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Implementing evidence in an onco-haematology nursing unit: a process of change using participatory action research
Version of Record online: 1 MAR 2013
© 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute
International Journal of Evidence-Based Healthcare
Volume 11, Issue 1, pages 46–55, March 2013
Additional Information
How to Cite
Abad-Corpa, E., Delgado-Hito, P., Cabrero-García, J., Meseguer-Liza, C., Zárate-Riscal, C. L., Carrillo-Alcaraz, A., Martínez-Corbalán, J. T. and Caravaca-Hernández, A. (2013), Implementing evidence in an onco-haematology nursing unit: a process of change using participatory action research. International Journal of Evidence-Based Healthcare, 11: 46–55. doi: 10.1111/1744-1609.12006
This article was part of the doctoral thesis by Eva Abad-Corpa.
This paper forms part of the fieldwork of the project entitled 'An Analysis of the Effectiveness of the Implementation of an Evidence-Based-Nursing Model Using Participatory Action Research in a Hematology/Oncology Department', financed by the Health Research Fund (PI05/1330, Health Ministry) after a peer reviewed funding process.
Publication History
- Issue online: 1 MAR 2013
- Version of Record online: 1 MAR 2013
Funded by
- Health Research Fund. Grant Number: PI05/1330
- Abstract
- Article
- References
- Cited By
- change theory;
- evidence implementation;
- oncology care;
- participatory action research;
- qualitative research
To implement evidence in a nursing unit and to gain a better understanding of the experience of change within a participatory action research.
Study design of a participatory action research type was use from the constructivist paradigm. The analytical-methodological decisions were inspired by Checkland Flexible Systems for evidence implementation in the nursing unit. The study was carried out between March and November 2007 in the isolation unit section for onco-haematological patients in a tertiary level general university hospital in Spain. Accidental sampling was carried out with the participation of six nurses. Data were collected using five group meetings and individual reflections in participants' dairies. The participant observation technique was also carried out by researchers. Data analysis was carried out by content analysis. The rigorous criteria were used: credibility, confirmability, dependence, transferability and reflexivity.
A lack of use of evidence in clinical practice is the main problem. The factors involved were identified (training, values, beliefs, resources and professional autonomy). Their daily practice (complexity in taking decisions, variability, lack of professional autonomy and safety) was compared with an ideal situation (using evidence it will be possible to normalise practice and to work more effectively in teams by increasing safety and professional recognition). It was decided to create five working areas about several clinical topics (mucositis, pain, anxiety, satisfaction, nutritional assessment, nauseas and vomiting, pressure ulcers and catheter-related problems) and seven changes in clinical practice were agreed upon together with 11 implementation strategies. Some reflections were made about the features of the study: the changes produced; the strategies used and how to improve them; the nursing 'subculture'; attitudes towards innovation; and the commitment as participants in the study and as healthcare professionals.
The findings throw light on the process of change in the healthcare sector. The results are useful to modify nursing practice based on evidence.
Evidence-based clinical practice (EBCP) is one of the main global research trends emerging in the healthcare world, and nursing professionals play a key role in providing effective and efficient healthcare to the population.[1] With the aim of bridging the gap between research and practice, it has been argued that EBCP could lead to the following contributions: CP guides, up-to-date knowledge, advances in nursing science, improvements in the credibility of nurses as autonomous professionals, improvements in the healthcare outcomes of patients and the control of healthcare costs and, finally, a faster utilisation of the results of the most up-to-date and reliable research in order to produce an improvement in the quality of healthcare in the mid to long term.[2]
Several EBCP models have already been implemented in nursing departments to bring about change in CP.[3-5] Other authors have also made recommendations for improving EBCP models in CP.[6] Additionally, there is an extensive literature reporting on the introduction of evidence into CP by evaluating multiple interventions.[7-9] However, introducing evidence into CP cannot be achieved solely by improving knowledge but requires a change in attitude and behaviour[10, 11]; nevertheless, there continue to be difficulties and barriers preventing the clinicians from following the recommendations made in light of research results.[12, 13]
Most of the previously quoted research proposes vertical implementation models, from top to bottom, but in recent years it has been considered necessary to find a new approach for achieving changes. In our organisations, CP is becoming more and more complex, making it essential to understand how it works. In our own professional practice, we are required to work as researchers and in this role we should take the following assumptions as starting points: research in organisations should be collaborative; participants should be researchers of their practice; and research should be a key tool for improving quality.[14, 15]
Action research[16] is an ongoing, holistic and egalitarian process involving researchers and practitioners, a process through which professionals decide and carry out changes in their practice and which needs to be experienced and reflected upon to be able to improve and change practice. This research method has been considered as a way of introducing evidence in CP. In fact, a review in 2009 found 21 studies that sought to implement evidence-based practice through action research,[17] assessing its effects on the professional's knowledge and performance, and patient and contextual outcomes. This review indicates that the implementation of EBCP using action research may be promising; in all the studies included, positive results have been reported for one or more of the outcome measures and action research would therefore seem to be a useful way of bridging the gap between research and practice.[17] The assessment of patient outcomes is the least reported outcome measure in the literature.[17] This is another relevant aspect in our overall project, although the evaluation of the impact of the action taken goes beyond the scope of this article.
Currently, we are carrying out participatory action research (PAR) to implement evidence related to an onco-haematology nursing unit in a tertiary level general university hospital in Spain. The findings of the present article are part of the process of change in CP and the investigation into the nature of change itself in a European and oncological CP context which has not been researched very extensively in the past. Accordingly, the following research objectives have been proposed: to implement evidence in a nursing unit; to describe in detail the changes and strategies considered by the actors involved; and to gain a better understanding of the experience of change within PAR.
Another factor making this research more relevant is that unlike the articles included in the aforementioned review,[17] the current study presents aspects of the four typologies of user participation:[18] our process of change encompasses experimental aspects (more researcher focused), organisational contexts (more system focused) and, to a lesser degree, professionalising and empowering typologies (more user/practitioner focused).
In this way, the present article will be useful for the following: (i) researchers who are interested in demonstrating how PAR can lead to the implementation of evidence in CP; (ii) healthcare managers who are committed to strengthening the professional groups they manage; and (iii) clinics due to the clear improvement in their CP.
A PAR study design was adopted from a qualitative methodological approach. Participatory researchers use methods based on democratic, cooperative, transparent and efficient ways of investigating and intervening in daily life, trying to reveal the complexity of problems through dialogue and collaboration.[16] We decided to frame the investigation within the constructivist paradigm rather than more frequently socio-critical one because the research team understands that reality only exists in the shape of multiple mental and social constructions, which fits in with the learning paradigm. What we were attempting to do was to understand the experience of change within PAR to modify nursing practice and recognise how PAR could bring about this change.[19]
Checkland's 'Soft Systems' Methodology[20] was adopted as the methodological guide for the study for the importance of learning to this methodology (key element for the constructivist paradigm). At the same time, this methodology was chosen because we were aware that there are problems in nursing practice that depend on 'system' dysfunctions, assuming the 'system' is a nursing unit, a hospital, etc. In order to change practice, we needed to carry out pragmatic and functionalist action, looking to change certain elements in this system. One of the great strengths of Checkland's methodology is its adaptability to the context; in our case, the methodology was widened adding a final reflection stage to close the cycle: (i) detection and expression of the problematic situation; (ii) delimitation of implied systems; (iii) desirable modelling of the systems; (iv) comparison of the desirable model and the problematic situation; (v) conceptualisation of what is desirable and feasible; (vi) putting in place of proposed strategies and observation; and (vii) reflection about the change.
