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Understanding the decision-making practices used by registered nurses assessing acuity at triage in emergency departments in the UK : a national survey
No full textBackground: International research suggests that triage nurses’ decision-making practices and training experiences vary significantly across emergency departments (EDs). However, there does not appear to be similar research published in the UK. Understanding factors, such as demographics, training and decision-making could provide a picture of triage nurses working in UK EDs, identify the interventions required to improve practice and inform further research.
Aim: To explore the demographics, training experiences and decision-making practices of registered nurses who assess patient acuity at triage in UK EDs.
Method: The study used an online, descriptive, cross-sectional survey design.
Results: A total of 51 triage nurses from across the UK responded to the survey. Most (61) had achieved a bachelor’s degree as their highest qualification, while 3 had postgraduate qualifications. Respondents had a median of seven years since qualifying, six years working in their current ED and five years working in triage and used a range of titles to describe their role. Low staffing and busy ED environments increased respondents’ stress levels, which affected confidence in triage decision-making abilities among less experienced nurses. More experienced respondents coped with their stress by relying on their knowledge and skills. Not all respondents had received triage training, and for those that had, the training varied in type and frequency across EDs. Overall, respondents had low satisfaction with the amount, quality and content of the training they had received.
Conclusion: There is a need for safer staffing levels in EDs and greater support for staff welfare. The development of national standards, incorporating defined knowledge and skills and set time periods for refresher training, is required to enhance triage practice in EDs
Improved measurement of CP violation parameters in Bs0→J/ψK+K− decays in the vicinity of the ϕ(1020) resonance
Get PDFThe decay-time-dependent C P asymmetry in B 0 s → J / ψ ( → μ + μ − ) K + K − decays is measured using proton-proton collision data, corresponding to an integrated luminosity of 6 fb − 1 , collected with the LHCb detector at a center-of-mass energy of 13 TeV. Using a sample of approximately 349 000 B 0 s signal decays with an invariant K + K − mass in the vicinity of the ϕ ( 1020 ) resonance, the C P -violating phase ϕ s is measured, along with the difference in decay widths of the light and heavy mass eigenstates of the B 0 s − ¯ B 0 s system, Δ Γ s , and the difference of the average B 0 s and B 0 meson decay widths, Γ s − Γ d . The values obtained are ϕ s = − 0.039 ± 0.022 ± 0.006 rad , Δ Γ s = 0.0845 ± 0.0044 ± 0.0024 ps − 1 , and Γ s − Γ d = − 0.005 6 + 0.0013 − 0.0015 ± 0.0014 ps − 1 , where the first uncertainty is statistical and the second systematic. These are the most precise single measurements to date and are consistent with expectations based on the Standard Model and with the previous LHCb analyses of this decay. These results are combined with previous independent LHCb measurements. The phase ϕ s is also measured independently for each polarization state of the K + K − system and shows no evidence for polarization dependence
Toward emplacing internationalization in Thai higher education
No full textIn Thailand, the number of Higher Education Institutions (HEIs) offering international programs has surged dramatically. Internationalization is seen as key for competing in the HE market, for modernizing educational programming, and for generating new streams of revenue. Yet, with such rapid change comes disorientation for International Higher Education (IHE) in the Thai context. That said, there is little disagreement on what it is not; it is not Thai. This chapter investigates apparent efforts to ‘de-place’ Thailand from IHE, and considers how these attempts may connect to (post-)colonial tensions between sovereignty and civilization. Through a synthesis of scholarship in the areas of higher education, cultural geography, and Thai Studies, we construct a framework for exploring how IHE is both imagined and experienced in Thailand. In particular, we re-examine datasets from across studies we conducted over recent years with stakeholders including executive leadership, international faculty, and university students. Through a series of narrative portraits, we construct a dialogue of voices that reflect distinct orientations to ‘Thainess’ in IHE. As vigorous as discursive attempts are to uproot HEIs from place, lived experiences are necessarily connected to the physical and conceptual space through local epistemologies. More than that, the effort to minimize, and even denigrate, local context in the pursuit of global relevance is subject to ethical and moral exposure. We argue that a wider and more inclusive orientation to internationalization is not only respectful of local identity, but is enhanced by it. Ultimately, this study hopes to offer a vision of what an ‘emplaced’ idea of IHE in Thailand might look like, one grounded in an orientation unique to a particular place with its own cultural and social coordinates
