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Little is known about filter media microbiome and characteristics during disruptive events and drastic hydraulic performance decline in drinking water biofilters.

Summary Combining thematic analysis and a human–computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions. Purpose The purpose of this study was to understand stakeholders’ perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model. Methods Qualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis. Results In total, 24 in-depth interviews were conducted with stakeholders. We identified 18 thematic constructs presented under the categories of context, content, and system. Context covered patient characteristics such as frailty, digital literacy, and patient or carer participation, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovative holistic models of care. Content outlines the active ingredients and approach in developing a digital health hub, and it highlights the importance of targeted education and behavior change. The system is a complicated matrix crossing different aspects of healthcare and offering a value proposition design through personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change. Conclusion The findings from this study provide insights around potential factors related to patients, community support, and healthcare delivery influencing the design and next-stage implementation of a digital health hub model of care for fragility hip fractures. Supplementary Information The online version contains supplementary material available at 10.1007/s11657-021-01031-3.

Background Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation. Objective This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub. Methods We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use. Results This study recruited 100 participants—55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=–0.50; P Conclusions This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios.

BACKGROUND Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation. OBJECTIVE This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub. METHODS We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use. RESULTS This study recruited 100 participants—55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=–0.50; PPP CONCLUSIONS This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios.

Continual efforts have been made to determine a simple and universal method of estimating heavy metal phytoavailability in terrestrial systems. In the present study, a mechanism-based multi-surface model (MSM) was developed to predict the partition of Ni(II) in soil–solution phases and its bioaccumulation in wheat (Triticum aestivum L.) in 19 Chinese soils with a wide range of soil properties. MSM successfully predicted the Ni(II) dissolution in 0.01 M CaCl2 extracting solution (R2 = 0.875). The two-site model for clay fraction improved the prediction, particularly for alkaline soils, because of the additional consideration of edge sites. More crucially, the calculated dissolved Ni(II) was highly correlated with the metal accumulation in wheat (R2 = 0.820 for roots and 0.817 for shoots). The correlation coefficients for the MSM and various chemical extraction methods have the following order: soil pore water > MSM ≈ diffuse gradient technique (DGT) > soil total Ni > 0.43 M HNO3 > 0.01 M CaCl2. The results suggested that the dissolved Ni(II) calculated using MSM can serve as an effective indicator of the bioavailability of Ni(II) in various soils; hence, MSM can be used as an supplement for metal risk prediction and assessment besides chemical extraction techniques.

The objective of this review is to evaluate the effectiveness of digital health supported targeted patient communication versus usual provision of health information, on the recovery of fragility fractures. The review considered studies including older people, aged 50 and above, with a fragility fracture. The primary outcome was prevention of secondary fractures by diagnosis and treatment of osteoporosis, and its adherence. This review considered both experimental and quasi-experimental study designs. A comprehensive search strategy was built to identify key terms including Medical subject headings (MeSH) and applied to the multiple electronic databases. An intention to treat analysis was applied to those studies included in the meta-analysis and odds ratio was calculated with random effects. Altogether, 15 studies were considered in the final stage for this systematic review. Out of these, 10 studies were Randomised controlled trials (RCT) and five were quasi experimental studies, published between the years 2003 and 2016 with a total of 5037 participants. Five Randomised control trails were included in the meta-analysis suggesting that digital health supported interventions were overall, twice as effective when compared with the usual standard care (OR 2.13, 95% CI 1.30&ndash, 3.48), despite the population sample not being homogeneous. Findings from the remaining studies were narratively interpreted.

BACKGROUND: Fragility hip fracture in older adults oftenhas poor outcomes, but these outcomes can be improvedwith attention to specifi c quality care indicators.PURPOSE: The International Collaboration of OrthopaedicNursing (ICON) developed an audit process to identify the extentto which internationally accepted nursing quality care indicatorsfor older adults with fragility hip fracture are refl ectedin policies, protocols, and processes guiding acute care.METHODS: A data abstraction tool was created for eachof 12 quality indicators. Data were collected using a mixedmethodsapproach with unstructured rounds. A rationaledocument providing evidence for the quality indicators anda user evaluation form were included with the audit tool. Apurposeful sample of 35 acute care hospitals representing 7countries was selected.RESULTS: Thirty-fi ve hospitals (100%) completed thesurvey. Respondents viewed the content as relevant and applicablefor the defi ned patient population. Although timingand frequency of implementation varied among and withincountries, the identifi ed quality indicators were refl ected inthe majority of policies, protocols, or processes guiding carein the hospitals surveyed.CONCLUSION: Developing and testing an audit of nursesensitivequality indicators for older adults with fragility hipfracture demonstrate international consensus on commoncore best practices to ensure optimal acute care.