Moreover, there are many ways of using PAR, giving it a technical, practical or emancipatory focus.[21] The fundamental criterion for this classification is based on the researcher's role. In the present study, it was decided to opt for a practical type of investigation in which the expert (main researcher) initiates the PAR and is able to facilitate and organise the process. Self-understanding and responsibility in practice was encouraged; as a result, the participants became co-researchers empowered to take decisions and change aspects of the research process, everyone's opinion was taken into account and decisions were taken through a democratic process.
Study setting
The study was carried out in the isolation unit section for onco-haematological patients in a tertiary level general university hospital in Spain in 2007. This unit was chosen because of its more stable nursing staff. There was a nurse–patient ratio of 4:1, and the nurses were young and enthusiastic about learning although they had little research experience. In Table 1, information can be seen about the patient and nursing characteristics, which will help to contextualise the setting where the PAR is taking place. In the same way, in this unit, the research culture was very prevalent among doctors but limited among nurses: nursing protocols were not up to date and the basic EBCP criteria had not been used for their elaboration. However, the management team of the unit and the hospital were very committed to the project (members of the research team). The project was approved by the Hospital's Clinical Research Ethics Committee.
|31.3 ± 8.1†
|Professional experience
|6.0 ± 5.4†
|Professional experience in oncology
|3.0 ± 3.5†
|Previous knowledge of evidence-based clinical practice
|45.9 ± 15.8†
|Hospital stay (days)
|30.8 ± 12.9†
|Bone marrow transplant
Study participants
The unit had 40 nurses on the staff. They carried out seven project presentation sessions to recruit participants (covering all the work shifts) with the aim of explaining the objectives and the study design and inviting the nurses to participate voluntarily. Using this purposive sampling procedure, 14 nurses came to the first group meeting but, after the second meeting, the PAR team consisted of 6 nurses. These losses were due to the inability of the nurses to be involved in all the activities, which are part of the process of change requiring a considerable amount of dedication and personal time.
The group consisted of relatively young nurses (mean age of 32 years), each having less than 10-year professional experience and most group members did not have family responsibilities. All six members of the group were highly motivated and committed to the organisation of the unit. One of the participants was a master's degree student and most had very basic knowledge of EBCP. The unit managers were the members of the research team who were made responsible for data collection through observation and who facilitated the field work into the unit. Although the work environment was not measured, there were no coercion or power struggles between the nurses and unit managers given that there was a good personal and working relationship beforehand, which prevented these conflictive situations from occurring. This good working relationship was crucial for the optimal development of PAR given that power relationships can arise when unit managers and nurses participate in this type of research.
In addition, the main researcher from outside the unit acted as an expert guiding the PAR group through the research. To do this, the main researcher was available to answer any questions of the participants by phone or email.
Throughout the study, just as with all PAR, the researcher and participants played an organisational, supportive and methodological role.
Data collection
Different data collection techniques were used throughout the stages of the Checkland model: group interviews, participant reflections written in their personal diaries and participant observation by researchers (Fig. 1).
Initially, three group meetings were planned, but in the end the PAR group democratically decided to meet on five occasions. In all the meetings, an interview guide (to reflect on the CP problems and their solutions) was used and interviews were tape recorded and transcribed verbatim in their entirety. The identity of the moderator or the facilitator could have inhibited access to and/or participation in the group; therefore, the meetings were moderated by the main researcher who was outside the unit. After each group meeting, the moderator and the observer did a first provisional audit of the recorded data to obtain possible clues to guide subsequent meetings.
At the same time, the participants used a personal diary to register notes and reflections about what had been said and done, their reaction, their progress, etc. Then, in the group meetings, the participants voluntarily shared their notes that served as a tool for collective reflection. The participating nurses became co-researchers with this data collection and reflection/analysis.
In addition, the participant observation technique was carried out by two members of the research team who worked in the same unit. During their day shift, these investigators literally took notes in an open way, providing descriptions of the events, the people and their interactions. They were crucial for obtaining this kind of information between the ward team, which warned that it would be observed.
Finally, many reflections were made in the main researcher field diary that served as a reflexive audit throughout the process.
In total, there were five group meetings each of 2-h duration, 75 personal diary notes and 55 observation notes.
Data analysis
A preliminary analysis was carried out, by the main researcher, after each group meeting in order to summarise findings, interpretations and observations about the dynamics of the meeting that helped to establish codification schemes for structuring the later analysis.
Data analysis was carried out using content analysis, both on a semantic level (the meaning of words and the analysis of categories either designed a priori or emerging during the process) and on a pragmatic level (circumstances in which the research occurs). The data were repeatedly coded; the categorisation process was profiled with the help of memos and analytical reports to build each model component with the help of the ATLAS.ti v.6A program (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). The transcripts were revised and work was carried out on codification, subcategorisation, categorisation and the relationship between categories of the verbatim of group discussions, personal diaries, field diary and observation notes with the aim of elaborating explanations that 'made sense' of the texts.[22]
During the first phase of analysis, codification was carried out between two researchers, and afterwards there was a counter-codification of the relationships between the codes and the explicative model. Finally, feedback from the participants was achieved by requesting that they collaborate and verify the final analysis.
Rigor and ethical considerations
The methodological rigor criteria included credibility, confirmability, dependence, transferability[23] and reflexivity.[24] The data were compared and contrasted on several occasions by different members of the research team. To achieve the confirmability and credibility criteria, the following procedures were used: the participants contrasted the summary of findings and triangulation (of techniques, researchers and sources). In order to provide clues about the replicability of findings (dependence), the roles of the participants were made explicit and the contexts were explained. An attempt was made to make a rich and detailed description looking for maximum transparency and transferability in handling the data. Finally, the main researcher carried out a reflection process about all the decisions taken throughout the research process, her relationship with the participants and how their concerns and interests influenced the study.
The project was approved by the Hospital's Clinical Research Ethics Committee and all participants took part in a voluntary way, giving their signed informed consent, and were able to withdraw from the study at any time. The anonymity of participants is protected: the participants were assigned with an identifying code number to be used for tape and transcript identification and the unit managers were not present in the meetings to prevent coercion. The transcripts do not contain any information that could identify the participants.
The findings presented are addressed to show the process of change in CP and to gain a better understanding of the experience of change within a PAR group. During the whole PAR process, the reflections made by participating nurses have been a powerful way to explore the gap between personal and professional experience in practice. In addition, they have led to the best possible action for their context.
Guided by Checkland's model, we have shown how the world of 'thought' and 'action' are joined together to implement evidence in nursing practice in the unit (Fig. 1).
Phase 1: detection of the problematic situation and expression of the problem
By exposing the participants to statistics, videos, data of evaluations about their unit[25] and a battery of open questions, a situation of enormous variability in CP emerged and there were also repercussions for the quality of care and the healthcare results of the patients. The group identified a lack of the use of evidence in CP as being their own problem.