Competition between phase ordering and phase segregation in the TixNbMoTaW and TixVNbMoTaW refractory high-entropy alloys
Get PDFRefractory high-entropy alloys are under consideration for applications where materials are subjected to high temperatures and levels of radiation, such as in the fusion power sector. However, at present, their scope is limited because they are highly brittle at room temperature. One suggested route to mitigate this issue is by alloying with Ti. In this theoretical study, using a computationally efficient linear-response theory based on density functional theory calculations of the electronic structure of the disordered alloys, we study the nature of atomic short-range order in these multi-component materials, as well as assessing their overall phase stability. Our analysis enables direct inference of phase transitions in addition to the extraction of an atomistic, pairwise model of the internal energy of an alloy suitable for study via, e.g., Monte Carlo simulations. Once Ti is added into either the NbMoTaW or VNbMoTaW system, we find that there is competition between chemical phase ordering and segregation. These results shed light on observed chemical inhomogeneity in experimental samples, as well as providing fundamental insight into the physics of these complex systems
The patterning of interactive organizational identity work
No full textOur study delves into how organizational identity work unfolds during interpersonal interactions among members of an organization. Most existing research focuses on the isolated utterances of individual members or on organizational-level discourse. Analyzing directly the interrelationships between individuals allows us to offer a fresh viewpoint on the concept of “organizational identity work.” Based on a longitudinal case study of an open innovation organization from inception, we reveal multiple patterns of interactive organizational identity work emerging over time. Although Monologue is a one-sided pattern that involves the dominance of a single voice, Polyphony involves episodes of engaged collective conversation about identity issues without clear resolution. In Dialogue, we see interactions around critical issues accumulating towards temporary compromises on identity concerns, whereas the Deadlock pattern arises when compromises appear unattainable, potentially culminating in Rupture, as interactions around identity lead members to dissociate themselves from the organization. We show how the direct and indirect focus on organizational identity issues (i.e., whether identity is the focal topic of conversation, or a consideration brought up in making another decision), as well as the intensity of personal identity engagement among participants (i.e., the degree to which the conversation addresses speakers’ personal identity commitments), may be implicated in the emergence of these patterns. Moreover, we show how the patterns in turn enact multiplicity and singularity in expressions of organizational identity within situated interactions
Mapping community-based youth mental health services in Tasmania, Australia
No full textBackground: Tasmania has the most rurally and remotely dispersed population of young people in Australia with high rates of youth experiencing mental ill health and socioeconomic disadvantage. Standard descriptions of mental healthcare provision are necessary for evidence-informed mental healthcare policy, planning and implementation. This systematic scoping study aimed to: (1) map and describe the characteristics of community-based youth mental health services (including substance-use) for young people in Tasmania, Australia and (2) identify gaps in service accessibility and provision.
Methods: A list of eligible services was developed through a systematic search and consultation with key stakeholders. Data were collected from a representative from each eligible service via an interview or online survey. A standardised framework was used to classify, describe and map services. Thematic analysis was used to analyse service providers' perceived gaps to service access and provision.
Results: Twenty-eight community-based mental health services for youth were identified, predominantly located in the major city of Tasmania's three service regions. Service gaps include the 'missing middle', lack of integrated supports and limited service capacity.