The theoretical inquiry undertaken in this paper examines the discourse of knowledge equivalence used to justify conflating academic and non-academic subjects in New Zealand secondary school science. The purpose is to open up a critical discussion of the discourse and its influence on curriculum and pedagogy. Using a conceptual methodology, we identify the differences between academic and non-academic subjects to argue that there are sound epistemological and equity reasons not to combine academic and non-academic subjects into innovated pathways. A research study which explored the curriculum practices of several senior science teachers is used to illustrate our theoretically derived analysis and explanation of the knowledge equivalence discourse.

Although counterproductive work behavior (CWB) has long been established as a broad domain of job behaviors, little agreement exists about its internal structure. The present research addressed alternative models of broadly defined CWB according to which specific behaviors can be grouped into (a) one general factor, or into (b) two, (c) five, or (d) eleven narrower facets, and a number of possible integrations of these models. First, conceptual differences between these models (including the nature of overall CWB as implying a reflective or formative model, boundaries of the domain, and relations among specific facets) are reviewed with regard to theoretical and practical implications. In Study 1, structural meta-analysis was then used to test whether a reflective higher-order factor underlies meta-analytically constructed correlation matrices of five CWB facets. Analyses supported a general factor model. For Study 2, a primary data set (N = 1,237 employees) was collected in order to test alternative structural models and possible integrations of these models. Confirmatory factor analyses revealed that the best fit was for a bimodal (nonhierarchical) model in which individual CWBs simultaneously load on one of the eleven facets describing their content (e.g., theft, absenteeism) and on one of three factors describing the target primarily harmed (organization, other persons, self). Less support was found for hierarchical models and for models involving fewer content factors. These findings suggest that CWB is best described by a reflective higher-order factor at the general level and by a complex set of bimodal facets at the more specific level.

Summary This paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice

Review question/objective The objective of this review is to synthesize the best available evidence on the effectiveness of follow-up care provided by stoma care nurses on quality of life in adults with a stoma. Inclusion criteria Types of participants This review will consider studies that include adults18 years to 70 years with a stoma. The published studies to be reviewed collect data without regard to cause of stomal surgery therefore all individuals with a stoma are included. All types of stomas are included i.e. ileostomy, colostomy or urostomy however some tools are not validated for patients with a urostomy. It will need to be assessed whether these can be included in the study. Types of intervention(s) This review will consider studies that evaluate follow-up care provided by specialized stoma care nurses compared to non-specialized nurse care. Areas of interest include: Frequency of stoma nurse intervention. Intensity of the intervention. Whether the intervention is delivered face-to-face or via phone or a combination of these. For this systematic review we will use the following definitions: Follow-up care in adults with a stoma refers to care given in regard to post-operative education, assistance with ongoing difficulties in stomal management and psychological adjustment to the patient with a stoma. Specialized stoma care nurse is defined as a registered nurse who has completed a nationally approved course in stoma care training. Types of outcomes This review will consider studies that include the following outcome measures: Quality of life assessed with a validated quality of life measurement tools. Tools that measure psychological adjustment will also be considered if found to be measured by a validated instrument. For this systematic review the quality of life measurement tools will include Stoma QOL, the Stoma Quality of Life Scale, the City of Hope Quality of Life-Ostomy Questionnaire and the Quality of Life Index.