- Nurse
Already before the first meeting you find differences in the way everybody works and it's happening now more than ever (after the meeting) I have found differences between the units, dealing with the same patients- there is great variation in the way we deal with the same cases.
- Nurse
… you don't know if what you are using is the result of the research or word of mouth and you start to consider 'Why do I do it this way, why don't I do it a different way?'; some practice is partly based on evidence, however in other cases practice comes from an opinion.
Phase 2: demarcation of the involved systems
Different factors such as a training deficit and limited institutional support and resources were identified as the cause of the lack of the use of evidence.
- Nurse
Another problem that can arise, is that we really don't know how to critically read a scientific paper and so on many occasions we see an article which seems to be 'ok' but if you start to analyze it in greater depth it is very biased, and we probably need some training for critically reading both qualitative and quantitative scientific papers to know if we can use them in practice or not.
- Nurse
When they (the managers) make resources available for you, people change and people adapt; when they (the managers) make things more difficult … well, how are you going to adapt? {…} if the managers don't provide you with more personnel or resources or motivation, people can't be bothered in the end.
On occasions, they are sceptical and believe that the evidence obtained from daily experience is enough for CP. However, at the same time, the participants are critical of nurses' collegues and social values such as the lack of commitment, motivation and conformism of the professionals. Attempting to change established practices could be potentially criticised by the other colleagues and changes in CP might therefore be discouraged.
- Nurse
Personally, I don't like transparent dressings, and this is based on 'my evidence'.
- Nurse
When you are new in a unit … you do what others tell you to do, those who have been there longer. I don't stop to think if it's good or not … they tell me to do it, I do it and that's the end of it.
- Diary
I believe that it is very important (in order to apply EBCP in CP) that the research, 'the world of the unknown', becomes an accessible field, known and necessary. {…} Basically what exists is 'the fear of the unknown', a barrier that stops us from enriching our knowledge. In the first meeting we reached the conclusion that we work according to our experience, I think this is a mistake. To carry out our daily practice we should be guided by the experiences (hundreds of them) of expert researchers. In this context, what 'I' have to say is not so important.
Phase 3 and 4: desirable modelling of the systems and comparison of the desirable model with the problematic situation
In these phases, the aim was to conceive a model of desirable practice (the direction in which to go) comparing it with daily practice.
On a day-to-day basis, the complexity of taking decisions impregnates daily CP; the lack of consensus produces insecurity and even sensations of guilt. The participants believe that in an ideal world evidence would be used and it would be possible to standardise practice to work better in teams, improving confidence and professional recognition.
- Diary
I can't understand why it's so difficult to change some things, how long do we have to wait before we replace the antiseptic used for wounds with the one proposed by the evidence? We know what is most effective and done in other hospitals. Are we making fun of our patients?
- Nurse
If we researched more and received more scientific support, they {the physicians} would see that we are not just there to follow their treatment.
- Nurse
It is clear that EBCP is improving! The first thing you are doing is working in a stable and calm way, through studies and with support.
Phase 4 and 5: a comparison between a desirable model and the problematic situation and an assessment of what is desirable and feasible
An attempt was made to reach stages 4 and 5 in the Checkland model by lowering levels of abstraction and being more specific in cases involving the clinical topics studied in the global project (selected because of their importance for the cancer patient): mucositis; pain; anxiety; satisfaction; nutritional evaluation; nauseas and vomiting; pressure ulcers; and problems related to the venous catheter. Participants compared real situations (their daily CP connected with these topics) with ideal ones (evidence about these topics) and considered attainable changes and implementation strategies. With the PAR functioning, the participants were able to acquire knowledge in a reflexive way about their own practices, the situations in which these are carried out and how to modify them. The PAR group had the capacity to self-organise and one great change that led to an improvement in the use of evidence in CP was the revision of the evidence about these clinical topics. This revision was guided by expert researchers (team research members) who played a mentor role (searching and summarising the evidence); after, they edited structured summaries and they formulated proposals for changes to implement evidence and strategies for doing this.[26-28]
The changes proposed were more pragmatic than theoretical given that the PAR group acted as a 'user' of evidence which had already been accepted, synthesised and evaluated by other 'creators' of evidence.[29]
The seven changes in CP involving individual and organisational behavior are shown in Table 2 with the 11 strategies proposed to implement changes. The 11 strategies would be put into place by three groups of actors with different roles: nurses, patients and managers (Fig. 2).
Phase 6: putting into practice the proposed strategies and observation
The implementation of changes started in July 2007 and new practices were added until October 2007. This was a summer period when a lot of temporary staff are employed, making it difficult to inform peers about the research.
Some of the strategies put into effect by the hospital managers took the longest to be introduced because the strategies were very complex or because the managers were only indirectly related to the project.
During this phase of implementing the changes, the participants were leaders in the implementation of the strategies through the dissemination among equals to the rest of the nurses of the unit. In this phase, the participants wrote down reflections in their field diaries. These individual reflections, related to change, were a starting point for group reflection, making it possible to validate as a group those that were more positive and feasible from the point of view of the participants.
Phase 7: reflections on the change
Finally, the fifth meeting dealt with stage 7 of the model and it aimed for participants to reflect on the process. Reflections emerged about the changes, the strategies and how to improve them, the nursing 'subculture' and its importance for introducing changes, attitudes to innovations and the commitment of participants to the study and as healthcare professionals.
The overall research process was attractive for the participants. They have gained confidence in themselves, just as Mme. Curie proposed: 'We stop fearing those things that we learn to understand'. However, they agree about the difficulty in producing changes in CP.
- Diary
I have had a great time taking part in the project, at the beginning I didn't think I was capable, but I know what EBCP is and I am able to explain it to my colleagues.
- Diary
It has been so difficult to want to implement EBCP; what is sure is that when I joined the research group it seemed really interesting to me, as I understood it was about working to improve our own work, this was exciting for me and it encouraged me to continue; {…} but it has been a long road, implementing EBCP in CP has been difficult, in terms of resources, means, time … I think that the effort made by a few people was the only thing that kept us going.
Positive and negative attitudes of the professionals from the unit have been identified among those who are not directly involved in the project which occasionally served as support and motivation for members of the PAR group.
- Nurse
However, in some things, everyone has lent a hand {my colleagues}, and what is more, they looked at us saying 'you are doing it very well!'.
- Observation
I am in the office and a nurse comes in criticizing the lack of unified criteria. I take advantage of the situation and comment that these concerns could help the PAR group; this nurse doesn't pay any attention to me, claiming that there isn't enough time and leaves without saying any more.
These attitudes can be influenced by nurses' feelings of inferiority about their capacity to bring in changes. It appears that nurses need to feel that their proposals for change are supported by other disciplines. The nurses are silencing and underestimating their own work as professionals.
- Nurse
I have sometimes considered that if changes had been made at a higher level {…}, if a physician had come along and said this and that should be done, How would we have acted? Although I think the same situation would have occurred. But, maybe the changes would have happened without being questioned'.
- Observation
I see a physician waiting and reading a poster about the research study we are carrying out; after a nurse from the PAR team approaches her and asks her 'Do you like it?'. The physician says 'yes' and encourages the nurse to continue; the nurse is proud of the interest shown by the medical colleague.
