross flow, indicative of a generic heat exchanger geometry, are examined over a range of flow velocities using particle image velocimetry (PIV) coupled with acoustic modal analysis using finite element analysis (FEA). The objective is twofold: to determine if the method originally developed for tandem cylinders is applicable to more geometrically complex configurations, with more restricted optical access; and hence to investigate the spatial distribution of acoustic sources within the tube array. The spatial and temporal aeroacoustic source distribution has been successfully obtained experimentally for the case of Strouhal acoustic coincidence (i.e., fa = fv). It is found that the acoustic sources are most intense behind the first row due to the spatial compactness of the vortices. However, a strong negative source (i.e., a sink) is also present in this location, so that the net contribution of the first row wake is small. In subsequent rows, the sources are weaker and more dispersed, but the sink is reduced dramatically. The result is that after the first row the remaining rows of the array contributes energy to the acoustic field. It is noted that, for the coincidence case in the tube bundle studied here, the spatial distribution of sources in the region around the first and second row is similar to the precoincidence regime found for tandem cylinders. This apparent contradiction requires further investigation. Nonetheless, it is concluded that the method of combining PIV with FEA to determine the source distribution can be applied to more complex geometries than previously reported. [ABSTRACT FROM AUTHOR]

The article presents a study whose aim is certify patients' satisfaction with the service provided by an advance nurse practitioner (ANP) in hematology at a regional specialist center in Ireland. It also intended to examine the "added value" of the ANP's contribution including the role in bone marrow examination, defining the unique contribution of blending nursing skills with medical knowledge. It shows the high level of satisfaction with a new ANP role in hematology.

This paper describes new developments and deliberations at the 35th Session of the World Heritage Committee in Paris in June 2011. One of the most striking aspects of this year's meetings was the vocal challenge to the expert status and authority of the Advisory Bodies (ICOMOS and IUCN) by the Committee in making recommendations for site inscription. By the end of the meetings they had overturned 22 of the Advisory Body recommendations previously presented in the Draft Decision. Many of those challenges reflect a broader desire to inscribe properties within nations that have been historically underrepresented on the World Heritage List. I also suggest, however, that long-standing political allegiances and new socioeconomic alliances were key factors in voting trends, while heritage sites themselves and their specific requirements received less substantive discussion. The ramifications of these developments for States Parties and communities in terms of site conservation and management can only be assessed in years to come. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this audit was to provide empirical evidence for the outcomes of care of advanced nurse practitioners (ANPs) within the emergency department (ED). In addition, the audit permitted the comparison of ANPs with other medical clinicians working in the ED setting in relation to results of radiology investigations, analgesia administration, and waiting times. Results show that ANPs have equivalent if not better radiology diagnostic skills, evidence of increased awareness of pain management practices, and a greater impact on reducing patient waiting times compared to other grades of clinician. [ABSTRACT FROM AUTHOR]

Abstract: The utility of cyclooxygenase-inhibiting non-steroidal anti-inflammatory drugs is limited by unwanted side effects that include disturbances in renal function. In order to further understand the mechanisms that underlie these renal side effects, the expression of the prostaglandin-synthesizing enzyme cyclooxygenase (COX) was examined by immunohistochemical methods in murine kidneys after treatment with indomethacin, a non-selective inhibitor or nimesulide, an inhibitor that preferentially and selectively blocks the COX-2 isoform of the enzyme. In untreated control kidneys, COX-1 protein was expressed in the glomeruli and parietal cells of the glomerular capsule, epithelial cells of the proximal and distal convoluted tubules including the juxtaglomerular region, and the collecting ducts. At therapeutic doses, indomethacin (10mg/kg) did not alter renal COX-1 expression relative to immunoreactivity in untreated control kidney. By contrast, an equipotent therapeutic dose of nimesulide reduced renal COX-1 expression within the first 24h of treatment. Taken together with the reports of reduced COX-1 expression prior to renal tissue damage following high-dose indomethacin treatment, our findings suggest that effects of NSAIDs on renal COX expression are dependent on dose and may be related to isoform specificity. [Copyright &y& Elsevier]

Summary: The clinical role of lecturers in nursing has been a focus of debate since the integration of nurse education into higher education institutions. The purpose of this paper is to report the findings from the preliminary phase of a study, undertaken to investigate the perceptions of key stakeholder groups in nurse education, regarding the current clinical role of nurse lecturers in Ireland. A descriptive exploratory design was used involving focus group and individual interviews, soliciting views of purposefully selected educationalists, clinicians, policy formulators and students. The issue was examined from a policy perspective, aiming to collectively represent views of all participant groups. This approach facilitated a more complete picture of perceptions of the role to emerge, to better inform future decision making. Twenty two focus group interviews and twenty one individual interviews were conducted. Content analysis was used to identify themes. All groups were in agreement that role definition was urgently required to dispel ambiguities surrounding what the clinical role should involve. Conflicting views were evident among groups regarding lecturers’ clinical credibility, visibility and teaching effectiveness. Findings highlight the essential nature of nurse lecturers engaging with clinical areas to maintain their skills, demonstrate a value for the practice component of the role and provide a link between education and practice. [Copyright &y& Elsevier]