This review asks "What is the experience and effectiveness of nurse practitioners in orthopaedic settings"?The objective of the quantitative component of this review is to synthesise the best available evidence on effectiveness of orthopaedic nurse practitioner specific care on patient outcomes and process indicators.The objective of the qualitative component of this review is to synthesise the best available evidence on the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation.The objective of the text and opinion component of this review is to synthesise the best available evidence of the contemporary discourse on the effectiveness and experience of nurse practitioners in orthopaedic settings.Nurse practitioner roles have emerged in response to areas of unmet healthcare needs in a variety of settings. Nurse practitioners first evolved in the United States 40 years ago in response to a shortage of primary health care physicians. Nurse practitioners filled the void by providing access to primary health care services where otherwise there was none. Nurse practitioners comprise one branch of advanced nursing practice in the US along with Nurse Anaesthetists (NA), Clinical Nurse Specialists (CNS) and Nurse Midwives (NM). Canada soon followed America's lead by establishing the nurse practitioner role in 1967. Canada has two areas of advanced nursing practice, namely nurse practitioner and clinical nurse specialist; they are moving towards introducing nurse anaesthetists currently. The nurse practitioner role was introduced into the United Kingdom 20 years ago.There is commonality amongst the definition and characteristics of Nurse Practitioner (NP)/Advanced Practice Nurse (APN) role and practice internationally in terms of education, practice standards and regulation; operationally there is variability however. Australia's progress with nurse practitioners is very much informed by the experiences of the United States and United Kingdom and for the most part there exists a parallel between the international experience and the Australian experience of nurse practitioners.This review will focus on orthopaedic nurse practitioners in an international context. However the local context of the primary reviewer which informs this review is Australian. Australia has mirrored the trends around nurse practitioner practice found elsewhere. In the last 20 years (post implementation of the 1986 Australian nursing career structure), the debate around advanced nursing practice and nurse practitioners, in an Australian context, has developed. The inaugural 'legalpolicy' nurse practitioner framework was developed in New South Wales (NSW) in 1998, with the first Australian nurse practitioner authorised to practise in NSW in 2000. It is posited that evaluation of emerging roles began to be seen in the research literature from 1990 onwards. In response to a need for creative workforce re-engineering and against a context of limited health resources, nurse practitioners in Australia over the last 20 years have emerged as an alternative model of health care delivery. For the last 10 years there has been a proliferation of influential 'reports' written by nurse researchers, generated to review the progress of Australia's nurse practitioners, commissioned by the health departments of respective state governments and other service planners to guide health workforce planning.In a national context the Australian NursingMidwifery Council (ANMC) as the peak national nursing body, defines a nurse practitioner as a Registered Nurse (RN) who is educated and authorised to practice autonomously and collaboratively in an advanced and extended clinical role. The ANMC Competency Standards for the Nurse Practitioner encompass three generic standards which are further defined by nine competencies. The competency standards provide a framework for practice and licensure of nurse practitioners in Australia. In order for the nurse practitioner to be endorsed by the Australian Health Practitioner Regulation Agency (AHPRA) to practise as a nurse practitioner they must have met the competency standards and be endorsed to practise by the Nursing and Midwifery Board of Australia (NMBA) as a nurse practitioner under section 95 of the National Law. The nurse practitioner's endorsement in Australia is contextualised by their scope of practice, as is the case internationally.At September 2011, 450 endorsed nurse practitioners were nationally registered with AHPRA; 54 of these were endorsed to practise in South Australia. The first orthopaedic nurse practitioner was authorised in South Australia in 2005. To date there are eight endorsed orthopaedic nurse practitioners in Australia authorised to practise in a diverse range of orthopaedic settings that include acute care, community care, outpatient settings, rehabilitation, private practice and rural settings. The current scope of practice for Australian orthopaedic nurse practitioners spans the clinical range of trauma, arthroplasty, fragility fracture and ortho-geriatric care, surgical care: spinal/neurology and paediatric care. Orthopaedic nurse practitioners work within contemporary orthopaedic/musculoskeletal client disease models. These clinical models of care articulate the health care needs of populations living with musculoskeletal conditions, disorders and disease. Osteoarthritis and osteoporosis are 'highly prevalent long term [musculoskeletal] conditions known to predominantly affect the elderly and comprise the most common cause of disability in Australia'. Musculoskeletal trauma or injury as a result of an 'external force' such as vehicle accident, a fall, industrial or home environment accident or assault comprises a leading cause of hospital admission that requires orthopaedic management and care.There is some evidence to suggest that orthopaedic nursing is a 'specialty under threat' as orthopaedic-specific hospital wards are increasingly being absorbed into general surgical units; a trend observed in the United States in the mid 1990's in response to the American experience of 'downsizing' orthopaedic nursing services. Despite a limited evidence base, early citations with specific reference to orthopaedic nurses in the American context in particular started to populate the literature on or around this time. Several proponents of the specialty began to refer to a core nursing skill set that was 'highly orthopaedic' when describing 'specialist' orthopaedic nursing practice. More recently commentators point to differences in certain variables when patients are 'outlied' or managed in a non-orthopaedic ward environment by non-orthopaedic nurses.Despite 'in-principle' support for expanded scopes of practice for various health practitioner roles, the observation exists from within the specialty of orthopaedic nursing that progress in establishing the orthopaedic nurse practitioner role for this group of specialist clinicians has been slow and their journey has not been without challenge. The majority of orthopaedic nurse practitioners in Australia at least have emerged from extended practice roles similar to the generally well established experience of other nurse practitioners emerging from their own practice interest. The orthopaedic nurse practitioner is considered a 'pioneer' as they fill a 'gap' in clinical need and develop an orthopaedic nurse practitioner role. An emerging evidence base suggests that barriers such as a lack of role understanding, lack of 'team' support and a lack of resources at a system, organisational and practice level, constrain nurse practitioner practice and integration of the role into practice settings. Nurse practitioners function in an advanced clinical role. Some attempts have been made at quantifying the work of nurse practitioners. For example, Gardner et al in 2010 divided the work of nurse practitioners into three domains of practice: direct care, indirect care and service-related activities. Within these domains nurse practitioners perform a variety of tasks. Reporting on such activity by way of performance outcome measures is a variable practice amongst nurse practitioners however numbers seen/occasions of service, waiting times, effectiveness of interventions, referral patterns, patient/client satisfaction, clinical quality of care indicators are typical of the data maintained and reported by nurse practitioners to either justify their existence, embed their role service wide and/or contribute to workforce planning. Furthermore the orthopaedic nurse practitioner must effectively define and characterise the patient population to which they deliver care within the nurse practitioner's own scope of practice, ultimately to form an 'indicator' for the nurse practitioner role.The international literature pertaining to nurse practitioners or advanced practice nurses resonates with the many challenges faced by these nurses when it comes to role development and role implementation. Furthermore there is a body of evidence that validates the effectiveness of these roles. This becomes increasingly important in a context of building the health workforce of the future: a redefined workforce that must ensure adequate numbers of suitably qualified health workers who provide 'care the first time and every time'.A search of the Joanna Briggs Institute (JBI) Library of Systematic Reviews, Cochrane Library, PubMed and CINAHL has shown there are no existing or systematic reviews underway on this topic. The JBI undertook a systematic review commissioned by the Department of Health South Australia on Advanced Practice in Nursing and Midwifery and recommended a framework for advanced practice in a report released in early 2008. The framework defined advanced practice, levels of advanced practice, scope of practice, credentialing, education, preparation and regulation of advanced practitioners. The search identified a published systematic review protocol in the JBI Library for a qualitative systematic review by Ramis looking broadly at the experience of advanced practice nurses working in acute settings. The JBI Library of Systematic Reviews also contains a systematic review examining the effectiveness of nurse practitioners in residential aged care. Whilst these publications provide valuable context to this review neither specifically examines the clinical practice of orthopaedic nurse practitioners.Similarly a search of the Cochrane Library revealed a review on the topic of substitution of doctors by nurses in primary care. The focus of this particular intervention review was neither specific to nurse practitioners nor the acute care setting, but the topic of 'doctor substitution' complements the practice of nurse practitioners and may be a consideration in this review. Doctor substitution or care provided by a nurse other than an orthopaedic nurse practitioner is a natural comparator when examining the role and practice of orthopaedic nurse practitioners.Given the breadth of this topic a comprehensive approach has been chosen to systematically review the evidence as it relates to orthopaedic nurse practitioner role and practice.