The changes have been evaluated as favourable, especially those involving patients in the decision-taking process. Similarly, the strategies involving 'pairs' were well considered, probably because of the importance of social interaction (formal and informal) as a source of knowledge. One future strategy we considered was the introduction of the figure of the clinical nursing leader as a 'reference for nursing'.
- Nurse
The cards for the dressings are very nice! {…}, because you feel closer to them (the patients). When you go to the foot of their bed at the end of your shift and you ask them about their pain (with the new registry), and you are speaking to them, you are showing interest, they have the feeling that you are there and you are worrying about them; you are not the nurse who just deals with medication, takes their blood pressure, and 'see you later', it is trust, it creates a relationship of trust which is vital for carrying out health care.
- Nurse
People who are experts in clinical matters to whom you ask 'Am I doing this right? What do you think about this? What have you seen? What literature have you found? Or look for something else for me', I get a lot of support from this type of nurse as a clinical reference.
One of the main pitfalls was the language problem. The reading of evidence was mainly in English (a language that is different from that of the participants), leading several professionals to abandon the project and those who remained experienced anxiety.
- Nurse
I have had a fantastic time, where I've suffered most is with the translation of articles, but I've had a good time.
- Observation
Two members of the PAR group ask about the articles and documentation which we are going to provide them with; when they see that they are in English they get very frightened saying 'oh no! What now?'.
Through the project, it has been possible to modify the practice of implementing evidence using PAR. The findings have provided us with a model for generating changes in CP, introducing evidence and finding out the attitudes of professionals towards EBCP. As in other similar research,[17] our results seem to be a useful way of bridging the gap between research and practice. What is more, in this article many aspects have been described in detail: the process of change brought about by PAR; the reason for the changes considered; the strategies for their implementation; and how the process has been experienced, etc., and all of the information is very useful for replicating further studies. In this line, we have learned several key elements in the evidence implementation process in CP settings: the effectiveness of multi-intervention, working with various disciplines and sectors as a whole, and the importance that the initiatives arise from bottom to top. Also, the process of change was conveyed using Checkland's 'Soft Systems' Methodology, demonstrating its utility in the healthcare sector not only for generating knowledge but also changes.[20]
The key to success is based on the self-generation of practical knowledge from the reflections made by the PAR group. The fact that it is the same group that detects the lack of the use of evidence in their CP, the effect of this on patients and the possible reasons for the gap between research and practice facilitated the stimulus needed to change their practice. The depth of knowledge of their daily CP was vital for choosing adequate strategies for change. In fact, coinciding with other authors,[30] the greatest problems for change implementation were due to organisational factors (vacation period and strategies put into practice by the managers and not by members of the PAR group). The great strength of the process of change in this research is that it came about from bottom to top (from a group of care nurses), also counting on the formal leaders (the unit managers were members of the research team). This situation was experienced as yet another advantage rather than a difficulty unlike in other studies.[31]
The key elements for the successful implementation coincide with previous research: the nature of the evidence, the context and the facilitating elements.[6] Also, our findings, about the attitudes of professionals towards EBCP, coincide with those of the literature and it is notable that experiential knowledge (the practice itself) together with social interaction is an important source of knowledge.[11] In addition, the factors identified that impede the use of results of research in CP (training, values, abilities, accessibility and institutional support) coincide with barriers identified in other studies.[12, 13] Specifically, in Spain, the language problem has been identified as an important barrier. In this respect, a special mention should be made of institutions such as The Spanish Collaboration Center of The Joanna Briggs Institute for Evidence-Based Nursing[32] and The Cochrane Library Plus for the work they have carried out in translating evidence into Spanish, thereby reducing the language barrier.
These findings raise new questions about future research. Firstly, they open up new professional and research areas that make the role of Clinical Nursing Leader much more relevant[33] as a figure of reference for the management of knowledge in the nursing units, which has spontaneously come about from the reflections made by the PAR group. Secondly, the real repercussions of change need to be evaluated, opening new lines of research into the effectiveness of the implementation of EBCP in the quality of daily healthcare practice in terms of healthcare outcomes in patients. Thirdly, we should explore the finding that through a process of group reflection it is possible to reach evidence implementation strategies that have already proved to be effective in previous systematic reviews, such as summaries of evidence, reminders, active multi-intervention and expert nurses.[7-9] Finally, we should study in more depth the knowledge used by the nurses in the PAR group analysing them according to patterns of scientific, esthetic, ethical, personal[34] or sociopolitical knowledge[35] or that described as 'emancipatory knowledge'.[36]
We should be aware of the limitations of this present research study given the qualitative nature of the study. Generalisations about the results cannot be made, but we should extend them to similar situations and contexts. However, it seems that the contextual factors of the unit are very similar to the many practice settings because the same barriers and facilitators have been detected. What is more, the participant sample was self-selected, the changes might not have been put into practice by most of the nurses of the unit and the final group of participants in the PAR was small. These losses could have been due to the fact that the PAR involved a great amount of personal effort (meetings, translations, training, etc., outside their normal timetable). However, there is also a possibility that the group was too large and difficult to motivate at the beginning. The temporary staff employed in the period of the study may be a limitation to the diffusion of changes. Finally, one of the major limitations of the PAR is that, with the passage of time, the unit misses achieved changes; currently, our research team is concluding an investigation along this line.
In spite of these limitations and that the research design does not allow or establish a causal relationship between reflection and change, we believe that PAR has been useful for introducing evidence in complex settings such as that of healthcare as stated by other authors.[17, 37]
This study has served to modify nursing practice based on evidence, throwing light on the processes of change in the healthcare sector and potentially improving healthcare results in patients. In our local context, researchers, managers and healthcare workers should take this method into account when their main aims are to improve our knowledge and to change and to evaluate CP.
We acknowledge the work of the participants of the PAR group for their dedication, enthusiasm and persistence.
Thanks also to Antonio Paredes Sidrach de Cardona for their general support. We would also like to thank Nicholas Jarvis for his collaboration in translation work.
- 1The state of the art and science of evidence-based nursing in UK and Europe. Worldviews Evid Based Nurs 2004; 1: 6–8..
- 2Evidence-Based Nursing. A Guide to Clinical Practice. St. Louis, MO: Elsevier Mosby, 2005., , .
- 3Evidence-based clinical practice. J Nurs Adm 1999; 29: 15–21., .
- 4A model for change to evidence-based practice. Image J Nurs Sch 1999; 31: 317–322., .
- 5Evidence-based pressure-ulcer practice: the Ottawa model of research use. Can J Nurs Res 1999; 31: 37–52., , , , .
- 6An exploration or the factors that influence the implementation of evidence into practice. J Clin Nurs 2004; 13: 913–924., , , , , .
- 7Guidelines in professions allied to medicine. Cochrane Database Syst Rev 2000; (2): CD000349., , , , , .
- 8Changing provider behaviour: an overview of systematic reviews of interventions to promote implementation of research findings by healthcare professionals. In: Haines A , Donald A , eds. Getting Research Findings into Practice, 2nd edn. London: BMJ, 2002; 29–67., , et al.
