Reusable learning objects for nurse education: development, evaluation, challenges and recommendations.

Online resources are expected within healthcare education, and a plethora of online or technology-based delivery methods are available. Reusable learning objects (RLOs) are a form of digitally supported education that can be used multiple times in various locations; they are especially favoured by nurses. Little is understood about the issues involved in their creation. This article examines the development of an RLO in respiratory physiology for first-year nurses and how those creating it worked together. Feedback during the development of the RLO was gathered over 1 year from academics, technologists and students. Issues that arose included variations and misunderstanding regarding terminology and academics' not appreciating the time it took to develop the resource and its potential. Practical matters included sourcing royalty-free or in-house images, record-keeping and version control, and addressing production logic in case developers moved to other projects. It is important to include students during the design process rather than in just evaluating the final product because user experience and navigation have to be considered together with pedagogical content. Addressing these issues when developing an RLO will help streamline the process and generate a student-focused output.

Central and peripheral pathology of kuru: pathological analysis of a recent case and comparison with other forms of human prion disease.

While the neuropathology of kuru is well defined, there are few data concerning the distribution of disease-related prion protein in peripheral tissues. Here we report the investigation of brain and peripheral tissues from a kuru patient who died in 2003. Neuropathological findings were compared with those seen in classical (sporadic and iatrogenic) Creutzfeldt-Jakob disease (CJD) and variant CJD (vCJD). The neuropathological findings of the kuru patient showed all the stereotypical changes that define kuru, with the occurrence of prominent PrP plaques throughout the brain. Lymphoreticular tissue showed no evidence of prion colonization, suggesting that the peripheral pathogenesis of kuru is similar to that seen in classical CJD rather than vCJD. These findings now strongly suggest that the characteristic peripheral pathogenesis of vCJD is determined by prion strain type alone rather than route of infection.

Magnetic retention for obturators.

Prosthetic rehabilitation can be challenging in cases of maxillectomy or developmental defect. This article describes a case in which a magnetically retained, implant-supported denture was used to restore the maxilla following hemi-maxillectomy. Use of the Oral Health Impact Profile before and after treatment showed a marked diminution in the number of adverse impacts 2 weeks post-placement and during review 6 months later.

Changes in intraocular pressure in anesthetized prone patients.

BACKGROUND: Postoperative visual loss occurs more commonly in patients placed prone. The mechanism may be raised intraocular pressure (IOP) causing an ischemic oculopathy. METHODS: IOP was measured in 20 patients undergoing spinal surgery. The IOP was measured prior to intubation, immediately after pronation, and at the end of surgery before the patient was returned to the supine position. Duration of surgery, method of head stabilization and standard physiological parameters were recorded. RESULTS: Both measurements of median IOP in the prone position were significantly higher than that in the supine position (P < 0.001). There was no evidence of a relationship between rise in IOP and duration of surgery, age, or body mass index. There was weak evidence of a tendency for patients whose heads were on pillows to have higher values of IOP at the end of surgery than patients whose heads were supported in pins. CONCLUSION: IOP increases when anesthetized patients are placed in the prone position.

Mouth opening: a new angle.

BACKGROUND: The authors hypothesized that craniocervical extension occurs during normal mouth opening. METHODS: Twenty volunteers were studied. Interdental distance was measured at four different degrees of craniocervical extension. RESULTS: Interdental distance increased from 28 mm (95% confidence interval, 25-30) in slight flexion to 46 mm (95% confidence interval, 42-49) at full extension. Nearly maximal mouth opening was obtained with 26 degrees (95% confidence interval, 22-30) of craniocervical extension from neutral. CONCLUSION: Craniocervical extension is an integral part of complete mouth opening in conscious subjects. Fixation of the craniocervical junction by disease, an internal or external fixation device, or technique may restrict mouth opening, with consequences for airway management.

An evaluation of recent blood lead levels in Port Pirie, South Australia.

The Port Pirie Lead Program commenced in 1984. The abatement program involves identification of children with elevated blood lead levels, house decontamination, soil treatment, development of heavily vegetated buffer zones around the smelter, family education and support and community education. Since 1984 the smelter has also implemented substantial new emission controls and environmental improvements. Blood lead and air monitoring programs as well as investigations of emission sources, ongoing household contamination and infant exposure mechanisms are in place. Although capillary blood lead monitoring has shown a significant decrease in the mean blood lead levels of the children, 61% of children aged 1-4 years still exceed 10 microg/dl, with 28% at or above 15 microg/dl. Re-entrainment of lead from the contaminated areas within the city is only a small contributor to air-borne lead levels compared with that from the smelter and its environs. The smelter has undertaken extensive work to reduce windborne fugitive emissions. While attempts to demonstrate reductions in air lead have been hampered by large annual variations in wind speed and direction, air lead studies have confirmed that only small losses are now arising from the stockpile area of the smelter site. Evidence suggests that worker hygiene improvements, relocation of children to lower exposure suburbs, community education, house decontamination, specific measures for individual children with elevated blood lead, and avoidance of tank rainwater have all been partially successful. A substantial investigation program has refocused intervention efforts towards reducing exposure from indoor environments during the first year of life and contributed to improved identification and ranking of ongoing smelter emission sources.

Water use by forests, limits and controls.

Based on a review of several studies that have been carried out to determine the water use of forests in relation to other crops in different regions of the world, it is shown that the principal controls on evaporation from forests and shorter crops vary markedly between the temperate and tropical regions and between the wet and dry zones of these regions. Although there are detailed physical and physiological models available that allow calculation of forest water use, these models are not always readily applicable. It is proposed that a knowledge of the limits on evaporation can be used to devise models of varying complexity for estimating water use of forests in different regions and for predicting differences in water use between forests and shorter crops. Limits on evaporation may be related to radiation, advection, tree physiology, soil water, tree size or drop size. Examples are given of the use of models based on the limits concept for solving forest related water resource problems in Malawi and the U.K.