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    12560 research outputs found

    Nurses’ perception of uncertainty in clinical decision-making:a qualitative study

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    Background: Uncertainty is a common challenge for nurses in clinical decision-making, which can compromise patient care quality and safety. To address this issue, it is essential to understand how nurses perceive and cope with uncertainty in their practice. Aim: This study aimed to explore nurses’ perceptions of uncertainty in clinical decision-making using a qualitative approach. Methods: This study was conducted with a qualitative approach and conventional content analysis in 2020. Participants consisted of 17 nurses from different wards of teaching hospitals in Northwestern Iran, recruited using the purposive sampling method. Data were collected through semi-structured interviews and analyzed simultaneously with data collection (June to December 2020). The data were analyzed using the content analysis approach suggested by Wildemuth. Data were managed with MAXQDA10 software. The analysis revealed four main themes and ten subthemes that described the nurses' experiences of uncertainty in clinical decision-making. Results: The main themes were: difficult choice, difficult situation, insufficient judgment, and emotional burden. Conclusions: The study participants defined uncertainty in clinical decision-making as a difficult choice that occurs in difficult situations, which influenced their clinical judgment and emotional well-being. These findings provide valuable insights for developing interventions to help nurses manage uncertainty and improve their decision-making skills and safety.</p

    Impairment-aware resource allocation scheme for elastic optical networks with different service priorities

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    Today, elastic optical networks (EONs) are required to accommodate traffic with different service priorities. For example, mission-critical applications such as industrial internet, smart grids, and remote surgery require an ultra-reliable low-latency communication system. The novel impairment-aware resource allocation scheme proposed here prioritises traffic. It satisfies the quality and latency requirements of mission-critical traffic while causing minimum disruptions to other forms of low-priority traffic connections. The results obtained for 6-node and 14-node networks under various traffic distribution environments indicate that the proposed algorithm achieves higher spectral efficiency, reduces spectrum fragmentation, and causes minimal disruptions over the benchmark algorithm.</p

    XR immersion for teaching and learning with precise alignment guidance in user perspective

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    User Perspective Learning is an approach that focuses on learning by getting taught from the user's point of view (POV). Activities are generally captured from the user's perspective and compiled into a video that can be viewed on desktop displays, televisions, and mobile devices. Extended Reality (XR) applications and devices have the potential to replace traditional displays in the near future. This technology can provide a very effective way to teach learners with the freedom to view and interact. XR technology is capable of tracking moving practice models and augmenting Computer-Generated Imagery (CGI) in real-time or completely teleport the learners in a digital environment. The advancements in handheld device processing have led to significant improvements in these portable XR technologies over the years. Complex computations can be handled in a fraction of a second by modern multi-core processors. In addition to standalone devices, XR technologies have been adapted to work with mobile devices (i.e., smart phones), making them more accessible. The purpose of this research is to explore the potential of XR for user perspective learning and its impact on immersion. An XR application was developed for the experiment, providing participants with a high degree of freedom to navigate in a virtualized environment (VE). The application allows for both handheld and head-mount viewing, for the users to choose their preference. By tracking the orientation of practice models, participants are guided, and task precision is enhanced. A pilot study was conducted with Games Art and Tech students from the university to evaluate the degree of immersion. To study the immersion levels of XR technology, a statistical analysis was conducted on the collected data.</p

    Tackling hospital service burden of alcohol dependence in England:a service evaluation of alcohol care teams (ACTs) and care pathways for integrated care

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    Background: Chronic alcohol disorder hospital admissions are increasing in England and present a huge cost to England’s health and social care costs. Hospital-based alcohol care teams (ACTs) aim to better meet these patients’ complex needs through assessment and targeted referral. This has the potential to work effectively within England’s newly established integrated care system. Methods: The aim of this project was to identify in what ways ACTs can be effective in improving care pathways for complex care in a whole-system health and social care setting. We conducted semi-structured, tailored interviews with practitioners, managers and commissioners, across three hospital and community settings in one large urban region in England, comparing ACT working with non-ACT working. Results: Effective pathways were enabled by the presence of an ACT, multi-agency community initiatives, assertive alcohol outreach and frequent-attender team meetings. Identified barriers were lack of systemic funding and commissioning, poor communication between agencies, lack of information-sharing and insufficient staff training. Conclusion: Community outreach and in-reach between hospitals and community services enable effective care pathways when ACTs provide the point of contact. A well-resourced ACT with clear operational remit can create links between diverse agencies and enables improved wraparound care for alcohol dependent patients.</p