- 9Interventions aimed at increasing research use in nursing: a systematic review. Implement Sci 2006; 2: 15., , , , .
- 10What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ 2004; 329: 1017., .
- 11Sources of practice knowledge among nurses. Qual Health Res 2005; 15: 460–476., , et al.
- 12Research-active nurses' perceptions of the barriers to undertaking research in practice. J Res Nurs 2002; 7: 363–375., .
- 13Barreras para la utilización de la investigación. Estudio descriptivo en profesionales de enfermería de la práctica clínica y en investigadores activos (Barriers to the utilization of research. A descriptive study of clinical nurses and nurses with experience as researchers). Enferm Clin 2010; 20: 153–164., , , .
- 14La investigación acción y el cambio organizacional (Action research and organizational change: training strategies for organizational change). In: Joaquín Gairín y Carme Armengol , ed. Estrategias de formación para el cambio organizacional. Barcelona: EDO, 2003; 389–403..
- 15Participatory health research. Nurs Inq 2010; 17: 281..
- 16Enhancing nursing health promotion through cooperative inquiry. In: Young LE , Hayes V , eds. Transforming Health Promotion Practice. Concepts, Issues, and Applications. Philadelphia, PA: F.A. Davis Company, 2002; 180–206., .
- 17Implementation of evidence-based practice in nursing using action research: a review. Worldviews Evid Based Nurs 2010; 7: 135–157., , , , .
- 18Action Research for Health and Social Care: A Guide to Practice. Buckingham: Open University Press, 1995., .
- 19Co-Operative Inquiry. Research into the Human Condition. London: Sage, 1996..
- 20Systems Thinking, Systems Practice. Chichester: John Wiley and Sons, 1981..
- 21Critical realism as emancipatory action: the case for realistic evaluation in practice development. Nurs Philos 2006; 7: 45–57., .
- 22Asuntos críticos en los métodos de investigación cualitativa (Critical Issues in Qualitative Research Methods). Alicante: Servicio de Publicaciones de la Universidad de Alicante, 2005..
- 23Naturalistic Inquiry. New York: Sage, 1985., .
- 24Outing the researcher: the provenance, process, and practice of reflexivity. Qual Health Res 2002; 12: 531–545..
- 25Estudio descriptivo sobre resultados de salud de pacientes oncohematológicos e intervenciones enfermeras (A descriptive study of nurse sensitive outcomes in oncohematological patients and nursing interventions). Enferm Clin 2009; 19: 184–190., , et al.
- 26Recuperando evidencias en pacientes oncohematológicos (1a parte): mucositis, dolor y satisfacción (Finding evidence about oncohematological patients (1st part): mucositis, pain and satisfaction). NURE Invest 2008. Available from: http://www.fuden.es/FICHEROS_ADMINISTRADOR/ORIGINAL/origrecmuc37.pdf, , , , .
- 27Recuperando evidencias en pacientes oncohematológicos (2a parte): infección por catéter venoso y úlceras por presión (Finding evidence about oncohematological patients (2nd part): catheter-related infection and pressure ulcers). NURE Invest 2009. Available from: http://www.fuden.es/FICHEROS_ADMINISTRADOR/ORIGINAL/recevicatulc_39632012152844.pdf, , , , , .
- 28Recuperando evidencias en pacientes oncohematológicos (3° parte): valoración nutricional, nauseas y vómitos (Finding evidences on oncohematological patientes (3rd part): nutrition assessment, nauseas and vomiting). NURE Invest 2009. Available from: http://www.fuden.es/FICHEROS_ADMINISTRADOR/ORIGINAL/origevidonctres41106200914248632012163930.pdf, , et al.
- 29Physicians answer more clinical questions and change clinical decisions more often with synthesized evidence: a randomized trial in primary care. Ann Fam Med 2005; 3: 507–513., , .
- 30Nursing as a means of governmentality. J Adv Nurs 2002; 38: 557–565., .
- 31La modificación de la práctica enfermera a través de la reflexión: una investigación acción participativa (The modification of nursing practice through reflection: participatory action research). Enferm Intensiva 2001; 12: 110–126., , et al.
- 32Editorial: improvement science: getting the evidence into practice. Int J Evid Based Healthc 2010; 8: 109..
- 33Initiating and Sustaining the Clinical Nurse Leader Role. A Practical Guide. London: Jones and Bartlett Publishers, 2010., .
- 34Fundamental patterns of knowing in nursing. ANS Adv Nurs Sci 1978; 1: 13–24..
- 35Integrated Theory and Knowledge Development in Nursing. St Louis, MO: Mosby, 2007., .
- 36Patterns of knowing: review, critique and update. ANS Adv Nurs Sci 1995; 17: 73–86..
- 37Development of nurses' abilities to reflect on how to create good caring relationships with patients in palliative care: an action research approach. Nurs Inq 2011; 18: 111–122., , , .


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Star Tracks
Miller and daughter Marlowe enjoy a girls' day out in N.Y.C. Plus: Selena Gomez, Gerard Butler, Mark Wahlberg and more
Credit: Fernando Allende/Milton Ventura/BroadImage
Published: Wednesday Mar 20, 2013 | 05:00 PM EDT
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Buoyant milk market predicted
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A shrinking world milk supply may see international commodity prices leap in the first half of next year, but the spur may come too late to put a smile back on dairy farmers' faces this season, Rabobank says.
Just a day after warnings that a big dip in Fonterra's final 2012 milk payout means tight cashflows for farmers and belt-tightening for the economy, the global agribusiness bank is predicting a return to milk scarcity in the next 12 months, which it says could push up international prices sharply.
A global milk glut in 2012 and the $1 billion impact of the strong New Zealand dollar on Fonterra's annual earnings to July 31 saw the final payout fall this week by $1.52 a kilogram on 2011's final payout, shaving about $183,000 off the average production farmer's annual paypacket.
Senior dairy analyst Hayley Moynihan said the tightening milk supply predicted for the 2013 season was largely the result of low milk prices, extreme feed costs and unfavourable weather in other milk-producing nations.
However, any consequent international price improvement would likely not come until next year, which could be too late to significantly boost Fonterra's 2012-2013 milk payout, currently forecast to be $5.25 per kilogram of milksolids - 13 per cent under the 2012 season's closing payout. Fonterra makes up 90 per cent of the New Zealand dairy industry.
"It may make some difference in the latter stages [of the 2012-2013 season], but will have a bigger impact in the 2013-2014 season," she said.
The price turnaround could be "quite sharp".
World dairy-market eyes are now on the success or otherwise of New Zealand's peak milk production period, or "flush", in October, she said.
The shape of the New Zealand flush would determine the direction of the world market before Christmas.
"The key driver will be scarcity. But it is not going to hit the markets until after the New Zealand flush and if anything disrupts that flush it could speed up the price [change]."
Moynihan said falling milk output in the United States and Europe had already driven up local wholesale prices in the third quarter.
"Assuming a steady rise in demand for imported product, prices will . . . need to rise substantially to achieve the required demand rationing to balance the international market."
This would likely send prices towards the higher end of Rabobank's target medium-term trading range of US$3300 ($3992) to US$3800 per tonne for wholemilk powder in Oceania trade in the first half of 2013. Fairfax NZ
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Triveni Digital will showcase its enhanced GuideBuilder NRT (non-real time) metadata platform at the 2011 NAB Show.
