Uptake of advanced clinical practice roles in the health service in England: perspectives at the micro level

Health care organisations in many countries are developing advanced clinical practitioner roles to address workforce shortages and growing demand for services. Even in countries where advanced practice roles are more established there are low numbers, clustered in a limited range of professions, mostly nursing specialities. Successful implementation of national policies encouraging increased advanced practice roles and from a broader range of professions, requires attention to all levels of the health system. There is a lack of evidence as to the motivation to take-up these roles at the micro, individual actor level. This study explored the motivations important at the micro level in influencing a range of health professionals to undertake advanced practice roles. The study used an interpretive methodology with thematic analysis and was framed by theories of motivational domains in the work environment. Semi-structured interviews were undertaken with eighteen advanced clinical practitioners working in health care organisations in England. The motivators for role take-up were found to be predominantly intrinsic reflecting participants’ desires for advancement, both personal and for their profession, and improved efficiency of patient care. Participants described experiencing limited organisational support and sometimes discouragement from other professionals. There is potential for health organisations at the meso level of health care systems to support national growth of advanced practice roles by giving attention to the motivations of diverse health professionals. We propose a new theoretical framework of motivators for advanced clinical practice role uptake at the micro level

Beam alignment techniques based on the current multiplication effect in photoconductors Third summary technical progress report, 15 Nov. 1966 - 15 Oct. 1967

Beam alignment techniques developed for infrared sensitive single crystal germanium to study multiplication effect in photoconductor

Fine structure and optical pumping of spins in individual semiconductor quantum dots

We review spin properties of semiconductor quantum dots and their effect on optical spectra. Photoluminescence and other types of spectroscopy are used to probe neutral and charged excitons in individual quantum dots with high spectral and spatial resolution. Spectral fine structure and polarization reveal how quantum dot spins interact with each other and with their environment. By taking advantage of the selectivity of optical selection rules and spin relaxation, optical spin pumping of the ground state electron and nuclear spins is achieved. Through such mechanisms, light can be used to process spins for use as a carrier of information

Are advanced clinical practice roles in England’s National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives

Objective: A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers’ and senior clinicians’ perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions. Methods: We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019. Results: Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles. Conclusions: While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in the context requires urgent attention

Non-Gaussian statistics of electrostatic fluctuations of hydration shells

We report the statistics of electric field fluctuations produced by SPC/E water inside a Kihara solute given as a hard-sphere core with a Lennard-Jones layer at its surface. The statistics of electric field fluctuations, obtained from numerical simulations, are studied as a function of the magnitude of a point dipole placed close to the solute-water interface. The free energy surface as a function of the electric field projected on the dipole direction shows a cross-over with the increasing dipole magnitude. While it is a single-well harmonic function at low dipole values, it becomes a double-well surface at intermediate dipole moment magnitudes, transforming to a single-well surface, with a non-zero minimum position, at still higher dipoles. A broad intermediate region where the interfacial waters fluctuate between the two minima is characterized by intense field fluctuations, with non-Gaussian statistics and the variance far exceeding the linear-response expectations. The excited state of the surface water is found to be lifted above the ground state by the energy required to break approximately two hydrogen bonds. This state is pulled down in energy by the external electric field of the solute dipole, making it readily accessible to thermal excitations. The excited state is a localized surface defect in the hydrogen-bond network creating a stress in the nearby network, but otherwise relatively localized in the region closest to the solute dipole