Conclusions: The findings highlight the limited availability, accessibility and capacity of youth mental health services across Tasmania. Recommendations focus on increasing accessibility of rural/regional supports, provision of assertive outreach, psychosocial support, integrated care and strengthening the rural mental health workforce. These findings may inform the (re)design/(re)development of community-based youth mental health services in Tasmania. The findings may also guide evidence-informed mental health service planning, decision-making, development and implementation of integrated models of youth mental health care across Australia
The social construction of sustainable futures : how models and scenarios limit climate mitigation possibilities
Get PDFThis article shines a light on the act of social construction of climate change mitigation as a policy issue at the hands of expert bodies enjoying epistemic power, notably the Intergovernmental Panel on Climate Change (IPCC), using Integrated Assessment Models (IAMs) as key tools. This is crucial to the politics of tackling climate change as IPCC models and scenarios profoundly shape what are seen as viable futures and mitigation policy options. Analysing how technocratic governance bodies broach climate change, its mitigation, and the associated economic costs and implications, reveals contestations within the technocratic politics of climate change. The particular social construction of mitigation as a policy issue through IAMs and IPCC scenarios has important and real socio-ecological consequences. This engagement with the technocratic politics of mitigation problematises five key assumptions that are fed into modelling, and reveals why and how they matter politically. We also highlight ways in which contestable assumptions built into IPCC IAMs undermine their credibility and usefulness for planning mitigation strategies
Effect of timed dosing of usual antihypertensives according to patient chronotype on cardiovascular outcomes : the Chronotype sub-study cohort of the Treatment in Morning versus Evening (TIME) study
No full textBackground
Timing drug administration to endogenous circadian rhythms may enhance treatment efficacy. In the Chronotype sub-study of the Treatment in Morning versus Evening (TIME) clinical trial we examined whether timing of usual antihypertensive medications according to patient chronotype (a behavioural marker of personal circadian rhythm) may influence clinical cardiovascular outcomes.
Methods
This was a cohort sub-study of TIME, a prospective, randomised, open-label, blinded-endpoint, UK clinical trial of morning versus evening dosing of usual antihypertensive medications and cardiovascular outcomes. On August 3rd, 2020, all active TIME participants were invited to complete a validated chronotype questionnaire. Chronotype was quantitatively assessed as the mid sleep time on free days corrected for sleep debt on workdays (MSFsc). We analysed associations between chronotype and antihypertensive dosing time and explored their combined effect on cardiovascular outcomes (a composite endpoint of hospitalisation for non-fatal myocardial infarction (MI) or non-fatal stroke, and single components) using proportional hazard time-to-event models adjusted for baseline covariates. These were used to specifically test for interactions between dosing time and chronotype.
Findings
Between August 3, 2020, and March 31, 2021, 5358 TIME participants completed the online questionnaire. 2778 were previously randomised to morning dosing and 2580 to evening dosing of their usual antihypertensives. Chronotype was symmetrically distributed around a median MSFsc of 3:07 am. The composite endpoint increased for later MSFsc (later chronotype) dosed in the morning but not in those dosed in the evening (hazard ratios 1.46 [95% CI 1.14–1.86] and 0.96 [95% CI 0.70–1.30] per hour of MSFsc, respectively; interaction p = 0.036). Later chronotype was associated with increased risk of hospitalisation for non-fatal MI in the morning dosing group, and reduced risk in the evening dosing group (hazard ratios 1.62 [95% CI 1.18–2.22] and 0.66 [95% CI 0.44–1.00] per hour of MSFsc, respectively; interaction p < 0.001). No interaction between chronotype and antihypertensive dosing time was observed for stroke events.
Interpretation
Alignment of dosing time of usual antihypertensives with personal chronotype could lower the incidence of non-fatal MI compared to a ‘misaligned’ dosing time regimen. Future studies are warranted to establish whether synchronizing administration time of antihypertensive therapy with individual chronotype reduces risk of MI
Nonparametric classification with missing data
No full textWe introduce a new nonparametric framework for classification problems in the presence of missing data. The key aspect of our framework is that the regression function decomposes into an anova-type sum of orthogonal functions, of which some (or even many) may be zero. Working under a general missingness setting, which allows features to be missing not at random, our main goal is to derive the minimax rate for the excess risk in this problem. In addition to the decomposition property, the rate depends on parameters that control the tail behaviour of the marginal feature distributions, the smoothness of the regression function and a margin condition. The ambient data dimension does not appear in the minimax rate, which can therefore be faster than in the classical nonparametric setting. We further propose a new method, called the Hard-thresholding Anova Missing data (HAM) classifier, based on a careful combination of a k-nearest neighbour algorithm and a thresholding step. The HAM classifier attains the minimax rate up to polylogarithmic factors and numerical experiments further illustrate its utility