The GuideBuilder system, now featuring mobile service support with electronic service guide (ESG) functionality for program content as well as interstitials and channel logos, offers broadcasters a unified solution for metadata and data management for PSIP, mobile ESG and NRT services.
Engineered in accordance with the new ATSC Mobile DTV A/153 Part 4 standard, which was developed under the leadership of Triveni Digital's CTO, Richard Chernock, the GuideBuilder's mobile capabilities ensure up-to-date scheduling and tuning managed through the operator's existing workflow components. Through existing connections, these same workflow components are used for scheduling NRT services and interactive elements of mobile services.
See Triveni Digital at the 2011 NAB Show in Booth SU3202.
Comic-Con: AMC Unveils 'Walking Dead' Season 7 Premiere Date, Trailer
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text:
DEFINITION of 'Clearstream International'
A leading supplier of post-trading services based in Europe, whose core businesses are settlement of market transactions and custody of securities. Clearstream International's primary services are to act as an international central securities depository and as a central securities depository for domestic securities from Germany and Luxembourg. It was formed through the merger of Cedel International and Deutsche Borse Clearing in January 2000, and is presently a wholly owned subsidiary of Deutsche Borse, one of the largest exchanges in the world.
BREAKING DOWN 'Clearstream International'
Clearstream has developed an especially strong position in the international fixed income market, handling the clearing and settlement of Eurobonds. It has about 2,500 customers in more than 110 countries, based on its capability to serve as a single point of access for the settlement and custody of international bonds and equities across 51 markets. Clearstream settles more than 250,000 transactions daily. The scale of its operations is immense - in 2011, custodial assets exceeded 11 trillion euro and the company processed 26.3 million transactions over the year.
Post-Trade ProcessingAfter a trade is complete, it goes through post-trade processing, ...
Depository Trust & Clearing Corporation ...Established in 1999, the DTCC is a holding company consisting ...
T+1 (T+2,T+3)Abbreviations that refer to the settlement date of security transactions. ...
Settlement PeriodThe period of time between the settlement date and the transaction ...
Depositary ReceiptA negotiable financial instrument issued by a bank to represent ...
Government DepositoryLibraries through the United States and its territories where ...
Depository Trust CompanyThe Depository Trust Company, founded in 1973 and based in New York City, is one of the world's largest securities depositories.
DTCC And Digital Asset Bring Blockchain To ReposThe rising interest in blockchain has attracted none other than the Depository Trust & Clearing Corporation (DTCC), an entity at the core of post-trade market infrastructure to test bitcoin's ...
Inside National Payment SystemsInvestopedia explains: The global interconnection of U.S. payment systems makes commerical and financial transfers possible.
Managing Wealth
What Is The Bank For International Settlements?Get the scoop on the structure and functions of the oldest global financial institution.
How To Trade Foreign StocksWe weigh the major ways to trade foreign stocks for investors.
ETFs & Mutual Funds
4 Ways to Get International Exposure in Your PortfolioInternational investing provides diversification, which is needed these days. When it comes to investing in foreign stocks, there are lots of options.
How The U.S. Government Formulates Monetary PolicyLearn about the tools the Fed uses to influence interest rates and general economic conditions.
Principal Trading and Agency TradingEver wonder what happens behind the scenes when you buy or sell a stock? Read on and find out!
Cautionary Signs For International Investors"Going global" is a fashionable investing style, but investors should know the risks.
Forex Tutorial: What is Forex Trading?What Is Forex?The foreign exchange market is the "place" where currencies are traded. Currencies are important to most people around the world, whether they realize it or not, because currencies ...
How does a depository bank benefit from issuing an ADR for a foreign company for ...For domestic investors the benefits of increasing the portion of their portfolio that they invest in foreign companies is ... Read Answer >>
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What's the difference between primary and secondary capital markets?Learn how in the primary capital market, securities are issued for the first time, while in the secondary market, investors ... Read Answer >>
How do mutual fund trades clear and settle?Learn how mutual fund trades are cleared and settled, and when the money owed must be available or the proceeds due must ... Read Answer >>
What is the average range for the price-to-earnings ratio in the electronics sector?Understand the difference between the primary market and the secondary market, and learn which investors are able to participate ... Read Answer >>


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FORT WORTH (CBSDFW.COM) – It's a boy this time! For the second time this summer, the Fort Worth Zoo is celebrating the birth of a baby elephant.
The zoo made the announcement Thursday morning. Bowie (pronounced boo-ee) was born on August 5 to first-time mom Bluebonnet. Bowie is only the third elephant to be born at the Fort Worth Zoo in its more than 100-year history.
Bowie weighed in at 228 pounds at birth was 39 inches long and 37.5 inches tall. His trunk is 12.6 inches long.
It was just a little more than a month ago on July 7, that the zoo welcomed the second elephant born there – another Asian elephant – who was eventually named Belle. Belle is Bowie's aunt.
The zoo says all of its elephants – Rasha, Belle, Bluebonnet and Bowie – will be on exhibit daily from 10:15 a.m. to noon, and briefly at 1:30, 2:30 and 3:30 p.m.
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ConsoleThe Air-4 has four microphone preamps built in. This allows the use of a host microphone and three guest microphones with the Air-4 without the use of any external mic preamps. The other key features include remote start logic for each fader, dual program busses with balanced outputs and USB connectivity. The console has 12 faders plus a phone fader designed for use with a hybrid. An automatic mix-minus is provided. All audio connections are via RJ-45 connectors to keep your wiring simple and inexpensive. The USB connection is patchable to any input fader, and internally dip-switchable to send from either program email@example.com
Aug. 4, Columbia, Mo.
Aug. 5–15, local chapters
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Byte Sized Lesson in IP/AV: IP Multicasting
Legrand Launches New Website, Absorbs Wattstopper.com
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Sustainability Saturday: Take 20% off 1+ yards of Eco Canvas Fabric Through 11:59 PM EDT July 30th.
Preview scale: 8.0 x 8.0 inches

Change DPI Base size is 150
Collection: a
dots (27566),
modern (12133),
feathers (2918),
quilting (2394),
peacock (1681),
decor (1304)
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amy_g says:
Posted over 2 years ago.
vo_aka_virginiao says:
vo_aka_virginiao uploaded a fabric image for
vo_aka_virginiao's design
I've got the muted peacock feather blues :
su_g says:
This is great! I love those dots - especially the big one pointing out the top of the motif - and the exact placement of the others, this is uniquely different.
vo_aka_virginiao says:
LOL, Kyspy I love your enthusiasm! I can't wait for you to get your free swatch AND see how it inspires you to design something yourself!
kyspy says:
I'm super excited for my free swatch!!!! I can't wait to design my own things!!!
kyspy uploaded a fabric image for
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I've got the muted peacock feather blues :
vo_aka_virginiao says:
Thanks so much Annelie! btw, I LOVE your profile pic!
mrshervi says:
i love this.
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Native Plants
Q. Who is Mr. Smarty Plants?
A: There are those who suspect Wildflower Center volunteers are the culpable and capable culprits. Yet, others think staff members play some, albeit small, role. You can torture us with your plant questions, but we will never reveal the Green Guru's secret identity.