    Making the case for local strategic coordination?:an investigation of fair access protocols and their role in the reintegration of pupils from alternative provision to mainstream school

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    Fair access protocols (FAPs) are intended to ensure all schools in a local authority (LA) area take collective responsibility for ensuring pupils struggling to access an in-year school place are quickly admitted to a school. Every LA must have a FAP which, once agreed, can be used to direct schools to admit pupils. This is somewhat against the fragmentation of local education systems seen in the academies agenda. This paper considers the role of FAPs in facilitating inclusive local education systems by exploring the reintegration of students from alternative provision (AP) to mainstream school. The data on which this paper draws were collected as part of an England-wide research project which drew on nationally published datasets, administrative data from freedom of information (FOI) requests, and survey data from 64 professionals working in AP. The extent of FAP use varies widely as do rates of reintegration. Likewise, there is both evidence suggesting that FAPs can play a significant role in facilitating strategic coordination, and that they have limited power/influence to ensure reintegration. These findings suggest that achieving inclusive local practice requires a shift towards an underlying logic of cooperation in the education system.</p

    Enhancing game development process using AI: a comparative analysis of image generative AI

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    The gaming industry continually faces the challenge of high costs and extensive time requirements for producing 2D assets. Gaming studies hire and pay high costs to artists to create images for the game which is also time consuming. With the pervasive integration of artificial intelligence across various sectors, the application of AI in game development presents a promising solution to these challenges. This study focuses on the comparison and outcomes of two advanced generative AI tools, DALL-E and Midjourney, to reduce the time and cost associated with the creation of dynamic 2D game assets. The comparison process for both the AI tools involves creation of a Unity based game that integrates DALL-E and Midjourney to generate dynamic game assets which were used in the gameplay to get the user feedback inside the game. The findings reveal that both DALL-E and Midjourney significantly reduce the time and financial barriers traditionally associated with game asset creation, democratizing game development and allowing smaller studios to produce competitive content. DALL-E was found to be highly effective in rapidly transforming textual descriptions into high-quality visual assets, making it superior in terms of speed and cost-efficiency compared to Midjourney. Player feedback indicated a higher level of satisfaction and engagement with DALL-E-generated assets, particularly due to its superior performance in handling prompts and generating contextually relevant images.<br/

    Commuting students before and during COVID-19: academic identity across home and campus spaces

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    Commuting students are believed to lack academic engagement because they do not ‘stick around’ on campus, but narratives of student belonging as tied to campus presence were challenged by emergency remote learning during the COVID-19 pandemic. This paper reports on a longitudinal project on geographical, cultural, and emotional dimensions of students’ practices of learning in an English widening participation university. We use theories of student belonging and mobilities as thinking tools to understand the relationships between students, spaces and learning practices in constructing fluid understandings of academic identity. Between 2016 and 2021, 28 students (17 commuting; 26 undergraduate; six mature; two part-time; 20 white British) were interviewed. Geographical and cultural distance from university, but closeness to family or to the domestic duties of home, affected commuting students’ practices of learning differently before and during emergency remote learning. When distance was enforced, remote learning was not necessarily easier for commuters, who had complex responses to losing social interaction. By rethinking how the benefits of being physically around campus are conceptualised and communicated, and how commuter identity is shaped by continuing interactions across home, digital, travel and campus spaces, we argue that commuting students’ multiple experiences should inform the post-pandemic university

    Spin and silence: royal penance and Carolingian propaganda

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    Since the pioneering work of Mayke de Jong, many historians have studied the political use of penance in the Carolingian empire. This article explores how eighth- and ninth-century texts turned demands for penance and penitential acts by members of the royal family into political propaganda, and changes in such approaches. The earlier Carolingians preferred to remain silent about their own sins, while making limited use of penitential punishment for rivals. Louis the Pious’ more ambitious use of self-confession for Christian exaltation was initially successful, but the rise of rival camps of propagandists led to this confession later being turned against him. By 840, there was a new reluctance by rulers and others to admit culpability, reflected in the rise of the “non-confession confession”, in which penitential tropes were used without any specific personal fault being admitted. Lothar II in the 860s made ingenious attempts to harness penitential discourse to support his divorce and remarriage. His claims show a keen awareness of the possibilities and pitfalls of public confession, but he was finally unable to counter his opponents’ arguments. By the 870s, the development of widespread legal-penitential expertise paradoxically led to a new royal penitential silence, in which no ruler would publicly confess to any offence, however notoriou

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