The effect of variable heating rates on the efficiency or resolution of the derivative of the thermogravimetry profiles of three model pharmaceutical compounds was investigated. The variable heating system utilized computer controlled algorithms for the evaluation of crystalline sodium warfarin, DuP 532 and hydrated DuP 925 as model compounds with one, two and three step weight loss profiles, respectively. As the heating modes were increased through each of the eight settings, the minimum heating rate decreased while the efficiency and resolution and the analysis times increased. The observed weight loss remained relatively constant for each of the model compounds as the heating modes were increased. The efficiency of the derivative of the weight loss profile of crystalline sodium warfarin increased from 121 to 621 as the heating mode increased. The resolution between the two steps of the derivative of the weight loss profile of DuP 532 increased from 1.73 to 3.88 as the heating mode increased. For hydrated DuP 925, the resolution increased from 1.49 to 5.46 between steps 1 and 2 of the derivative of the weight loss profile and from 1.87 to 3.24 between steps 2 and 3 of the derivative of the weight loss profile. Variable heating rates provided a valuable aid in obtaining high efficiency/resolution thermograms. The enhanced efficiency/resolution permitted greater separation of the volatilization process, especially for samples with multi-step weight loss profiles. Increasing the heating mode afforded higher efficiencies/resolutions that typically reached a maximum value at mode 6.

The psychological well being of the patient and the patient’s entire family is critically important to successful rehabilitation of individuals with multiple sclerosis (MS). This article deals with the psychotherapeutic management and problems faced by the person with MS, including fatigue, chronic pain, stressful life events, and cognitive defects.