Did you know you can access the Native Plant Information Network with your web-enabled smartphone?
Ask Mr. Smarty Plants is a free service provided by the staff and volunteers at the Lady Bird Johnson Wildflower Center.
rate this answer
Tuesday - November 19, 2013
From: Bastrop, TX
Region: Southwest
Topic: General Botany, Plant Identification
Title: Which one is huajillo and which one is guajillo?
Answered by: Nan Hampton
QUESTION:Recently I attended a field trip to the Leonard Garden at the Kleberg Institute in Kingsville. I took a picture of a tree that was referred to as Tenaza or huajillo. Later I took another photo of a Thornless Catclaw which was referred to a guajillo. They both looked liked acacias to me. According to your database, huajillo is an alternative name for both of these trees. However, guajillo is only attached to the Thornless catclaw. So, I'm confused. Would you please enlighten me? I know, I should use the scientific names, but.. Thanks, Judy
This is the problem with common names. The same common name may refer to one plant in one place or to one person; but, in another place or to another person, it will mean a completely different plant. Here's a "for instance"—in our Native Plant Database try searching for "frostweed". The search results in 8 plants with 8 different species names. The one we know in Central Texas as "frostweed", Verbesina virginica (Frostweed), is not only a different species than the other seven, but it is in a different genus, as well. There are many more examples of one common name used for several different species of plants. That is why it is always best to use the botanical name if you are referring to a particular species of plant.
You have already noticed the confusion between which plant is guajillo, huajillo, or huajilla.
In our Native Plant Database Acacia berlandieri (Guajillo) is also called Berlandier acacia, Thornless Catclaw, Mimosa Catclaw, Round-flowered Catclaw, Huajillla and Matoral. It is in the Genus Acacia, i.e., it is an acacia. USDA Plants Database gives the common name as 'guajillo'. Texas A&M Aggie Horticulture calls it 'guajillo' or 'huajilla'.
In our Native Plant Database Havardia pallens (Tenaza) is also called Huajillo and Ape's ear-ring. Its botanical synonym (what it was formerly known as) is Pithecellobium pallens. You can see more synonyms and more taxonomic information on the USDA ARS-GRIN page. It is in the Genus Havardia so it isn't an acacia; however, it does look a lot like the Acacia berlandieri. The two plants are both in the Family Fabaceae (Pea Family) but the botanical taxonomists have seen a difference in the two that they considered significant enough to separate them into two different genera. USDA Plants Database gives the common name as 'huajillo'. Texas A&M Aggie Horticulture calls it 'guajilla' or 'huajillo'.
In the Manual of the Vascular Plants of Texas by D. S. Correll and M. C. Johnston (1970, Texas Research Foundation), the key separates the two species by this characteristic:
- Acacia berlandieri: "Stamens are free to the top of the floral cup or nearly so". The common name is listed as 'Guajillo'.
- Pithecellobium pallens (or Havardia pallens): "Stamens united above the floral cup forming a tube 2-5 mm. long." The common name is listed as 'Tenaza'.
Obviously, there are other differences. See, for instance, the differences between the two by comparing their characteristics as listed on the Texas A&M Aggie Horticulture pages referred to above.
Just to make things worse, Robert A. Vines in his book, Trees, Shrubs and Wood Vines of the Southwest. (1960, University of Texas Press) says that, as well as Acacia berlandieri, Acacia angustissima (Prairie acacia) is also called 'guajillo' and 'huajilla'; Acacia greggii (Catclaw acacia) is called 'huajilla'; and Havardia pallens (known in his book by the synonym, Pithecellobium pallens) is called 'huajillo' and 'guajilla'.
Guajillo, guajilla, huajillo and huajilla appear to be variations in spelling. I checked several Spanish dictionaries for a translation for any of these words but found none. I tried on the Internet and the only ones I found were for a guajillo (guajilla) chile or a reference to one of the trees/shrubs, usually Acacia berlandieri.
At this point, you may be sorry you ever asked the question. The takeaway is, however, that the assignment of common names to plants (or animals, for that matter) is not controlled; so, you may get several different unrelated plants bearing the same common name—or, one species of plant with several common names. The botanical names are controlled. They do occasionally change but you can usually find the trail of the change and know fairly well what plant you mean by using its botanical name.
More Plant Identification Questions
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June 28, 2012 - A bush w/6" long pencil thin seed pod, leaves 4"x1/2", flower that looks like the flower on the Chitalpa tree. Is there a Chitalpa bush. The one I have I grew from seed from the pod; flat, round ...
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November 13, 2015 - I am not sure if my previous question went thru, so I am submitting it again. How unusual is it to find a few blooming specimens of Spiranthes sp. on a rocky hilltop west of Loop 360 near Bee Caves R...
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26 Incredibly Detailed Nail Art Designs
These guys nailed it. Literally.
1. This elaborate Up–inspired set:
2. Or this more minimal approach:
3. Alice in Wonderland:
4. Harry Potter:
5. Summer-worthy snacks:
6. And desserts:
7. A set of superheroes:
8. Grumpy cat:
9. A romantic meal for two:
10. Before there was Flappy Bird…
11. There was Mario:
12. Andy's toy chest:
13. A salute to Sherlock:
14. Literary art:
15. Always a classic:
16. The Walking Dead:
17. The Disney crowd:
18. Destination? Under the sea:
19. Star Wars:
20. The classic battle of Starbucks…
21. …versus Dunkin' Donuts:
22. The Hunger Games:
23. Take two:
24. Calling all Daleks:
25. An ode to Drunk Uncle:
26. Finally, true devotion:
Preview Your Response
In The News Today
- Hillary Clinton's campaign was reportedly hacked as part of what appears to be a broad cyber attack on Democrats.
- A federal court struck down North Carolina's voting restrictions, ruling they intentionally made it harder for black people to vote.
- Four people in Florida are likely the first to contract the Zika virus from mosquitos in the US, the state's governor says.


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Saratoga County News
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sales jobs near Shrewsbury, MA
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We have an opening for an experienced Municipal Equipment Sales Representative. Someone with the capability to maintain and grow sales within an existing...
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This position will be career path to sales management for the right candidate. The position is home based but will require attending a weekly sales meeting in...
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Due to growth, we have an opening for a highly motivated Territory Sales Representative to join our All Star Sales Team headquartered in Holliston, MA....
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text:
Left parties merger a 'political duty': CPI leader
Coimbatore: Welcoming CPI-M politburo member
Sitaram Yechury`s remarks about possible merger of the two
Left parties, Tamil Nadu unit CPI Secretary D Pandian on Tuesday
said the merger was a "political duty".
"Merger of CPI and CPI-M was a political duty of national
significance and necessity and also compulsion of time," he
told reporters here.
The merger process should be accelerated and completed
before the All India Conferences of the two Left parties
scheduled in March 2012, he said.
Yechury yesterday spoke of a possible merger of CPI and
CPI-M hoping the two Left parties can come together in the
near future after their split nearly five decades ago, but
said no time-frame could be given for the completion of the
Pandian said there were no major ideological differences
between CPI and CPI-M, which came into being in 1964 after
some leaders broke away from the parent party.
