Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study.

BACKGROUND: The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. METHODS: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. RESULTS: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. CONCLUSIONS: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

Production of Trans-Cinnamic Acid by Immobilization of the Bambusa oldhamii BoPAL1 and BoPAL2 Phenylalanine Ammonia-Lyases on Electrospun Nanofibers.

Phenylalanine ammonia-lyase (PAL) catalyzes the nonoxidative deamination of phenylalanine to yield trans-cinnamic acid and ammonia. Recombinant Bambusa oldhamii BoPAL1/2 proteins were immobilized onto electrospun nanofibers by dextran polyaldehyde as a cross-linking agent. A central composite design (CCD)-response surface methodology (RSM) was utilized to optimize the electrospinning parameters. Escherichia coli expressed eBoPAL2 exhibited the highest catalytic efficiency among four enzymes. The optimum conditions for fabricating nanofibers were determined as follows: flow rate of 0.10 mL/h, voltage of 13.8 kV, and distance of 13 cm. The response surface models were used to obtain the smaller the fiber diameters as well as the highest PAL activity in the enzyme immobilization. Compared with free BoPALs, immobilized BoPALs can be reused for at least 6 consecutive cycles. The remained activity of the immobilized BoPAL proteins after storage at 4 °C for 30 days were between 75 and 83%. In addition, the tolerance against denaturants of the immobilized BoPAL proteins were significantly enhanced. As a result, the dextran polyaldehyde natural cross-linking agent can effectively replace traditional chemical cross-linking agents for the immobilization of the BoPAL enzymes. The PAL/nylon 6/polyvinyl alcohol (PVA)/chitosan (CS) nanofibers made are extremely stable and are practical for industrial applications in the future.

Final year nursing students' preparedness for medication administration during COVID-19: A multi-site survey study.

AIM: To examine final-year undergraduate nursing students' characteristics and their perceived preparedness for medication administration across three universities during COVID-19. BACKGROUND: Medication administration is a complex process and medication errors can cause harm to the patient. Nurses are at the frontline of medication administration; therefore, nursing students must be well-prepared to administer medicines safely before graduation. Little is known about final-year undergraduate nursing students' perceived medication administration preparedness during COVID-19. DESIGN: A multi-site study using a cross-sectional survey of student demographics, the 'Preparedness for Medication Administration' (Revised) tool and an open-ended question. METHODS: The questionnaire was distributed to nursing students in their final semester of the program in 2022 across two universities in Australia and one in New Zealand. Completed surveys n=214. Descriptive statistics were used to analyse the demographic data. Differences in demographic data and preparedness scores between the three universities were analysed using ranked means, correlation coefficient, Chi-Square, Mann- Whitney U and Kruskal- Wallace H. Directed content analysis was used to analyse the data from the open-ended question. RESULTS: Overall, students reported high preparedness scores for medication. International students reported significantly higher preparedness scores (Md =119, n=29) compared with domestic students (Md=112.00, n=164), U=1759.50, z=-2.231, p=02, r=.16. Mean ranked scores for each item were above average across the three universities. The impact of COVID-19 on curriculum and students' opportunity to practice may be one explanation for the difference in preparedness scores between universities. International participants reported significantly higher scores on the Preparedness for Medication Administration (Revised) tool than domestic participants. Older students were more confident in applying principles of pharmacology to practice. Students' comments generated three major categories and five subcategories indicating preparedness gaps. CONCLUSION: This study provides insights into students' medication management preparedness during restrictions and before transitioning to the role of Registered Nurse. It highlights the need to provide integrated and comprehensive medication education and assessments throughout the curriculum and the need for additional support for newly graduated nurses in medication management due to the restrictions.

Improvement of 3D white chocolate printing molding effect with oleogels.

This study used oleogels to resolve unsolidified white chocolate in 3D printing. Because white chocolate cannot be shaped during 3D printing, the oleogel system is used to solve this problem. The printing parameters and accuracy in a 3D printing system were investigated by using different oleogels added to white chocolate as a material to enhance chocolate extrusion solidification, monoglycerides (MAG), sucrose fatty acid ester (SE) and hydroxypropyl methylcellulose (HPMC), and their effects on rheological characterization, bridging experiments, and optimal print parameters (material formulation, nozzle height, layer height and print speed) were compared. In the rheological analysis, the viscosity recovery was more than 80% for the HPMC group and less than 80% for the MAG and SE groups. In the bridging experiment, when MAG and SE were added at more than 2%, the white chocolate could be effectively extruded and solidified, and the bridging distance could be stretched to 10 mm. The suitable printing parameters are a nozzle height of 3 mm, a layer height of 3 mm, and a printing speed of 10 mm/s. This study provides a future solution to solve the problem of extruded unsolidified chocolate.

Developing New Health Material: The Utilization of Spray Drying Technology on Avocado (Persea Americana mill.) Seed Powder.

Avocado (Persea Americana Mill.) generates byproducts, especially the avocado seeds. Hence, the aim of this study was to investigate the potential utilization of avocado seed as a very important, high phenolic content, climacteric fruit with unique characteristics and high nutritional properties. As such, theantioxidative test is conducted, then spray drying is used to produce avocado seed powder. The objective of this study was to develop an avocado seed powder using the spray drying technique by investigating the solution stability with different avocado seed extract concentrations, and to determine the physical properties of spray dried avocado powder that consists of powder yield, moisture, water activity, solubility, and color. The avocado seed extract was mixed with maltodextrin and water and homogenized for 10 min at 8000 rpm. The avocado seed solution was then spray dried with different inlet temperatures and feed flow rates. The spray dried avocado seed powder was analyzed for its yield, moisture content, water activity, solubility, and color. It was reported that the solution with the least avocado extract concentration (10 g) had the best stability in terms of presence of solute particles and color. The avocado seed powder obtained from this experiment had yield ranges from 24.46-35.47%, moisture content ranges from 7.18-7.96%, water activity ranges from 0.27-0.34, solubility ranges from 55.50-79.67 seconds, L* value ranges from 38.38-41.05, a* value ranges from 6.20-7.25, and b* value ranges from 13.33-15.17. In addition, increasing inlet temperature resulted in an increase in powder yield, solubility, a* value, and b*value, as well as a decrease in moisture, water activity, and L* value. Meanwhile, increasing the feed flow rate resulted in an increase in powder yield, moisture, water activity, and all L*, a*, b* values, as well as a decrease in solubility. In conclusion, spray drying technology is able to develop avocado seed powder.