The interaction between acoustic resonance and damping controlled fluidelastic instability (FEI) in a normal triangular tube array (P/d = 1.32) has been investigated. The duct acoustics were excited with speakers placed adjacent to the tube array to artificially replicate flow-induced acoustic resonance. The paper deals with the effect on the rms level of tube vibration of three independent parameters: imposed acoustic sound pressure level freestream flow velocity, and structural damping. A fall in the FEI vibration amplitude with increasing sound pressure level in the tube array has been observed. In addition, the imposed acoustic field delays the onset of damping controlled fluidelastic instability. The effects of flow velocity and structural damping in conjunction with acoustic resonance on the rms of tube displacement are discussed. While the current study has clearly captured the phenomenon of interaction between the fluidelastic motion at approximately 10 Hz and the acoustic field at approximately 1 kHz, it is not apparent what the physical mechanism at work might be. [ABSTRACT FROM AUTHOR]

A single-vaned centrifugal pump, typical of the kind employed in waste-water applications (e.g. sewage treatment), has been investigated numerically. The primary objective was to identify a modelling approach that was accurate, but at an acceptable computational cost. A test program has been executed to provide data to validate the numerical models. The global performance of the pump was assessed in terms of the pressure head, the mass flowrate, the power consumption, and the pump efficiency. In addition, time-resolved surface-pressure measurements were made at the volute wall. Five combinations of three modelling approximations (two or 3D; k -ε or Reynolds stress model turbulence model; unsteady or quasi-steady) were investigated and compared with the experimental results. It was found that the choice of turbulence model did not have a significant effect on the predictions. In all cases, the head-discharge curve was well predicted. However, it was found that only the quasi-steady models could capture the trend of the power consumption curve, and hence that of the efficiency. Discrepancies in the magnitude of the power consumption can be accounted for by the lack of losses such as leakage in the numerical models. Qualitative analysis of the numerical results identifies the trailing edge of the impeller as the primary source of power loss, with the flow in the region of the cut water also contributing significantly to the poor overall efficiency of the design. [ABSTRACT FROM AUTHOR]

The article looks at the patterns of mortuary and religious usage in Ptolemaic and Roman period from contextual archaeology perspective. It highlights the analysis and interpretations of the site of Deir el-Medina that demonstrates a broad spectrum with the construction of a temple and significant Saite, Ptolemaic and Roman mortuary activity. It presents the general pattern of burials, Roman family burial in the cellar of a Ramesside house, and the Hathor temple. It also illustrates the shift of status from Ptolemaic to the early Christian Period and conceptualization of different ideologies.

Aeroacoustic resonance of bluff bodies exposed to cross flow can be problematic for many different engineering applications and knowledge of the location and interaction of acoustic sources is not well understood. Thus, an empirical investigation of the acoustically coupled flow around two tandem cylinders under two different resonant conditions is presented. It is assumed that the resonant acoustic field could be decoupled from the hydrodynamic flow field, resolved separately, and then recoupled to predict the flow/sound interaction mechanisms using Howe's theory of aerodynamic sound. Particle image velocimetry was employed to resolve the phase-averaged flow field characteristics around the cylinders at various phases in an acoustic wave cycle. It was found that the vortex shedding patterns of the two resonant conditions exhibit substantial differences. For the first condition, which occurred at low flow velocities where the natural vortex shedding frequency was below the acoustic resonance frequency, fully developed vortices formed in both the gap region between the cylinders and in the wake. These vortices were found to be in phase with each other. For the second resonant condition, which occurred at higher flow velocities where the natural vortex shedding frequency was above the acoustic resonant frequency, fully developed vortices only formed in the wake and shedding from the two cylinders were not in phase. These differences in the flow field resulted in substantial variation in the flow-acoustic interaction mechanisms between the two resonant conditions. Corresponding patterns of the net acoustic energy suggest that acoustic resonance at the lower flow velocity is due to a combination of shear layer instability in the gap and vortex shedding in the wake, while acoustic resonance at the higher flow velocity is driven by the vortex shedding in the wake of the two cylinders. [ABSTRACT FROM AUTHOR]