The discriminative stimulus properties of the prototypical atypical neuroleptic clozapine (5 mg/kg, IP) were characterised in rats using a fixed ratio assay. Clozapine induced full dose-related generalization in the absence of response suppression. Amphetamine and pentylenetetrazol failed to generalise at doses known to be discriminable, showing a degree of specificity for the clozapine cue. The typical neuroleptics haloperidol and loxapine induced minimal (20%) generalization at doses with marked behavioural effects; thus clozapine discrimination dissociates clozapine from typical neuroleptics. Atypical neuroleptics which are not clozapine congeners produced weak partial generalization when tested up to the highest doses that could be studied. The maximal levels of generalization induced by these agents were: amisulpiride 28%, risperidone 40% and sertindole 50%. Clozapine congeners typically caused more generalization, the novel pyridobenzoxapine JL13 inducing 70% maximal generalization. Most generalization (83%) was seen with the clozapine congener seroquel, although in contrast to clozapine, it only generalised at doses with marked effects on responding, so that no drug mimicked clozapine fully. Surprisingly, the clozapine congener olanzapine only induced a maximal level of 38% generalization. This apparently anomalous finding is attributed to an inability to test high doses of the drug due to its rate-suppressant actions. The clozapine cue can be used to rank atypical neuroleptics in terms of their similarity to clozapine in vivo. The clozapine cue is probably a compound cue, since only agents showing "polyvalent" receptor pharmacology induced substantial generalization.

The search for an improved clozapine-like compound has resulted in the selection of a new molecule: JL13 (5-(4-methylpiperazin-1-yl)-8-chloro-pyrido[2,3-b][1,5] benzoxazepine fumarate). Like clozapine, JL13 did not antagonize apomorphine-induced stereotypy and did not produce catalepsy but antagonized apomorphine-induced climbing in rodents (ID50 = 3.9 mg kg-1 s.c.). It was inactive against d-amphetamine-induced stereotypy but antagonized d-amphetamine-induced hyperactivity in the mouse (ID50 = 4.4 mg kg-1 i.p.). JL13, like clozapine, was able to antagonize (+/-)-DOI-induced head-twitches in the mouse (ID50 = 2.0 mg kg-1 i.p.). In the open-field test in the rat and forced swimming test in the mouse a high similarity was noted between the two drugs in the same range of doses. In a complex temporal regulation schedule in the dog, JL13 showed a high resemblance with clozapine without inducing sialorrhea, palpebral ptosis or any significant motor side effects. In rats trained to discriminate clozapine, JL13 (10 mg kg-1 i.p.) induced a high level of generalization (70%) to clozapine. In a drug discrimination procedure in the squirrel monkey, JL13 (3-10 mg kg-1 i.m.) produced a full substitution of clozapine. On the basis of these preclinical data, it is thus predicted that JL13 would be a promising atypical antipsychotic drug.

Summary The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus. This includes (in the first, earlier, part): Pain Delirium and in this part Pressure Ulcers Fluid Balance/Nutrition Constipation/Catheter Associated Urinary Tract Infection Vigilant nursing assessment and prompt intervention may prevent the development of the complications we discuss. If they do occur and are identified early on, they may resolve with appropriate and timely nursing management. This "tool kit" has been developed under the auspices of the International Collaboration of Orthopaedic Nursing (ICON) a coalition of national associations of orthopaedic nursing (www.orthopaedicnursing.org).

Vaccine efficacy can be enhanced by delivery of antigens in synthetic microspheres. The process of antigen incorporation into microspheres can expose fragile antigens to damaging conditions, such as high temperatures, and to bacterial contamination. Maintenance of immunogenicity of several antigens and reduction of bacterial load in alginate microspheres following boiling was evaluated. Mice were immunized subcutaneously, initially and again 21 days later, with either non-boiled or boiled microspheres containing ovalbumin (OVA), a culture supernatant vaccine of Pasteurella haemolytica (PHV), or a potassium thiocyanate extract of P. multocida (PTE). Serum samples were obtained prior to immunization and at the time of euthanasia 28 days later. Culture of microspheres showed that boiling completely eliminated aerobic bacterial growth for OVA-containing microspheres, and reduced growth by a factor of 10(4) for PTE microspheres. More bacteria were cultured after boiling than before for PHV microspheres. ELISA performed on serum and intestinal lamina propria explant supernatants showed that immunogenicity of PHV microspheres was not altered by boiling. Boiled OVA microspheres were still able to stimulate a significant serum IgG anti-OVA titer in mice, but boiled PTE microspheres completely lacked immunogenicity. Elispot assays of spleens showed that only PHV microspheres were able to retain immunogenicity after boiling. Results indicate that boiling is not an effective means for reducing the bacterial load of alginate microspheres and that the process is associated with a diminution of vaccine immunogenicity.