A united Communist Party would be able to fight for
people`s causes, particularly in the prevailing situation of
corruption and scams, he said.
Welcoming the implementation of seven electoral promises
of AIADMK by Chief Minister Jayalalithaa, Pandian said the
government should expedite the nationalisation of Cable TV
network in the state.
He also lauded the resolution passed in the Assembly
seeking economic sanctions against Sri Lanka.
He said the state government should take steps to retrieve
lands encroached by grabbers and reinvestigate cases relating
to death of three employees of Tamil daily Dinakaran in
Madurai and police-lawyers clash in Madras High Court campus
and bring the culprits to book.
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text:
Back at the Barnyard 2007 | TV Show Watchlist
Season 1, Episode 4 Saving Mrs. Beady; The Farmer Takes a Woman
First Aired: October 21, 2007
Mrs. Beady is committed to a mental institution, and the animals try to free her after hearing horror stories of what happens in the facility. Later, the animals find a date for the farmer online, but they discover she is only interested in him for his money.
Cast & Details See all »
- Premiered: September 29, 2007
- Rating: TV-Y7
- Premise: Following the computer-animated adventures of fun-loving farm animals led by Otis the cow, a real party animal, and his friends Bessy the bovine, Pip the mouse, Freddy the ferret, Peck the accident-prone rooster, and the dim but loyal Pig. Based on the 200… (more)
Trending TonightSee all »
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Watch This
Who Said It: Taylor Swift or Meredith Grey?
Back at the Barnyard: Cowman - The Uddered Avenger
By NickelodeonBuy New: $7.59
Popular Shows
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text:
Ressurrect Project Pay 2 Play (PP2P)
This petition has been formed to target specific RSC players who find the idea of RSCE being the only Runescape Classic Private Server available(Excluding small under-funded Servers). I feel that RSC is dying BECAUSE we players feel trapped, Or FORCED even, Into playing the only server we are sick of. If you are banned on RSCE, Where will you go? How will you play RSC?
I URGE YOU TO SIGN THIS PETITION, WHICH WILL BE SUBMITTED TO MATT(the owner of PP2P), Once it reaches a significant length, It just may be enough to bring back a great server that should have never left!
All we will need to do Is stick together! BRING BACK PP2P!!!!!
Is there a cause you really care about? Start a free petition like this one and make a real difference.
6 years agovsl Sweden6 years ago
6 years agoErik United States6 years ago
6 years agochoobpkinpmp United States6 years ago


text:
Star Tracks
Wentz takes his son Bronx for a stroll near their Beverly Hills home. Plus: George Clooney, Willow Smith and more
Credit: Alpha/Landov
Published: Tuesday Mar 22, 2011 | 05:00 PM EDT
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text:
Learn more
Mangoes and Curry Leaves: Culinary Travels Through the Great Subcontinent Hardcover – Nov 15 2005
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From Publishers Weekly
Starred Review. With their most recent cookbook, Home Baking, the authors of Seductions of Rice and Hot Sour Salty Sweet strayed slightly from the kind of pungent Asian food that is their strength, but they're back on track with this paean to the subcontinent, which they've been visiting separately and together since the 1970s. The many dals, like soupy Easy Karnataka Chana with chickpeas and salads like Nepali Green Bean-Sesame Salad are simple and terrific. Entrees are often spicy and always authentic, like Goan Pork Vindaloo, made by rubbing a vinegar-spice paste into the meat. A chapter on street foods is full of promising tidbits, including the suggestion that readers make fried foods such as Mushroom Pakoras with Fresh Herb Chutney for guests (so long as they don't mind spending a whole lot of time in the kitchen). Reading Alford and Duguid's chatty text and headnotes is like receiving envy-inducing postcards from a college friend who never gave up backpacking—if you have the sort of friends who would be disposed to build a tandoor oven out of clay and manure or visit Arugam Bay in Sri Lanka based on a tip from a snake-bitten fellow traveler. This is a comprehensive book filled with compelling writing—a worthy addition to the couple's impressive body of work. Color and b&w photos. (On sale Nov. 20)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an alternate Hardcover edition.
"Random House Canada continues its impressive cookbook program with another lavish volume from world travelers Jeffrey Alford and Naomi Duguid."
–Quill and Quire
"What is left to say about the astonishing husband-and-wife team Jeffrey Alford and Naomi Duguid?...This wonderful coffee table book is the result of multiple trips over three decades to the Indian subcontinent…Alford and Duguid have gathered a breathtaking range of recipes…The book's gorgeous design is filled out with the authors' own luminous travel photos…Mangoes and Curry Leaves is so fascinating it renders one virtually speechless."
–Quill and Quire
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Jeffrey AlfordCDN$ 53.69
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Overall this book rates an average for me. All recipes instructions are easy to follow. This book is recommended for people who would like to show respect to the cultural... Read morePublished on April 1 2009 by Taranjit S. Hara
Have cooked a number of recipes out of the book already and they were easy and fun to make and a real pleasure for the senses. Can't wait to try the next recipe.Published on March 4 2009 by E. Fehr
Mangoes and Curry Leaves: Culinary Travels Through the Great Subcontinent
This is an excellent collection of culture, food and pictorial insights of the "Great Subcontinent. Read more


text:
Translation of "residence" - English-Arabic dictionary
(Translation of "residence" from the Cambridge English-Arabic Dictionary © Cambridge University Press)
Get a quick, free translation!
Create and share your own word lists and quizzes for free!
More translations of "residence" in Arabic
Word of the Day
a delicate, soft type of cloth made from a thread produced by silkworms, or the thread itself
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text:
Anybody did compile Farseer Physics Engine 3.0 with XNA 4 ?
We started with Q&A. Technical documentation is next, and we need your help.
Whether you're a beginner or an experienced developer, you can contribute.
Read the release page:
You can download the latest source from http://farseerphysics.codeplex.com/SourceControl/list/changesets - although it may not be as nicely packaged as the release. It also may not be as stable.
Of course - I imagine that you probably can use Farseer 3.0 on XNA 4.0, because as far as I know there are no breaking changes in the maths-related classes between XNA 3.1 and XNA 4.0. You just won't be able to compile the demos (unless you fiddle with them).
Andrew is correct. Everything is upgraded in the latest source, however only the rendering part of the samples and testbed need to be modified for the release version to work in 4.0. The engine itself has to dependencies on any specific version of Xna and even includes a Vanilla version for use without Xna.


text:
Panchayat poll candidate caught distributing fake currency
Morigaon: An independent candidate for the ongoing Panchayat polls in Assam was caught red handed when he was distributing fake currency notes among the voters in south Dharamtul gaon panchayat constituency on Sunday.
Violating the election model code of conduct, Dhushmanta Das was distributing the fake notes in the early hours when he was apprehended, police said.
While he was being taken to Jagiroad police station, his supporters clashed with the security forces, prompting police to lathicharge and fire seven rounds in the air to disperse them, they said.
No injury was reported.
The situation was brought under control and police recovered five fake currencies with a face value of Rs 1,000 and ten fake notes of Rs 500 denomination.
A decision is yet to be taken on Das`s poll fate.
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