Soil water distribution for subsurface and surface drip irrigation

Devido à falta de estudos sobre o movimento da água quando aplicada abaixo da superfície, realizou-se este trabalho com o objetivo de avaliar a distribuição de água aplicada pelo sistema de gotejamento enterrado e convencional. O experimento de campo foi conduzido na área experimental do Departamento de Engenharia Rural da ESALQ/USP - Piracicaba, SP. Para o estudo, trincheiras foram abertas e instaladas sondas de TDR, dispostas a 0,05; 0,15; 0,25; 0,35 e 0,45 m profundidade, e a 0,05; 0,15; 0,25; 0,35 m comprimento, totalizando 17 sondas por trincheira. Os tratamentos foram baseados na profundidade de aplicação (0,0 e 0,10 m) e vazão aplicada (2 e 4 L h-1): ENT2; ENT4; SUP2 e SUP4. A cada hora era aplicado 1 L de água (total de 10 L), seguida de leituras com o TDR. Medições do disco úmido e saturado foram feitas com régua milimetrada; além disso, estabeleceu-se um volume controle onde foi avaliada a uniformidade de aplicação; assim, foi possível verificar, em relação aos sistemas superficiais, que os sistemas enterrados apresentaram menor área superficial molhada e atingiram maior largura e profundidade; já as maiores concentrações foram obtidas próximas ao ponto de emissão.Studies of sub-surface water movement is an interesting topic in irrigation but, in spite of the its importance, there is little literature. One of the purposes of this study was to contribute to this subject and evaluate the distribution of water applied by both subsurface drip irrigation (SDI) and conventional irrigation. Experiments were conducted at the Department of Rural Engineering (ESALQ/USP), located at Piracicaba, SP. Trenches were opened and 17 three-rod TDR probes were installed, placed at 0.05, 0.15, 0.25, 0.35 and 0.45 m depths, and to 0.05, 0.15, 0.25, 0.35 m intervals. This procedure was repeated using a dripper buried at 0 and 0.10 m for each discharge rate of 2 and 4 L h-1 tested. Wetted soil volume was observed with 1 L of water applications at intervals (total 10 L). The saturated disc around the dripper and the advance of the wetting front on the soil surface were measured with a ruler. Also, a central control volume was established inside the wetted soil volume where the uniformity of application was evaluated. The results suggest that SDI presented smaller wetted soil surface area and it reached larger distance and depth with greater storage of solution adjacent to the dripper

Geoacoustic inversion by mode amplitude perturbation

Author Posting. © Acoustical Society of America, 2008. This article is posted here by permission of Acoustical Society of America for personal use, not for redistribution. The definitive version was published in Journal of the Acoustical Society of America 123 (2008): 667-678, doi:10.1121/1.2821975.This paper introduces a perturbative inversion algorithm for determining sea floor acoustic properties, which uses modal amplitudes as input data. Perturbative inverse methods have been used in the past to estimate bottom acoustic properties in sediments, but up to this point these methods have used only the modal eigenvalues as input data. As with previous perturbative inversion methods, the one developed in this paper solves the nonlinear inverse problem using a series of approximate, linear steps. Examples of the method applied to synthetic and experimental data are provided to demonstrate the method's feasibility. Finally, it is shown that modal eigenvalue and amplitude perturbation can be combined into a single inversion algorithm that uses all of the potentially available modal data.Funding for the research presented here was provided by the Office of Naval Research, and the WHOI Academic Programs Office

Electric field inside a "Rossky cavity" in uniformly polarized water

Electric field produced inside a solute by a uniformly polarized liquid is strongly affected by dipolar polarization of the liquid at the interface. We show, by numerical simulations, that the electric "cavity" field inside a hydrated non-polar solute does not follow the predictions of standard Maxwell's electrostatics of dielectrics. Instead, the field inside the solute tends, with increasing solute size, to the limit predicted by the Lorentz virtual cavity. The standard paradigm fails because of its reliance on the surface charge density at the dielectric interface determined by the boundary conditions of the Maxwell dielectric. The interface of a polar liquid instead carries a preferential in-plane orientation of the surface dipoles thus producing virtually no surface charge. The resulting boundary conditions for electrostatic problems differ from the traditional recipes, affecting the microscopic and macroscopic fields based on them. We show that relatively small differences in cavity fields propagate into significant differences in the dielectric constant of an ideal mixture. The slope of the dielectric increment of the mixture versus the solute concentration depends strongly on which polarization scenario at the interface is realized. A much steeper slope found in the case of Lorentz polarization also implies a higher free energy penalty for polarizing such mixtures.Comment: 9 pages, 8 figure

Viscosity of High Energy Nuclear Fluids

Relativistic high energy heavy ion collision cross sections have been interpreted in terms of almost ideal liquid droplets of nuclear matter. The experimental low viscosity of these nuclear fluids have been of considerable recent quantum chromodynamic interest. The viscosity is here discussed in terms of the string fragmentation models wherein the temperature dependence of the nuclear fluid viscosity obeys the Vogel-Fulcher-Tammann law.Comment: 6 pages, ReVTeX 4 format, two figures, *.eps forma